0001104659-20-139275.txt : 20201223 0001104659-20-139275.hdr.sgml : 20201223 20201223180854 ACCESSION NUMBER: 0001104659-20-139275 CONFORMED SUBMISSION TYPE: 4/A PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20200317 FILED AS OF DATE: 20201223 DATE AS OF CHANGE: 20201223 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Jacobson Mark L. CENTRAL INDEX KEY: 0001805812 FILING VALUES: FORM TYPE: 4/A SEC ACT: 1934 Act SEC FILE NUMBER: 001-37635 FILM NUMBER: 201413851 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/A 1 tm2039202-2_4seq1.xml OWNERSHIP DOCUMENT X0306 4/A 2020-03-17 2020-03-19 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) 45.14 2020-03-17 4 A 0 48237 0 A 2030-03-16 Common Stock 48237 48237 D Restricted Stock Units 2020-03-17 4 A 0 14767 0 A Common Stock 14767 14767 D The option will vest in substantially equal quarterly installments over four years such that the option will be fully vested on March 17, 2024. 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 17, 2024. 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 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. Due to an administrative error, the Form 4 originally filed on March 19, 2020 (the "Original Form 4") misstated the number of options and RSUs granted to the reporting person. This amended Form 4 is being filed to amend and restate the Original Form 4 solely to reflect the correct number of options and RSUs. No other changes are being made to the Original Form 4. /s/ Mark Jacobson 2020-12-23