CINDY JACOBS - 04 Sep 2025 Form 4 Insider Report for ACHIEVE LIFE SCIENCES, INC. (ACHV)

Signature
/s/ Sandra Thomson as attorney-in-fact for Cindy Jacobs
Issuer symbol
ACHV
Transactions as of
04 Sep 2025
Net transactions value
-$76,532
Form type
4
Filing time
08 Sep 2025, 16:51:59 UTC
Previous filing
30 Jan 2025

Reporting Owners (1)

Name Relationship Address Signature Signature date CIK
JACOBS CINDY President & CMO 22722 29TH DR SE, SUITE 100, BOTHELL /s/ Sandra Thomson as attorney-in-fact for Cindy Jacobs 08 Sep 2025 0001229762

Transactions Table

Type Sym Class Transaction Value $ Shares Change % * Price $ Shares After Date Ownership Footnotes
transaction ACHV Common Stock Options Exercise $0 +110,000 +331% $0.000000 143,214 04 Sep 2025 Direct F1
transaction ACHV Common Stock Sale $76,532 -27,629 -19% $2.77 115,585 04 Sep 2025 Direct F2, F3

Derivative Securities (e.g., puts, calls, warrants, options, convertible securities)

Type Sym Class Transaction Value $ Shares Change % * Price $ Shares After Date Underlying Class Amount Exercise Price Ownership Footnotes
transaction ACHV Performance Restricted Stock Unit (PRSU) Options Exercise $0 -84,000 -100% $0.000000 0 04 Sep 2025 Common Stock 84,000 Direct F4, F5, F6
transaction ACHV Performance Restricted Stock Unit (PRSU) Options Exercise $0 -26,000 -20% $0.000000 104,000 04 Sep 2025 Common Stock 26,000 Direct F5, F7, F8
* An asterisk sign (*) next to the price indicates that the price is likely invalid.

Explanation of Responses:

Id Content
F1 Represents shares of common stock acquired upon settlement of the performance restricted stock units ("PRSUs") listed in Table II.
F2 Represents shares of common stock that have been sold by the Issuer to satisfy its income tax withholding and remittance obligations in connection with the net settlement of the PRSUs.
F3 The reported price in Column 4 is a weighted average price. These shares were sold in multiple transactions at prices ranging from $2.68 to $2.88 per share, inclusive. The reporting person undertakes to provide to the Issuer, any security holder of the Issuer, or the staff of the Securities and Exchange Commission, upon request, full information regarding the number of shares sold at each separate price within the range set forth in this footnote.
F4 Represents PRSUs previously reported on January 24, 2024 that were earned by the Reporting Person upon the achievement of certain performance criteria as certified by the Compensation Committee of the Issuer's Board of Directors.
F5 Each PRSU represents a contingent right to receive one share of the issuer's common stock at settlement.
F6 Pursuant to the terms of the award agreement governing the PRSU, the total number of shares underlying the PRSU vest on the achievement of one of certain milestones.
F7 Represents PRSUs previously reported on January 30, 2025 that were earned by the Reporting Person upon the achievement of certain performance criteria as certified by the Compensation Committee of the Issuer's Board of Directors.
F8 Pursuant to the terms of the award agreement governing the PRSU, the number of underlying shares of the Issuer's common stock that may ultimately vest ranges from 0% to 100% of the number of the PRSUs initially granted, subject to certain milestones being met during the measurement period.