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