-----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, GrYkIai1YO+zx0VPm+qNc4CG3wXCOjz4skyGcI0PfbZGhKU614kQy4AX5Sg/Zyke 7mo+OQKLwmghzGnfbM/fRA== 0001144204-10-039599.txt : 20100727 0001144204-10-039599.hdr.sgml : 20100727 20100727175704 ACCESSION NUMBER: 0001144204-10-039599 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20100725 FILED AS OF DATE: 20100727 DATE AS OF CHANGE: 20100727 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: 000-26285 FILM NUMBER: 10972519 MAIL ADDRESS: STREET 1: 1660 WALT WHITMAN ROAD STREET 2: SUITE 105 CITY: MELVILLE STATE: NY ZIP: 11747 4 1 v191620_ex.xml X0303 4 2010-07-25 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 Convertible Notes 0.50 2010-07-25 4 A 0 500000 A 2010-07-25 2010-12-02 Common Stock 1000000 500000 D Warrants to purchase shares 0.50 2010-07-25 4 A 0 250000 A 2010-07-25 2017-07-24 Common Stock 250000 250000 D On June 3, 2010 and July 25, 2010, the Reporting Person acquired secured promissory notes in the aggregate principal amount of $500,000. As of June 25, 2010, the Reporting Person entered into an agreement with the Issuer, pursuant to which the Issuer granted the Reporting Person the right to convert such notes into shares of common stock at a conversion price of $0.50, subject to customary anti-dilution adjustments. The Note is subject to earlier repayment upon the occurrence of certain events described therein. As of July 25, 2010, the date that (1) the conversion feature of the notes and (2) the warrants were acquired, the most recent transaction price quoted for the Issuer's common stock was $0.50 per share. /s/ John Pappajohn 2010-07-27 -----END PRIVACY-ENHANCED MESSAGE-----