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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 |
| (CUSIP Number) |
| February 23, 2011 |
| (Date of Event which Requires Filing of this Statement) |
|
CUSIP No.
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12619C101
|
13G
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Page 2 of 6 Pages
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| 1 |
NAMES OF REPORTING PERSONS:
I.R.S. IDENTIFICATION NOS. OF ABOVE PERSONS (ENTITIES ONLY):
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ANDY SASSINE
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| 2 | CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP (SEE INSTRUCTIONS): |
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(a) o
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(b) o
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| 3 | SEC USE ONLY: | ||||
| 4 | CITIZENSHIP OR PLACE OF ORGANIZATION: | ||||
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USA
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| 5 | SOLE VOTING POWER: | ||||
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NUMBER OF
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3,598,832
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SHARES
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6 | SHARED VOTING POWER: | |||
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BENEFICIALLY
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OWNED BY
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0
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EACH
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7 | SOLE DISPOSITIVE POWER: | |||
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REPORTING
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PERSON
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3,598,832
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WITH:
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8 | SHARED DISPOSITIVE POWER: | |||
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0
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| 9 | AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON: | ||||
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3,598,832
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| 10 | CHECK IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES (SEE INSTRUCTIONS): | ||||
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o
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| 11 | PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (9): | ||||
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6.04%
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| 12 | TYPE OF REPORTING PERSON (SEE INSTRUCTIONS): | ||||
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IN
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CUSIP No.
|
12619C101
|
13G
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Page 3 of 6 Pages
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Item 1(a)
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Name of Issuer:
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CNS Response, Inc.
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Item 1(b)
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Address of Issuer’s Principal Executive Offices:
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85 Enterprise, Suite 410, Aliso Viejo, CA 92656
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Item 2(a)
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Name of Person Filing:
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Andy Sassine
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Item 2(b)
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Address of Principal Business Office or, if None, Residence:
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| 82 Devonshire Street, Boston, MA 02109 | |
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Item 2(c)
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Citizenship:
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Mr. Sassine is a United States citizen.
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Item 2(d)
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Title of Class of Securities:
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Common Stock
|
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Item 2(e)
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CUSIP Number:
|
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12619C101
|
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Item 3.
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If this statement is filed pursuant to §§240.13d-1(b) or (c), check whether the person filing is a: N/A
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Not applicable.
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CUSIP No.
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12619C101
|
13G
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Page 4 of 6 Pages
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Item 4.
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Ownership. | |
| (a) |
Amount Beneficially Owned
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3,598,832 (as of March 8, 2011)
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| (b) |
Percent of Class
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6.04%
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| (c) |
Number of Shares as to which the person has
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(i)
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Sole power to vote or direct the vote
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| 3,598,832 | |||
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(ii)
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Shared power to vote or to direct the vote
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| 0 | |||
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(iii)
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Sole power to dispose or direct the disposition of
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| 3,598,832 | |||
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(iv)
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Shared power to dispose or direct the disposition of
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0
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CUSIP No.
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12619C101
|
13G
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Page 5 of 6 Pages
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Item 5.
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Ownership of Five Percent or Less of a Class.
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Not Applicable.
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Item 6.
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Ownership of More than Five Percent on Behalf of Another Person.
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Not Applicable.
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Item 7.
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Identification and Classification of the Subsidiary which Acquired the Security Being Reported On by the Parent Holding Company.
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Not Applicable.
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Item 8.
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Identification and Classification of Members of the Group.
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Not Applicable.
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Item 9.
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Notice of Dissolution of Group.
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Not Applicable.
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Item 10.
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Certification
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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.
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March 11, 2011
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(Date)
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/s/ Andy Sassine
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Andy Sassine
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