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