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