Sec Form 4 Filing - ADAMS STREET PARTNERS LLC @ Icosavax, Inc. - 2021-08-02

Insider filing report for Changes in Beneficial Ownership
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FORM 4
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
ADAMS STREET PARTNERS LLC
2. Issuer Name and Ticker or Trading Symbol
Icosavax, Inc. [ ICVX]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director _____ 10% Owner
_____ Officer (give title below) X __ Other (specify below)
Former 10% Owner
(Last) (First) (Middle)
ONE NORTH WACKER DRIVE, SUITE 2700
3. Date of Earliest Transaction (MM/DD/YY)
08/02/2021
(Street)
CHICAGO, IL60606
4. If Amendment, Date Original Filed (MM/DD/YY)
6. Individual or Joint/Group Filing (Check Applicable Line)
__ X __ Form filed by One Reporting Person
_____ Form filed by More than One Reporting Person
(City) (State) (Zip)
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security
(Instr. 3)
2. Transaction Date (MM/DD/YY) 2A. Deemed Execution Date, if any (MM/DD/YY) 3. Transaction Code
(Instr. 8)
4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
6. Ownership Form: Direct (D) or Indirect (I)
(Instr. 4)
7. Nature of Indirect Beneficial Ownership
(Instr. 4)
Code V Amount (A) or (D) Price
Common Stock 08/02/2021 C 948,188 ( 9 ) A $ 0 ( 1 ) 948,188 ( 9 ) I See footnotes ( 2 ) ( 8 )
Common Stock 08/02/2021 P( 10 ) 47,981 A $ 15 996,169 I See footnotes ( 2 ) ( 8 )
Common Stock 08/02/2021 C 916,558 A $ 0 ( 1 ) 916,558 I See footnotes ( 3 ) ( 8 )
Common Stock 08/02/2021 P( 11 ) 46,381 A $ 15 962,939 I See footnotes ( 3 ) ( 8 )
Common Stock 08/02/2021 C 272,131 ( 9 ) A $ 0 ( 1 ) 272,131 ( 9 ) I See footnotes ( 4 ) ( 8 )
Common Stock 08/02/2021 C 352,037 A $ 0 ( 1 ) 352,037 I See footnotes ( 5 ) ( 8 )
Common Stock 08/02/2021 C 525,729 ( 9 ) A $ 0 ( 1 ) 525,729 ( 9 ) I See footnotes ( 6 ) ( 8 )
Common Stock 08/02/2021 P( 12 ) 26,604 A $ 15 552,333 I See footnotes ( 6 ) ( 8 )
Common Stock 08/02/2021 C 244,415 A $ 0 ( 1 ) 244,415 I See footnotes ( 7 ) ( 8 )
Common Stock 08/02/2021 P( 13 ) 12,368 A $ 15 256,783 I See footnotes ( 7 ) ( 8 )
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
( e.g. , puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security
(Instr. 3)
2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (MM/DD/YY) 3A. Deemed Execution Date, if any (MM/DD/YY) 4. Transaction Code
(Instr. 8)
5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4, and 5)
6. Date Exercisable and Expiration Date
(MM/DD/YY)
7. Title and Amount of Underlying Securities
(Instr. 3 and 4)
8. Price of Derivative Security
(Instr. 5)
9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 4)
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 4)
11. Nature of Indirect Beneficial Ownership
(Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Series A-1 Preferred Stock $ 0 08/02/2021 C 3,631,066 ( 1 ) ( 1 ) Common Stock 873,755 ( 1 ) 0 I See footnotes ( 2 ) ( 8 )
Series A-1 Preferred Stock $ 0 08/02/2021 C 3,509,939 ( 1 ) ( 1 ) Common Stock 844,608 ( 1 ) 0 I See footnotes ( 3 ) ( 8 )
Series A-1 Preferred Stock $ 0 08/02/2021 C 1,042,120 ( 1 ) ( 1 ) Common Stock 250,768 ( 1 ) 0 I See footnotes ( 4 ) ( 8 )
Series A-1 Preferred Stock $ 0 08/02/2021 C 1,348,119 ( 1 ) ( 1 ) Common Stock 324,402 ( 1 ) 0 I See footnotes ( 5 ) ( 8 )
Series A-1 Preferred Stock $ 0 08/02/2021 C 2,013,269 ( 1 ) ( 1 ) Common Stock 484,459 ( 1 ) 0 I See footnotes ( 6 ) ( 8 )
Series A-1 Preferred Stock $ 0 08/02/2021 C 935,985 ( 1 ) ( 1 ) Common Stock 225,229 ( 1 ) 0 I See footnotes ( 7 ) ( 8 )
Series B-1 Preferred Stock $ 0 08/02/2021 C 309,321 ( 1 ) ( 1 ) Common Stock 74,432 ( 1 ) 0 I See footnotes ( 2 ) ( 8 )
Series B-1 Preferred Stock $ 0 08/02/2021 C 299,003 ( 1 ) ( 1 ) Common Stock 71,950 ( 1 ) 0 I See footnotes ( 3 ) ( 8 )
Series B-1 Preferred Stock $ 0 08/02/2021 C 88,775 ( 1 ) ( 1 ) Common Stock 21,362 ( 1 ) 0 I See footnotes ( 4 ) ( 8 )
Series B-1 Preferred Stock $ 0 08/02/2021 C 114,843 ( 1 ) ( 1 ) Common Stock 27,635 ( 1 ) 0 I See footnotes ( 5 ) ( 8 )
Series B-1 Preferred Stock $ 0 08/02/2021 C 171,505 ( 1 ) ( 1 ) Common Stock 41,269 ( 1 ) 0 I See footnotes ( 6 ) ( 8 )
Series B-1 Preferred Stock $ 0 08/02/2021 C 79,734 ( 1 ) ( 1 ) Common Stock 19,186 ( 1 ) 0 I See footnotes ( 7 ) ( 8 )
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
ADAMS STREET PARTNERS LLC
ONE NORTH WACKER DRIVE
SUITE 2700
CHICAGO, IL60606
Former 10% Owner
Signatures
/s/ Sara Robinson Dasse 08/03/2021
Signature of Reporting Person Date
Explanation of Responses:
( 1 )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.
( 2 )The shares are held directly by Adams Street Venture/Growth Fund VI LP ("ASVG VI").
( 3 )The shares are held directly by Adams Street Growth Equity Fund VII LP ("AS GE VII").
( 4 )The shares are held directly by Adams Street 2016 Direct Venture/Growth Fund LP ("AS 2016").
( 5 )The shares are held directly by Adams Street 2017 Direct Venture/Growth Fund LP ("AS 2017").
( 6 )The shares are held directly by Adams Street 2018 Direct Venture/Growth Fund LP ("AS 2018").
( 7 )The shares are held directly by Adams Street 2019 Direct Growth Equity Fund LP ("AS 2019").
( 8 )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.
( 9 )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.
( 10 )ASVG VI acquired additional shares in the Issuer's initial public offering.
( 11 )AS GE VII acquired additional shares in the Issuer's initial public offering.
( 12 )AS 2018 acquired additional shares in the Issuer's initial public offering.
( 13 )AS 2019 acquired additional shares in the Issuer's initial public offering.

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