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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1188732

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

    NOTE:Commmittee Name is different than previously reported

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

2. Date: 10/20/2017

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

Jackson Holdings LLC
1105 N Market Street
Ste 1300
Wilmington, Delaware 19801
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Joanna Coddington
1504 N Chester Rd.
Charlotte, MI 48813
Title: Gov't Relations
Phone # (517) 367-4858

Treasurer:

Michael Costello
6415 Oakencliffe Ln.
East Lansing, Michigan 48823
Title: SVP Controller
Phone # (517) 367-3854

Designated Agent(s):

Joanna Coddington
1504 N Chester Rd.
Charlotte, Michigan 48813
Title: Gov't Relations
Phone # (517) 367-4858

Banks or Depositories

JP Morgan Chase
6015 S. Pennsylvania
Lansing, Michigan 48911

Signed: Joanna Coddington
Date Signed: 10/20/2017

(End FEC FORM 1)

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