FEC FORM 1
STATEMENT OF ORGANIZATION
FILING FEC-1188355
1. BROOKE HOLDINGS LLC AND JACKSON NATIONAL LIFE INSURANCE COMPANY SEPARATE SEGREGATED FUND (Jackson National PAC)
NOTE:Commmittee Name is different than previously reported
1 Corporate WayLANSING, MI 48951
Email: joanna.coddington@jackson.com;joanna.coddington@jackson.com
2. Date: 10/19/2017
3. FEC Committee ID #: C00254953 This committee is a separate segregated fund. Its connected organization is a CorporationIn addition, this committee is a Lobbyist/Registrant PAC.
Affiliated Committees/Organizations
Jackson Holdings LLC1105 N Market Street
Ste 1300
Wilmington, Delaware 19801
Affiliated Relationship Code: Connected Organization
Custodian of Records:
Joanna Coddington1504 N Chester Rd.
Charlotte, MI 48813
Title: Gov't Relations
Phone # (517) 367-4858
Treasurer:
Michael Costello6415 Oakencliffe Ln.
East Lansing, Michigan 48823
Title: SVP Controller
Phone # (517) 367-3854
Designated Agent(s):
Joanna Coddington1504 N Chester Rd.
Charlotte, Michigan 48813
Title: Gov't Relations
Phone # (517) 367-4858
Banks or Depositories
JP Morgan Chase6015 S. Pennsylvania
Lansing, Michigan 48911