Sec Form 4 Filing - GOLD MITCHELL @ ALPINE IMMUNE SCIENCES, INC. - 2019-01-18

Insider filing report for Changes in Beneficial Ownership
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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
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
GOLD MITCHELL
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
X __ Officer (give title below) _____ Other (specify below)
Executive Chairman and CEO
(Last) (First) (Middle)
C/O ALPINE IMMUNE SCIENCES, INC., 201 ELLIOTT AVENUE WEST, SUITE 230
3. Date of Earliest Transaction (MM/DD/YY)
01/18/2019
(Street)
SEATTLE, WA98119
4. If Amendment, Date Original Filed (MM/DD/YY)
6. Individual or Joint/Group Filing (Check Applicable Line)
__ X __ Form filed by One Reporting Person
_____ Form filed by More than One Reporting Person
(City) (State) (Zip)
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security
(Instr. 3)
2. Transaction Date (MM/DD/YY) 2A. Deemed Execution Date, if any (MM/DD/YY) 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 I ( 2 ) Alpine ImmunoSciences, L.P. ( 2 ) ( 3 )
Common Stock 05/14/2018 G V 3,000 D $ 0 20,292 D
Common Stock 05/15/2018 G V 3,000 D $ 0 17,292 D
Common Stock 05/21/2018 G V 6,000 D $ 0 11,292 D
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 (MM/DD/YY) 3A. Deemed Execution Date, if any (MM/DD/YY) 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
(MM/DD/YY)
7. Title and Amount of Underlying Securities
(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
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 I ( 2 ) Alpine ImmunoSciences, L.P. ( 2 ) ( 3 )
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
GOLD MITCHELL
C/O ALPINE IMMUNE SCIENCES, INC.
201 ELLIOTT AVENUE WEST, SUITE 230
SEATTLE, WA98119
X X Executive Chairman and CEO
Signatures
/s/ James Paul Rickey, attorney-in-fact 01/22/2019
Signature of Reporting Person Date
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 is the general partner of Alpine ImmunoSciences, L.P. Dr. Gold is a Managing Partner of Alpine BioVentures GP, LLC. Dr. Gold is also a limited partner of Alpine ImmunoSciences, L.P. By virtue of such relationships, Dr. Gold 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.
( 3 )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.

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