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