Initial Statement of Beneficial Ownership (3)
September 23 2021 - 4:34PM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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OMB APPROVAL
OMB Number:
3235-0104
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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
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Rajitha Grace 2018 Irrevocable Trust |
2. Date of Event Requiring Statement (MM/DD/YYYY)
8/27/2021
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3. Issuer Name and Ticker or Trading Symbol
Acasti Pharma Inc. [ACST]
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(Last)
(First)
(Middle)
40 BEY LEA ROAD, SUITE C 202 |
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director ___X___ 10% Owner _____ Officer (give title below) _____ Other (specify below)
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(Street)
TOMS RIVER, NJ 08753
(City)
(State)
(Zip)
| 5. If Amendment, Date Original Filed(MM/DD/YYYY)
| 6. Individual or Joint/Group Filing(Check Applicable Line)
___ Form filed by One Reporting Person
_X_ Form filed by More than One Reporting Person
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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) |
CLASS A COMMON SHARES | 4689547 | D | |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security (Instr. 4) | 2. Date Exercisable and Expiration Date (MM/DD/YYYY) | 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 |
Explanation of Responses: |
Remarks: Remarks: The trustee of the Rajitha Grace 2018 Irrevocable Trust is Swami Sambamurty Iyer. Mr. Iyer disclaims beneficial ownership over the shares except to the extent of his role as trustee. Exhibit List - Exhibit 24 - Power of Attorney |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Rajitha Grace 2018 Irrevocable Trust 40 BEY LEA ROAD, SUITE C 202 TOMS RIVER, NJ 08753 |
| X |
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Iyer Swami Sambamurty 40 BEY LEA ROAD, SUITE C 202 TOMS RIVER, NJ 08753 |
| X |
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Signatures
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/s/ Jason Comerford, Attorney-in-Fact | | 9/23/2021 |
**Signature of Reporting Person | Date |
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