Richard L. Jackson - 08 Dec 2021 Form 3/A - Amendment Insider Report for Jackson Acquisition Co

Role: President and CEO, Director, 10%+ Owner
Signature: /s/ Richard L. Jackson
Issuer symbol: N/A
Transactions as of: 08 Dec 2021
Net transactions value: $0
Form type: 3/A - Amendment
Filing time: 28 Dec 2021, 15:00:35 UTC
Date Of Original Report: 08 Dec 2021
Next filing: 12 Dec 2024
SEC: View on sec.gov

Derivative Securities (e.g., puts, calls, warrants, options, convertible securities)

Type	Sym	Class	Transaction	Value $	Shares	Change %	* Price $	Shares After	Date	Underlying Class	Amount	Exercise Price	Ownership	Footnotes
holding	RJAC	Class B Common Stock							08 Dec 2021	Class A Common Stock	5,635,000		See Footnote	F1, F2
holding	RJAC	Class B Common Stock							08 Dec 2021	Class A Common Stock	5,635,000		Direct	F1, F2

* An asterisk sign (*) next to the price indicates that the price is likely invalid.

Explanation of Responses:

Id	Content
F1	As described in the issuer's registration statement on Form S-1 (File No. 333-254727) under the heading "Description of Securities - Founder Shares," the shares of Class B common stock, par value $0.0001 per share, of the issuer will automatically convert into shares of Class A common stock, par value $0.0001 per share, of the issuer at the time of the issuer's initial business combination, or earlier at the option of the holder, on a one-for-one basis, subject to certain adjustment, and have no expiration date. Includes 750,000 shares of Class B common stock that are subject to forfeiture if the underwriter of the issuer's initial public offering does not exercise in full its option to purchase additional units.
F2	The shares are owned directly by RJ Healthcare SPAC, LLC (the "Sponsor"). Mr. Jackson has an interest in shares of Class B common stock through his membership interest in the Sponsor. The Sponsor is managed by a board of managers consisting of entities controlled by Richard L. Jackson, President and Chief Executive Officer and director of the issuer, and John Ellis Bush, chairman of the board of directors of the issuer. Mr. Jackson is the controlling member of the Sponsor and exercises voting and dispositive control over the securities held by the Sponsor. Mr. Jackson disclaims any beneficial ownership of the reported shares other than to the extent of any pecuniary interest he may have therein, directly or indirectly.

Content

As described in the issuer's registration statement on Form S-1 (File No. 333-254727) under the heading "Description of Securities - Founder Shares," the shares of Class B common stock, par value $0.0001 per share, of the issuer will automatically convert into shares of Class A common stock, par value $0.0001 per share, of the issuer at the time of the issuer's initial business combination, or earlier at the option of the holder, on a one-for-one basis, subject to certain adjustment, and have no expiration date. Includes 750,000 shares of Class B common stock that are subject to forfeiture if the underwriter of the issuer's initial public offering does not exercise in full its option to purchase additional units.

The shares are owned directly by RJ Healthcare SPAC, LLC (the "Sponsor"). Mr. Jackson has an interest in shares of Class B common stock through his membership interest in the Sponsor. The Sponsor is managed by a board of managers consisting of entities controlled by Richard L. Jackson, President and Chief Executive Officer and director of the issuer, and John Ellis Bush, chairman of the board of directors of the issuer. Mr. Jackson is the controlling member of the Sponsor and exercises voting and dispositive control over the securities held by the Sponsor. Mr. Jackson disclaims any beneficial ownership of the reported shares other than to the extent of any pecuniary interest he may have therein, directly or indirectly.

Remarks:

This Form 3 is being amended and restated solely for the purpose of adding the EDGAR codes for RJ Healthcare SPAC, LLC. Exhibit 24.1 - Power of Attorney Exhibit 24.2 - Power of Attorney