Sec Form 4 Filing - Venkatesan Jay @ ALPINE IMMUNE SCIENCES, INC. - 2022-07-15

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
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/YY)
07/15/2022
(Street)
SEATTLE, WA98102
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 18,633 I By Raj Venkatesan as UTMA custodian for Reid Coleman Venkatesan( 1 )( 2 )
Common Stock 2,600,980 I By Alpine ImmunoSciences, L.P.( 1 )( 3 )
Common Stock 18,633 I By Raj Venkatesan as UTMA custodian for Nathaniel Graham Venkatesan( 1 )( 2 )
Common Stock 07/15/2022 M 20,063 A $ 0.45 238,126 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
Stock Option (Right to buy) $ 0.45( 4 ) 07/15/2022 M 20,063 ( 5 ) 12/15/2025 Common Stock 20,063 $ 0.45 70,000 D
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, WA98102
X X
Signatures
/s/ James Paul Rickey, attorney-in-fact 07/19/2022
Signature of Reporting Person Date
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 )Pursuant to that certain Agreement and Plan of Merger and Reorganization (the "Merger Agreement"), dated as of April 18, 2017, by and among the Issuer, Nautilus Merger Sub, Inc. and the corporation then known as Alpine Immune Sciences, Inc. ("Old Alpine"), each share of Old Alpine common stock was converted into 0.4969 shares of the Issuer's common stock (the "Exchange Ratio"). Each option to purchase shares of Old Alpine outstanding and unexercised was assumed by the Issuer pursuant to the Merger Agreement and converted into an option, subject to vesting, to purchase shares of common stock of the Issuer, with the number of shares of the Issuer's common stock underlying such option and the exercise price for such option adjusted to reflect the Exchange Ratio.
( 5 )The Reporting Person was initially granted an option to acquire 300,000 shares, 75,000 shares of which vested on May 25, 2016, and the remaining shares vested or vest in 36 substantially equal monthly installments starting on September 1, 2016, subject to the Reporting person's continued service with the Issuer and certain change of control provisions.

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* If the form is filed by more than one reporting person, see Instruction 4(b)(v).
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