SC 13G: Schedule filed to report acquisition of beneficial ownership of 5% or more of a class of equity securities by passive investors and certain institutions
Published on March 22, 2017
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
SCHEDULE 13G
INFORMATION TO BE INCLUDED IN STATEMENTS FILED
PURSUANT TO RULES 13d-1(b), (c) AND (d) AND AMENDMENTS THERETO
FILED PURSUANT TO RULE 13d-2
(Amendment No. ___)*
Acasti Pharma Inc.
(Name of Issuer)
Common Shares
(Title of Class of Securities)
00430K105
(CUSIP Number)
March 14, 2017
(Date of Event Which Requires Filing of this Statement)
Check the appropriate box to designate the rule pursuant to which this Schedule is filed:
| ¨ | Rule 13d-1(b) |
| x | Rule 13d-1(c) |
| ¨ | Rule 13d-1(d) |
* The remainder of this cover page shall be filled out for a reporting person's initial filing on this form with respect to the subject class of securities, and for any subsequent amendment containing information which would alter the disclosures provided in a prior cover page.
The information required in the remainder of this cover page shall not be deemed to be “filed” for the purpose of Section 18 of the Securities Exchange Act of 1934 (“Act”) or otherwise subject to the liabilities of that section of the Act but shall be subject to all other provisions of the Act (however, see the Notes).
| CUSIP No. 00430K105 | 13G | Page 2 of 6 |
| 1. |
NAMES OF REPORTING PERSONS George W. Haywood |
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| 2. |
CHECK THE APPROPRIATE BOX IF
A MEMBER OF A GROUP (see instructions) (a) ¨ (b) ¨ |
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| 3. |
SEC USE ONLY |
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| 4. |
CITIZENSHIP OR PLACE OF ORGANIZATION United States |
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NUMBER OF SHARES BENEFICIALLY OWNED BY EACH REPORTING PERSON WITH |
5. |
SOLE VOTING POWER 1,084,000 (1) |
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| 6. |
SHARED VOTING POWER 395,000 (2) |
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| 7. |
SOLE DISPOSITIVE POWER 1,084,000 (1) |
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| 8. |
SHARED DISPOSITIVE POWER 395,000 (2) |
| 9. |
AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON 1,479,000 |
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| 10. |
CHECK IF THE AGGREGATE AMOUNT
IN ROW (9) EXCLUDES CERTAIN SHARES (see instructions) ¨ |
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| 11. |
PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (9) 9.9% |
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| 12. |
TYPE OF REPORTING PERSON (see instructions) IN |
| (1) | Includes 5,000 shares held in a custodial account for one of Mr. Haywood’s children and 304,000 shares underlying warrants. |
| (2) | Represents 155,000 shares owned by Mr. Haywood’s spouse and an aggregate of 240,000 shares owned jointly by Mr. Haywood and his non-minor children. |
| CUSIP No. 00430K105 | 13G | Page 3 of 6 |
Item 1.
| (a) |
Name of Issuer Acasti Pharma Inc. |
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| (b) |
Address of Issuer’s Principal Executive Offices 545 Promenade du Centropolis, Suite 100, Laval, Quebec, Canada H7T 0A3 |
Item 2.
