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