Form: 3

Initial statement of beneficial ownership of securities

September 16, 2022

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
OMB APPROVAL
OMB Number: 3235-0104
Estimated average burden
hours per response: 0.5
1. Name and Address of Reporting Person*
Kohli Prashant

(Last) (First) (Middle)
C/O ACASTI PHARMA INC.
3009 BOUL. DE LA CONCORDE, SUITE 102

(Street)
LAVAL A6 H7T 0A3

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
09/09/2022
3. Issuer Name and Ticker or Trading Symbol
Acasti Pharma Inc. [ ACST ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
CCO
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)
Class A Common Shares 128,138 D
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
Share Option (Right to Buy) (1) 06/22/2032 Class A Common Shares 75,000 0.89(2) D
Share Option (Right to Buy) (3) 11/12/2031 Class A Common Shares 124,100 1.63(4) D
Explanation of Responses:
1. Represents 75,000 Class A common shares underlying 75,000 share options granted on 06/22/2022. These share options vest on an even and quarterly basis over 36 months.
2. Based on conversion of exercise price of C$1.15 into U.S. dollars based on an exchange rate of C$1.00 = US$0.7727 on the date of grant.
3. Represents 124,100 Class A common shares underlying 124,100 share options granted on 11/12/2021. These share options vest on an even and quarterly basis over 36 months.
4. 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
/s/ Jason Comerford, Attorney-in-Fact 09/16/2022
** 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.