0001209191-19-046194.txt : 20190815
0001209191-19-046194.hdr.sgml : 20190815
20190815171521
ACCESSION NUMBER: 0001209191-19-046194
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20190813
FILED AS OF DATE: 20190815
DATE AS OF CHANGE: 20190815
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: 191031049
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
2019-08-13
0
0000949858
ACHIEVE LIFE SCIENCES, INC.
ACHV
0001229762
JACOBS CINDY
520 PIKE STREET
SUITE 2250
SEATTLE
WA
98101
0
1
0
0
EVP, CMO
Common Stock
2018-08-13
4
M
0
1370
0.00
A
3209
D
Common Stock
2018-08-13
4
F
0
408
1.88
D
2801
D
Restricted Stock Unit (RSU)
2019-08-13
4
M
0
1370
0.00
D
2021-08-01
Common Stock
1370
2740
D
Represents shares of common stock acquired upon settlement of the restricted stock units ("RSUs") listed in Table II.
Represents shares of common stock that have been sold by the Issuer to satisfy its income tax withholding and remittance obligations in connection with the net settlement of the RSUs and does not represent a sale by the reporting person.
Each RSU represents a contingent right to receive one share of the issuer's common stock at settlement.
Pursuant to the terms of the RSU, 25% of the total shares underlying the RSU vest annually on the later of (i) each anniversary of August 1, 2017 and (ii) the first day thereafter during which the issuer's trading window is open.
Sandra Thomson as attorney-in-fact for Cindy Jacobs
2019-08-15