Richard Lee Jackson Form 3/A Jackson Acquisition / Richard Lee Jackson ownership change

SEC Form 3

FORM 3

UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

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 Richard Lee

(Last)

(First)

(Middle)

C/O JACKSON ACQUISITION COMPANY

2655 NORTHWINDS PARKWAY

(Street)

ALPHARETTA

30009

(City)

(State)

(Zip)

2. Date of Event Requiring Statement (Month/Day/Year)
12/08/2021

3. Issuer Name and Ticker or Trading Symbol
Jackson Acquisition Co [ RJAC ]

4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)

X	Director	X	10% Owner
X	Officer (give title below)		Other (specify below)
President and CEO

5. If Amendment, Date of Original Filed (Month/Day/Year)
12/08/2021

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 Beneficially Owned
1. Title of Security (Instr. 4)	2. Amount of Securities Beneficially Owned (Instr. 4)	3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5)	4. Nature of Indirect Beneficial Ownership (Instr. 5)

Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4)	2. Date Exercisable and Expiration Date (Month/Day/Year)		3. Title and Amount of Securities Underlying Derivative Security (Instr. 4)		4. Conversion or Exercise Price of Derivative Security	5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5)	6. Nature of Indirect Beneficial Ownership (Instr. 5)
1. Title of Derivative Security (Instr. 4)	Date Exercisable	Expiration Date	Title	Amount or Number of Shares	4. Conversion or Exercise Price of Derivative Security	5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5)	6. Nature of Indirect Beneficial Ownership (Instr. 5)
Class B Common Stock	⁽¹⁾	⁽¹⁾	Class A Common Stock	5,635,000⁽¹⁾	⁽¹⁾	I	See Footnote⁽²⁾
Class B Common Stock	⁽¹⁾	⁽¹⁾	Class A Common Stock	5,635,000⁽¹⁾	⁽¹⁾	D⁽²⁾

1. Name and Address of Reporting Person^*

Jackson Richard Lee

(Last)

(First)

(Middle)

C/O JACKSON ACQUISITION COMPANY

2655 NORTHWINDS PARKWAY

(Street)

ALPHARETTA

30009

(City)

(State)

(Zip)

1. Name and Address of Reporting Person^*

RJ Healthcare SPAC, LLC

(Last)

(First)

(Middle)

C/O JACKSON ACQUISITION COMPANY

2655 NORTHWINDS PARKWAY

(Street)

ALPHARETTA

30009

(City)

(State)

(Zip)

Explanation of Responses:

1. 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.

2. 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

	/s/ Richard L. Jackson	12/28/2021
	/s/ Richard L. Jackson, as attorney-in fact for RJ Healthcare SPAC, LLC	12/28/2021
	** 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 5 (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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Richard Lee Jackson Form 3/AJackson Acquisition / Richard Lee Jackson ownership change