0000899243-18-000478.txt : 20180104 0000899243-18-000478.hdr.sgml : 20180104 20180104171348 ACCESSION NUMBER: 0000899243-18-000478 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20180102 FILED AS OF DATE: 20180104 DATE AS OF CHANGE: 20180104 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Thompson Peter A. CENTRAL INDEX KEY: 0001357522 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37449 FILM NUMBER: 18511003 MAIL ADDRESS: STREET 1: C/O ANTHERA PHARMACEUTICALS, INC. STREET 2: 25801 INDUSTRIAL BOULEVARD, SUITE B CITY: HAYWARD STATE: CA ZIP: 94545 FORMER NAME: FORMER CONFORMED NAME: Thompson Peter A DATE OF NAME CHANGE: 20060327 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: ALPINE IMMUNE SCIENCES, INC. CENTRAL INDEX KEY: 0001626199 STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834] IRS NUMBER: 208969493 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 201 ELLIOTT AVE. WEST, SUITE 230 CITY: SEATTLE STATE: WA ZIP: 98119 BUSINESS PHONE: 206-788-4545 MAIL ADDRESS: STREET 1: 201 ELLIOTT AVE. WEST, SUITE 230 CITY: SEATTLE STATE: WA ZIP: 98119 FORMER COMPANY: FORMER CONFORMED NAME: Nivalis Therapeutics, Inc. DATE OF NAME CHANGE: 20150211 FORMER COMPANY: FORMER CONFORMED NAME: N30 Pharmaceuticals, Inc. DATE OF NAME CHANGE: 20141121 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2018-01-02 0 0001626199 ALPINE IMMUNE SCIENCES, INC. ALPN 0001357522 Thompson Peter A. C/O ALPINE IMMUNE SCIENCES, INC. 201 ELLIOTT AVENUE WEST, SUITE 230 SEATTLE WA 98119 1 0 1 0 Stock Option (Right to buy) 11.31 2018-01-02 4 A 0 7650 0.00 A 2028-01-01 Common Stock 7650 7650 D The exercise price is equal to the closing price per share of Common Stock as reported on the Nasdaq Global Market on the date of grant. 100% of the shares subject to the option become vested and exercisable on January 2, 2019. In accordance with the internal policies of OrbiMed Advisors LLC, the options received by Dr. Thompson must be held for the benefit of OrbiMed Advisors LLC and its affiliates. Exhibit 24.1 - Power of Attorney /s/ James Paul Rickey, attorney-in-fact 2018-01-04 EX-24.1 2 attachment1.htm EX-24.1 DOCUMENT

                                POWER OF ATTORNEY

      The undersigned hereby makes, constitutes and appoints each of the Chief
Executive Officer, President, and the Chief Financial Officer of Alpine Immune
Sciences, Inc., a Delaware corporation, or any successor thereto (the "Company")
and Wilson Sonsini Goodrich & Rosati, P.C., as the undersigned's true and lawful
attorney-in-fact, to:

     1.     complete and execute Forms ID, 3,4 and 5 and other forms and all
            amendments thereto as such attorney-in-fact shall in his or her
            discretion determine to be required or advisable pursuant to
            Section 16 of the Securities Exchange Act of 1934 (as amended) and
            the rules and regulations promulgated thereunder, or any successor
            laws and regulations, as a consequence of the undersigned's
            ownership, acquisition or disposition of securities of the C
            ompany; and

     2.     do all acts necessary in order to file such forms with the
            Securities and Exchange Commission, any securities exchange or
            national association, the Company and such other person or agency as
            the attorney-in-fact shall deem appropriate.

      The undersigned hereby ratifies and confirms all that said
attorneys-in-fact and agents shall do or cause to be done by virtue hereof.  The
undersigned acknowledges that the foregoing attorneys-in-fact, in serving in
such capacity at the request of the undersigned, are not assuming, nor is the
Company assuming, any of the undersigned's responsibilities to comply with
Section 16 of the Securities Exchange Act of 1934 (as amended).

      This Power of Attorney shall remain in full force and effect until the
undersigned is no longer required to file Forms ID, 3, 4 and 5 with respect to
the undersigned's holdings of and transactions in securities issued by the
Company, unless earlier revoked by the undersigned in a signed writing
delivered to the Company and the foregoing attorneys-in-fact.

      IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to
be executed as of this  4th day of January, 2018.



                          Signature:     /s/ Peter Thompson, M.D.
                                         -------------------------------
                                         Peter A. Thompson