0000899243-21-031369.txt : 20210803
0000899243-21-031369.hdr.sgml : 20210803
20210803185644
ACCESSION NUMBER: 0000899243-21-031369
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20210802
FILED AS OF DATE: 20210803
DATE AS OF CHANGE: 20210803
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Gould Terry P
CENTRAL INDEX KEY: 0001553470
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-40655
FILM NUMBER: 211141623
MAIL ADDRESS:
STREET 1: C/O ONCOMED PHARMACEUTICALS, INC.
STREET 2: 800 CHESAPEAKE DRIVE
CITY: REDWOOD CITY
STATE: CA
ZIP: 94063
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: (858) 775-4523
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
2021-08-02
0
0001786255
Icosavax, Inc.
ICVX
0001553470
Gould Terry P
C/O ICOSAVAX, INC.
1616 EASTLAKE AVENUE E., SUITE 208
SEATTLE
WA
98102
1
0
0
0
Common Stock
2021-08-02
4
C
0
948188
0.00
A
948188
I
See footnotes
Common Stock
2021-08-02
4
P
0
47981
15.00
A
996169
I
See footnotes
Common Stock
2021-08-02
4
C
0
916558
0.00
A
916558
I
See footnotes
Common Stock
2021-08-02
4
P
0
46381
15.00
A
962939
I
See footnotes
Common Stock
2021-08-02
4
C
0
272131
0.00
A
272131
I
See footnotes
Common Stock
2021-08-02
4
C
0
352037
0.00
A
352037
I
See footnotes
Common Stock
2021-08-02
4
C
0
525729
0.00
A
525729
I
See footnotes
Common Stock
2021-08-02
4
P
0
26604
15.00
A
552333
I
See footnotes
Common Stock
2021-08-02
4
C
0
244415
0.00
A
244415
I
See footnotes
Common Stock
2021-08-02
4
P
0
12368
15.00
A
256783
I
See footnotes
Series A-1 Preferred Stock
0.00
2021-08-02
4
C
0
3631066
D
Common Stock
873755
0
I
See footnotes
Series A-1 Preferred Stock
0.00
2021-08-02
4
C
0
3509939
D
Common Stock
844608
0
I
See footnotes
Series A-1 Preferred Stock
0.00
2021-08-02
4
C
0
1042120
D
Common Stock
250768
0
I
See footnotes
Series A-1 Preferred Stock
0.00
2021-08-02
4
C
0
1348119
D
Common Stock
324402
0
I
See footnotes
Series A-1 Preferred Stock
0.00
2021-08-02
4
C
0
2013269
D
Common Stock
484459
0
I
See footnotes
Series A-1 Preferred Stock
0.00
2021-08-02
4
C
0
935985
D
Common Stock
225229
0
I
See footnotes
Series B-1 Preferred Stock
0.00
2021-08-02
4
C
0
309321
D
Common Stock
74432
0
I
See footnotes
Series B-1 Preferred Stock
0.00
2021-08-02
4
C
0
299003
D
Common Stock
71950
0
I
See footnotes
Series B-1 Preferred Stock
0.00
2021-08-02
4
C
0
88775
D
Common Stock
21362
0
I
See footnotes
Series B-1 Preferred Stock
0.00
2021-08-02
4
C
0
114843
D
Common Stock
27635
0
I
See footnotes
Series B-1 Preferred Stock
0.00
2021-08-02
4
C
0
171505
D
Common Stock
41269
0
I
See footnotes
Series B-1 Preferred Stock
0.00
2021-08-02
4
C
0
79734
D
Common Stock
19186
0
I
See footnotes
On August 2, 2021, the shares of Series A-1 Preferred Stock and Series B-1 Preferred Stock converted into shares of the Issuer's common stock at a ratio of 4.1557-for-1 automatically upon the closing of the Issuer's initial public offering without payment or further consideration. The shares have no expiration date. As a result of the Issuer's initial public offering, the reporting person is no longer a 10% owner of the Issuer and is therefore no longer subject to Section 16 in connection with its transactions in the equity securities of the Issuer.
The shares are held directly by Adams Street Venture/Growth Fund VI LP ("ASVG VI").
The shares are held directly by Adams Street Growth Equity Fund VII LP ("AS GE VII").
The shares are held directly by Adams Street 2016 Direct Venture/Growth Fund LP ("AS 2016").
The shares are held directly by Adams Street 2017 Direct Venture/Growth Fund LP ("AS 2017").
The shares are held directly by Adams Street 2018 Direct Venture/Growth Fund LP ("AS 2018").
The shares are held directly by Adams Street 2019 Direct Growth Equity Fund LP ("AS 2019").
Adams Street Partners, LLC as the managing member of the general partner of the general partner of ASVG VI, AS GE VII, AS 2016, AS 2017, AS 2018 and AS 2019 (collectively the "Funds"), may be deemed to beneficially own the shares held by the Funds. Thomas S. Bremner, Jeffrey T. Diehl, Elisha P. Gould III, Robin P. Murray and Fred Wang, each of whom is a partner of Adams Street Partners, LLC (or a subsidiary thereof), may be deemed to have shared voting and investment power over the shares held by the Funds. Adams Street Partners, LLC and Thomas S. Bremner, Jeffrey T. Diehl, Elisha P. Gould, Robin Murray and Fred Wang disclaim beneficial ownership of the shares held by the Funds except to the extent of their pecuniary interest therein.
Includes additional shares of Common Stock as a result of the conversion of Preferred Stock calculated on an aggregate basis of all shares of Preferred Stock held by the holder.
ASVG VI acquired additional shares in the Issuer's initial public offering.
AS GE VII acquired additional shares in the Issuer's initial public offering.
AS 2018 acquired additional shares in the Issuer's initial public offering.
AS 2019 acquired additional shares in the Issuer's initial public offering.
/s/ Thomas Russo, Attorney-in-Fact
2021-08-03