0001626199-24-000073.txt : 20240510 0001626199-24-000073.hdr.sgml : 20240510 20240510192403 ACCESSION NUMBER: 0001626199-24-000073 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20240508 FILED AS OF DATE: 20240510 DATE AS OF CHANGE: 20240510 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: GOLD MITCHELL CENTRAL INDEX KEY: 0001242882 ORGANIZATION NAME: FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37449 FILM NUMBER: 24936549 MAIL ADDRESS: STREET 1: ALPINE IMMUNE SCIENCES, INC. STREET 2: 188 EAST BLAINE STREET, SUITE 200 CITY: SEATTLE STATE: WA ZIP: 98102 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: ALPINE IMMUNE SCIENCES, INC. CENTRAL INDEX KEY: 0001626199 STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834] ORGANIZATION NAME: 03 Life Sciences IRS NUMBER: 208969493 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 188 EAST BLAINE ST., SUITE 200 CITY: SEATTLE STATE: WA ZIP: 98102 BUSINESS PHONE: 206-788-4545 MAIL ADDRESS: STREET 1: 188 EAST BLAINE ST., SUITE 200 CITY: SEATTLE STATE: WA ZIP: 98102 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 wk-form4_1715383433.xml FORM 4 X0508 4 2024-05-08 0 0001626199 ALPINE IMMUNE SCIENCES, INC. ALPN 0001242882 GOLD MITCHELL C/O ALPINE IMMUNE SCIENCES, INC. 188 EAST BLAINE STREET, SUITE 200 SEATTLE WA 98102 1 1 0 0 Executive Chairman and CEO 0 Common Stock 2024-05-08 4 M 0 13245 7.55 A 109245 D Common Stock 2627157 I Alpine ImmunoSciences, L.P. Stock Option (Right to buy) 7.55 2024-05-08 4 M 0 13245 0 D 2033-01-03 Common Stock 13245 336755 D Includes 96,000 shares of common stock underlying a restricted stock unit grant made on January 4, 2024. Alpine BioVentures GP, LLC is the general partner of Alpine ImmunoSciences, L.P. Dr. Gold is a Managing Partner of Alpine BioVentures GP, LLC. Dr. Gold is also a limited partner of Alpine ImmunoSciences, L.P. By virtue of such relationships, Dr. Gold may be deemed to have voting and investment power with respect to the shares held by Alpine ImmunoSciences, L.P. and as a result may be deemed to have beneficial ownership of such shares. The Reporting Person disclaims beneficial ownership of the shares of common stock reported herein except to the extent of his pecuniary interest therein, if any, and this report shall not be deemed an admission that the Reporting Person is the beneficial owner of such shares for purposes of Section 16 of the Securities Exchange Act of 1934, as amended, or for any other purpose. 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. One-fourth (1/4th) of the Shares subject to the Option will vest on January 4, 2024, and one thirty-sixth (1/36th) of the remaining Shares subject to the Option shall vest each month thereafter, subject to the Reporting Person continuing to be a service provider through each such date. /s/ James Paul Rickey, attorney-in-fact 2024-05-10