Clerk of the Legislature

NEBRASKA PRINCIPAL QUARTERLY REPORT NADC FORM C

Postmark Date

Room 2014 State Capitol

Office Use Only

PO Box 94604

Lincoln, NE 68509

(402) 471-2608

· Reports are required to be filed within 15 days after the end of each calendar quarter with the Clerk of the Legislature. File an original and one copy. · Special Monthly Reports are required by principals 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 C-C. · A Principal is required to file a single Quarterly Report and may not file separate reports for each of its lobbyists. · For further information refer to Title 4, Chapter 6, Rules and Regulations for Lobbying.

ITEM 1

NATURE OF FILING (Check appropriate box)

Year of Session

2004

First Quarter 1/1-3/31

Second Quarter 4/1 – 6/30

Third Quarter 7/1-9/30

Fourth Quarter 10/1 – 12/31

Amended Report (Check Applicable Quarter)

ITEM 2

NAME OF PRINCIPAL AND LOBBYIST(S)

Check here if any information in item 2 is new

Principal Name

NE Association of Independent Ambulatory Centers

Telephone No.

402-489-8838

Address

1710 S. 70^th Street, Lincoln, NE 68506

Street

City

State

Zip

Name(s) of all Registered Lobbyist(s):

O'Hara, Lindsay & Associates

ITEM 3

RECEIPTS AND EXPENDITURES

State the name and address of every person from whom more than $100 has been received in any one month for lobbying purposes. State the month of the receipt. Attach information if space is not sufficient. If none, write none. Amounts given by those listed below should be part of the total listed on Line 1, Total Receipts. 49-1483.01. December: Omaha Surgical Center, $1500; Urology Surgical Center, $1500 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 the terms of the loan, promise or payment. If none, write none. Any amounts reported here should be part of the total on Line 2, Miscellaneous Expenses. 49-1483(1)(b) and Ch. 6, sec. 009.08. None

RECEIPTS THIS PERIOD OF PRINCIPAL – Complete Each Blank Space. Write 0 if Applicable
1. Total Receipts			$3,000.00
EXPENDITURES THIS PERIOD BY PRINCIPAL -- Complete Each Blank Space. Write 0 if Applicable
2. Miscellaneous Expenses			$125.86
3. Entertainment Expenses
a) Members of Legislature	$0.00
b) Elected Executive Branch Officials	$0.00
c) Entertainment other than 3a and 3b	$0.00
d) Total (Lines 3a, 3b, and 3c)			$ 0.00
4. Lodging Expenses			$0.00
5. Travel Expenses			$0.00
6. Office Expenses (see instructions)			$0.00
7. Lobbyist Compensation paid by Principal			$3,000.00
8. Lobbyist Reimbursement paid by Principal			$0.00
9. Gifts (except gifts of admissions)
a) Members of Legislature	$0.00
b) Elected Executive Branch Officials	$0.00
c) Gifts other than 9a and 9b	$0.00
d) Total (Lines 9a, 9b, and 9c)			$ 0.00
10. Gifts of Admissions (See instructions)
a) Members of Legislature	$0.00
b) Elected Executive Branch Officials	$0.00
c) Gifts of Admissions other than 10a and 10b	$0.00
d) Total (Lines 10a, 10b, and 10c)			$ 0.00
11. Total (Sum of 2, 3d, 4, 5, 6, 7, 8, 9d, and 10d)			$3,125.86
Principal Name (Print or Type)
Principal Signature		Date
YOU MUST FILE AN ORIGINAL AND ONE COPY OF THIS REPORT WITH THE CLERK OF THE LEGISLATURE.
DO NOT FILE THE INSTRUCTION PAGE