0001209191-23-035786.txt : 20230609 0001209191-23-035786.hdr.sgml : 20230609 20230609161539 ACCESSION NUMBER: 0001209191-23-035786 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20230329 FILED AS OF DATE: 20230609 DATE AS OF CHANGE: 20230609 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Sellig Thomas CENTRAL INDEX KEY: 0001969416 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 033-80623 FILM NUMBER: 231005469 MAIL ADDRESS: STREET 1: 22722 29TH DR 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: 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 doc4.xml FORM 4 SUBMISSION X0407 4 2023-03-29 0 0000949858 ACHIEVE LIFE SCIENCES, INC. ACHV 0001969416 Sellig Thomas 22722 29TH DR SE SUITE 100 BOTHELL WA 98021 1 0 0 0 0 Stock Option (right to buy) 5.97 2023-03-29 4 A 0 23250 0.00 A 2033-03-29 Common Stock 23250 23250 D These options were granted on March 29, 2023 (the "Grant Date") pursuant to the 2023 Non-Employee Director Equity Incentive Plan (the "Plan"), subject to the Plans approval by the Issuers stockholders. The Plan was approved by the Issuers stockholders at the Issuers 2023 Annual Meeting of Stockholders on June 7, 2023. These options will vest on the one month anniversary of the Grant Date and thereafter in monthly installments over 36 months. Sandra Thomson attorney-in-fact for Thomas Sellig 2023-06-09