Filing Details

Accession Number:
0001209191-22-058064
Form Type:
4
Zero Holdings:
No
Publication Time:
2022-11-21 14:27:20
Reporting Period:
2022-11-18
Accepted Time:
2022-11-21 14:27:20
SEC Url:
Form 4 Filing
Issuer
Cik Name Symbol Sector (SIC) IRS No
949858 Achieve Life Sciences Inc. ACHV In Vitro & In Vivo Diagnostic Substances (2835) 954343413
Insiders
Cik Name Reported Address Insider Title Director Officer Large Shareholder Other
1477056 John Bencich 22722 29Th Dr Se
Suite 100
Bothell WA 98021
Ceo Yes Yes No No
Reported Non-Derivative Transactions
Sec. Name Acquisiton - Disposition Date Amount Price Remaning Holdings Equity Swap Involved Form Type Code Nature of Ownership Explanation
Common Stock Acquisiton 2022-11-18 22,000 $0.00 36,920 No 4 P Direct
Equity Swap Involved Form Type Code Nature of Ownership Explanation
No 4 P Direct
Reported Derivative Transactions
Sec. Name Sec. Type Acquisiton - Disposition Date Amount Price Amount - 2 Price - 2
Common Stock Common Stock Warrants (right to buy) Acquisiton 2022-11-18 11,000 $0.00 11,000 $4.50
Remaning Holdings Exercise Date Expiration Date Equity Swap Involved Transaction Form Type Transaction Code Nature of Ownership
11,000 2023-05-18 2029-11-18 No 4 P Direct
Footnotes
  1. The unregistered shares reported on this Form 4 were purchased in a private placement as part of a unit. Each unit consists of (i) two shares of the Issuer's common stock, and (ii) a warrant to purchase one share of common stock, at a purchase price of $4.625 per unit. The warrants are exercisable at a price per share of common stock of $4.50.