0000903423-14-000075.txt : 20140212 0000903423-14-000075.hdr.sgml : 20140212 20140212185719 ACCESSION NUMBER: 0000903423-14-000075 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20140212 FILED AS OF DATE: 20140212 DATE AS OF CHANGE: 20140212 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: CONCERT PHARMACEUTICALS, INC. CENTRAL INDEX KEY: 0001367920 STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834] IRS NUMBER: 000000000 BUSINESS ADDRESS: STREET 1: 99 HAYDEN AVENUE STREET 2: SUITE 500 CITY: LEXINGTON STATE: MA ZIP: 02421 BUSINESS PHONE: 781-860-0045 MAIL ADDRESS: STREET 1: 99 HAYDEN AVENUE STREET 2: SUITE 500 CITY: LEXINGTON STATE: MA ZIP: 02421 FORMER COMPANY: FORMER CONFORMED NAME: CONCERT PHARMACEUTICALS INC DATE OF NAME CHANGE: 20060628 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: GLAXOSMITHKLINE PLC CENTRAL INDEX KEY: 0001131399 STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834] FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36310 FILM NUMBER: 14602186 BUSINESS ADDRESS: STREET 1: 980 GREAT WEST ROAD CITY: BRENTFORD MIDDLESEX STATE: X0 ZIP: TW8 9GS BUSINESS PHONE: 011442080475000 MAIL ADDRESS: STREET 1: 980 GREAT WEST ROAD CITY: BRENTFORD MIDDLESEX STATE: X0 ZIP: TW8 9GS 3 1 gsk.xml OWNERSHIP DOCUMENT X0206 3 2014-02-12 0 0001367920 CONCERT PHARMACEUTICALS, INC. CNCE 0001131399 GLAXOSMITHKLINE PLC 980 GREAT WEST ROAD BRENTFORD MIDDLESEX X0 TW8 9GS UNITED KINGDOM 0 0 1 0 Series C Convertible Preferred Stock Common Stock 141592 I By S.R. One Limited Series D Convertible Preferred Stock Common Stock 1179941 I By Glaxo Group Limited Convertible into Common Stock on a 1-for-5.65 basis without payment of further consideration. Each share will automatically convert into 0.176991 shares of Common Stock upon the closing of the Issuer's initial public offering (the 'IPO"), for no additional consideration. Not applicable. Shares are held by S.R. One Limited, an indirect, wholly-owned subsidiary of GlaxoSmithKline plc (Reporting Person). Shares are held by Glaxo Group Limited, an indirect, wholly-owned subsidiary of GlaxoSmithKline plc (Reporting Person). /s/ Simon Dingemans, Chief Financial Officer 2014-02-12