0000899243-19-000499.txt : 20190104 0000899243-19-000499.hdr.sgml : 20190104 20190104160133 ACCESSION NUMBER: 0000899243-19-000499 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20190102 FILED AS OF DATE: 20190104 DATE AS OF CHANGE: 20190104 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: 19509932 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 2019-01-02 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 0 1 0 Stock Option (Right to buy) 4.09 2019-01-02 4 A 0 7650 0.00 A 2029-01-01 Common Stock 7650 7650 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. 1/12th of the shares subject to the option become vested and exercisable on February 2, 2019 and 1/12th of the shares subject to the option shall vest monthly thereafter. /s/ James Paul Rickey, attorney-in-fact 2019-01-04