Form: 3

Initial statement of beneficial ownership of securities

November 23, 2021

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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(Print or Type Responses)
1. Name and Address of Reporting Person *
  Kottayil George
2. Date of Event Requiring Statement (Month/Day/Year)
11/10/2021
3. Issuer Name and Ticker or Trading Symbol
Acasti Pharma Inc. [ACST]
(Last)
(First)
(Middle)
C/O ACASTI PHARMA INC., 3009 BOUL. DE LA CONCORDE, SUITE 102
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director _____ 10% Owner
__X__ Officer (give title below) _____ Other (specify below)
COO, US
5. If Amendment, Date Original Filed(Month/Day/Year)
(Street)

LAVAL, A6 H7T 0A3
6. Individual or Joint/Group Filing(Check Applicable Line)
_X_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
(City)
(State)
(Zip)
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)
Class A Common Shares 2,222,122
D
 
Class A Common Shares 746,064
I
By Kottayil Grace Pharma LLC

Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. SEC 1473 (7-02)
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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 of Derivative Security: 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) 11/10/2031 Class A Common Shares 287,900 $ 1.63 (2) D  

Reporting Owners

Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
Kottayil George
C/O ACASTI PHARMA INC.
3009 BOUL. DE LA CONCORDE, SUITE 102
LAVAL, A6 H7T 0A3
      COO, US  

Signatures

/s/ Jason Comerford, Attorney-in-Fact 11/23/2021
**Signature of Reporting Person Date

Explanation of Responses:

* 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).
(1) Represents 287,900 Class A common shares underlying 287,900 share options granted on November 10, 2021. These share options vest on an even and quarterly basis over 36 months.
(2) Based on conversion of exercise price of C$2.05 into U.S. dollars based on an exchange rate of C$1.00 = US$0.7959 on the date of grant.
 
Remarks:
Exhibit List - Exhibit 24 - Power of Attorney

Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, See Instruction 6 for procedure.

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