Statement of Changes in Beneficial Ownership (4)
December 31 2020 - 04:03PM
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. [ STAF ] |
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)
12/29/2020
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(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 |
Table I - Non-Derivative Securities Acquired, Disposed of, or
Beneficially Owned
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1.Title of Security
(Instr. 3) |
2. Trans. Date |
2A. Deemed Execution Date, if any |
3. Trans. Code
(Instr. 8) |
4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5) |
5. Amount of Securities Beneficially Owned Following
Reported Transaction(s)
(Instr. 3 and 4) |
6. Ownership Form: Direct (D) or Indirect (I)
(Instr. 4) |
7. Nature of Indirect Beneficial Ownership (Instr.
4) |
Code |
V |
Amount |
(A) or (D) |
Price |
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 |
12/29/2020 |
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J (1) |
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620 |
10/31/2022 |
(2) |
Common Stock |
620000 |
$620000 |
0 (2) |
D (3) |
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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 1,267 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. |
Remarks:
This form is filed by both Jackson Investment Group, LLC and
Richard L. Jackson, the sole manager and controlling owner of
Jackson Investment Group, LLC. |
Reporting
Owners
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Reporting Owner Name / Address |
Relationships
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Director |
10% Owner |
Officer |
Other |
Jackson Investment Group, LLC
2655 NORTHWINDS PARKWAY
ALPHARETTA, GA 30009 |
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X |
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Jackson Richard Lee
2655 NORTHWINDS PARKWAY
ALPHARETTA, GA 30009 |
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X |
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Signatures
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/s/ Jackson Investment Group, LLC By: Richard L.
Jackson, Manager and CEO, By David A. Stockton pursuant to power of
attorney filed as an exhibit to this Form 4. |
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12/31/2020 |
**Signature
of Reporting Person |
Date |
/s/ Richard L. Jackson, By David A. Stockton
pursuant to power of attorney filed as an exhibit to this Form
4. |
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12/31/2020 |
**Signature
of Reporting Person |
Date |