0001209191-24-002194.txt : 20240124 0001209191-24-002194.hdr.sgml : 20240124 20240124185824 ACCESSION NUMBER: 0001209191-24-002194 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20240122 FILED AS OF DATE: 20240124 DATE AS OF CHANGE: 20240124 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: JACOBS CINDY CENTRAL INDEX KEY: 0001229762 ORGANIZATION NAME: FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 033-80623 FILM NUMBER: 24558236 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] ORGANIZATION NAME: 03 Life Sciences 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 X0508 4 2024-01-22 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 Performance Restricted Stock Unit (PRSU) 2024-01-22 4 A 0 84000 0.00 A 2028-01-22 Common Stock 84000 84000 D Stock Option (right to buy) 4.55 2024-01-22 4 A 0 36000 0.00 A 2034-01-22 Common Stock 36000 36000 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 total number of shares underlying the PRSU vest on the achievement of one of certain milestones being met. The PRSUs will lapse in full if achievement of at least one of the milestones is not met. The options vest one-third on the first anniversary of January 22, 2024 and thereafter in monthly installments over 24 months. Sandra Thomson as attorney-in-fact for Cindy Jacobs 2024-01-24