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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1258967

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1. Jackson Holdings LLC and Jackson National Life Insurance Company Federal SSF (Jackson National Federal PAC)

    1 Corporate Way
    Lansing, MI 48951
    Email: joanna.coddington@jackson.com

2. Date: 08/23/2018

3. FEC Committee ID #: C00686055 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

Committee ID# C00254953
JACKSON HOLDINGS LLC AND JACKSON NATIONAL LIFE INSURANCE COMPANY SEPARATE SEGREGATED FUND (JACKSON NATIONAL PAC)
1 Corporate Way
Lansing, Michigan 48951
Affiliated Relationship Code: Affiliated Committee

Jackson Holdings LLC and Jackson Natio
1 Corporate Way
Lansing, Michigan 48951
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Joanna Coddington
1 Corporate Way
Lansing, MI 48951
Title: Asst.Treasurer
Phone # (517) 367-4858

Treasurer:

Michael Costello
1 Corporate Way
Lansing, Michigan 48951
Title: Treasurer
Phone # (517) 367-3854

Designated Agent(s):

Joanna Coddington
1 Corporate Way
Lansing, Michigan 48951
Title: Asst. Treasurer
Phone # (517) 367-4858

Banks or Depositories

J.P. Morgan Chase
6015 S. Pennsylvania
Lansing, Michigan 48911

Signed: Michael Costello
Date Signed: 08/23/2018
Official Committee URL: None

(End FEC FORM 1)

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