0001209191-23-005286.txt : 20230127
0001209191-23-005286.hdr.sgml : 20230127
20230127164726
ACCESSION NUMBER: 0001209191-23-005286
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20230125
FILED AS OF DATE: 20230127
DATE AS OF CHANGE: 20230127
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: JACOBS CINDY
CENTRAL INDEX KEY: 0001229762
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 033-80623
FILM NUMBER: 23563874
MAIL ADDRESS:
STREET 1: 1522 217TH PLACE SE
STREET 2: SUITE 100
CITY: BOTHELL
STATE: WA
ZIP: 98021
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
2023-01-25
0
0000949858
ACHIEVE LIFE SCIENCES, INC.
ACHV
0001229762
JACOBS CINDY
22722 29TH DR SE
SUITE 100
BOTHELL
WA
98021
1
1
0
0
President & CMO
Performance Restricted Stock Unit (PRSU)
2023-01-25
4
A
0
60000
0.00
A
2025-12-31
Common Stock
60000
60000
D
Stock Option (right to buy)
4.90
2023-01-25
4
A
0
60000
0.00
A
2033-01-25
Common Stock
60000
60000
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 award agreement governing the PRSU, the number of underlying shares of the Issuers common stock that may ultimately vest range from 0% to 100% of the number of PRSUs initially granted, subject to certain milestones being met during the measurement period that begins on January 3, 2023 and ends on December 31, 2025.
The options vest one-third on the first anniversary of January 25, 2023 and thereafter in monthly installments over 24 months.
Sandra Thomson as attorney-in-fact for Cindy Jacobs
2023-01-27