Nebraska Legislature - Lobbyist Reporting Application

FORM
A

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Jan 6, 2025

Clerk of the Legislature
Room 2014, State Capitol
PO Box 94604
Lincoln, NE 68509-4604
Phone: (402) 471-2608

For Calendar Year of:

Amended Registration

Lobbyist Registration Fee:
{49-1480.01}

Compensated

$300.00

(If you are a salaried employee of your principal, you are a compensated lobbyist.)

Not Compensated

$15.00

(File a Form E for quarterly report exemption. You are not exempt from the Form D Activity Report.)

PLEASE FILL IN ALL BLANKS

LOBBYIST {49-1480(1)}

Name

Radcliffe Gilbertson & Brady

Office Address (Street, Box, or Route)

625 S 14th Street, Suite 100

Permanent Residence (Street, Box, or Route)

City

Lincoln

State

Zip

68508

City

State

Zip

Office Phone

(402) 476-7272

Home Phone

Email Address

korbyg@rgblobby.com

PRINCIPAL {49-1480(2)}

Name

Delta Dental of Nebraska

Office Phone

(612) 224-3297

Office Address (Street, Box, or Route)

1299 Farnam St. #300

Official to Whom Lobbyist is Accountable

Ben Wogsland

City

Omaha

State

Zip

68102

Nature of Business {49-1480(3)}

Prepaid limited Health Insurance

AMOUNTS GIVEN or to be given to lobbyist as compensation or reimbursement of lobbying: {49-1480(3)}. Please state the basis for your compensation.
50,000.00 Per Year

IDENTIFICATION of MATTERS on which principal or lobbyist expects to lobby: {49-1480(5)} Dental Insurance

Description of industry, trade, profession, or interests and groups represented by the principal:
Prepaid Limited Health Insurance

Names and addresses of principal's officers:

Rod Young, CEO of Delta Dental Nebraska c/0 Delta Dental of Nebraska 1299 Farnam St., Suite 300 Omaha, NE 68102

GIVE NAME and ADDRESS of any OFFICIAL in the Legislative or Executive Branch and of any members of any such official's staff or immediate family who is employed by you or by anyone acting on your behalf: {49-1480(8)}

I certify that all information presented in this form is accurate to the best of my knowledge.

Korby M Gilbertson

Lobbyist Name

Jan 6, 2025

Date