0001209191-18-044358.txt : 20180730 0001209191-18-044358.hdr.sgml : 20180730 20180730155818 ACCESSION NUMBER: 0001209191-18-044358 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20180726 FILED AS OF DATE: 20180730 DATE AS OF CHANGE: 20180730 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: 18977579 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: 520 PIKE STREET STREET 2: SUITE 2250 CITY: SEATTLE STATE: WA ZIP: 98101 BUSINESS PHONE: 425-686-1500 MAIL ADDRESS: STREET 1: 520 PIKE STREET STREET 2: SUITE 2250 CITY: SEATTLE STATE: WA ZIP: 98101 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 X0306 4 2018-07-26 0 0000949858 ACHIEVE LIFE SCIENCES, INC. ACHV 0001229762 JACOBS CINDY 520 PIKE STREET SUITE 2250 SEATTLE WA 98101 0 1 0 0 EVP, CMO Stock Option (right to buy) 3.37 2018-07-26 4 A 0 20000 0.00 A 2028-07-26 Common Stock 20000 20000 D The options vest in monthly installments over 48 months commencing one month from July 26 2018. Sandra Thomson as attorney-in-fact for Cindy Jacobs 2018-07-30