Key: a = Direct Contribution B = In-Kind Contribution C = Loans D = Independent Expenditures

NEBRASKA POSTMARK ACCOUNTABILITY AND DATE MICROFILM DISCLOSURE COMMISSION OUT OF STATE NUMBER 1225 L St., Suite 400 CONTRIBUTION P.O. Box 95086 OFFICE USE ONLY Lincoln, NE 68509 REPORT (402) 471-2522 www.nadc.nebraska.gov NADC FORM B-9 BEFORE COMPLETING THIS FORM READ THE INSTRUCTIONS ON THE LAST PAGE  Any corporation, union, trade association or professional association which is not organized under the laws of the State of Nebraska and which makes contributions totaling more than $10,000 in any calendar year must file.  A person or committee registered with the Federal Election Commission, a committee that has a Statement of Organization on file with the Accountability and Disclosure Commission, a person required to file campaign statements with the Accountability and Disclosure and those entities required to file a Report of Political Contributions of a Corporation, Union or Other Entity with the Accountability and Disclosure Commission are exempted from filing this report.  Attach all schedules (A & B) and type or print all information.  Late filing fees are $100 per day for each of the first 10 days the report remains unfiled. Beginning on the 11 th day an additional late fee of 1% of the amount to be disclosed by the report is assessed, not to exceed 10%.  Persons who fail to file this report or otherwise do not comply with the reporting provisions of the law are subject to civil penalties. ITEM 1 NAME, ADDRESS AND PHONE NUMBER OF CORPORATION, UNION OR OTHER ASSOCIATION

Corporation Labor Organization Industry or Trade Organization Professional Association

Name Phone Number

Address STREET ADDRESS OR RURAL ROUTE CITY STATE ZIP CODE

ITEM 2 VERIFICATION (This item must be completed before filing will be accepted)

I, state that I have used all reasonable diligence in the preparation of this Out of State (NAME OF INDIVIDUAL SIGNING) Contribution Report, and to my knowledge it is true, correct and complete.

(SIGNATURE AND TITLE) (DATE)

Revised January 2018 Schedule A -- Contributions of More Than $200 Received During a Calendar Year List all persons from whom contributions totaling more than $200 were received by the major out of state contributor during the period covered by the report and all persons who have a cumulative total of more than $200 for the calendar year. All contributions from the same donor must be listed under the same name. In the first column list the name and address of each person who has contributed a cumulative total of more than $200 during the calendar year. In the next column, list the occupation and employer of the contributor. In the next column, list the date(s) of the contribution(s) except those previously listed. In column A, list the total amount of contributions previously listed during the calendar year for each of the persons listed. If this is the first report for the calendar year, this column will be zero. If you are filing your 2nd report or any other subsequent report, this column must include any amounts previously listed on previous reports filed for the calendar year. In columns B, C, and D list contributions received during this reporting period. In column E, list the total contributions received from each contributor for the calendar year to date. (e.g. A person who gave $175 during the reporting period of the first report and gave an additional $50 during the reporting period for the next report would be listed as the cumulative amount contributed during calendar year is now more than $200). Total Contributions Cash In-Kind Unpaid Total Name, Street Address or Rural Previously Contributions Contributions Pledges This Contributions Route, City, State and Zip Code of Occupation Reported During This Period This Period Period Calendar Year Each Contributor Giving a and Date the Election to Date Cumulative Total of More Than Employer Period $200 During the Calendar Year to the Major Out of State Contributor A + B + C + D = E

$0.00

Schedule B - Allocated Cumulative Expenditures for Nebraska State and Local Candidates and Ballot Questions Indicate the total amount of expenditures for or against each Nebraska candidate or ballot question (B.Q.) during this reporting period and the total for the calendar year to date. An expenditure made in support of more than one candidate or ballot question must be apportioned reasonably among the candidates or ballot questions supported or opposed. "Expenditure" for the purpose of this schedule includes direct contributions, loans, and all other disbursements of funds made in support or in opposition to Nebraska state and local candidates and ballot questions.

