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