0001209191-23-009242.txt : 20230214
0001209191-23-009242.hdr.sgml : 20230214
20230214171502
ACCESSION NUMBER: 0001209191-23-009242
CONFORMED SUBMISSION TYPE: 5
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20220531
FILED AS OF DATE: 20230214
DATE AS OF CHANGE: 20230214
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Holtzman Douglas
CENTRAL INDEX KEY: 0001874371
FILING VALUES:
FORM TYPE: 5
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-40655
FILM NUMBER: 23631578
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
5
1
doc5.xml
FORM 5 SUBMISSION
X0306
5
2022-05-31
0
0
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
Common Stock
2022-05-31
5
A
0
1667
5.77
A
294925
D
Common Stock
2792
I
By Stanley Holtzman
These shares were acquired under the Issuer's Employee Stock Purchase Plan on May 31, 2022 by the Reporting person in a transaction exempt from Section 16(b) pursuant to Rule 16b-3(c).
Douglas Holtzman, Ph.D. holds power-of-attorney (POA) over the shares owned by Stanley Holtzman. As POA, Dr. Holtzman holds voting and dispositive control over such shares. Dr. Holtzman disclaims beneficial ownership of the shares over which he has POA except to the extent of any pecuniary interest therein.
/s/ Elizabeth Bekiroglu, Attorney-in-Fact
2023-02-14