FORM
A-R
NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST
Nov 13, 2023

(This report is required to be filed on or before December 31 of each calendar year.)
49-1480.01(3)

Amended Registration
Lobbyist Registration Fee:
{49-1480.01}

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

1045 Lincoln Mall, Suite 200 

 

Lincoln 

NE 

68508 

 

 

 

(402) 474-4472 

 

teresam@nebmed.org 

PRINCIPAL {49-1480(2)}

(402) 474-4472 

1045 Lincoln Mall, Suite 200 

 

Lincoln 

NE 

68508 

HEALTH 

AMOUNTS GIVEN
1,025.00  Per Quarter  
IDENTIFICATION of MATTERS on which principal or lobbyist expects to lobby: {49-1480(5)} All matters of interest to the Nebraska Medical Association  
Description of industry, trade, profession, or interests and groups represented by the principal:
 
Names and addresses of principal's officers:

President: Todd Hlavaty, 421 S. Maloney Dr., North Platte, NE 69101
Treasurer: Jason Kruger, 6701 Wildflower Ct., Lincoln, NE 68516

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:

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

Amy Reynoldson

Lobbyist Name

Nov 13, 2023

Date