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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-997443

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1. BROOKE HOLDINGS LLC AND JACKSON NATIONAL LIFE INSURANCE COMPANY SEPARATE SEGREGATED FUND (Jackson National PAC)

    1 Corporate Way
    LANSING, MI 48951
    Email: cindy.dolan@jackson.com

2. Date: 03/16/2015

3. FEC Committee ID #: C00254953 This committee is a separate segregated fund. Its connected organization is a Corporation
     In addition, this committee is a Lobbyist/Registrant PAC.

Affiliated Committees/Organizations

Brooke Holdings LLC
1105 N. Market Street
Suite 1300
Wilmington, Delaware 19801
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Cynthia Dolan
9741 Sunny Pointe Drive
Laingsburg, MI 48848
Title: GR Specialist
Phone # (517) 367-4358

Treasurer:

Michael Costello
6234 Pine Hollow Drive
East Lansing, Michigan 48823
Title: SVP & Controller
Phone # (517) 367-3854

Designated Agent(s):

Cynthia Dolan
9741 Sunny Pointe Drive
Laingsburg, Michigan 48848
Title: GR Specialist
Phone # (517) 367-4358

Banks or Depositories

JP Morgan Chase
6015 S. Pennsylvania
Lansing, Michigan 48911

Signed: Michael Costello
Date Signed: 03/16/2015

(End FEC FORM 1)

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