0001571049-17-001063.txt : 20170206 0001571049-17-001063.hdr.sgml : 20170206 20170206171619 ACCESSION NUMBER: 0001571049-17-001063 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20170126 FILED AS OF DATE: 20170206 DATE AS OF CHANGE: 20170206 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: NY FISCAL YEAR END: 0531 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 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Jackson Investment Group, LLC CENTRAL INDEX KEY: 0001571267 STATE OF INCORPORATION: GA FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37575 FILM NUMBER: 17576432 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: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37575 FILM NUMBER: 17576433 MAIL ADDRESS: STREET 1: 2655 NORTHWINDS PARKWAY CITY: ALPHARETTA STATE: GA ZIP: 30009 3 1 t1700079_jacksonstaf0126.xml FORM 3 X0206 3 2017-01-26 0 0001499717 Staffing 360 Solutions, Inc. STAF 0001572666 Jackson Richard Lee 2655 NORTHWINDS PARKWAY ALPHARETTA, GA 30009 0 0 1 0 0001571267 Jackson Investment Group, LLC 2655 NORTHWINDS PARKWAY ALPHARETTA, GA 30009 0 0 1 0 Common Stock 1805577 D Warrant 1.35 2017-07-26 2022-01-26 Common Stock 3150000 D Note Interest Conversion Shares 2.00 2017-01-26 2018-07-25 Common Stock D Richard L. Jackson, the sole manager and controlling owner of Jackson Investment Group, LLC ("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. Maximum amount of shares issuable under the Warrant, subject to adjustment upon any reverse stock split, reclassification or stock split. The Exercise Price is subject to anti-dilution protection, including protection in circumstances where Common Stock is issued pursuant to the terms of certain existing convertible securities, provided that the exercise price shall not be adjusted below a price that is less than the consolidated closing bid price of the Common Stock as reported by the NASDAQ Stock Market on the business day immediately prior to the date of issuance. JIG LLC may convert up to 50% of the accrued interest on a Note, dated January 25, 2017, between JIG LLC and the Issuer, into shares of Common Stock, at the sole election of the Purchaser at any time prior to maturity. /s/ Jackson Investment Group, LLC, by Richard L. Jackson, Manager and CEO 2017-02-06 /s/ Richard L. Jackson 2017-02-06