0000950170-24-046974.txt : 20240423 0000950170-24-046974.hdr.sgml : 20240423 20240423163512 ACCESSION NUMBER: 0000950170-24-046974 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20240419 FILED AS OF DATE: 20240423 DATE AS OF CHANGE: 20240423 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: 24865303 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 ownership.xml 4 X0508 4 2024-04-19 0000949858 ACHIEVE LIFE SCIENCES, INC. ACHV 0001229762 JACOBS CINDY 22722 29TH DR SE SUITE 100 BOTHELL WA 98021 true true false false President & CMO false Common Stock 2024-04-19 4 M false 16250 0 A 34511 D Common Stock 2024-04-19 4 F false 3957 4.51 D 30554 D Performance Restricted Stock Unit (PRSU) 2024-04-19 4 M false 16250 0 D 2026-01-03 Common Stock 16250 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 2024-04-23