0001144204-13-031922.txt : 20130528 0001144204-13-031922.hdr.sgml : 20130527 20130528195620 ACCESSION NUMBER: 0001144204-13-031922 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20130523 FILED AS OF DATE: 20130528 DATE AS OF CHANGE: 20130528 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: 13876524 MAIL ADDRESS: STREET 1: 1660 WALT WHITMAN ROAD STREET 2: SUITE 105 CITY: MELVILLE STATE: NY ZIP: 11747 4 1 v346298_4.xml OWNERSHIP DOCUMENT X0306 4 2013-05-23 0 0000822370 CNS RESPONSE, INC. CNSO 0000897464 PAPPAJOHN JOHN C/O CNS RESPONSE, INC. 85 ENTERPRISE SUITE 410 ALISO VIEJO CA 92656 1 0 0 0 Option to Purchase 0.0472 2013-05-23 4 A 0 250000 0 A 2022-12-10 Common Stock 250000 250000 D The grant of these options under the Company's 2012 Omnibus Incentive Compensation Plan (as amended, the "Plan") was approved by the Company's board of directors on December 10, 2012, subject to stockholder approval of the Plan. The stockholders approved the Plan at the Company's Annual Meeting of Stockholders on May 23, 2013. These options vest pro rata over 36 months beginning on December 10, 2012. /s/ John Pappajohn 2013-05-28