Nebraska Legislature - Lobbyist Reporting Application

Clerk of the Legislature

Room 2014 State Capitol

PO Box 94604

Lincoln, NE 68509

(402) 471-2608

NEBRASKA REGISTERED
LOBBYIST QUARTERLY
REPORT

NADC FORM B

Submission Date: Apr 23, 2019

Reports are required to be filed within 30 days after the end of each calendar quarter with the Clerk of the Legislature.
Special Monthly Reports are required by lobbyists receiving or spending more than $5,000 for lobbying purposes during any calendar month in which the legislature is in session. Certain exceptions apply. See NADC Form B-B.
Late filing fees for filing this statement after the due date are $25.00 per day, not to exceed $750.00
For further information see Title 4, Chapter 6, Rules and Regulations for Lobbying.

ITEM 1

NATURE OF FILING (Check appropriate box)

For Calendar Year of

2019

First Quarter
1/1-3/31 1^st Qtr

Second Quarter
4/1-6/30 2^nd Qtr

Third Quarter
7/1-9/30 3^rd Qtr

Fourth Quarter
10/1-12/31 4^th Qtr

Amended Report
(Check Applicable Quarter)

ITEM 2

NAME OF LOBBYIST AND PRINCIPAL

LOBBYIST

Lobbyist Name

Faustman, Nicholas

Phone

(402) 260-3288

Address

5733 S. 34th Street, Suite 500

City

Lincoln

State

Zip

68516

PRINCIPAL

Principal Name

American Cancer Society Cancer Action Network

Office Phone

(402) 260-3288

Office Address (Street, Box, or Route)

5733 S. 34th, Suite 500

City

Lincoln

State

Zip

68516

ITEM 3

RECEIPTS AND EXPENDITURES

MONEY LOANED, PROMISED OR PAID. Give a detailed description of any money loaned, promised, or paid by you or anyone on your behalf to any official in the Legislative or Executive Branch of the State Government or a member of the official's staff. Identify the recipient or beneficiary of the payment and the date, amount and reason for the payment. If none, write none. Any amount reported should also be part of the total entered on line 4, Miscellaneous Expense. 49-1483(2)(b) and Ch. 6, sec. 008.07.

none.

SUMMARY OF RECEIPTS FOR THIS PERIOD - Complete Each Blank Space. Write 0 if Applicable

1. Compensation received by Lobbyist

18,000.00

2. Reimbursement of Expenses

0.00

3. Total (Lines 1 plus 2)

18,000.00

EXPENDITURES THIS PERIOD BY LOBBYIST - Complete Each Blank Space. Write 0 if Applicable

4. Miscellaneous Expenses

0.00

5. Entertainment Expenses

a) Members of the Legislature

0.00

b) Elected Executive Branch Officials

0.00

c) Entertainment other than 5a and 5b

0.00

d) Total (Lines 5a, 5b, and 5c)

0.00

6. Lodging Expenses

0.00

7. Travel Expenses

0.00

8. Office Expenses (see instructions)

0.00

9. Lobbyist Compensation paid by Lobbyist

0.00

10. Lobbyist Reimbursement paid by Lobbyist

0.00

11. Gifts (except gifts of admissions)

a) Members of the Legislature

0.00

b) Elected Executive Branch Officials

0.00

c) Gifts other than 11a and 11b

0.00

d) Total (Lines 11a, 11b, and 11c)

0.00

12. Gifts of Admissions (see instructions)

a) Members of the Legislature

0.00

b) Elected Executive Branch Officials

0.00

c) Gifts of Admissions other than 12a and 12b

0.00

d) Total (Lines 12a, 12b, and 12c)

0.00

13. Total (Sum of 4, 5d, 6, 7, 8, 9, 10, 11d and 12d)

0.00

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

Faustman, Nicholas

Lobbyist Name

Apr 23, 2019

Date