SEC Form 4 · accession 0001104659-15-081132
Axsome Therapeutics, Inc. · AXSM
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Mark Coleman
Director
Period of report
Nov 24, 2015
Accepted (ET)
Nov 24, 2015 · 4:25 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 | 243,750 | $5.40 | A | 326,800 | D | |
| Common Stock | Nov 24, 2015 | C | 180,526 | $5.94 | A | 507,326 | D | |
| Common Stock | Nov 24, 2015 | C | 140,672 | $5.94 | A | 647,998 | D |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| 8% Convertible NoteF1 | $5.40 | Nov 24, 2015 | A | 243,750 | A | — | Sep 9, 2024 | Common Stock | 243,750 | 0 | D |
| 8% Convertible NoteF2 | $5.94 | Nov 24, 2015 | A | 180,526 | A | — | Dec 30, 2024 | Common Stock | 180,526 | 0 | D |
| 8% Convertible NoteF3 | $5.94 | Nov 24, 2015 | A | 140,672 | A | — | May 6, 2025 | Common Stock | 140,672 | 0 | D |
Explanation of responses
- F1Consists of an 8% Convertible Note with a principal balance of $1,200,000 and interest accrued through November 24, 2015 of $116,252.
- F2Consists of an 8% Convertible Note with a principal balance of $1,000,000 and interest accrued through November 24, 2015 of $72,329.
- F3Consists of an 8% Convertible Note with a principal balance of $800,000 and interest accrued through November 24, 2015 of $35,595.