Statement of Changes in Beneficial Ownership (4)
February 16 2021 - 09:12AM
Edgar (US Regulatory)
FORM 4
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
*
Jackson Investment Group, LLC |
2. Issuer Name and Ticker or Trading Symbol
Staffing 360 Solutions, Inc.
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STAF
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director __X__ 10% Owner _____ Officer (give title below) _____ Other (specify below)
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(Last)
(First)
(Middle)
2655 NORTHWINDS PARKWAY |
3. Date of Earliest Transaction
(MM/DD/YYYY)
2/12/2021 |
(Street)
ALPHARETTA, GA 30009
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
___ Form filed by One Reporting Person
_
X
_ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security (Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code (Instr. 8)
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4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. Code (Instr. 8) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 6. Date Exercisable and Expiration Date | 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) | 8. Price of Derivative Security (Instr. 5) | 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) | 10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) |
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Series E Convertible Preferred Stock | $1.00 | 2/12/2021 | | J (1) | | | 4518 | 10/31/2022 | (2) | Common Stock | 4518000 | $4518000 | 0 (2) | D (3) | |
Explanation of Responses: |
(1) | The reported securities were called for redemption by the issuer at a price equal to their face value. |
(2) | The remaining shares of Series E Preferred Stock owned by the Reporting Person are not convertible into Common Stock until October 31, 2022 so are not included as being beneficially owned. The Reporting Person continues to beneficially own 1,407 shares of Series E-1 Preferred Stock. |
(3) | Richard L. Jackson, the sole manager and controlling owner of Jackson Investment Group, 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. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Jackson Investment Group, LLC 2655 NORTHWINDS PARKWAY ALPHARETTA, GA 30009 |
| X |
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Jackson Richard Lee 2655 NORTHWINDS PARKWAY ALPHARETTA, GA 30009 |
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Signatures
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/s/ Jackson Investment Group, LLC By: Richard L. Jackson, Manager and CEO | | 2/16/2021 |
**Signature of Reporting Person | Date |
/s/ Richard L. Jackson | | 2/16/2021 |
**Signature of Reporting Person | Date |
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