0001209191-23-026321.txt : 20230501
0001209191-23-026321.hdr.sgml : 20230501
20230501175453
ACCESSION NUMBER: 0001209191-23-026321
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20230428
FILED AS OF DATE: 20230501
DATE AS OF CHANGE: 20230501
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: 23875568
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
X0407
4
2023-04-28
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
0
Common Stock
2023-04-28
4
M
0
2500
0.00
A
18870
D
Common Stock
2023-04-28
4
F
0
609
8.29
D
18261
D
Performance Restricted Stock Unit (PRSU)
2023-04-28
4
M
0
2500
0.00
D
2025-01-26
Common Stock
2500
0
D
Represents shares of common stock acquired upon settlement of the performance restricted stock units ("PRSUs") listed in Table II.
Represents shares of common stock that have been withheld by the issuer to satisfy the tax liability in connection with the settlement of PRSUs.
Each PRSU represents a contingent right to receive one share of the issuer's common stock at settlement.
Pursuant to the terms of the PRSU 50% of the total shares underlying the PRSU vest on the achievement of a performance-based milestone, and 50% vest on the first anniversary of the achievement of such milestone.
Sandra Thomson as attorney-in-fact for Cindy Jacobs
2023-05-01