SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

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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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
Jackson Investment Group, LLC

(Last) (First) (Middle)
2655 NORTHWINDS PARKWAY

(Street)
ALPHARETTA GA 30009

(City) (State) (Zip)
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)
3. Date of Earliest Transaction (Month/Day/Year)
05/06/2021
4. If Amendment, Date of Original Filed (Month/Day/Year)
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
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction 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
Common Stock 05/06/2021 J(1) V 7,665,000(2) D $1 4,467,204(3) D
Common Stock 05/06/2021 J(1) V 7,665,000(2) A $1 4,467,204(3) D
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction 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 (Month/Day/Year) 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: 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 05/06/2021 J(1) V 6,172 10/31/2022 (4) Common Stock 6,172,000 $6,172,000 0 D(5)
Series G Convertible Preferred Stock $1 05/06/2021 J(1) V 6,172 10/31/2022 (4) Common Stock 6,172,000 $6,172,000 0 D(5)
Series E-1 Convertible Preferred Stock $1 05/06/2021 J(1) V 1,493 10/31/2020 (4) Common Stock 1,493,000 $1,493,000 1,493 D(5)
Series G-1 Convertible Preferred Stock $1 05/06/2021 J(1) V 1,493 10/31/2020 (4) Common Stock 1,493,000 $1,493,000 1,493 D(5)
1. Name and Address of Reporting Person*
Jackson Investment Group, LLC

(Last) (First) (Middle)
2655 NORTHWINDS PARKWAY

(Street)
ALPHARETTA GA 30009

(City) (State) (Zip)
1. Name and Address of Reporting Person*
Jackson Richard Lee

(Last) (First) (Middle)
2655 NORTHWINDS PARKWAY

(Street)
ALPHARETTA GA 30009

(City) (State) (Zip)
Explanation of Responses:
1. Pursuant to a reclassification exempt under Rule 16b-7, on May 6, 2021, each share of Series E Convertible Preferred Stock was exchanged by the Reporting Person for one share of newly-issued Series G Convertible Preferred Stock and each share of Series E-1 Convertible Preferred Stock was exchanged by the Reporting Person for one share of newly-issued Series G-1 Convertible Preferred Stock.This transaction is being voluntarily reported on this Form 4.
2. Consists of all shares of common stock underlying the Convertible Preferred Stock reported in Table 2.
3. Includes 2,068,696 shares owned, 905,508 shares that could be acquired pursuant to presently exercisable warrants, and 1,493,000 shares that would be acquired upon conversion of series G-1 shares owned.
4. The Preferred Stock is perpetual and therefore has no expiration date.
5. The shares of Series G 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.
/s/ Jackson Investment Group, LLC By: Richard L. Jackson, Manager and CEO 05/13/2021
/s/ Richard L. Jackson 05/13/2021
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 4 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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