0001626199-21-000113.txt : 20210921
0001626199-21-000113.hdr.sgml : 20210921
20210921171416
ACCESSION NUMBER: 0001626199-21-000113
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20210917
FILED AS OF DATE: 20210921
DATE AS OF CHANGE: 20210921
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: 211267189
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: 188 EAST BLAINE ST., SUITE 200
CITY: SEATTLE
STATE: WA
ZIP: 98102
BUSINESS PHONE: 206-788-4545
MAIL ADDRESS:
STREET 1: 188 EAST BLAINE ST., SUITE 200
CITY: SEATTLE
STATE: WA
ZIP: 98102
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
wf-form4_163225883908242.xml
FORM 4
X0306
4
2021-09-17
0
0001626199
ALPINE IMMUNE SCIENCES, INC.
ALPN
0001413350
Venkatesan Jay
C/O ALPINE IMMUNE SCIENCES, INC.
188 EAST BLAINE STREET, SUITE 200
SEATTLE
WA
98102
1
0
1
0
Common Stock
2021-09-17
4
S
0
400000
9.40
D
2600980
I
By Alpine ImmunoSciences, L.P.
Common Stock
18633
I
By Raj Venkatesan as UTMA custodian for Reid Coleman Venkatesan
Common Stock
218063
D
Common Stock
18633
I
By Raj Venkatesan as UTMA custodian for Nathaniel Graham Venkatesan
These shares were sold in a private transaction to an investor in the Issuer simultaneously with the closing of the Issuer's private placement on September 17, 2021.
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.
Alpine BioVentures GP, LLC is the general partner of Alpine ImmunoSciences, L.P. Dr. Venkatesan is a Managing Partner of Alpine BioVenture 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.
These shares are held by Raj Venkatesan as custodian for Reporting Person's sons under the California Uniform Transfers to Minors Act.
/s/ James Paul Rickey, attorney-in-fact
2021-09-21