| (a) |
Name of Person Filing George W. Haywood |
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| (b) |
Address of the Principal Office or, if None, Residence c/o Moomjian, Waite & Coleman, LLP, 100 Jericho Quadrangle, Suite 208, Jericho, New York 11753 |
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| (c) |
Citizenship United States |
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| (d) |
Title of Class of Securities Common Shares |
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| (e) |
CUSIP Number 00430K105 |
Item 3. If this statement is filed pursuant to §§240.13d-1(b) or 240.13d-2(b) or (c), check whether the person filing is a:
| (a) | ¨ | Broker or dealer registered under section 15 of the Act (15 U.S.C. 78o). | |
| (b) | ¨ | Bank as defined in section 3(a)(6) of the Act (15 U.S.C. 78c). | |
| (c) | ¨ | Insurance company as defined in section 3(a)(19) of the Act (15 U.S.C. 78c). | |
| (d) | ¨ | Investment company registered under section 8 of the Investment Company Act of 1940 (15 U.S.C. 80a-8). | |
| (e) | ¨ | An investment adviser in accordance with §240.13d-1(b)(1)(ii)(E); | |
| (f) | ¨ | An employee benefit plan or endowment fund in accordance with §240.13d-1(b)(1)(ii)(F); | |
| (g) | ¨ | A parent holding company or control person in accordance with §240.13d-1(b)(1)(ii)(G); | |
| (h) | ¨ | A savings associations as defined in Section 3(b) of the Federal Deposit Insurance Act (12 U.S.C. 1813); | |
| (i) | ¨ | A church plan that is excluded from the definition of an investment company under section 3(c)(14) of the Investment Company Act of 1940 (15 U.S.C. 80a-3); | |
| (j) | ¨ | A non-U.S. institution in accordance with Rule 13d-1(b)(1)(ii)(J); | |
| (k) | ¨ | Group, in accordance with §240.13d-1(b)(1)(ii)(K). | |
| CUSIP No. 00430K105 | 13G | Page 4 of 6 |
Item 4. Ownership.
Provide the following information regarding the aggregate number and percentage of the class of securities of the issuer identified in Item 1.
| (a) | Amount beneficially owned: | 1,479,000 | |
| (b) | Percent of class: | 9.9% | |
| (c) | Number of shares as to which the person has: | ||
| (i) | Sole power to vote or to direct the vote: | 1,084,000 | |
| (ii) | Shared power to vote or to direct the vote: | 395,000 | |
| (iii) | Sole power to dispose or to direct the disposition of: | 1,084,000 | |
| (iv) | Shared power to dispose or to direct the disposition of: | 395,000 | |
Item 5. Ownership of Five Percent or Less of a Class.
If this statement is being filed to report the fact that as of the date hereof the reporting person has ceased to be the beneficial owner of more than 5 percent of the class of securities, check the following ¨.
Item 6. Ownership of More than Five Percent on Behalf of Another Person.
Included as shares for which there exist sole voting and dispositive power are (a) 5,000 shares held in a custodial account for one of Mr. Haywood’s children, which child would have the rights to the receipt of dividends from, and the proceeds for the sale of, such shares and (b) 304,000 shares underlying warrants.
Included as shares for which there exists shared voting and dispositive power are 155,000 shares owned by Mr. Haywood’s spouse, which Mr. Haywood’s spouse would have the right to the receipt of dividends from, and proceeds for the sale of, such shares.
Also included as shares for which there exists shared voting and dispositive power are an aggregate of 240,000 shares owned jointly by Mr. Haywood and his non-minor children, which Mr. Haywood’s non-minor children would have the shared right to the receipt of dividends from, and proceeds for the sale of, such shares.
Item 7. Identification and Classification of the Subsidiary Which Acquired the Security Being Reported on By the Parent Holding Company or Control Person.
Not applicable.
| CUSIP No. 00430K105 | 13G | Page 5 of 6 |
Item 8. Identification and Classification of Members of the Group.
Not applicable.
Item 9. Notice of Dissolution of Group.
Not applicable.
Item 10. Certifications.
By signing below I certify that, to the best of my knowledge and belief, the securities referred to above were not acquired and are not held for the purpose of or with the effect of changing or influencing the control of the issuer of the securities and were not acquired and are not held in connection with or as a participant in any transaction having that purpose or effect, other than activities solely in connection with a nomination under Section 240.14a-11.
| CUSIP No. 00430K105 | 13G | Page 6 of 6 |
SIGNATURE
After reasonable inquiry and to the best of my knowledge and belief, I certify that the information set forth in this statement is true, complete and correct.
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March 22, 2017 Date |
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/s/ George W. Haywood Signature |
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George W. Haywood Name/Title |
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