Statement of Changes in Beneficial Ownership (4)
April 23 2021 - 6:14PM
Edgar (US Regulatory)
FORM 4
[ ]
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
|
OMB APPROVAL
OMB Number:
3235-0287
Estimated average burden hours per response...
0.5
|
|
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
|
|
1. Name and Address of Reporting Person
*
Venkatesan Jay |
2. Issuer Name and Ticker or Trading Symbol
ALPINE IMMUNE SCIENCES, INC.
[
ALPN
]
|
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__X__ Director __X__ 10% Owner _____ Officer (give title below) _____ Other (specify below)
|
(Last)
(First)
(Middle)
C/O ALPINE IMMUNE SCIENCES, INC., 188 EAST BLAINE STREET, SUITE 200 |
3. Date of Earliest Transaction
(MM/DD/YYYY)
3/30/2021 |
(Street)
SEATTLE, WA 98102
(City)
(State)
(Zip)
|
4. If Amendment, Date Original Filed
(MM/DD/YYYY)
|
6. Individual or Joint/Group Filing
(Check Applicable Line)
_X
_ Form filed by One Reporting Person
___ 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. Trans. Date
|
2A. Deemed Execution Date, if any
|
3. Trans. 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 | 3/30/2021 | | M | | 7650 | A | $4.09 | 210413 | D | |
Common Stock | 3/31/2021 | | M | | 7650 | A | $3.6233 | 218063 | D | |
Common Stock | | | | | | | | 18633 | I | By Raj Venkatesan as UTMA custodian for Reid Coleman Venkatesan (1)(2) |
Common Stock | | | | | | | | 18633 | I | By Raj Venkatesan as UTMA custodian for Nathaniel Graham Venkatesan (1)(2) |
Common Stock | | | | | | | | 3000980 | I | By Alpine ImmunoSciences, L.P. (1)(3) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
|
1. Title of Derivate Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. 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 | 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 of Derivative Security: 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 |
Stock Option (Right to buy) | $4.09 | 3/30/2021 | | M | | | 7650 | (4) | 1/1/2029 | Common Stock | 7650.0 | $0 | 0 | D | |
Stock Option (Right to buy) | $3.6233 | 3/31/2021 | | M | | | 7650 | (5) | 1/1/2030 | Common Stock | 7650.0 | $0 | 0 | D | |
Explanation of Responses: |
(1) | 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. |
(2) | These shares are held by Raj Venkatesan as custodian for Reporting Person's sons under the California Uniform Transfers to Minors Act. |
(3) | 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. |
(4) | The shares subject to the option became fully vested and exercisable on January 2, 2020. |
(5) | The shares subject to the option became fully vested and exercisable on January 2, 2021. |
Reporting Owners
|
Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Venkatesan Jay C/O ALPINE IMMUNE SCIENCES, INC. 188 EAST BLAINE STREET, SUITE 200 SEATTLE, WA 98102 | X | X |
|
|
Signatures
|
/s/ James Paul Rickey, attorney-in-fact | | 4/22/2021 |
**Signature of Reporting Person | Date |
Alpine Immune Sciences (NASDAQ:ALPN)
Historical Stock Chart
From Mar 2024 to Apr 2024
Alpine Immune Sciences (NASDAQ:ALPN)
Historical Stock Chart
From Apr 2023 to Apr 2024