10/06/2026 | Press release | Distributed by Public on 10/06/2026 14:15
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FORM 4
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940 |
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| Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
| Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number. | SEC 1474 (9-02) | ||
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1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) |
4. Transaction Code (Instr. 8) |
5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4, and 5) |
6. Date Exercisable and Expiration Date (Month/Day/Year) |
7. Title and Amount of Underlying Securities (Instr. 3 and 4) |
8. Price of Derivative Security (Instr. 5) |
9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) |
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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| Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
| Stock Option (right to buy) | $7.01 | 10/05/2026 | A | 200,000 | (1) | 10/05/2036 | Common Stock | 200,000 | $ 0 | 200,000 | D | ||||
| Restricted Stock Unit (RSU) | (2) | 10/05/2026 | A | 200,000 | (3) | 10/05/2030 | Common Stock | 200,000 | $ 0 | 200,000 | D | ||||
| Reporting Owner Name / Address | Relationships | |||
| Director | 10% Owner | Officer | Other | |
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Halladay Benjamin C/O ACHIEVE LIFE SCIENCES, INC. 22722 29TH DR. SE, SUITE 100 BOTHELL, WA 98021 |
Chief Financial Officer | |||
| /s/ Erik Atkisson as attorney-in-fact | 10/06/2026 | |
| **Signature of Reporting Person | Date |
| * | If the form is filed by more than one reporting person, see Instruction 4(b)(v). |
| ** | Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). |
| (1) | This option will vest as to 1/4 of the total award on the first anniversary of October 5, 2026, and thereafter in substantially equal monthly installments over 36 months, subject to the Reporting Person's provision of service to the Issuer on each vesting date. |
| (2) | Each RSU represents a contingent right to receive one share of the issuer's common stock at settlement. |
| (3) | The RSUs will vest as to 1/4 of the total award on each of October 5, 2027, October 5, 2028, October 5, 2029 and October 5, 2030 subject to the Reporting Person's provision of service to the Issuer on each vesting date. |