Nebraska Legislature - Lobbyist Reporting Application

FORM
A-R

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Dec 23, 2019

(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

Kelley Plucker, LLC

Office Address (Street, Box, or Route)

2804 S 87th Avenue

Permanent Residence (Street, Box, or Route)

2804 S 87th Avenue

City

Omaha

State

Zip

68124

City

Omaha

State

Zip

68124

Office Phone

(402) 397-1898

Home Phone

Email Address

nikki@kelleyplucker.com

PRINCIPAL {49-1480(2)}

Name

CVS Health

Office Phone

(202) 772-3516

Office Address (Street, Box, or Route)

1275 Pennsylvania Avenue NW, Suite 700

Official to Whom Lobbyist is Accountable

Erik Woehrmann

City

Washington

State

Zip

20004

Nature of Business {49-1480(3)}

HEALTH

AMOUNTS GIVEN or to be given to lobbyist as compensation or reimbursement of lobbying: {49-1480(3)}. Please state the basis for your compensation.
3,833.33 Per Month

IDENTIFICATION of MATTERS on which principal or lobbyist expects to lobby: {49-1480(5)} healthcare; pharmacy benefit manager

Description of industry, trade, profession, or interests and groups represented by the principal:
Pharmacy; PBM

Names and addresses of principal's officers:

Mike Ayotte, Senior Director, State Government Affairs, 1275 Pennsylvania Avenue NW, Washington DC 20004

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.

Kelley Plucker, LLC

Lobbyist Name

Dec 23, 2019

Date