SEC Form 4 · accession 0001209191-17-039846
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
Jun 12, 2017
Accepted (ET)
Jun 14, 2017 · 4:39 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 12, 2017 | M | 9,375 | $0.00 | A | 149,425 | D | |
| Common StockF2 | Jun 12, 2017 | F | 4,472 | $0.36 | D | 144,953 | D | |
| Common StockF1 | Jun 12, 2017 | M | 5,000 | $0.00 | A | 89,055 | 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 | — | Jun 12, 2017 | M | 9,375 | D | — | Jun 12, 2018 | Common Stock | 9,375 | 9,375 | D |
| Restricted Stock Unit (RSU)F3,F4 | — | Jun 12, 2017 | M | 5,000 | D | — | Jun 12, 2018 | Common Stock | 5,000 | 5,000 | 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 and does not represent a sale by the reporting person.
- 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 each anniversary of June 12, 2014, subject to the reporting person's provision of service to the issuer on each vesting date.