FEC FORM 1
STATEMENT OF ORGANIZATION
FILING FEC-1506071
1. Jackson Holdings LLC and Jackson National Life Insurance Company Separate Segregated Fund (Jackson N
1 Corporate WayLansing, MI 489511001
Email: martha.vozza@jackson.com;outsourcing@aristotle.com
NOTE: Email address is different than previously reported
2. Date: 03/15/2021
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
Committee ID# C00686055Jackson Holdings LLC and Jackson National Life Insurance Company Federal SSF (Jackson National Feder
1 Corporate Way
Lansing, Michigan 489511001
Affiliated Relationship Code: Affiliated Committee
Jackson Holdings LLC and Jackson Natio
1105 N Market St
Ste 1300
Wilmington, Delaware 198011241
Affiliated Relationship Code: Connected Organization
Custodian of Records:
Martha Vozza1 Corporate Way
Lansing, MI 489511001
Title: Custodian of Records
Phone # (517) 367-4055
Treasurer:
Michael Costello1 Corporate Way
Lansing, Michigan 489511001
Title: Treasurer
Phone # (517) 367-3854
Designated Agent(s):
Martha Vozza1 Corporate Way
Lansing, Michigan 489511001
Title: Assistant Treasurer
Phone # (517) 367-4055
Banks or Depositories
Northern Trust50 South Lasalle Street
Chicago, Illinois 60603