SEC Form 4 · accession 0001209191-16-122834
ACHIEVE LIFE SCIENCES, INC. · ACHV
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
David V Smith
Director
Period of report
May 20, 2016
Accepted (ET)
May 24, 2016 · 1:19 pm EDT
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,F2 | May 20, 2016 | M | 2,500 | — | A | 9,500 | 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 | — | May 20, 2016 | M | 2,500 | D | May 20, 2016 | — | Common Stock | 2,500 | 0 | D |
Explanation of responses
- F1Represents shares of common stock acquired upon settlement of the restricted stock units ("RSUs") listed in Table II.
- F2RSUs convert into common stock on a one-for-one basis.
- F3Each RSU represents a contingent right to receive one share of the issuer's common stock.
- F4The RSUs expire 30 days from the date they vest.