FEC FORM 1
STATEMENT OF ORGANIZATION
FILING FEC-726075
1. BROOKE HOLDINGS INC AND JACKSON NATIONAL LIFE INSURANCE COMPANY SSF (Jackson National PAC)
NOTE:Commmittee Name is different than previously reported
1 Corporate WayLANSING, MI 48951
Email: cindy.dolan@jackson.com
2. Date: 04/21/2011
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 National Life Insurance Company1 Corporate Way
Lansing, Michigan 48951
Affiliated Relationship Code: Connected Organization
Custodian of Records:
Cynthia Dolan9741 Sunny Pointe Drive
Laingsburg, MI 48848
Title: GR Specialist
Phone # (517) 367-4358
Treasurer:
Mr. Robert Fritts2411 Sugar Tree
Lansing, Michigan 48917
Title: Senior VP
Phone # (517) 702-2431
Designated Agent(s):
Banks or Depositories
JP Morgan Chase Bank, NA--Michigan/FloP.O. Box 260180
Baton Rouge, Louisiana 708260180