0001209191-21-005887.txt : 20210128 0001209191-21-005887.hdr.sgml : 20210128 20210128163200 ACCESSION NUMBER: 0001209191-21-005887 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20210126 FILED AS OF DATE: 20210128 DATE AS OF CHANGE: 20210128 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Stewart Richard Alistair CENTRAL INDEX KEY: 0001713369 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 033-80623 FILM NUMBER: 21565568 BUSINESS ADDRESS: BUSINESS PHONE: 6046305411 MAIL ADDRESS: STREET 1: 19820 NORTH CREEK PARKWAY STREET 2: SUITE 201 CITY: BOTHELL STATE: WA ZIP: 98011 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: ACHIEVE LIFE SCIENCES, INC. CENTRAL INDEX KEY: 0000949858 STANDARD INDUSTRIAL CLASSIFICATION: IN VITRO & IN VIVO DIAGNOSTIC SUBSTANCES [2835] IRS NUMBER: 954343413 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 520 PIKE STREET STREET 2: SUITE 2250 CITY: SEATTLE STATE: WA ZIP: 98101 BUSINESS PHONE: 425-686-1500 MAIL ADDRESS: STREET 1: 520 PIKE STREET STREET 2: SUITE 2250 CITY: SEATTLE STATE: WA ZIP: 98101 FORMER COMPANY: FORMER CONFORMED NAME: ONCOGENEX PHARMACEUTICALS, INC. DATE OF NAME CHANGE: 20080821 FORMER COMPANY: FORMER CONFORMED NAME: SONUS PHARMACEUTICALS INC DATE OF NAME CHANGE: 19950825 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2021-01-26 0 0000949858 ACHIEVE LIFE SCIENCES, INC. ACHV 0001713369 Stewart Richard Alistair 520 PIKE STREET SUITE 2250 SEATTLE WA 98101 1 1 0 0 Executive Chairman Performance Restricted Stock Unit (PRSU) 2021-01-26 4 A 0 10000 0.00 A 2025-01-26 Common Stock 10000 10000 D Stock Option (right to buy) 13.09 2021-01-26 4 A 0 50000 0.00 A 2031-01-26 Common Stock 50000 50000 D Each PRSU represents a contingent right to receive one share of the issuer's common stock at settlement. Pursuant to the terms of the PRSU 50% of the total shares underlying the PRSU vest on the achievement of a performance-based milestone, and 50% vest on the first anniversary of the achievement of such milestone. The PRSUs will lapse in full if achievement of such milestone is not met. The options vest 25% on the first anniversary of January 26, 2021 and thereafter in monthly installments over 36 months. Sandra Thomson as attorney-in-fact for Richard Stewart 2021-01-28