Nebraska Legislature - Lobbyist Reporting Application

FORM
A

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Jan 3, 2023

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

Potter, Cara E.

Office Address (Street, Box, or Route)

624 2nd Street

Permanent Residence (Street, Box, or Route)

615 Chestnut Street

City

Friend

State

Zip

68359

City

Friend

State

Zip

68359

Office Phone

(402) 730-0276

Home Phone

Email Address

cara.potter@medica.com

PRINCIPAL {49-1480(2)}

Name

Medica

Office Phone

(952) 992-3059

Office Address (Street, Box, or Route)

401 Carlson Parkway CP250

Official to Whom Lobbyist is Accountable

City

Minnetonka

State

Zip

55305

Nature of Business {49-1480(3)}

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.
90.00 Per Hour

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

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

Names and addresses of principal's officers:

Jay Mclaren: 401 Carlson Parkway CP250, Minnetonka, MN 55305

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.

Cara Potter

Lobbyist Name

Jan 3, 2023

Date