Nebraska Legislature - Lobbyist Reporting Application

FORM
A-R

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Dec 20, 2023

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

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

Faustman, Nicholas

Office Address (Street, Box, or Route)

8790 F St Suite 404

Permanent Residence (Street, Box, or Route)

11711 Arbor Street #110

City

Omaha

State

Zip

68114

City

Omaha

State

Zip

68114

Office Phone

(402) 260-7907

Home Phone

(402) 260-7907

Email Address

compliance_NE_ALZ_1@multistate.us

PRINCIPAL {49-1480(2)}

Name

Alzheimer's Association

Office Phone

(402) 502-4300

Office Address (Street, Box, or Route)

11711 Arbor Street; Suite 110

Official to Whom Lobbyist is Accountable

City

Omaha

State

Zip

68114

Nature of Business {49-1480(3)}

Non-profit

AMOUNTS GIVEN or to be given to lobbyist as compensation or reimbursement of lobbying: {49-1480(3)}. Please state the basis for your compensation.
40,000.00 Percentage of salary

IDENTIFICATION of MATTERS on which principal or lobbyist expects to lobby: {49-1480(5)} Alzheimer's and dementia support, training, regulation, and resources. Family and caregiver leave support policies. Education and training policy. Tax credits.

Description of industry, trade, profession, or interests and groups represented by the principal:
Alzheimer's support and treatment

Names and addresses of principal's officers:

Harry Johns, CEO
1212 New York Ave NW #800
Washington, DC 20005

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.

Nicholas Faustman

Lobbyist Name

Dec 20, 2023

Date