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