0001209191-17-046581.txt : 20170728 0001209191-17-046581.hdr.sgml : 20170728 20170728162248 ACCESSION NUMBER: 0001209191-17-046581 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20170724 FILED AS OF DATE: 20170728 DATE AS OF CHANGE: 20170728 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Heron Patrick J CENTRAL INDEX KEY: 0001365617 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37449 FILM NUMBER: 17990289 MAIL ADDRESS: STREET 1: 550 HAMILTON AVE., SUITE 100 CITY: PALO ALTO STATE: CA ZIP: 94301 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Frazier Life Sciences VIII, L.P. CENTRAL INDEX KEY: 0001655827 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37449 FILM NUMBER: 17990292 BUSINESS ADDRESS: STREET 1: 601 UNION STREET STREET 2: SUITE 3200 CITY: SEATTLE STATE: WA ZIP: 98101 BUSINESS PHONE: 206-254-7200 MAIL ADDRESS: STREET 1: 601 UNION STREET STREET 2: SUITE 3200 CITY: SEATTLE STATE: WA ZIP: 98101 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: FHM LIFE SCIENCES VIII, L.P. CENTRAL INDEX KEY: 0001698755 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37449 FILM NUMBER: 17990291 BUSINESS ADDRESS: STREET 1: 601 UNION STREET STREET 2: SUITE 3200 CITY: SEATTLE STATE: WA ZIP: 98101 BUSINESS PHONE: 206.621.7200 MAIL ADDRESS: STREET 1: 601 UNION STREET STREET 2: SUITE 3200 CITY: SEATTLE STATE: WA ZIP: 98101 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: FHM LIFE SCIENCES VIII, L.L.C. CENTRAL INDEX KEY: 0001698823 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37449 FILM NUMBER: 17990290 BUSINESS ADDRESS: STREET 1: 601 UNION STREET STREET 2: SUITE 3200 CITY: SEATTLE STATE: WA ZIP: 98101 BUSINESS PHONE: 206.621.7200 MAIL ADDRESS: STREET 1: 601 UNION STREET STREET 2: SUITE 3200 CITY: SEATTLE STATE: WA ZIP: 98101 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 3 1 doc3.xml FORM 3 SUBMISSION X0206 3 2017-07-24 0 0001626199 ALPINE IMMUNE SCIENCES, INC. ALPN 0001655827 Frazier Life Sciences VIII, L.P. 601 UNION STREET, SUITE 3200 SEATTLE WA 98101 0 0 1 0 0001698755 FHM LIFE SCIENCES VIII, L.P. 601 UNION STREET, SUITE 3200 SEATTLE WA 98101 0 0 1 0 0001698823 FHM LIFE SCIENCES VIII, L.L.C. 601 UNION STREET, SUITE 3200 SEATTLE WA 98101 0 0 1 0 0001365617 Heron Patrick J 601 UNION STREET, SUITE 3200 SEATTLE WA 98101 0 0 1 0 Common Stock 2199011 D This report is filed jointly by Frazier Life Sciences VIII, L.P. ("FLS-VIII"), FHM Life Sciences VIII, L.P. (FHM-VIII L.P."), FHM Life Sciences VIII, L.L.C. ("FHM-VIII LLC") and Patrick J. Heron. Shares are held directly by FLS-VIII. FHM-VIII L.P. serves as the sole general partner of FLS-VIII and owns no shares directly. FHM-VIII LLC serves as the sole general partner of FHM VIII L.P. and owns no shares directly. Mr. Heron and James Topper are members of FHM-VIII LLC and share voting and dispositive power over the shares held by FLS-VIII; however, they disclaim beneficial ownership of the shares held by FLS-VIII except to the extent of their pecuniary interests therein. By: FHM Life Sciences VIII, L.P., its general partner, By FHM Life Sciences VIII, L.L.C., its general partner, By: /s/ Steve Bailey, Chief Financial Officer 2017-07-28 By: FHM Life Sciences VIII, L.L.C., its general partner, By: /s/ Steve Bailey, Chief Financial Officer 2017-07-28 By: /s/ Steve Bailey, Chief Financial Officer 2017-07-28 /s/ Patrick J. Heron 2017-07-28