0001104659-20-003964.txt : 20200114 0001104659-20-003964.hdr.sgml : 20200114 20200114170009 ACCESSION NUMBER: 0001104659-20-003964 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20191111 FILED AS OF DATE: 20200114 DATE AS OF CHANGE: 20200114 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Jackson Investment Group, LLC CENTRAL INDEX KEY: 0001571267 STATE OF INCORPORATION: GA FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37575 FILM NUMBER: 20526525 BUSINESS ADDRESS: STREET 1: 2655 NORTHWINDS PARKWAY CITY: ALPHARETTA STATE: GA ZIP: 30009 BUSINESS PHONE: 770-643-5529 MAIL ADDRESS: STREET 1: 2655 NORTHWINDS PARKWAY CITY: ALPHARETTA STATE: GA ZIP: 30009 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Jackson Richard Lee CENTRAL INDEX KEY: 0001572666 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37575 FILM NUMBER: 20526526 MAIL ADDRESS: STREET 1: 2655 NORTHWINDS PARKWAY CITY: ALPHARETTA STATE: GA ZIP: 30009 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Staffing 360 Solutions, Inc. CENTRAL INDEX KEY: 0001499717 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-HELP SUPPLY SERVICES [7363] IRS NUMBER: 680680859 STATE OF INCORPORATION: DE FISCAL YEAR END: 1228 BUSINESS ADDRESS: STREET 1: 641 LEXINGTON AVENUE STREET 2: 27TH FLOOR CITY: NEW YORK STATE: NY ZIP: 10022 BUSINESS PHONE: 646-507-5710 MAIL ADDRESS: STREET 1: 641 LEXINGTON AVENUE STREET 2: 27TH FLOOR CITY: NEW YORK STATE: NY ZIP: 10022 FORMER COMPANY: FORMER CONFORMED NAME: GOLDEN FORK CORP DATE OF NAME CHANGE: 20100820 4 1 tm203303-1_form4.xml OWNERSHIP DOCUMENT X0306 4 2019-11-11 0 0001499717 Staffing 360 Solutions, Inc. STAF 0001571267 Jackson Investment Group, LLC 2655 NORTHWINDS PARKWAY ALPHARETTA, GA 30009 0 0 1 0 0001572666 Jackson Richard Lee 2655 NORTHWINDS PARKWAY ALPHARETTA, GA 30009 0 0 1 0 Common Stock 2019-11-11 4 J 0 100000 0.00 A 2474204 D On November 11, 2019 Jackson Investment Group, LLC ("JIG LLC") acquired 100,000 shares of Common Stock in connection with and in consideration of its waiver of the Company's covenant default under that certain Amended and Restated Note Purchase Agreement, dated as of September 15, 2017, by and between JIG LLC, the Company and certain of its subsidiaries as guarantors, as amended (the "Covenant Waiver Transaction"). The Covenant Waiver Transaction was valued using the November 11, 2019 closing price of the Company's common stock. Richard L. Jackson, the sole manager and controlling owner of JIG LLC, may be deemed the indirect beneficial owner, but he disclaims beneficial ownership of the reported securities except to the extent of his pecuniary interest therein. Total in Table 1, Item 5 does not include 144 shares of common stock personally owned by Richard L. Jackson, the chief executive officer of JIG LLC. These shares are directly and beneficially owned by Richard L. Jackson, one of the Reporting Persons; however, they are not owned by JIG LLC, the designated Reporting Person. This form is filed by both JIG LLC and Richard L. Jackson, the sole manager and controlling owner of JIG LLC. /s/ Jackson Investment Group, LLC, by Richard L. Jackson, CEO 2020-01-14 /s/ Richard L. Jackson 2020-01-14