SEC Form 4 · accession 0001209191-15-008039
ACHIEVE LIFE SCIENCES, INC. · ACHV
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Scott Daniel Cormack
Officer — President and CEO · Director
Period of report
Jan 27, 2015
Accepted (ET)
Jan 30, 2015 · 6:46 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0000949858
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF1 | Jan 27, 2015 | M | 20,100 | $0.00 | A | 108,263 | D | |
| Common StockF2 | Jan 30, 2015 | F | 9,206 | $2.11 | D | 99,057 | D |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Restricted Stock Unit (RSU)F3,F4,F5 | — | Jan 27, 2015 | M | 20,100 | D | — | Jul 1, 2015 | Common Stock | 20,100 | 0 | D |
Explanation of responses
- F1Represents shares of common stock acquired upon settlement of the restricted stock units ("RSUs") listed in Table II.
- F2Represents shares of common stock that have been withheld by the issuer to satisfy the tax liability in connection with the settlement of RSUs.
- F3Each RSU represents a contingent right to receive one share of the issuer's common stock at settlement.
- F4Pursuant to the terms of the RSU, the total underlying shares vest when certain performance criteria relating to the issuer are met.
- F5The RSUs expire 30 days from the date they vest.