0001209191-24-002198.txt : 20240124
0001209191-24-002198.hdr.sgml : 20240124
20240124190512
ACCESSION NUMBER: 0001209191-24-002198
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: Wan Jerry
CENTRAL INDEX KEY: 0001828041
ORGANIZATION NAME:
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 033-80623
FILM NUMBER: 24558266
MAIL ADDRESS:
STREET 1: 1040 WEST GEORGIA STREET
STREET 2: SUITE 1030
CITY: VANCOUVER
STATE: A1
ZIP: V6E 4H1
FORMER NAME:
FORMER CONFORMED NAME: Wann Jerry
DATE OF NAME CHANGE: 20201013
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
0001828041
Wan Jerry
1040 WEST GEORGIA STREET
SUITE 1030
VANCOUVER
A1
V6E 4H1
BRITISH COLUMBIA, CANADA
0
1
0
0
Principal Accounting Officer
0
Performance Restricted Stock Unit (PRSU)
2024-01-22
4
A
0
24500
0.00
A
2028-01-22
Common Stock
24500
24500
D
Stock Option (right to buy)
4.55
2024-01-22
4
A
0
10500
0.00
A
2034-01-22
Common Stock
10500
10500
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 Jerry Wan
2024-01-24