Statement of Changes in Beneficial Ownership (4)
05 January 2022 - 09:20AM
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
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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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1. Name and Address of Reporting Person
*
Thompson Peter A. |
2. Issuer Name and Ticker or Trading Symbol
ALPINE IMMUNE SCIENCES, INC.
[
ALPN
]
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5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__X__ Director __X__ 10% Owner _____ Officer (give title below) _____ Other (specify below)
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(Last)
(First)
(Middle)
C/O ALPINE IMMUNE SCIENCES, INC. (ALPN), 188 EAST BLAINE STREET, SUITE 200 |
3. Date of Earliest Transaction
(MM/DD/YYYY)
1/3/2022 |
(Street)
SEATTLE, WA 98102
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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6. Individual or Joint/Group Filing
(Check Applicable Line)
_X
_ Form filed by One Reporting Person
___ Form filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security (Instr. 3)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code (Instr. 8)
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4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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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) | $13.89 (1) | 1/3/2022 | | A | | 10000 | | (2) | 1/2/2032 | Common Stock | 10000.0 | $0 | 10000 | D (3) | |
Explanation of Responses: |
(1) | The exercise price is equal to the closing price per share of Common Stock as reported on the Nasdaq Global Market on the date of grant. |
(2) | 1/12th of the shares subject to the option become vested and exercisable on February 3, 2022 and 1/12th of the shares subject to the option shall vest monthly thereafter. |
(3) | The Reporting Person is a member of OrbiMed Advisors LLC ("OrbiMed Advisors"). Pursuant to an agreement with OrbiMed Advisors, the Reporting Person is obligated to transfer these securities, or the economic benefit thereof, to OrbiMed Advisors and OrbiMed Capital GP VI LLC, which will in turn ensure that such securities or economic benefits are provided to OrbiMed Private Investments VI, LP. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Thompson Peter A. C/O ALPINE IMMUNE SCIENCES, INC. (ALPN) 188 EAST BLAINE STREET, SUITE 200 SEATTLE, WA 98102 | X | X |
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Signatures
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/s/ James Paul Rickey, attorney-in-fact | | 1/4/2022 |
**Signature of Reporting Person | Date |
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