SEC FORM 3 SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
 
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1. Name and Address of Reporting Person*
Sanofi

(Last) (First) (Middle)
54, RUE LA BOETIE

(Street)
PARIS I0 75008

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
07/28/2021
3. Issuer Name and Ticker or Trading Symbol
Icosavax, Inc. [ ICVX ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director X 10% Owner
Officer (give title below) Other (specify below)
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Series A-1 Preferred Stock (par value, $0.0001) (1) (1) Common Stock 3,003,224 0.00 I Through its wholly-owned subsidiary, Aventis, Inc.(2)
Series B-1 Preferred Stock (par value, $0.0001) (1) (1) Common Stock 85,278 0.00 I Through its wholly-owned subsidiary, Aventis, Inc.(2)
Explanation of Responses:
1. The shares of Series A-1 Preferred Stock and Series B-1 Preferred Stock are convertible, at any time at the holder's election, to shares of the Issuer's Common Stock, as shown in Column 3, at a ratio of 4.1557-for-1. In addition, effective immediately prior to the closing of the Issuer's initial public offering of its Common Stock, each share of Series A-1 Preferred Stock and Series B-1 Preferred Stock will automatically convert to shares of the Issuer's Common Stock at a ratio of 4.1557-for-1 as shown in Column 3. The Series A-1 Preferred Stock and Series B-1 Preferred Stock have no expiration date.
2. Sanofi is the beneficial owner of 3,003,224 Shares of Series A-1 Preferred Stock and 85,278 Shares of Series B-1 Preferred Stock of the Issuer through its wholly owned subsidiary, Aventis, Inc.
Remarks:
/s/ Alexander Roger, Head of Securities Law and Capital Markets 07/28/2021
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 5 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
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