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