Nebraska Legislature - Lobbyist Reporting Application

FORM
A

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Jan 10, 2025

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

$300.00

(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

Sand Creek Strategy Group LLC

Office Address (Street, Box, or Route)

1101 43 Road

Permanent Residence (Street, Box, or Route)

City

Heartwell

State

Zip

68945

City

State

Zip

Office Phone

(308) 830-1514

Home Phone

Email Address

john@sandcreekstrategy.com

PRINCIPAL {49-1480(2)}

Name

Prairie Health Ventures

Office Phone

(402) 476-7333

Office Address (Street, Box, or Route)

575 Fallbrook Blvd Suite 204

Official to Whom Lobbyist is Accountable

Rodney Triplett

City

Linncoln

State

Zip

68521

Nature of Business {49-1480(3)}

Health Care

AMOUNTS GIVEN or to be given to lobbyist as compensation or reimbursement of lobbying: {49-1480(3)}. Please state the basis for your compensation.
2,000.00 Per Month

IDENTIFICATION of MATTERS on which principal or lobbyist expects to lobby: {49-1480(5)} Health Care

Description of industry, trade, profession, or interests and groups represented by the principal:
Health Care

Names and addresses of principal's officers:

Rodney Triplett, CEO
575 Fallbrook Blvd Suite 204
Lincoln, NE 68521

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.

Sand Creek Strategy Group LLC

Lobbyist Name

Jan 10, 2025

Date