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