0000899243-19-001663.txt : 20190122 0000899243-19-001663.hdr.sgml : 20190122 20190122204629 ACCESSION NUMBER: 0000899243-19-001663 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20190118 FILED AS OF DATE: 20190122 DATE AS OF CHANGE: 20190122 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Alpine ImmunoSciences, L.P. CENTRAL INDEX KEY: 0001628571 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37449 FILM NUMBER: 19536404 BUSINESS ADDRESS: STREET 1: 600 STEWART STREET STREET 2: SUITE 1503 CITY: SEATTLE STATE: WA ZIP: 98101 BUSINESS PHONE: 206-441-5064 MAIL ADDRESS: STREET 1: 600 STEWART STREET STREET 2: SUITE 1503 CITY: SEATTLE STATE: WA ZIP: 98101 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Alpine Bioventures, GP, LLC CENTRAL INDEX KEY: 0001712676 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37449 FILM NUMBER: 19536405 BUSINESS ADDRESS: STREET 1: 600 STEWART STREET STREET 2: SUITE 1503 CITY: SEATTLE STATE: WA ZIP: 98101 BUSINESS PHONE: 206-441-5064 MAIL ADDRESS: STREET 1: 600 STEWART STREET STREET 2: SUITE 1503 CITY: SEATTLE STATE: WA ZIP: 98101 FORMER NAME: FORMER CONFORMED NAME: Alpine Bioventures GP, LLC DATE OF NAME CHANGE: 20170724 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 2019-01-18 0 0001626199 ALPINE IMMUNE SCIENCES, INC. ALPN 0001628571 Alpine ImmunoSciences, L.P. 600 STEWART STREET, SUITE 1503 SEATTLE WA 98101 0 0 1 0 0001712676 Alpine Bioventures, GP, LLC 600 STEWART STREET, SUITE 1503 SEATTLE WA 98101 0 0 1 0 Common Stock 2019-01-18 4 P 0 190875 5.37 A 3994781 D Warrant (right to buy) 12.74 2019-01-18 4 P 0 74441 A 2019-01-18 2024-01-18 Common Stock 74441 74441 D Represents shares acquired in a private placement pursuant to that Securities Purchase Agreement, dated as of January 15, 2019, by and among the Issuer and the Purchasers set forth on the signature pages thereto (the "Securities Purchase Agreement"). Pursuant to the terms of the Securities Purchase Agreement, investors purchased common stock units for $5.37 per common stock unit. Each common stock unit consisted of one share of the Company's Common Stock and a warrant to purchase 0.39 shares of the Company's Common Stock. Alpine BioVentures GP, LLC ("ABV LLC") is the general partner of the Reporting Person. Dr. Mitchell Gold and Dr. Jay Venkatesan are the Managing Partners of ABV LLC. Dr. Gold and Dr. Venkatesan are also limited partners of the Reporting Person. By virtue of their positions as Managing Partners of ABV LLC, Dr. Gold and Dr. Venkatesan may be deemed to have voting and investment power with respect to the shares held by the Reporting Person and as a result may be deemed to have beneficial ownership of such shares. Each of Dr. Gold and Dr. Venkatesan disclaims beneficial ownership of the shares held by the Reporting Person, except to the extent of his pecuniary interest therein, if any, and this report shall not be deemed an admission that the Reporting Person, Dr. Gold or Dr. Venkatesan 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. /s/ Mitchell Gold 2019-01-22