Name and Address of the Committee, Date of Total for the Nature Total at close Expenditures Candidate or Person Receiving the Support Oppose Expenditures Calendar Year to (See Key) of last period this period Contribution this Period Date

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Key: A = Direct Contribution B = In-kind Contribution C = Loans D = Independent Expenditures E = Pledge Describe In-Kind Contributions and Independent Expenditures in the first column. General Information - Filing Information I. Who Should file: A Major Out-of-State Contributor is defined as any corporation, Report of earmarked contributions (NADC Form B-3): Any union or industry, trade and professional association which is not person, other than a committee, which acts as an intermediary or organized under the laws of the State of Nebraska which makes agent in transferring an earmarked contribution directly or indirectly expenditures, contributions or provides personal services of more from a contributor to the recipient candidate or political committee must than $10,000 in any calendar year for the purpose of influencing report the contribution on NADC Form B-3, Report of Earmarked or attempting to influence the action of the voters for or against Contribution, within 10 days of that person's receipt of the earmarked the nomination or election of one or more candidates or the contribution. The earmarked contribution must be transferred to the qualification, passage or defeat of one or more ballot questions recipient candidate or committee within the same 10-day period. elections in the State of Nebraska. Agent's Expenditure Report: No expenditure shall be made by An exemption applies to those entities who have a Statement of an agent or an independent contractor, including and advertising Organization of a Political Committee (NADC Form A-1) on file agency, other than for normal operating expenses and overhead, with the Commission, a person or organization required to file unless it is reported by the committee as if the expenditure were made campaign statements with the Commission and those entities directly by the committee or unless the agent or independent required to file a Report of Political Contribution of a Corporation, contractor files an Agent's Expenditure Report. Union or Other Entity (NADC Form B-7) with the Commission. In addition, a committee or organization registered with the Federal An expenditure shall not made, other than for overhead or normal Election Commission need not file the Out of State Contribution operating expenses by an individual or entity gathering petition Report. signatures on behalf of a person, including a ballot question committee, unless the expenditure is reported by the ballot question II. When to File: committee as if the expenditure were made directly by the committee, Within ten (10) days after the end of the calendar month in which or unless the person or entity gathering petition signatures files an the Major Out-of-State Contributor has made more than $10,000 Agent's Expenditure Report. of contributions or expenditures to influence elections during a calendar year in Nebraska. For the remainder of the calendar NOTE: Any person who is under contract with the Lottery Division of year, an Out of State Contribution Report shall be filed within ten the Nebraska Department of Revenue as a lottery contractor for a (10) days after the end of the calendar month for each month the major procurement may not make contributions to candidates for any contributor makes a contribution or expenditure to influence Nebraska state elective office. Nebraska elections.

III. Where to File: With the Nebraska Accountability and Disclosure Commission, 1225 L St., Suite 400, P.O. Box 95086, Lincoln, NE 68509

Definitions Ballot Question means any question which is submitted or which is Expenditure means a payment, donation, loan, pledge, or promise of intended to be submitted to a popular vote at an election by way of payment of money or anything of ascertainable monetary value for initiative, referendum, recall, or bond issue or as a result of legislative goods, materials, services or facilities in assistance of, or in opposition action, whether or not it qualifies for the ballot. to, the nomination or election of a candidate, or the qualification, passage or defeat of a ballot question. Expenditure includes a Contribution means a payment, gift, subscription, assessment, contribution or transfer of anything of ascertainable monetary value for expenditure, contract, payment for services, dues, advance, purposes of influencing the nomination or election of any candidate or forbearance, loans, donation, pledge or promise of money or anything the qualification, passage, or defeat of a ballot question. of ascertainable monetary value to a person, made for the purpose of influencing the nomination or election of a candidate, or for the An Independent Expenditure means a payment, donation, loan, qualification, passage or defeat of a ballot question. A contribution pledge, or promise of payment of money or anything of ascertainable includes the purchase of tickets or payment of an attendance fee for monetary value for goods, materials, services, or facilities in assistance events such as dinners, luncheons, rallies, testimonials, and similar of, or in opposition to, the nomination or election of a candidate, or the fund raising events. It also includes the granting of discounts or qualification, passage or defeat of a ballot question, which is not made rebates by broadcast media and newspapers not extended on an at the direction of, under the control of, or in cooperation with another equal basis to all candidates for the same office. person and which is not a direct contribution to a committee or candidate. An in-kind contribution means a contribution as defined above, other than money, i.e. goods, materials, services or other things of value Any expenditure which is made as a result of a request or explicit furnished by your corporation, union or association to a candidate or suggestion of the candidate, the committee treasurer, or anyone acting other political committee. on behalf of either, shall be considered an in-kind contribution and not an independent expenditure. A Pledge is an oral or written promise of a future payment of money or anything of ascertainable monetary value. Personal Services means personnel provided to or for the benefit of a candidate or ballot question or a political party committee when the Earmarked means a designation, instruction, or encumbrance, person rendering such services is paid his or her regular salary or is including those which are direct or indirect, express or implied, or oral otherwise compensated by such corporation, union or association. or written which results in any part of a contribution or expenditure, including any in-kind expenditure made in exchange for a contribution, being made to or expended on behalf of a candidate or a committee.

Election means a primary, general, special, or other election held in this state or a convention or caucus of a political party held this state to nominate a candidate. Election shall include a vote on a Ballot Question.