FEC FORM 1
STATEMENT OF ORGANIZATION
FILING FEC-867037
1. BROOKE HOLDINGS LLC AND JACKSON NATIONAL LIFE INSURANCE COMPANY SEPARATE SEGREGATED FUND (Jackson National PAC)
1 Corporate WayLANSING, MI 48951
Email: cindy.dolan@jackson.com
2. Date: 04/16/2013
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
Brooke Holdings LLC1105 N. Market Street
Suite 1300
Wilmington, Delaware 19801
Affiliated Relationship Code: Connected Organization
Custodian of Records:
Treasurer:
Michael Costello6234 Pine Hollow Drive
East Lansing, Michigan 48823
Title: SVP & Controller
Phone # (517) 367-3854
Designated Agent(s):
Banks or Depositories
JP Morgan Chase6015 S. Pennsylvania
Lansing, Michigan 48911