Nebraska Legislature - Lobbyist Reporting Application

FORM
A

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Dec 13, 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

Prem, Sara

Office Address (Street, Box, or Route)

1225 Davenport St STE 101

Permanent Residence (Street, Box, or Route)

8721 West 81st Street

City

Omaha

State

Zip

68154

City

Overland Park

State

Zip

66204

Office Phone

(402) 502-4950

Home Phone

(913) 638-6977

Email Address

sara.prem@lung.org

PRINCIPAL {49-1480(2)}

Name

American Lung Association

Office Phone

(312) 781-1100

Office Address (Street, Box, or Route)

55 W Wacker Dr STE 115

Official to Whom Lobbyist is Accountable

Paul Billings

City

Chicago

State

Zip

60601

Nature of Business {49-1480(3)}

Nonprofit public health advocacy

AMOUNTS GIVEN or to be given to lobbyist as compensation or reimbursement of lobbying: {49-1480(3)}. Please state the basis for your compensation.
10.00 Percentage of salary

IDENTIFICATION of MATTERS on which principal or lobbyist expects to lobby: {49-1480(5)} public health, lung health, preventing lung disease, healthcare access, advancing health equity, clean air, tobacco control and prevention

Description of industry, trade, profession, or interests and groups represented by the principal:
Nonprofit public health organization

Names and addresses of principal's officers:

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.

Sara Prem

Lobbyist Name

Dec 13, 2023

Date