0001104659-16-124832.txt : 20160601 0001104659-16-124832.hdr.sgml : 20160601 20160601160207 ACCESSION NUMBER: 0001104659-16-124832 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20160527 FILED AS OF DATE: 20160601 DATE AS OF CHANGE: 20160601 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Axsome Therapeutics, Inc. CENTRAL INDEX KEY: 0001579428 STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834] IRS NUMBER: 454241907 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 25 BROADWAY, 9TH FLOOR CITY: NEW YORK STATE: NY ZIP: 10004 BUSINESS PHONE: 212-203-5072 MAIL ADDRESS: STREET 1: 25 BROADWAY, 9TH FLOOR CITY: NEW YORK STATE: NY ZIP: 10004 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: TABUTEAU HERRIOT CENTRAL INDEX KEY: 0001219927 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37635 FILM NUMBER: 161689135 4 1 a4.xml 4 X0306 4 2016-05-27 0 0001579428 Axsome Therapeutics, Inc. AXSM 0001219927 TABUTEAU HERRIOT 25 BROADWAY, 9TH FLOOR NEW YORK NY 10004 1 1 1 0 Chief Executive Officer Employee Stock Option (Right to Buy) 8.02 2016-05-27 4 A 0 524000 0 A 2026-05-26 Common Stock 524000 524000 D Represents 375,000 options granted as an initial employment grant and 149,000 options granted as an annual grant. The option will vest in substantially equal quarterly installments such that the option will be fully vested on May 27, 2020. /s/ Constance Ames, Attorney-in-Fact 2016-06-01