0001209191-24-002106.txt : 20240123 0001209191-24-002106.hdr.sgml : 20240123 20240123181519 ACCESSION NUMBER: 0001209191-24-002106 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20240122 FILED AS OF DATE: 20240123 DATE AS OF CHANGE: 20240123 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Simpson Adam K. CENTRAL INDEX KEY: 0001873839 ORGANIZATION NAME: FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-40655 FILM NUMBER: 24553792 MAIL ADDRESS: STREET 1: C/O ICOSAVAX, INC. STREET 2: 1616 EASTLAKE AVENUE E., 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] ORGANIZATION NAME: 03 Life Sciences 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 X0508 4 2024-01-22 0 0001786255 Icosavax, Inc. ICVX 0001873839 Simpson Adam K. C/O ICOSAVAX, INC. 1930 BOREN AVE., SUITE 1000 SEATTLE WA 98101 1 1 0 0 Chief Executive Officer 0 Common Stock 2024-01-22 4 M 0 4789 0.84 A 265430 D Common Stock 2024-01-22 4 M 0 93227 1.04 A 358657 D Common Stock 531576 I By family trust Common Stock 129032 I By family trust Common Stock 129032 I By family trust Stock Option (Right to Buy) 0.84 2024-01-22 4 M 0 4789 0.00 D 2030-05-10 Common Stock 4789 0 D Stock Option (Right to Buy) 1.04 2024-01-22 4 M 0 93227 0.00 D 2031-01-28 Common Stock 93227 206449 D 25% of the shares subject to the option vested on February 21, 2021, and 1/48th of the shares subject to the option vest monthly thereafter. 25% of the shares subject to the option vested on January 14, 2022, and 1/48th of the shares subject to the option vest monthly thereafter. /s/ Elizabeth Bekiroglu, Attorney-in-Fact 2024-01-23