0001144204-13-033526.txt : 20130606
0001144204-13-033526.hdr.sgml : 20130606
20130606103541
ACCESSION NUMBER: 0001144204-13-033526
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20130125
FILED AS OF DATE: 20130606
DATE AS OF CHANGE: 20130606
ISSUER:
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
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
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: PAPPAJOHN JOHN
CENTRAL INDEX KEY: 0000897464
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35527
FILM NUMBER: 13896258
MAIL ADDRESS:
STREET 1: 1660 WALT WHITMAN ROAD
STREET 2: SUITE 105
CITY: MELVILLE
STATE: NY
ZIP: 11747
4
1
v347144_4.xml
OWNERSHIP DOCUMENT
X0306
4
2013-01-25
0
0000822370
CNS RESPONSE, INC.
CNSO
0000897464
PAPPAJOHN JOHN
C/O CNS RESPONSE, INC.
85 ENTERPRISE SUITE 410
ALISO VIEJO
CA
92656
1
0
1
0
Common Stock
2013-01-25
4
M
0
4300551
0.0472
A
4603471
D
Common Stock
2013-03-21
4
M
0
6538258
0.0472
A
11141729
D
Convertible Note
0.0472
2013-01-25
4
M
0
200000
D
2012-11-28
2013-11-28
Common Stock
4300551
300000
D
Convertible Note
0.0472
2013-03-21
4
M
0
300000
D
2012-11-28
2013-11-28
Common Stock
6538258
0
D
These Notes were acquired by the Reporting Person as reported on the Reporting Person's Form 4 filed with the Securities & Exchange Commission on December 13, 2012. On January 25, 2013, the Reporting Person converted $200,000 in aggregate principal amount of such Notes and $2,900 in accrued interest. On March 21, 2013, the Reporting Person converted $300,000 in aggregate principal amount of such Notes and $8,475 in accrued interest. The conversion price was $0.04718, which has been rounded to $0.0472 in the above table.
Does not include accrued interest.
/s/ John Pappajohn
2013-06-06