Initial Statement of Beneficial Ownership (3)
March 09 2020 - 6:51PM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0104
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Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
*
Jacobson Mark L. |
2. Date of Event Requiring Statement (MM/DD/YYYY)
2/28/2020
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3. Issuer Name and Ticker or Trading Symbol
Axsome Therapeutics, Inc. [AXSM]
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(Last)
(First)
(Middle)
C/O AXSOME THERAPEUTICS, INC., 200 BROADWAY, 3RD FLOOR |
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director _____ 10% Owner
___X___ Officer (give title below) _____ Other (specify below)
Chief Operating Officer / |
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(Street)
NEW YORK, NY 10038
(City)
(State)
(Zip)
| 5. If Amendment, Date Original Filed(MM/DD/YYYY)
| 6. Individual or Joint/Group Filing(Check Applicable Line)
_X_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Beneficially Owned
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1.Title of Security
(Instr. 4) | 2. Amount of Securities Beneficially Owned
(Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I)
(Instr. 5) | 4. Nature of Indirect Beneficial Ownership
(Instr. 5) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 4) | 2. Date Exercisable and Expiration Date
(MM/DD/YYYY) | 3. Title and Amount of Securities Underlying Derivative Security
(Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 5) | 6. Nature of Indirect Beneficial Ownership
(Instr. 5) |
| Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
| Stock Option (Right to Buy) | (1) | 4/2/2024 | Common Stock | 24662 | $1.30 | D | |
| Stock Option (Right to Buy) | (2) | 6/17/2024 | Common Stock | 19862 | $1.30 | D | |
| Stock Option (Right to Buy) | (1) | 12/28/2024 | Common Stock | 47739 | $4.04 | D | |
| Stock Option (Right to Buy) | (1) | 9/14/2025 | Common Stock | 40673 | $6.47 | D | |
| Stock Option (Right to Buy) | (3) | 5/26/2026 | Common Stock | 25000 | $8.02 | D | |
| Stock Option (Right to Buy) | (4) | 3/14/2027 | Common Stock | 25000 | $4.95 | D | |
| Stock Option (Right to Buy) | (5) | 9/12/2027 | Common Stock | 15000 | $4.85 | D | |
| Stock Option (Right to Buy) | (6) | 3/11/2028 | Common Stock | 45378 | $2.85 | D | |
| Stock Option (Right to Buy) | (7) | 3/19/2029 | Common Stock | 119704 | $12.95 | D | |
| Stock Option (Right to Buy) | (8) | 10/10/2029 | Common Stock | 25813 | $17.61 | D | |
| Explanation of Responses: |
| (1) | The option is exercisable immediately. |
| (2) | 6,169 options will vest upon the achievement of certain performance based milestones and the remainder of the option is exercisable immediately. |
| (3) | The option was granted on May 27, 2016, and vests in equal increments on a quarterly basis over a four (4) year period, until fully vested. |
| (4) | The option was granted on March 15, 2017, and vests in equal increments on a quarterly basis over a four (4) year period, until fully vested. |
| (5) | The option was granted on September 13, 2017, and vests in equal increments on a quarterly basis over a four (4) year period, until fully vested. |
| (6) | The option was granted on March 12, 2018, and vests in equal increments on a quarterly basis over a four (4) year period, until fully vested. |
| (7) | The option was granted on March 19, 2019, and vests in equal increments on a quarterly basis over a four (4) year period, until fully vested. |
| (8) | The option was granted on October 10, 2019. Fifty percent (50%) of the option is exercisable immediately as of the date of grant with the remaining fifty percent (50%) to vest in equal increments on a quarterly basis over a four (4) year period. |
Reporting Owners
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| Reporting Owner Name / Address | Relationships |
| Director | 10% Owner | Officer | Other |
Jacobson Mark L.
C/O AXSOME THERAPEUTICS, INC.
200 BROADWAY, 3RD FLOOR
NEW YORK, NY 10038 |
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| Chief Operating Officer |
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Signatures
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| /s/ Mark Jacobson | | 3/9/2020 |
| **Signature of Reporting Person | Date |
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