ACHIEVE LIFE SCIENCES, INC. — Director's Dealing 2021

Jan 28, 2021

SEC Form 4 — Statement of Changes in Beneficial Ownership

Issuer: ACHIEVE LIFE SCIENCES, INC. (ACHV)
CIK: 0000949858
Period of Report: 2021-01-26

Reporting Person: Bencich John (Director, CEO)

Derivative Transactions

Date	Security	Exercise Price	Code	Shares	A/D	Expiration	Underlying	Ownership
2021-01-26	Performance Restricted Stock Unit (PRSU)	$	A	15000	Acquired	2025-01-26	Common Stock (15000)	Direct
2021-01-26	Stock Option (right to buy)	$13.09	A	60000	Acquired	2031-01-26	Common Stock (60000)	Direct

Footnotes

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 25% on the first anniversary of January 26, 2021 and thereafter in monthly installments over 36 months.