0001144204-12-068051.txt : 20121214 0001144204-12-068051.hdr.sgml : 20121214 20121214170020 ACCESSION NUMBER: 0001144204-12-068051 CONFORMED SUBMISSION TYPE: D PUBLIC DOCUMENT COUNT: 1 ITEM INFORMATION: Rule 506 FILED AS OF DATE: 20121214 DATE AS OF CHANGE: 20121214 EFFECTIVENESS DATE: 20121214 FILER: COMPANY DATA: COMPANY CONFORMED NAME: CNS RESPONSE, INC. CENTRAL INDEX KEY: 0000822370 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-MISC HEALTH & ALLIED SERVICES, NEC [8090] IRS NUMBER: 870419387 STATE OF INCORPORATION: DE FISCAL YEAR END: 0930 FILING VALUES: FORM TYPE: D SEC ACT: 1933 Act SEC FILE NUMBER: 021-188439 FILM NUMBER: 121266326 BUSINESS ADDRESS: STREET 1: 85 ENTERPRISE STREET 2: SUITE 410, CITY: ALISO VIEJO STATE: CA ZIP: 92656 BUSINESS PHONE: (714) 545 3288 MAIL ADDRESS: STREET 1: 85 ENTERPRISE STREET 2: SUITE 410, CITY: ALISO VIEJO STATE: CA ZIP: 92656 FORMER COMPANY: FORMER CONFORMED NAME: STRATIVATION, INC. DATE OF NAME CHANGE: 20051115 FORMER COMPANY: FORMER CONFORMED NAME: SalesTactix, Inc. DATE OF NAME CHANGE: 20040805 FORMER COMPANY: FORMER CONFORMED NAME: AGE RESEARCH INC DATE OF NAME CHANGE: 19990210 D 1 primary_doc.xml X0706 D LIVE 0000822370 CNS RESPONSE, INC. 85 ENTERPRISE SUITE 410, ALISO VIEJO CA CALIFORNIA 92656 (714) 545 3288 DELAWARE Strativation, Inc. Age Research Inc. STRATIVATION, INC. SalesTactix, Inc. AGE RESEARCH INC Corporation true George Carpenter c/o CNS Response, Inc. 85 Enterprise, Suite 410 Aliso Viejo CA CALIFORNIA 92656 Executive Officer John Pappajohn c/o CNS Response, Inc. 85 Enterprise, Suite 410 Aliso Viejo CA CALIFORNIA 92656 Director Zachary McAdoo c/o CNS Response, Inc. 85 Enterprise, Suite 410 Aliso Viejo CA CALIFORNIA 92656 Director Walter Schindler c/o CNS Response, Inc. 85 Enterprise, Suite 410 Aliso Viejo CA CALIFORNIA 92656 Director Paul Buck c/o CNS Response, Inc. 85 Enterprise, Suite 410 Aliso Viejo CA CALIFORNIA 92656 Executive Officer Daniel Hoffman c/o CNS Response, Inc. 85 Enterprise, Suite 410 Aliso Viejo CA CALIFORNIA 92656 Executive Officer Michael Darkoch c/o CNS Response, Inc. 85 Enterprise, Suite 410 Aliso Viejo CA CALIFORNIA 92656 Executive Officer Other Health Care Decline to Disclose 06 false 2012-11-28 false true false 0 135846 135846 0 The 165,666 shares of common stock were issued to executive officers in consideration for the forfeiture of accrued salary and wages. false 3 0 0 0 false CNS RESPONSE, INC. /s/ Paul Buck Paul Buck Chief Financial Officer 2012-12-14