Nebraska Legislature - Lobbyist Reporting Application

FORM
A

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Dec 29, 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

Pollock, Shawn

Office Address (Street, Box, or Route)

3300 Mutual of Omaha Plz

Permanent Residence (Street, Box, or Route)

7701 Hidden Valley Dr

City

Omaha

State

Zip

68175

City

Papillion

State

Zip

68046

Office Phone

(402) 351-4847

Home Phone

(402) 619-0333

Email Address

Shawn.Pollock@MutualofOmaha.com

PRINCIPAL {49-1480(2)}

Name

Mutual of Omaha

Office Phone

(402) 342-7600

Office Address (Street, Box, or Route)

3300 Mutual of Omaha Plaza

Official to Whom Lobbyist is Accountable

Jason Coyle

City

Omaha

State

Zip

68175

Nature of Business {49-1480(3)}

Insurance & Financial Services

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 & financial services

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

Names and addresses of principal's officers:

President & CEO: James Blackledge
Executive Vice President: Scott Ault, Brad Buechler, Richard Hrabchak, Mike Lechtenberger, Stacy Scholtz, Jason Coyle, Liz Mazotta

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.

Shawn Pollock

Lobbyist Name

Dec 29, 2023

Date