0001104659-21-097615.txt : 20210729 0001104659-21-097615.hdr.sgml : 20210729 20210729164034 ACCESSION NUMBER: 0001104659-21-097615 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210723 FILED AS OF DATE: 20210729 DATE AS OF CHANGE: 20210729 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: 211128052 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: 211128051 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: 0102 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 tm2123579-1_4.xml FORM 4 X0306 4 2021-07-23 1 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 Series G Convertible Preferred Stock 1.00 2021-07-23 4 J 0 6172 6172000 A 2022-10-31 Common Stock 1028667 0 D Series G-1 Convertible Preferred Stock 1.00 2021-07-23 4 J 0 1561 1561000 A 2020-10-31 Common Stock 260166 0 D On July 23, 2021, each share of Series G and G-1 Convertible Preferred Stock owned by the Reporting Person was converted into debt of the Company. The Preferred Stock is perpetual and therefore has no expiration date. /s/ David Stockton, as attorney-in-fact for Jackson Investment Group, LLC 2021-07-29 /s/ David Stockton, as attorney-in-fact for Richard L. Jackson 2021-07-29