-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, AizaXobWRNQIN/obr/v6hpFTFCoe9Y0uuGw8dtEgPZE9wmiCtXLGJRQk1OyPeK9t SW3pUyND8MESah4yW8rjVQ== 0001144204-10-020815.txt : 20100416 0001144204-10-020815.hdr.sgml : 20100416 20100416145435 ACCESSION NUMBER: 0001144204-10-020815 CONFORMED SUBMISSION TYPE: 3/A PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20090612 FILED AS OF DATE: 20100416 DATE AS OF CHANGE: 20100416 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: 3/A SEC ACT: 1934 Act SEC FILE NUMBER: 000-26285 FILM NUMBER: 10754518 MAIL ADDRESS: STREET 1: 1660 WALT WHITMAN ROAD STREET 2: SUITE 105 CITY: MELVILLE STATE: NY ZIP: 11747 3/A 1 v181275_ex.xml X0203 3/A 2009-06-12 2009-06-22 0 0000822370 CNS RESPONSE, INC. CNSO.OB 0000897464 PAPPAJOHN JOHN 666 WALNUT STREET, SUITE 2116 DES MOINES IA 50309 0 0 1 0 Stock Purchase Warrant 0.30 2009-06-12 2016-06-30 Common Stock, par value $.001 2333333 D Does not include Common Stock Warrants to purchase an aggregate of 1,000,000 shares of Common Stock gifted for no consideration at the time of issuance to certain relatives of Mr. Pappajohn for which he disclaims beneficial ownership. On June 12, 2009, the Issuer also issued to Mr. Pappajohn a Secured Convertible Promissory Note in the principal amount of $1,000,000. In the event the Issuer consummates an equity financing transaction of at least $1,500,000 (excluding any and all notes and other liabilities or indebtedness which are converted) during the term of such note, the then outstanding principal amount of such note shall be automatically converted into the securities issued in the equity financing by dividing such amount by the per share price paid by the investors in such financing. This Amendment to Form 3 is being filed to correct the reported number of shares of Common Stock underlying the Stock Purchase Warrant acquired by Mr. Pappajohn on June 12, 2009, in light of the gift described in Note 1 above. The number of shares underlying such warrant was previously reported as 3,333,333. /s/ John Pappajohn 2010-04-16 -----END PRIVACY-ENHANCED MESSAGE-----