SEC Form 4 · accession 0001209191-16-128047
ACHIEVE LIFE SCIENCES, INC. · ACHV
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Cindy Jacobs
Officer — EVP, CMO
Period of report
Jun 13, 2016
Accepted (ET)
Jun 15, 2016 · 5:52 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 | Jun 13, 2016 | M | 5,000 | $0.00 | A | 78,853 | D | |
| Common StockF2,F3 | Jun 13, 2016 | S | 1,437 | $1.0254 | D | 77,416 | 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)F4,F5 | — | Jun 13, 2016 | M | 5,000 | D | — | Jun 12, 2018 | Common Stock | 5,000 | 10,000 | 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 sold by the issuer to satisfy the tax liability in connection with the settlement of RSUs.
- F3The price reported reflects the weighted average sales price. These shares were sold in multiple transactions at prices ranging from $1.01 to $1.045 per share, inclusive. The reporting person hereby undertakes to provide to the issuer, any security holder of the issuer, or the staff of the SEC, upon request, full information regarding the number of shares sold at each separate price within the range set forth in this footnote.
- F4Each restricted stock unit represents a contingent right to receive one share of the issuer's common stock at settlement.
- F5Pursuant to the terms of the RSU, 25% of the total shares underlying the RSU vest annually on the later of (i) each anniversary of June 12, 2014; and (ii) the first day thereafter during which the issuer's trading window is open, subject to the reporting person's provision of service to the issuer on each vesting date.