0000899243-18-000490.txt : 20180104 0000899243-18-000490.hdr.sgml : 20180104 20180104171843 ACCESSION NUMBER: 0000899243-18-000490 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20180102 FILED AS OF DATE: 20180104 DATE AS OF CHANGE: 20180104 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Venkatesan Jay CENTRAL INDEX KEY: 0001413350 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37449 FILM NUMBER: 18511064 MAIL ADDRESS: STREET 1: C/O AYER CAPITAL MANAGEMENT, LP STREET 2: 230 CALIFORNIA ST, SUITE 600 CITY: SAN FRANCISCO STATE: CA ZIP: 94111 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 2018-01-02 0 0001626199 ALPINE IMMUNE SCIENCES, INC. ALPN 0001413350 Venkatesan Jay C/O ALPINE IMMUNE SCIENCES, INC. 201 ELLIOTT AVENUE WEST, SUITE 230 SEATTLE WA 98119 1 1 1 0 President Stock Option (Right to buy) 11.31 2018-01-02 4 A 0 25000 0.00 A 2028-01-01 Common Stock 25000 25000 D 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. 1/4th of the shares subject to the option become vested and exercisable on January 2, 2019 and 1/36th of the remaining shares subject to the option shall vest monthly thereafter. /s/ James Paul Rickey, attorney-in-fact 2018-01-04