0001209191-22-056826.txt : 20221114 0001209191-22-056826.hdr.sgml : 20221114 20221114185801 ACCESSION NUMBER: 0001209191-22-056826 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20221110 FILED AS OF DATE: 20221114 DATE AS OF CHANGE: 20221114 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Holtzman Douglas CENTRAL INDEX KEY: 0001874371 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40655 FILM NUMBER: 221388564 MAIL ADDRESS: STREET 1: 1616 EASTLAKE AVENUE E. STREET 2: SUITE 208 CITY: SEATTLE STATE: WA ZIP: 98102 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: 1930 BOREN AVE., SUITE 1000 CITY: SEATTLE STATE: WA ZIP: 98101 BUSINESS PHONE: (206) 737-0085 MAIL ADDRESS: STREET 1: 1930 BOREN AVE., SUITE 1000 CITY: SEATTLE STATE: WA ZIP: 98101 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2022-11-10 0 0001786255 Icosavax, Inc. ICVX 0001874371 Holtzman Douglas C/O ICOSAVAX, INC. 1930 BOREN AVE., SUITE 1000 SEATTLE WA 98101 0 1 0 0 Chief Scientific Officer Stock Option (Right to Buy) 2.47 2022-11-10 4 A 0 82580 0.00 A 2032-11-09 Common Stock 82580 82580 D One-third (1/3rd) of the shares subject to the option shall vest on each of the first three anniversaries of November 10, 2022, subject to the reporting person's continued service through the applicable vesting date. /s/ Elizabeth Bekiroglu, Attorney-in-Fact 2022-11-14