LD-1 Disclosure Form

Clerk of the House of Representatives
Legislative Resource Center
135 Cannon Building
Washington, DC 20515
http://lobbyingdisclosure.house.gov

Secretary of the Senate
Office of Public Records
232 Hart Building
Washington, DC 20510
http://www.senate.gov/lobby

LOBBYING REGISTRATION

Lobbying Disclosure Act of 1995 (Section 4)

Check One: New Registrant New Client for Existing Registrant Amendment

			1. Effective Date of Registration		12/1/2017
2. House Identification	38429			Senate Identification	308775

REGISTRANT Organization/Lobbying Firm Self Employed Individual

3. Registrant

Organization

Monument Policy Group, LLC

Address

1100 G Street NW

Address2

Suite 750

City

Washington

State

Zip

20005

Country

USA

4. Principal place of business (if different than line 3)

City

State

Zip

Country

5. Contact name and telephone number

International Number

Contact

Mr. C. STEWART VERDERY, JR.

Telephone

2027199999

E-mail

stewart@monumentpolicy.com

6. General description of registrant’s business or activities

government affairs and strategic consulting services

CLIENT A Lobbying Firm is required to file a separate registration for each client. Organizations employing in-house lobbyists should check the box labeled “Self” and proceed to line 10. Self

7. Client name	Ancestry
Address	1300 W. Traverse Parkway

City

Lehi

State

Zip

84043

Country

USA

8. Principal place of business (if different than line 7)

City

State

Zip

Country

9. General description of client’s business or activities

family history and consumer genomics

LOBBYISTS

10. Name of each individual who has acted or is expected to act as a lobbyist for the client identified on line 7. If any person listed in this section has served as a “covered executive branch official” or “covered legislative branch official” within twenty years of first acting as a lobbyist for the client, state the executive and/or legislative position(s) in which the person served.

Name			Covered Official Position (if applicable)
First	Last	Suffix
Chan	Park		General Counsel (Democratic), Senate Judiciary Committee; Senior Counsel, Senate Judiciary Committee; Assistant United States Attorney, U.S. Attorney's Office for the District of Maryland
Joseph	Hoefer
C. Stewart	Verdery	Jr.	Assistant Secretary and Consultant, Department of Homeland Security; General Counsel, Assistant Senate Majority Leader Don Nickles; Counsel, Senate Judiciary Committee; Counsel, Senator John Warner; Lead Staffer, Sen. Republicans High Tech Task Force
Kate	Mills		Assistant Director for Congressional Relations, Deputy Assistant Director for Congressional Relations, U.S. Immigration and Customs Enforcement; Senior Legislative Counsel, Rep. Zoe Lofgren
Tim	Punke		International Trade Counsel, Chief International Trade Counsel, Senate Finance Committee; International Trade Advisor, National Economic Council, White House

LOBBYING ISSUES

11. General lobbying issue areas (Select all applicable codes).

HCR

TEC

12. Specific lobbying issues (current and anticipated)

Issues related to healthcare and technology

AFFILIATED ORGANIZATIONS

13. Is there an entity other than the client that contributes more than $5,000 to the lobbying activities of the registrant in a quarterly period and either participates in and/or in whole or in major part supervises or controls the registrant’s lobbying activities?

No --> Go to line 14.

Yes --> Complete the rest of this section for each entity matching the criteria above, then proceed to line 14.

Internet Address:

Name

Address

Principal Place of Business

Street

City

State/Province

Zip Code

Country

City

State

Country

City

State

Country

City

State

Country

FOREIGN ENTITIES

14. Is there any foreign entity

a) holds at least 20% equitable ownership in the client or any organization identified on line 13; or

b) directly or indirectly, in whole or in major part, plans, supervises, controls, directs, finances or subsidizes activities of the client or any organization identified on line 13; or

c) is an affiliate of the client or any organization identified on line 13 and has a direct interest in the outcome of the lobbying activity?

No --> Sign and date the registration.

Yes --> Complete the rest of this section for each entity matching the criteria above, then sign the registration.

Address

Ownership

Name

Street

Principal place of business

Amount of contribution

City

State/Province

Country

(city and state or country)

for lobbying activities

61, rue de Rollingergrund, L-2440

City

Ancelux Topco S.C.A.

Luxembourg

LUX

State

Country

100

2775 Sand Hill Road, Suite 100

City

SLP Hero Holdings S.a.r.l.

Menlo Park

USA

State

Country

Signature

Digitally Signed By: C. Stewart Verdery, Jr.

Date

1/15/2018 7:41:23 PM

ADDITIONAL LOBBYISTS

10. Supplemental. List any additional lobbyists for this client not listed on page 1, number 10.

Name			Covered Official Position (if applicable)	Have you been convicted of a crime?
First	Last	Suffix

ADDITIONAL LOBBYING ISSUES
11. Supplemental. General lobbying issue areas. Enter any additional codes for issues not listed on page 2, number 11.

ADDITIONAL AFFILIATED ORGANIZATIONS13. Supplemental. List any other affiliated organization that meets the criteria specified and is not listed on page 2, number 13.

Name

Address

Principal Place of Business

Street

City

State/Province

Zip Code

Country

City

State

Country

City

State

Country

City

State

Country

ADDITIONAL FOREIGN ENTITIES
14. Supplemental. List any other foreign entity that meets the criteria specified and is not listed on page 2, number 14.

Name

Address

Principal place of business
(city and state or country)

Amount of contribution for lobbying activities

Ownership

Street
City	State/Province	Country

Jasmine Ventures Pte Ltd.

1 Bush Street
San Francisco	CA	USA

City
State		Country

36 %

City
State		Country

City
State		Country