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