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