0001571049-17-007971.txt : 20170919 0001571049-17-007971.hdr.sgml : 20170919 20170919193718 ACCESSION NUMBER: 0001571049-17-007971 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20170918 FILED AS OF DATE: 20170919 DATE AS OF CHANGE: 20170919 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: 171093075 MAIL ADDRESS: STREET 1: 2655 NORTHWINDS PARKWAY CITY: ALPHARETTA STATE: GA ZIP: 30009 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: 171093076 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 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: 1231 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 t1700505_jackson0918.xml FORM 4 X0306 4 2017-09-18 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 2017-09-18 4 J 0 2250000 0.00 A 9411019 D On September 18, 2017, Jackson Investment Group, LLC ("JIG LLC") acquired 2,250,000 shares of Common Stock as a commitment fee in connection with the acquisition by JIG LLC of a $40,000,000 senior secured note of the Issuer with a maturity date of September 15, 2020. 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 does not include 721 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, Manager and CEO 2017-09-19 /s/ Richard L. Jackson 2017-09-19