SEC Form 4 · accession 0001104659-15-081129
Axsome Therapeutics, Inc. · AXSM
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Herriot Tabuteau
Officer — Chief Executive Officer · Director · 10% Owner
Period of report
Nov 24, 2015
Accepted (ET)
Nov 24, 2015 · 4:24 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0001579428
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common Stock | Nov 24, 2015 | C | 7,229 | $5.94 | A | 7,229 | D | |
| Common StockF1 | holding | — | — | — | 7,344,500 | I | By Antecip Capital LLC |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 8% Convertible NoteF2 | $5.94 | Nov 24, 2015 | A | 7,229 | A | — | Jun 16, 2025 | Common Stock | 7,229 | 0 | D |
Explanation of responses
- F1The reporting person is the managing member of Antecip Capital LLC and so may be deemed to beneficially own such shares of common stock.
- F2Consists of an 8% Convertible Note with a principal balance of $41,469.47 and interest accrued through November 24, 2015 of $1,472.