SEC Form 4 · accession 0001209191-17-047599
ACHIEVE LIFE SCIENCES, INC. · ACHV
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
A later amendment supersedes this filing — read the amendment. The figures below are kept as originally reported (version chain, not an overwrite).
Reporting owner
Cindy Jacobs
Officer — EVP, CMO
Period of report
Aug 1, 2017
Accepted (ET)
Aug 3, 2017 · 9:01 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 | holding | — | — | — | 7,975 | 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)F2,F3,F4 | — | Aug 1, 2017 | A | 54,800 | A | — | Aug 1, 2021 | Common Stock | 54,800 | 54,800 | D |
| Stock Option (right to buy)F5 | $4.57 | Aug 1, 2017 | A | 274,000 | A | — | Aug 1, 2027 | Common Stock | 274,000 | 274,000 | D |
| Stock Option (right to buy)F1,F6 | $245.08 | holding | — | — | — | — | Dec 31, 2019 | Common Stock | 1,090 | 1,090 | D |
| Stock Option (right to buy)F1,F6 | $175.67 | holding | — | — | — | — | Dec 14, 2020 | Common Stock | 1,818 | 1,818 | D |
| Stock Option (right to buy)F1,F6 | $143.00 | holding | — | — | — | — | May 8, 2022 | Common Stock | 1,363 | 1,363 | D |
| Stock Option (right to buy)F1,F6 | $131.45 | holding | — | — | — | — | Mar 12, 2023 | Common Stock | 1,818 | 1,818 | D |
| Stock Option (right to buy)F1,F7 | $129.69 | holding | — | — | — | — | Mar 14, 2024 | Common Stock | 2,272 | 2,272 | D |
| Stock Option (right to buy)F1,F8 | $20.46 | holding | — | — | — | — | May 19, 2025 | Common Stock | 3,409 | 3,409 | D |
| Restricted Stock Unit (RSU)F2,F9,F1 | — | holding | — | — | — | — | Apr 1, 2018 | Common Stock | 284 | 284 | D |
| Restricted Stock Unit (RSU)F2,F10,F1 | — | holding | — | — | — | — | Jun 12, 2018 | Common Stock | 454 | 454 | D |
| Restricted Stock Unit (RSU)F2,F11,F1 | — | holding | — | — | — | — | May 19, 2019 | Common Stock | 852 | 852 | D |
Explanation of responses
- F1Reflects the 11-for-1 reverse stock split effected on August 1, 2017 immediately following the merger between OncoGenex Pharmaceuticals, Inc. and Achieve Life Science, Inc.
- F10Pursuant 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.
- F11Pursuant 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.
- F2Each RSU represents a contingent right to receive one share of the issuer's common stock at settlement.
- F3Pursuant to the terms of the RSU, 25% of the total shares underlying the RSU vest annually on the later of (i) each anniversary of August 1, 2017 and (ii) the first day thereafter during which the issuer's trading window is open.
- F4The RSUs expire 30 days from the date they vest.
- F5The options vest as to 25% on August 1, 2018 and thereafter in monthly installments over 36 months.
- F6The options are fully vested and exercisable.
- F7The options vest in monthly installments over 48 months commencing one month from January 1, 2014.
- F8The options vest in monthly installments over 48 months commencing one month from January 1, 2015.
- F9Pursuant 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.