Nebraska Legislature - Lobbyist Reporting Application

FORM
A

NEBRASKA LEGISLATURE
APPLICATION FOR REGISTRATION AS A LOBBYIST

Dec 31, 2019

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

McLaren, Jay

Office Address (Street, Box, or Route)

401 Carlson Parkway, CP250

Permanent Residence (Street, Box, or Route)

515 Harbor Court

City

Minnetonka

State

Zip

55305

City

Shoreview

State

Zip

55126

Office Phone

(952) 992-3059

Home Phone

(651) 238-4973

Email Address

jay.mclaren@medica.com

PRINCIPAL {49-1480(2)}

Name

Medica

Office Phone

Office Address (Street, Box, or Route)

401 Carlson Parkway

Official to Whom Lobbyist is Accountable

Jim Jacobson, SVP & General Counsel

City

Minnetonka

State

Zip

55305

Nature of Business {49-1480(3)}

Health insurance

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, health insurance, and Medicaid policy

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

Names and addresses of principal's officers:

Jim Jacobson, 401 Carlson Parkway, Minnetonka, MN 55305

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)}

N/A

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

McLaren, Jay

Lobbyist Name

Dec 31, 2019

Date