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