0001179110-20-000546.txt : 20200114 0001179110-20-000546.hdr.sgml : 20200114 20200114160850 ACCESSION NUMBER: 0001179110-20-000546 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20200110 FILED AS OF DATE: 20200114 DATE AS OF CHANGE: 20200114 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: JEFFS ROGER CENTRAL INDEX KEY: 0001231615 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37635 FILM NUMBER: 20526140 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: 200 BROADWAY, 3RD FLOOR CITY: NEW YORK STATE: NY ZIP: 10038 BUSINESS PHONE: (212) 332-3241 MAIL ADDRESS: STREET 1: 200 BROADWAY, 3RD FLOOR CITY: NEW YORK STATE: NY ZIP: 10038 4 1 edgar.xml FORM 4 - X0306 4 2020-01-10 0 0001579428 Axsome Therapeutics, Inc. AXSM 0001231615 JEFFS ROGER C/O AXSOME THERAPEUTICS, INC 200 BROADWAY, 3RD FLOOR NEW YORK NY 10038 1 0 0 0 Common Stock 2020-01-10 4 M 0 9127 9.00 A 65747 D Common Stock 2020-01-10 4 M 0 5193 8.02 A 70940 D Common Stock 2020-01-10 4 M 0 11000 4.95 A 81940 D Common Stock 2020-01-10 4 M 0 34866 12.95 A 116806 D Common Stock 46912 I GRAT Stock Option (Right to Buy) 9.00 2020-01-10 4 M 0 9127 0 D 2016-11-19 2025-11-18 Common Stock 9127 0 D Stock Option (Right to Buy) 8.02 2020-01-10 4 M 0 5193 0 D 2016-05-27 2026-05-26 Common Stock 5193 0 D Stock Option (Right to Buy) 4.95 2020-01-10 4 M 0 11000 0 D 2018-03-15 2027-03-14 Common Stock 11000 0 D Stock Option (Right to Buy) 12.95 2020-01-10 4 M 0 34866 0 D 2019-03-19 2029-03-18 Common Stock 34866 0 D The Reporting Person has elected to exercise and hold the shares at this time. Represents additional shares held indirectly by the Reporting Person prior to January 10, 2019. /s/ Herriot Tabuteau, M.D., Attorney-in-Fact 2020-01-14