SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person*
Baker L. Allen Jr.

(Last) (First) (Middle)
5000 LEGACY DR., STE. 350

(Street)
PLANO TX 75024

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
10/22/2014
3. Issuer Name and Ticker or Trading Symbol
BG Staffing, Inc. [ BGSF ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
X Officer (give title below) Other (specify below)
President and CEO
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Common Stock, $0.01 per share par value 50 D
Common Stock, $0.01 per share par value 182,469 I Allen and Debra Baker Revocable Trust
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Stock Options(1) 02/06/2014 02/06/2024 Common Stock, $0.01 per share par value 200,271 $6.25 D
Stock Options(1) 02/06/2015 02/06/2024 Common Stock, $0.01 per share par value 30,000 $6.25 D
Stock Options(1) 02/06/2016 02/06/2024 Common Stock, $0.01 per share par value 30,000 $6.25 D
Stock Options(1) 02/06/2017 02/06/2024 Common Stock, $0.01 per share par value 30,000 $6.25 D
Stock Options(1) 02/06/2018 02/06/2024 Common Stock, $0.01 per share par value 30,000 $6.25 D
Stock Options(1) 02/06/2014 02/06/2024 Common Stock, $0.01 per share par value 17,402 $12.5 D
Warrants 05/24/2010 05/24/2015 Common Stock, $0.01 per share par value 559 $12.53 I Allen and Debra Baker Revocable Trust
Explanation of Responses:
1. Stock options to purchase shares pursuant to the BG Staffing, Inc. 2013 Long-Term Incentive Plan.
Remarks:
Exhibit 24 - Power of Attorney (CE)
/s/ L. Allen Baker, Jr., by Michael A. Rutledge, as Attorney-in-Fact 10/22/2014
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 5 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.