-----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, BCG53V7+ExRQg6FZOleofq6YDKJduaw7qMMwPeFSnSs4sKQtSvrENLgp0d7FCb4W y7QEeFjDyB5SO10jrY2E2A== 0001193805-09-001318.txt : 20090622 0001193805-09-001318.hdr.sgml : 20090622 20090622173223 ACCESSION NUMBER: 0001193805-09-001318 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20090612 FILED AS OF DATE: 20090622 DATE AS OF CHANGE: 20090622 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: 2755 BRISTOL ST. CITY: COSTA MESA STATE: CA ZIP: 92626 BUSINESS PHONE: (949) 248-5461 MAIL ADDRESS: STREET 1: 2755 BRISTOL ST. CITY: COSTA MESA STATE: CA ZIP: 92626 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 SEC ACT: 1934 Act SEC FILE NUMBER: 000-26285 FILM NUMBER: 09904161 MAIL ADDRESS: STREET 1: 1660 WALT WHITMAN ROAD STREET 2: SUITE 105 CITY: MELVILLE STATE: NY ZIP: 11747 3 1 e605589_ex.xml FORM 3 X0203 3 2009-06-12 0 0000822370 CNS RESPONSE, INC. CNSO.OB 0000897464 PAPPAJOHN JOHN 666 WALNUT ST, STE. 2116 DES MOINES IA 50309 0 0 1 0 Stock Purchase Warrant .30 2009-06-12 2016-06-30 Common Stock, par value $.001 3333333 D 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. /s/ John Pappajohn 2009-06-22 -----END PRIVACY-ENHANCED MESSAGE-----