CNS RESPONSE, INC. 4
4 · CNS RESPONSE, INC. · Filed Jun 18, 2013
Insider Transaction Report
Form 4
FOLLMAN ROBERT J
Director10% Owner
Transactions
- Conversion
Common Stock
2013-06-14$0.05/sh+4,491,310$211,990→ 4,491,310 total(indirect: By Trust) - Conversion
Convertible Note
2013-01-25→ 0 total(indirect: By Trust)Exercise: $0.05From: 2012-10-19Exp: 2013-10-19→ Common Stock (4,239,085 underlying)
Footnotes (3)
- [F1]These Notes were purchased by the Reporting Person pursuant to an Amended and Restated Note Purchase Agreement, dated as of October 19, 2012, between the Company and the investors party thereto in connection with a $2 million bridge financing, all as more specifically reported on the Issuer's Form 8-K filed with the Securities & Exchange Commission on December 4, 2012. On June 14, 2013, the Reporting Person converted $200,000 in aggregate principal amount of such Notes and $11,900 in accrued interest.
- [F2]Does not include accrued interest.
- [F3]The converted shares are held in The Declaration of Trust of Robert .J. Follman and Carole A. Follman dated August 14, 1979 of which the Reporting Person is a trustee.