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