0001209191-20-059123.txt : 20201118 0001209191-20-059123.hdr.sgml : 20201118 20201118163521 ACCESSION NUMBER: 0001209191-20-059123 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20201116 FILED AS OF DATE: 20201118 DATE AS OF CHANGE: 20201118 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Bencich John CENTRAL INDEX KEY: 0001477056 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 033-80623 FILM NUMBER: 201325535 MAIL ADDRESS: STREET 1: 2401 FOURTH AVENUE, SUITE 1050 CITY: SEATTLE STATE: WA ZIP: 98121 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 2020-11-16 0 0000949858 ACHIEVE LIFE SCIENCES, INC. ACHV 0001477056 Bencich John 520 PIKE STREET SUITE 2250 SEATTLE WA 98101 1 1 0 0 CEO Stock Option (right to buy) 10.36 2020-11-16 4 A 0 20000 0.00 A 2030-11-16 Common Stock 20000 20000 D Pursuant to the terms of the options 50% of the total shares underlying the option vest on the achievement of a performance-based milestone, and 50% vest on the first anniversary of the achievement of such milestone. The options will lapse in full if achievement of such milestone is not met. Sandra Thomson as attorney-in-fact for John Bencich 2020-11-18