0001209191-22-058064.txt : 20221121
0001209191-22-058064.hdr.sgml : 20221121
20221121142720
ACCESSION NUMBER: 0001209191-22-058064
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20221118
FILED AS OF DATE: 20221121
DATE AS OF CHANGE: 20221121
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Bencich John
CENTRAL INDEX KEY: 0001477056
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 033-80623
FILM NUMBER: 221405359
MAIL ADDRESS:
STREET 1: 2401 FOURTH AVENUE, SUITE 1050
CITY: SEATTLE
STATE: WA
ZIP: 98121
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: 22722 29TH DR. SE
STREET 2: SUITE 100
CITY: SEATTLE
STATE: WA
ZIP: 98021
BUSINESS PHONE: 425-686-1500
MAIL ADDRESS:
STREET 1: 22722 29TH DR. SE
STREET 2: SUITE 100
CITY: SEATTLE
STATE: WA
ZIP: 98021
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
2022-11-18
0
0000949858
ACHIEVE LIFE SCIENCES, INC.
ACHV
0001477056
Bencich John
22722 29TH DR SE
SUITE 100
BOTHELL
WA
98021
1
1
0
0
CEO
Common Stock
2022-11-18
4
P
0
22000
A
36920
D
Common Stock Warrants (right to buy)
4.50
2022-11-18
4
P
0
11000
A
2023-05-18
2029-11-18
Common Stock
11000
11000
D
The unregistered shares reported on this Form 4 were purchased in a private placement as part of a unit. Each unit consists of (i) two shares of the Issuer's common stock, and (ii) a warrant to purchase one share of common stock, at a purchase price of $4.625 per unit. The warrants are exercisable at a price per share of common stock of $4.50.
Sandra Thomson as attorney-in-fact for John Bencich
2022-11-21