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*
Dalcourt Pierre Joseph

(Last) (First) (Middle)
C/O NOVO INTEGRATED SCIENCES, INC.,
11120 NE 2ND STREET, SUITE 100,

(Street)
BELLEVUE, WA 98004

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
02/19/2021
3. Issuer Name and Ticker or Trading Symbol
Novo Integrated Sciences, Inc. [ NVOS ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director X 10% Owner
Officer (give title below) Other (specify below)
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)
Common Stock(1) 3,387,794 I See Footnote(2)
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
Explanation of Responses:
1. Information reported on this Form 3 has been adjusted to give effect to the 1-for-10 reverse stock split of the issuer's common stock, which was effective on February 1, 2021.
2. Shares owned by 1218814 Ontario Inc., which is 50% owned by the reporting person, and 50% owned by the reporting person's spouse. 1218814 Ontario Inc.'s shares are held by the Dalcourt Family Trust. The reporting person and his wife are co-trustees of the Dalcourt Family Trust and share voting and depository power over these shares.
/s/ Christopher David, as Attorney-in-Fact for Pierre Dalcourt 02/19/2021
** 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.