CINDY JACOBS - 03 Jan 2022 Form 4 Insider Report for ACHIEVE LIFE SCIENCES, INC. (ACHV)

Role
President & CMO, Director
Signature
Sandra Thomson as attorney-in-fact for Cindy Jacobs
Issuer symbol
ACHV
Transactions as of
03 Jan 2022
Net transactions value
$0
Form type
4
Filing time
05 Jan 2022, 15:33:50 UTC
Previous filing
19 Aug 2021
Next filing
29 Apr 2022
SEC
View on sec.gov

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) Award $0 +32,500 $0.000000 32,500 03 Jan 2022 Common Stock 32,500 Direct F1, F2
transaction ACHV Stock Option (right to buy) Award $0 +32,500 $0.000000 32,500 03 Jan 2022 Common Stock 32,500 $8.26 Direct F3
* An asterisk sign (*) next to the price indicates that the price is likely invalid.

Explanation of Responses:

Id Content
F1 Each PRSU represents a contingent right to receive one share of the issuer's common stock at settlement.
F2 Pursuant to the terms of the PRSU 50% of the total shares underlying the PRSU vest on the achievement of a performance-based milestone, and 50% vest on the first anniversary of the achievement of such milestone. The PRSUs will lapse in full if achievement of such milestone is not met.
F3 The options vest one-third on the first anniversary of January 3, 2022 and thereafter in monthly installments over 24 months.