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*
Mattacchione Robert

(Last) (First) (Middle)
C/O NOVO INTEGRATED SCIENCE INC.
11120 NE 2ND ST, 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
X Officer (give title below) Other (specify below)
Chief Executive Officer
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) 12,908,562 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
Stock Option (right to buy)(1)(3) 05/03/2017 05/03/2024 Common Stock 25,000 1.6 I By spouse
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 are owned by ALMC-ASAP Holdings, Inc., which is wholly owned by the Mattacchione Family Trust. The reporting person is trustee of the Mattacchione Family Trust, with voting and dispositive power over the shares.
3. Represents a grant by the issuer, approved by the issuer's Board of Directors.
/s/ Christopher David, as Attorney -in- Fact for Robert Mattachione 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.
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