SEC Form 4 · accession 0001209191-17-003460
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 10, 2017
Accepted (ET)
Jan 12, 2017 · 11:31 am 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 10, 2017 | M | 20,312 | $0.00 | A | 149,740 | D | |
| Common StockF2 | Jan 10, 2017 | F | 9,690 | $0.63 | D | 140,050 | D | |
| Common StockF1 | Jan 10, 2017 | M | 10,312 | $0.00 | A | 84,055 | I | By Spouse |
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 | — | Jan 10, 2017 | M | 4,687 | D | — | Jan 31, 2017 | Common Stock | 4,687 | 0 | D |
| Restricted Stock Unit (RSU)F3,F5 | — | Jan 10, 2017 | M | 6,250 | D | — | Apr 13, 2018 | Common Stock | 6,250 | 6,250 | D |
| Restricted Stock Unit (RSU)F3,F6 | — | Jan 10, 2017 | M | 9,375 | D | — | Jun 18, 2019 | Common Stock | 9,375 | 18,750 | D |
| Restricted Stock UnitF3,F4 | — | Jan 10, 2017 | M | 2,500 | D | — | Jan 31, 2017 | Common Stock | 2,500 | 0 | I |
| Restricted Stock Unit (RSU)F3,F5 | — | Oct 10, 2017 | M | 3,125 | D | — | Apr 13, 2018 | Common Stock | 3,125 | 3,125 | I |
| Restricted Stock Unit (RSU)F3,F6 | — | Oct 10, 2017 | M | 4,687 | D | — | Jun 18, 2019 | Common Stock | 4,687 | 9,375 | I |
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 restricted stock unit represents a contingent right to receive one share of the issuer's common stock at settlement.
- F4Pursuant to the terms of the RSU, 25% of the total shares underlying the RSU vest annually on the later of (i) each anniversary of January 1, 2013; and (ii) the first day thereafter during which the issuer's trading window is open.
- 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 January 1, 2014; and (ii) the first day thereafter during which the issuer's trading window is open.
- F6Pursuant to the terms of the RSU, 25% of the total shares underlying the RSU vest annually on the later of (i) each anniversary of January 1, 2015; and (ii) the first day thereafter during which the issuer's trading window is open.