0000899243-21-010807.txt : 20210309 0000899243-21-010807.hdr.sgml : 20210309 20210309214620 ACCESSION NUMBER: 0000899243-21-010807 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210305 FILED AS OF DATE: 20210309 DATE AS OF CHANGE: 20210309 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Jacobson Mark L. CENTRAL INDEX KEY: 0001805812 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37635 FILM NUMBER: 21728081 MAIL ADDRESS: STREET 1: 200 BROADWAY STREET 2: 3RD FLOOR CITY: NEW YORK STATE: NY ZIP: 10038 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: 22 CORTLANDT STREET, 16TH FLOOR CITY: NEW YORK STATE: NY ZIP: 10007 BUSINESS PHONE: (212) 332-3241 MAIL ADDRESS: STREET 1: 22 CORTLANDT STREET, 16TH FLOOR CITY: NEW YORK STATE: NY ZIP: 10007 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2021-03-05 0 0001579428 Axsome Therapeutics, Inc. AXSM 0001805812 Jacobson Mark L. C/O AXSOME THERAPEUTICS, INC. 22 CORTLANDT STREET, 16TH FLOOR NEW YORK NY 10007 0 1 0 0 Chief Operating Officer Employee Stock Option (Right to Buy) 65.02 2021-03-05 4 A 0 41638 0.00 A 2031-03-04 Common Stock 41638 41638 D Restricted Stock Units 2021-03-05 4 A 0 22163 0.00 A Common Stock 22163 22163 D The option will vest in substantially equal quarterly installments over four years such that the option will be fully vested on March 5, 2025. Each restricted stock unit ("RSU") represents a contingent right to receive one share of the Issuer's common stock. 25% of the RSUs will vest on the one (1) year anniversary of the date of grant. The remaining RSUs will vest in in three substantially equal annual installments, such that the RSUs will be fully vested on March 5, 2025. Vested shares will be delivered to the reporting person upon the earlier of (i) the closing of a Change in Control (as defined in the Issuer's Amended and Restated 2015 Omnibus Incentive Compensation Plan (the "Plan"), (ii) the reporting person's separation of service from the Issuer (including termination with or without Cause (as defined in the Plan), or termination due to death or disability), or (iii) seven (7) years from the date of grant. /s/ Mark Jacobson 2021-03-09