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CNS RESPONSE, INC.
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(Name
of Issuer)
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Common Stock, par value $0.001 per
share
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(Title
of Class of Securities)
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12619C101
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(CUSIP
Number)
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David
B. Jones
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c/o
SAIL Venture Partners, LP
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600
Anton Blvd., Suite 1010
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Costa
Mesa, California 92626
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(714)
241-7500
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November 3, 2010
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(Date
of Event which Requires Filing of this
Statement)
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CUSIP
No. 12619C101
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1
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NAME
OF REPORTING PERSONS.
SAIL VENTURE PARTNERS,
LLC
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||
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2
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CHECK THE APPROPRIATE BOX
IF A MEMBER OF A GROUP (See
instructions)
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(a)
¨
(b)
¨
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|
3
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SEC
USE ONLY
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||
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4
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SOURCE OF FUNDS
(See
instructions)
OO
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||
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5
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CHECK BOX IF DISCLOSURE OF
LEGAL PROCEEDINGS IS REQUIRED PURSUANT TO ITEMS 2(d)
or 2e)
|
o
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6
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CITIZENSHIP
OR PLACE OF ORGANIZATION
Delaware
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||
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NUMBER
OF
SHARES
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7
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SOLE
VOTING POWER
12,014,636
|
|
|
BENEFICIALLY
OWNED
BY
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8
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SHARED
VOTING POWER
0
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|
|
EACH
REPORTING
|
9
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SOLE
DISPOSITIVE POWER
12,014,636
|
|
|
PERSON
WITH
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10
|
SHARED
DISPOSITIVE POWER
0
|
|
|
11
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AGGREGATE
AMOUNT BENEFICIALLY OWNED BY EACH
REPORTING PERSON
12,014,636
|
||
|
12
|
CHECK
BOX IF THE AGGREGATE AMOUNT IN ROW (11) EXCLUDES CERTAIN SHARES
(See instructions) |
o
|
|
13
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PERCENT
OF CLASS REPRESENTED BY AMOUNT IN ROW (11)
19.5%
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||
|
14
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TYPE
OF REPORTING PERSON
(See
instructions)
OO
LIMITED LIABILITY COMPANY
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||
|
CUSIP
No. 12619C101
|
|
1
|
NAME
OF REPORTING PERSONS.
SAIL VENTURE PARTNERS,
LP
|
||
|
2
|
CHECK THE APPROPRIATE BOX
IF A MEMBER OF A GROUP (See
instructions)
|
(a)
¨
(b)
¨
|
|
3
|
SEC
USE ONLY
|
||
|
4
|
SOURCE OF FUNDS
(See
instructions)
OO
|
||
|
5
|
CHECK BOX IF DISCLOSURE OF
LEGAL PROCEEDINGS IS REQUIRED PURSUANT TO ITEMS 2(d)
or 2e)
|
o
|
|
6
|
CITIZENSHIP
OR PLACE OF ORGANIZATION
Delaware
|
||
|
NUMBER
OF
SHARES
|
7
|
SOLE
VOTING POWER
12,014,636
|
|
|
BENEFICIALLY
OWNED
BY
|
8
|
SHARED
VOTING POWER
0
|
|
|
EACH
REPORTING
|
9
|
SOLE
DISPOSITIVE POWER
12,014,636
|
|
|
PERSON
WITH
|
10
|
SHARED
DISPOSITIVE POWER
0
|
|
|
11
|
AGGREGATE
AMOUNT BENEFICIALLY OWNED BY EACH
REPORTING PERSON
12,014,636
|
||
|
12
|
CHECK
BOX IF THE AGGREGATE AMOUNT IN ROW (11) EXCLUDES CERTAIN SHARES
(See instructions) |
o
|
|
13
|
PERCENT
OF CLASS REPRESENTED BY AMOUNT IN ROW (11)
19.5%
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||
|
14
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TYPE
OF REPORTING PERSON
(See
instructions)
PN
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||
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ITEM 5.
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Interests
in Securities of the Issuer.
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ITEM
6.
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Contracts,
Arrangements, Understandings or Relationships with Respect to Securities
of the Issuer.
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ITEM
7.
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Material to be Filed
as Exhibits.
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Exhibit No.
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Description
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2
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Purchase
Option Agreement, dated as of November 3, 2010, by and among SAIL Venture
Partners, LP, Deerwood Holdings LLC, Deerwood Partners LLC and CNS
Response, Inc.
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3
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Form
of Guaranty (incorporated by reference to Exhibit 4.2 of the Current
Report on Form 8-K filed by CNS Response, Inc. on August 24,
2010)
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Dated:
November 5, 2010
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SAIL
Venture Partners, LP
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a
Delaware limited partnership
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/s/ David B.
Jones
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By:
SAIL Venture Partners, LLC
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a
Delaware limited liability company
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By:
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David
B. Jones
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Its:
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Manager
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Dated:
November 5, 2010
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SAIL
Venture Partners, LLC
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a
Delaware limited liability company
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/s/ David B.
Jones
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By:
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David
B. Jones
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Its:
|
Manager
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Exhibit No.
|
Description
|
|
|
2
|
Purchase
Option Agreement, dated as of November 3, 2010, by and among SAIL Venture
Partners, LP, Deerwood Holdings LLC, Deerwood Partners LLC and CNS
Response, Inc.
|
|
|
3
|
Form
of Guaranty (incorporated by reference to Exhibit 4.2 of the Current
Report on Form 8-K filed by CNS Response, Inc. on August 24,
2010)
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(i)
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If
to either of the Deerwood Entities:
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Deerwood
Holdings LLC/Deerwood Partners LLC
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Attn: Dr.
George Kallins
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16
Deerwood Lane
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Newport
Beach, California 92660
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(ii)
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If
to SAIL:
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SAIL
Venture Partners, LP
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Attn: David
B. Jones
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600
Anton Blvd., Suite 1010
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Costa
Mesa, California 92626
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(iii)
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If
to the Company:
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CNS
Response, Inc.
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Attn: Chief
Financial Officer
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85
Enterprise, Suite 410
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Aliso
Viejo, California 92656
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DEERWOOD
HOLDINGS LLC
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By:
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/s/ George J. Kallins,
M.D.
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Name:
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George
J. Kallins, M.D.
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Title:
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Manager
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DEERWOOD
PARTNERS LLC
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By:
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/s/ George J. Kallins,
M.D.
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Name:
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George
J. Kallins, M.D.
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Title:
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Manager
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SAIL
VENTURE PARTNERS, LP
|
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By:
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/s/ David B. Jones
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Name:
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David
B. Jones
|
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Title:
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Senior
Partner
|
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CNS
RESPONSE, INC.
|
|
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By:
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/s/ Paul Buck
|
|
Name:
|
Paul
Buck
|
|
Title:
|
Chief
Financial Officer
|