X0306 4 2017-07-24 0 0001626199 ALPINE IMMUNE SCIENCES, INC. ALPN 0001242882 GOLD MITCHELL C/O ALPINE IMMUNE SCIENCES, INC. 201 ELLIOTT AVENUE WEST, SUITE 230 SEATTLE WA 98119 1 1 1 0 Executive Chairman and CEO Common Stock 2017-07-24 4 J 0 24845 A 24845 I By The Mitch & Dawn Gold Irrevocable Trust fbo Aidan J. Gold Common Stock 2017-07-24 4 J 0 24845 A 24845 I By The Mitch & Dawn Gold Irrevocable Trust fbo Noah M. Gold Common Stock 2017-07-24 4 J 0 24845 A 24845 I By The Mitch & Dawn Gold Irrevocable Trust fbo Simon P. Gold Common Stock 2017-07-24 4 A 0 23292 A 23292 D Common Stock 2017-07-24 4 J 0 3803906 A 3803906 I Alpine Immunosciences, L.P. Employee Stock Option (right to buy) 0.45 2017-07-24 4 A 0 51242 0.00 A 2025-12-15 Common Stock 51242 51242 D Employee Stock Option (right to buy) 0.65 2017-07-24 4 A 0 300624 0.00 A 2027-03-13 Common Stock 300624 300624 D Employee Stock Option (right to buy) 5.02 2017-07-24 4 A 0 208916 0.00 A 2027-04-11 Common Stock 208916 208916 D Pursuant to that certain Agreement and Plan of Merger and Reorganization (the "Merger Agreement"), dated as of April 18, 2017, by and among the Issuer, Nautilus Merger Sub, Inc. and the corporation then known as Alpine Immune Sciences, Inc. ("Old Alpine"), each share of Old Alpine common stock was converted into 0.4969 shares of the Issuer's common stock (the "Exchange Ratio"). Bradley Hurwitz serves as the trustee for these trusts. 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 the shares for purposes of Section 16 of the Securities Exchange Act of 1934, as amended, or for any other purpose. Each option to purchase shares of Old Alpine outstanding and unexercised was assumed by the Issuer pursuant to the Merger Agreement and converted into an option, subject to vesting, to purchase shares of common stock of the Issuer, with the number of shares of the Issuer's common stock underlying such option and the exercise price for such option adjusted to reflect the Exchange Ratio. The Reporting Person was initially granted an option to acquire 300,000 shares, 150,000 shares of which vested on May 16, 2016, and the remaining shares vested or vest in 32 substantially equal monthly installments thereafter, subject to the Reporting Person's continued service with the Issuer and certain change of control provisions. This option vests 25% on January 20, 2018, and the remaining 75% vests in 36 substantially equal monthly installments thereafter, subject to the Reporting Person's continued service with the Issuer and certain change of control provisions. Ex. 24.1 - Power of Attorney (incorporated by reference to the Power of Attorney filed as Exhibit 24.1 to the Form 3 filed by the Reporting Person on July 26, 2017) /s/ James Paul Rickey, attorney-in-fact 2017-07-26