SEC Form 4 · accession 0001209191-19-006168
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
Jan 29, 2019
Accepted (ET)
Jan 31, 2019 · 4:40 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0000949858
Table I — non-derivative securities
No Table I lines on this filing.
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Stock Option (right to buy)F1 | $1.42 | Jan 29, 2019 | A | 30,000 | A | — | Jan 29, 2029 | Common Stock | 30,000 | 30,000 | D |
| Stock Option (right to buy)F2 | $1.42 | Jan 29, 2019 | A | 10,000 | A | — | Jan 29, 2029 | Common Stock | 10,000 | 10,000 | D |
Explanation of responses
- F1The options vest 25% on the first anniversary of January 29, 2019 and thereafter in monthly installments over 36 months.
- F2Pursuant to the terms of the options 25% of the total shares underlying the option vest on the achievement of a performance-based milestone, and 75% vest in monthly installments over 24 months commencing one month from achievement of such milestone. The options will lapse in full if achievement of such milestone is not met by mid-2019