SEC Form 4 · accession 0000899243-19-001661

ALPINE IMMUNE SCIENCES, INC. · ALPN

Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗

Reporting owner

Jay Venkatesan

Director · 10% Owner

Period of report

Jan 18, 2019

Accepted (ET)

Jan 22, 2019 · 8:44 pm EST

Rule 10b5-1 plan

unknown — predates the checkbox

Issuer CIK

0001626199

Table I — non-derivative securities

Security	Date	Code	Shares	Price	A/D	Owned after	D/I	Nature of ownership
Common Stock^F1,F2,F3	Jan 18, 2019	P	190,875	$5.37	A	3,994,781	I	Alpine ImmunoSciences, L.P.
Common Stock^F3,F4	holding	—	—		—	18,633	I	By Raj Venkatesan as UTMA custodian for Reid Coleman Venkatesan
Common Stock^F3,F4	holding	—	—		—	18,633	I	By Raj Venkatesan as UTMA custodian for Nathaniel Graham Venkatesan
Common Stock	holding	—	—		—	21,739	D

Table II — derivative securities

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	Owned after	D/I
Warrant (right to buy)^F1,F2,F3	$12.74	Jan 18, 2019	P	74,441	A	Jan 18, 2019	Jan 18, 2024	Common Stock	74,441	74,441	I

Explanation of responses

F1Represents 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.
F2Alpine BioVentures GP, LLC is the general partner of Alpine ImmunoSciences, L.P. Dr. Venkatesan is a Managing Partner of Alpine BioVentures GP, LLC. Dr. Venkatesan is also a limited partner of Alpine ImmunoSciences, L.P. By virtue of such relationships, Dr. Venkatesan 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.
F3The 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.
F4These shares are held by Raj Venkatesan as custodian for Reporting Person's sons under the California Uniform Transfers to Minors Act.