Nebraska Legislature - Lobbyist Reporting Application

FORM
A

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Dec 9, 2016

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

$200.00

(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

Ullstrom, Galen F.

Office Address (Street, Box, or Route)

930 Fall Creek Road

Permanent Residence (Street, Box, or Route)

930 Fall Creek Road

City

Lincoln

State

Zip

68510

City

Lincoln

State

Zip

68510

Office Phone

(402) 351-5235

Home Phone

(402) 489-7248

Email Address

galen.ullstrom@mutualofomaha.com

PRINCIPAL {49-1480(2)}

Name

Mutual of Omaha

Office Phone

(402) 342-7600

Office Address (Street, Box, or Route)

Mutual of Omaha Plaza

Official to Whom Lobbyist is Accountable

Stacy Scholtz

City

Omaha

State

Zip

68175

Nature of Business {49-1480(3)}

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.
200.00 Per Hour

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

Description of industry, trade, profession, or interests and groups represented by the principal:

Names and addresses of principal's officers:

Mutual of Omaha Insurance Company
Officers as of November 1, 2016
Chief Executive Officer
James T. Blackledge
Executive Vice President
Richard C. Anderl Daniel P. Martin
David A. Diamond Stephanie M. Pritchett
Richard R. Hrabchak Stacy A. Scholtz
Michael A. Lechtenberger
Senior Vice President
Sheryl F. Abegglen Scott L. Herchenbach
Stephen J. Abels Jeffrey R. Hunt
Timothy S. Ault Craig R Kallin
Bradley N. Buechler Justin P. Kavan
Curtis R. Caldwell Kent (NMI) Knudsen
Kurt S. Christiansen Paul J. Kramper
Keith F. Clark Michelle A. Lebens
Terrance S. DeWald Elizabeth A. Mazzotta
Laura A. Fender Randall J. Mousel
John P. Foley Kathleen P. Olson
Tess L. Grace Thomas A. Reeder
Lance D. Grigsby Galen F. Ullstrom
Richard W. Healey William L. Vigliotte
Dee A. Henry
Vice President
Carl T. Adamson, Jr. Anna M. Messersmith
Leonel L. Benoist Cory S. Michel
Justin W. Brauer Steven P. Miller
Alan D. Brinkman Michael J. Mohr
Rachelle L. Bruning Robert A. Nicas
John A. Corrieri James P. Nolan
Timothy R. Darnall Albert J. Palimenio
Grace B. Davis Brian D. Poppe
Gary L. Denniston Scott M. Priebe
Troy R. Gerhardt Amber L. Rinehart
Raymond A. Gibson Ernest L. Rongish
Gail A. Graeve Andrew B. Rouillard
Bradley R. Hammitt Jerry L. Sayre
Scott L. Hanson Elizabeth G. Schmidt
Alexis N. Hayes Alfred J. Skar
Nancy L. Heimonen Janis M. Starman
Bruce W. Henricks, MD Kurtis R. Stewart
Shannon M. Hite Mary L. Swanson
Scott A. Hoppe Ann C. Tanis
Jason T. Jarzynka Melissa S. Taylor
Marty L. Johnson Kathleen (NMI) Tibke
Shawn K. Johnson Martin F. Traynor
Daniel J. Kennelly Timothy Kai-Tim Tse, MD
Joseph A. Kenny Brenda S. Watke
Jude M. Knipper Douglas J. Wiens
Eric J. Kuncl Michael D. Wilkins, MD
Lee R. Martin Carrie L. Wohlers
Kathryn L. Mellor Jennifer J. Wulf
Regional Vice President
Jeffrey P. Eilers
Stephen T. Hannah
Robert J. Lott

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.

Ullstrom, Galen F.

Lobbyist Name

Dec 9, 2016

Date