CNS RESPONSE, INC. 4
4 · CNS RESPONSE, INC. · Filed Sep 16, 2015
Insider Transaction Report
Form 4
FOLLMAN ROBERT J
Director10% Owner
Transactions
- Award
5% Secured Convertible Note due March 2016
2015-09-15(indirect: By Trust)Exercise: $0.05From: 2016-03-06Exp: 2016-03-21→ Common Stock (3,000,000 underlying) - Award
5% Secured Convertible Note due March 2016
2015-09-14(indirect: By Trust)Exercise: $0.05From: 2016-03-06Exp: 2016-03-21→ Common Stock (2,000,000 underlying)
Footnotes (5)
- [F1]On September 14, 2015, the Issuer and the holders of the 5% Secured Convertible Notes due March 2016 (the "Notes") entered into an Omnibus Amendment to fix the conversion price of the Notes at $0.05 per share. The Omnibus Amendment amended the Notes and the September 22, 2014 Note Purchase Agreement, as amended, pursuant to which the Notes were issued.
- [F2]The Notes are convertible into shares of common stock either: (i) voluntarily, beginning 15 days prior to the March 21, 2016 maturity date of the Notes (the "Maturity Date"), by the holder or (ii) automatically, if, prior to the Maturity Date, the Issuer consummates a Qualified Financing (as defined in the Notes).
- [F3]The Maturity Date of the Notes is March 21, 2016.
- [F4]The number of derivate securities beneficially owned does not include interest accrued at 5% per annum on the Notes.
- [F5]The Notes are held in the Declaration of Trust of Robert J. Follman and Carole A. Follman, dated August 14, 1979 of which Mr. Follman is a trustee