Andraczke Andrzej Form 3 CNS Pharmaceuticals / Andrzej Andraczke ownership change

SEC Form 3

FORM 3

UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

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^*

Andraczke Andrzej

(Last) (First) (Middle)

C/O CNS PHARMACEUTICALS, INC.

100 WEST LOOP SOUTH, SUITE 900

(Street)

HOUSTON TX 77027

(City) (State) (Zip)

2. Date of Event Requiring Statement (Month/Day/Year)
11/07/2019

3. Issuer Name and Ticker or Trading Symbol
CNS Pharmaceuticals, Inc. [ CNSP ]

4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)

X	Director	10% Owner
	Officer (give title below)	Other (specify below)

5. If Amendment, Date of Original Filed (Month/Day/Year)

6. Individual or Joint/Group Filing (Check Applicable Line)

X	Form filed by One Reporting Person
	Form filed by More than One Reporting Person

Table I - Non-Derivative Securities Beneficially Owned
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)
1. Title of Derivative Security (Instr. 4)	2. Date Exercisable and Expiration Date (Month/Day/Year)		3. Title and Amount of Securities Underlying Derivative Security (Instr. 4)		4. Conversion or Exercise Price of Derivative Security	5. Ownership Form: 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
Option to purchase common stock (right to buy)	(1)	07/09/2028	Common Stock	100,000	1.5	D

Explanation of Responses:

1. The options set forth in this table vest in 36 equal monthly installments succeeding the issuance date, or July 9, 2018, subject to the grantee's continued service on the Company's Board of Directors on each vesting date.

	/s/ John M. Climaco, Attorney-in-fact	11/08/2019
	** Signature of Reporting Person	Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 5 (b)(v).
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