SEC FORM 4 SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
Alpine ImmunoSciences, L.P.

(Last) (First) (Middle)
600 STEWART STREET, SUITE 1503

(Street)
SEATTLE WA 98101

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
ALPINE IMMUNE SCIENCES, INC. [ ALPN ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director X 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
01/18/2019
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
Form filed by One Reporting Person
X Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Common Stock 01/18/2019 P(1) 190,875 A $5.37(1) 3,994,781 D(2)
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction Code (Instr. 8) 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) 6. Date Exercisable and Expiration Date (Month/Day/Year) 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) 8. Price of Derivative Security (Instr. 5) 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Warrant (right to buy) $12.74 01/18/2019 P(1) 74,441 01/18/2019 01/18/2024 Common Stock 74,441 (1) 74,441 D(2)
1. Name and Address of Reporting Person*
Alpine ImmunoSciences, L.P.

(Last) (First) (Middle)
600 STEWART STREET, SUITE 1503

(Street)
SEATTLE WA 98101

(City) (State) (Zip)
1. Name and Address of Reporting Person*
Alpine Bioventures, GP, LLC

(Last) (First) (Middle)
600 STEWART STREET, SUITE 1503

(Street)
SEATTLE WA 98101

(City) (State) (Zip)
Explanation of Responses:
1. Represents 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.
2. Alpine BioVentures GP, LLC ("ABV LLC") is the general partner of the Reporting Person. Dr. Mitchell Gold and Dr. Jay Venkatesan are the Managing Partners of ABV LLC. Dr. Gold and Dr. Venkatesan are also limited partners of the Reporting Person. By virtue of their positions as Managing Partners of ABV LLC, Dr. Gold and Dr. Venkatesan may be deemed to have voting and investment power with respect to the shares held by the Reporting Person and as a result may be deemed to have beneficial ownership of such shares. Each of Dr. Gold and Dr. Venkatesan disclaims beneficial ownership of the shares held by the Reporting Person, except to the extent of his pecuniary interest therein, if any, and this report shall not be deemed an admission that the Reporting Person, Dr. Gold or Dr. Venkatesan 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.
Remarks:
/s/ Mitchell Gold 01/22/2019
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 4 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.