0001209191-23-025536.txt : 20230425 0001209191-23-025536.hdr.sgml : 20230425 20230425162857 ACCESSION NUMBER: 0001209191-23-025536 CONFORMED SUBMISSION TYPE: 4/A PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20230421 FILED AS OF DATE: 20230425 DATE AS OF CHANGE: 20230425 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Bencich John CENTRAL INDEX KEY: 0001477056 FILING VALUES: FORM TYPE: 4/A SEC ACT: 1934 Act SEC FILE NUMBER: 033-80623 FILM NUMBER: 23845246 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/A 1 doc4a.xml FORM 4/A SUBMISSION X0407 4/A 2023-04-21 2023-04-24 0 0000949858 ACHIEVE LIFE SCIENCES, INC. ACHV 0001477056 Bencich John 22722 29TH DR SE SUITE 100 BOTHELL WA 98021 1 1 0 0 CEO 0 Common Stock 2023-04-21 4 F 0 5863 6.80 D 56057 D This amended Form 4 is filed to correct an administrative error which applied additional taxes and misreported the number of shares of common stock withheld by the issuer to satisfy the tax liability in connection with the settlement of performance restricted stock units. 5,863 shares were withheld instead of 7,324. The number of shares beneficially owned by the reporting person increased from 54,596 shares to 56,075 shares. Sandra Thomson as attorney-in-fact for John Bencich 2023-04-25