0001144204-11-014757.txt : 20110315 0001144204-11-014757.hdr.sgml : 20110315 20110315114517 ACCESSION NUMBER: 0001144204-11-014757 CONFORMED SUBMISSION TYPE: SC 13G PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 20110315 DATE AS OF CHANGE: 20110315 FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: SASSINE ANDY CENTRAL INDEX KEY: 0001515322 FILING VALUES: FORM TYPE: SC 13G MAIL ADDRESS: STREET 1: 82 DEVONSHIRE STREET CITY: BOSTON STATE: MA ZIP: 02109 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: CNS RESPONSE, INC. CENTRAL INDEX KEY: 0000822370 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-MISC HEALTH & ALLIED SERVICES, NEC [8090] IRS NUMBER: 870419387 STATE OF INCORPORATION: DE FISCAL YEAR END: 0930 FILING VALUES: FORM TYPE: SC 13G SEC ACT: 1934 Act SEC FILE NUMBER: 005-79934 FILM NUMBER: 11687681 BUSINESS ADDRESS: STREET 1: 85 ENTERPRISE STREET 2: SUITE 410, CITY: ALISO VIEJO STATE: CA ZIP: 92656 BUSINESS PHONE: (714) 545 3288 MAIL ADDRESS: STREET 1: 85 ENTERPRISE STREET 2: SUITE 410, CITY: ALISO VIEJO STATE: CA ZIP: 92656 FORMER COMPANY: FORMER CONFORMED NAME: STRATIVATION, INC. DATE OF NAME CHANGE: 20051115 FORMER COMPANY: FORMER CONFORMED NAME: SalesTactix, Inc. DATE OF NAME CHANGE: 20040805 FORMER COMPANY: FORMER CONFORMED NAME: AGE RESEARCH INC DATE OF NAME CHANGE: 19990210 SC 13G 1 v214402_sc13g.htm Unassociated Document
SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, DC 20549
____________
 
SCHEDULE 13G
 
INFORMATION TO BE INCLUDED IN STATEMENTS FILED PURSUANT
TO RULES 13d-1(b), (c), AND (d) AND AMENDMENTS THERETO FILED
PURSUANT TO RULE 13d-2
 
CNS Response, Inc.
(Name of Issuer)
 
Common Stock, par value $0.001 per share
(Title of Class of Securities)
 
12619C101
(CUSIP Number)
 
February 23, 2011
(Date of Event which Requires Filing of this Statement)
 
Check the appropriate box to designate the rule pursuant to which this Schedule is filed:
 
o Rule 13d-1(b)
 
x Rule 13d-1(c)
 
o Rule 13d-1(d)
 
*The remainder of this cover page shall be filled out for a reporting person's initial filing on this form with respect to the subject class of securities, and for any subsequent amendment containing information which would alter the disclosures provided in a prior cover page.

The information required in the remainder of this cover page shall not be deemed to be "filed" for the purpose of Section 18 of the Securities Exchange Act of 1934 ("Act") or otherwise subject to the liabilities of that section of the Act but shall be subject to all other provisions of the Act (however, see the Notes).
 
 
 
 
 
CUSIP No. 
 12619C101
13G
Page 2 of 6 Pages
 
           
1  
NAMES OF REPORTING PERSONS:
I.R.S. IDENTIFICATION NOS. OF ABOVE PERSONS (ENTITIES ONLY):
 
 
 
ANDY SASSINE
     
2   CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP (SEE INSTRUCTIONS):
 
(a)   o
 
(b)   o
     
3   SEC USE ONLY:
   
   
     
4   CITIZENSHIP OR PLACE OF ORGANIZATION:
   
 
USA
       
  5   SOLE VOTING POWER:
     
NUMBER OF
  
3,598,832
 
      
SHARES
 6   SHARED VOTING POWER:
BENEFICIALLY
    
OWNED BY
  
0
 
      
EACH
 7   SOLE DISPOSITIVE POWER:
REPORTING
    
PERSON
  
3,598,832
 
      
WITH:
 8   SHARED DISPOSITIVE POWER:
     
   
0
     
9   AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON:
   
 
3,598,832
     
10   CHECK IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES (SEE INSTRUCTIONS):
   
 
o
     
11   PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (9):
   
 
6.04%
     
12   TYPE OF REPORTING PERSON (SEE INSTRUCTIONS):
   
 
IN
 
 
 
 
 
CUSIP No. 
 12619C101
13G
Page 3 of 6 Pages
 
Item 1(a)
Name of Issuer:
   
 
CNS Response, Inc.
   
Item 1(b)
Address of Issuer’s Principal Executive Offices:
   
 
85 Enterprise, Suite 410, Aliso Viejo, CA 92656
   
Item 2(a)
Name of Person Filing:
   
 
Andy Sassine
   
Item 2(b)
Address of Principal Business Office or, if None, Residence:
   
  82 Devonshire Street, Boston, MA 02109
   
Item 2(c)
Citizenship:
   
 
Mr. Sassine is a United States citizen.
   
Item 2(d)
Title of Class of Securities:
   
 
Common Stock
   
Item 2(e)
CUSIP Number:
   
 
12619C101
   
Item 3.
If this statement is filed pursuant to §§240.13d-1(b) or (c), check whether the person filing is a: N/A
   
 
Not applicable.
 
 
 
 
 
CUSIP No. 
 12619C101
13G
Page 4 of 6 Pages
 
Item 4.
 Ownership.
     
  (a)
Amount Beneficially Owned
     
   
3,598,832 (as of March 8, 2011)
     
  (b)
Percent of Class
     
   
6.04%
     
  (c)
Number of Shares as to which the person has
     
   
(i)
Sole power to vote or direct the vote
       
      3,598,832
     
 
   
(ii)
Shared power to vote or to direct the vote
       
      0
     
 
   
(iii)
Sole power to dispose or direct the disposition of
       
      3,598,832
     
 
   
(iv)
Shared power to dispose or direct the disposition of
       
     
0
 
 
 
 
 
CUSIP No. 
 12619C101
13G
Page 5 of 6 Pages
 
Item 5.
Ownership of Five Percent or Less of a Class.
   
 
Not Applicable.
   
Item 6.
Ownership of More than Five Percent on Behalf of Another Person.
   
 
Not Applicable.
   
Item 7.
Identification and Classification of the Subsidiary which Acquired the Security Being Reported On by the Parent Holding Company.
   
 
Not Applicable.
   
Item 8.
Identification and Classification of Members of the Group.
   
 
Not Applicable.
   
Item 9.
Notice of Dissolution of Group.
   
 
Not Applicable.
   
Item 10.
Certification
   
 
By signing below I certify that, to the best of my knowledge and belief, the securities referred to above were not acquired and are not held for the purpose of or with the effect of changing or influencing the control of the issuer of the securities and were not acquired and are not held in connection with or as a participant in any transaction having that purpose or effect.
 
 
 
 
 
SIGNATURE
 
After reasonable inquiry and to the best of my knowledge and belief, I certify that the information set forth in this statement is true, complete and correct.
 
   
March 11, 2011
  
   
(Date)
  
       
       
 
  
/s/ Andy Sassine
  
   
Andy Sassine