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*
(Street)
| 2. Date of Event Requiring Statement (Month/Day/Year) 04/01/2020 | 3. Issuer Name and Ticker or Trading Symbol Acasti Pharma Inc. [ ACST ] | |||||||||||||
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
| 5. If Amendment, Date of Original Filed (Month/Day/Year) | ||||||||||||||
6. Individual or Joint/Group Filing (Check Applicable Line)
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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) |
Common Shares | 10,600 | D |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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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 | ||||
Share Option (Right to Buy) | (1) | 09/22/2028 | Common Shares | 200,000 | 0.78(5) | D | |
Share Option (Right to Buy) | (2) | 04/15/2029 | Common Shares | 17,000 | 1.28(5) | D | |
Share Option (Right to Buy) | (3) | 04/15/2029 | Common Shares | 58,000 | 1.28(5) | D | |
Share Option (Right to Buy) | (4) | 03/31/2030 | Common Shares | 253,000 | 0.53(5) | D |
Explanation of Responses: |
1. Represents 200,000 common shares underlying 200,000 share options granted on September 22, 2018. These share options vest in 12 equal installments on a quarterly basis starting from September 22, 2018 until September 22, 2021. |
2. Represents 17,000 common shares underlying 17,000 share options granted on April 15, 2019. These share options vest in 12 equal installments on a quarterly basis starting from April 15, 2019 until April 15, 2022. |
3. Represents 58,000 common shares underlying 58,000 share options granted on April 15, 2019. These share options vest in 12 equal installments on a quarterly basis starting from April 15, 2019 until April 15, 2022. |
4. Represents 253,000 common shares underlying 253,000 share options granted on March 31, 2020. These share options vest in 12 equal installments on a quarterly basis starting from March 31, 2020 until March 31, 2023. |
5. Canadian dollars. |
Remarks: |
Exhibit List - Exhibit 24 - Power of Attorney |
/s/ Kelsey Weiner, Attorney-in-Fact | 04/01/2020 | |
** 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). | ||
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). | ||
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. | ||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. |