0001209191-22-036740.txt : 20220614
0001209191-22-036740.hdr.sgml : 20220614
20220614170147
ACCESSION NUMBER: 0001209191-22-036740
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 2
CONFORMED PERIOD OF REPORT: 20220610
FILED AS OF DATE: 20220614
DATE AS OF CHANGE: 20220614
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: FIELDS HEIDI
CENTRAL INDEX KEY: 0001014330
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-40655
FILM NUMBER: 221015598
MAIL ADDRESS:
STREET 1: 5301 STEVENS CREEK BLVD
STREET 2: MS 1A-LC
CITY: SANTA CLARA
STATE: CA
ZIP: 95051
FORMER NAME:
FORMER CONFORMED NAME: FIELDS HEIDI KUNZ
DATE OF NAME CHANGE: 20090415
FORMER NAME:
FORMER CONFORMED NAME: KUNZ HEIDI
DATE OF NAME CHANGE: 19960513
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: Icosavax, Inc.
CENTRAL INDEX KEY: 0001786255
STANDARD INDUSTRIAL CLASSIFICATION: BIOLOGICAL PRODUCTS (NO DIAGNOSTIC SUBSTANCES) [2836]
IRS NUMBER: 000000000
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 1616 EASTLAKE AVE E, SUITE 208
CITY: SEATTLE
STATE: WA
ZIP: 98102
BUSINESS PHONE: (206) 737-0085
MAIL ADDRESS:
STREET 1: 1616 EASTLAKE AVE E, SUITE 208
CITY: SEATTLE
STATE: WA
ZIP: 98102
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2022-06-10
0
0001786255
Icosavax, Inc.
ICVX
0001014330
FIELDS HEIDI
C/O ICOSAVAX, INC.
1930 BOREN AVE., SUITE 1000
SEATTLE
WA
98101
1
0
0
0
Common Stock
2022-06-10
4
A
0
5543
0.00
A
14293
D
Stock Option (Right to Buy))
6.25
2022-06-10
4
A
0
22278
0.00
A
2032-06-09
Common Stock
22278
22278
D
Represents restricted stock units ("RSUs") which will vest on the first to occur of (A) the first anniversary of the date of grant or (B) the next occurring annual meeting of the Issuer's stockholders, subject to the Reporting Person's continuous service on the board of directors of the Issuer through such vesting date. Each RSU represents a contingent right to receive one share of common stock of the Issuer and the RSUs have no expiration date.
1/12th of the total number of shares of common stock subject to the option vest monthly following June 10, 2022, the vesting commencement date, provided if the next occurring annual meeting of the Issuer's stockholders occurs prior to the full vesting of the option, any remaining options will vest on the date of such annual meeting, subject to the Reporting Person's continuous service on the board of directors of the Issuer through such vesting date.
/s/ Elizabeth Bekiroglu, Attorney-in-Fact for Heidi Fields
2022-06-14
EX-24
2
poa.txt
POA DOCUMENT
POWER OF ATTORNEY
Know all by these presents, that the undersigned hereby constitutes and
appoints each of the Chief Financial Officer, who is currently Thomas Russo,
CFA, the Chief Business Officer, who is currently Cassia Cearley, Ph.D., and the
General Counsel, who is currently Elizabeth Bekiroglu, and their respective
successors, signing singly, the undersigned's true and lawful attorney-in-fact
to:
(1) prepare, execute in the undersigned's name and on the undersigned's
behalf, and submit to the U.S. Securities and Exchange Commission (the "SEC") a
Form ID, including amendments thereto, and any other documents necessary or
appropriate to obtain codes and passwords enabling the undersigned to make
electronic filings with the SEC of reports required by Section 16(a) of the
Securities Exchange Act of 1934 or any rule or regulation of the SEC;
(2) execute for and on behalf of the undersigned, in the undersigned's capacity
as an officer and/or director of Icosavax, Inc., a Delaware corporation (the
"Company") and/or beneficial owner of more than 10% of the Company's capital
stock, Forms 3, 4, and 5 and any amendments thereto in accordance with Section
16(a) of the Securities Exchange Act of 1934 and the rules thereunder;
(3) do and perform any and all acts for and on behalf of the undersigned
which may be necessary or desirable to complete and execute any such Form 3, 4,
or 5, complete and execute any amendment or amendments thereto, and timely file
such form with the SEC and any stock exchange or similar authority; and
(4) take any other action of any type whatsoever in connection with the
foregoing which, in the opinion of such attorney-in-fact, may be of benefit to,
in the best interest of, or legally required by, the undersigned, it being
understood that the documents executed by such attorney-in-fact on behalf of the
undersigned pursuant to this Power of Attorney shall be in such form and shall
contain such terms and conditions as such attorney-in-fact may approve in such
attorney-in-fact's discretion.
The undersigned hereby grants to each such attorney-in-fact full power and
authority to do and perform any and every act and thing whatsoever requisite,
necessary, or proper to be done in the exercise of any of the rights and powers
herein granted, as fully to all intents and purposes as the undersigned might or
could do if personally present, with full power of substitution or revocation,
hereby ratifying and confirming all that such attorney-in-fact, or such
attorney-in-fact's substitute or substitutes, shall lawfully do or cause to be
done by virtue of this Power of Attorney and the rights and powers herein
granted. The undersigned acknowledges that the foregoing attorneys-in-fact, in
serving in such capacity at the request of the undersigned, are not assuming,
nor is the Company assuming, any of the undersigned's responsibilities to comply
with Section 16 of the Securities Exchange Act of 1934.
The undersigned agrees that each such attorney-in-fact herein may rely entirely
on information furnished orally or in writing by the undersigned to such
attorney-in-fact. The undersigned also agrees to indemnify and hold harmless
the Company and each such attorney-in-fact against an losses, claims, damages or
liabilities (or actions in these reports) that arise out of or are based upon
any untrue statements or omission of necessary facts in the information provided
by the undersigned to such attorney-in-fact for purposes of executing,
acknowledging, delivering or filing Forms 3, 4 or 5 (including amendments
thereto) or Form ID and agrees to reimburse the Company and such
attorney-in-fact for any legal or other expenses reasonably incurred in
connection with investigating or defending against any such loss, claim, damage,
liability or action.
This Power of Attorney supersedes any power of attorney previously executed by
the undersigned regarding the purposes outlined in the first paragraph hereof
("Prior Powers of Attorney"), and the authority of the attorney-in-fact named in
any Prior Powers of Attorney is hereby revoked.
This Power of Attorney shall remain in full force and effect until the
undersigned is no longer required to file Forms 3, 4, and 5 with respect to the
undersigned's holdings of and transactions in securities issued by the Company,
unless earlier revoked by the undersigned in a signed writing delivered to the
foregoing attorneys-in-fact.
IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be
executed as of this 10th day of June, 2022.
Signature: /s/ Heidi Fields
Name: Heidi Fields