0001209191-14-012093.txt : 20140220
0001209191-14-012093.hdr.sgml : 20140220
20140220083525
ACCESSION NUMBER: 0001209191-14-012093
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20140219
FILED AS OF DATE: 20140220
DATE AS OF CHANGE: 20140220
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: TVM Life Science Ventures VI LP
CENTRAL INDEX KEY: 0001318584
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36310
FILM NUMBER: 14627912
BUSINESS ADDRESS:
STREET 1: PO BOX 309 UGLAND HOUSE
CITY: CAYMAN ISLAND
STATE: A1
ZIP: 00000
MAIL ADDRESS:
STREET 1: PO BOX 309 UGLAND HOUSE
CITY: CAYMAN ISLAND
STATE: A1
ZIP: 00000
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: SCHUHSLER HELMUT
CENTRAL INDEX KEY: 0001133921
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36310
FILM NUMBER: 14627913
MAIL ADDRESS:
STREET 1: C/O TVM TECHNO VENTURE MANAGEMENT
STREET 2: MAXIMILLIANSTR. 35, ENTRACE C D-
CITY: MUNICH
STATE: 2M
ZIP: 80539
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Polack Axel
CENTRAL INDEX KEY: 0001579076
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36310
FILM NUMBER: 14627914
MAIL ADDRESS:
STREET 1: C/O BLUEBIRD BIO, INC.
STREET 2: 840 MEMORIAL DRIVE
CITY: CAMBRIDGE
STATE: MA
ZIP: 02139
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Fischer Stefan
CENTRAL INDEX KEY: 0001398596
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36310
FILM NUMBER: 14627916
MAIL ADDRESS:
STREET 1: MAXIMILIANSTRASSE 35/EINGANG C
CITY: MUNCHEN
STATE: 2M
ZIP: 80539
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Birner Hubert
CENTRAL INDEX KEY: 0001398598
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36310
FILM NUMBER: 14627917
MAIL ADDRESS:
STREET 1: MAXIMILIANSTRASSE 35/EINGANG C
CITY: MUNCHEN
STATE: 2M
ZIP: 80539
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: TVM Life Science Ventures VI GmbH & Co KG
CENTRAL INDEX KEY: 0001599744
STATE OF INCORPORATION: 2M
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36310
FILM NUMBER: 14627918
BUSINESS ADDRESS:
STREET 1: C/O TVM CAPITAL GROUP
STREET 2: OTTOSTRASSE 4
CITY: MUNICH
STATE: 2M
ZIP: 80333
BUSINESS PHONE: 49 89 998 992-0
MAIL ADDRESS:
STREET 1: C/O TVM CAPITAL GROUP
STREET 2: OTTOSTRASSE 4
CITY: MUNICH
STATE: 2M
ZIP: 80333
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Goll Alexandra
CENTRAL INDEX KEY: 0001397372
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36310
FILM NUMBER: 14627915
MAIL ADDRESS:
STREET 1: 101 ARCH STREET
STREET 2: SUITE 1950
CITY: BOSTON
STATE: MA
ZIP: 02110
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2014-02-19
1
0001367920
CONCERT PHARMACEUTICALS, INC.
CNCE
0001599744
TVM Life Science Ventures VI GmbH & Co KG
C/O TVM CAPITAL GROUP
OTTOSTRASSE 4
MUNICH
2M
80333
GERMANY
1
0
1
0
0001398598
Birner Hubert
C/O TVM CAPITAL GROUP
OTTOSTRASSE 4
MUNICH
2M
80333
GERMANY
0
0
1
0
0001398596
Fischer Stefan
C/O TVM CAPITAL GROUP
OTTOSTRASSE 4
MUNICH
2M
80333
GERMANY
0
0
1
0
0001397372
Goll Alexandra
C/O TVM CAPITAL GROUP
OTTOSTRASSE 4
MUNICH
2M
80333
GERMANY
0
0
1
0
0001579076
Polack Axel
C/O TVM CAPITAL GROUP
OTTOSTRASSE 4
MUNICH
2M
80333
GERMANY
0
0
1
0
0001133921
SCHUHSLER HELMUT
C/O TVM CAPITAL GROUP
OTTOSTRASSE 4
MUNICH
2M
80333
GERMANY
1
0
1
0
0001318584
TVM Life Science Ventures VI LP
C/O TVM CAPITAL GROUP
OTTOSTRASSE 4
MUNICH
2M
80333
GERMANY
0
0
1
0
Common Stock
2014-02-19
4
C
0
289991
A
329535
D
Common Stock
2014-02-19
4
C
0
560211
A
889746
D
Common Stock
2014-02-19
4
C
0
148936
A
1038682
D
Common Stock
2014-02-19
4
C
0
99389
A
112942
I
By TVM Life Sciences Ventures VI LP
Common Stock
2014-02-19
4
C
0
192003
A
304945
I
By TVM Life Sciences Ventures VI LP
Common Stock
2014-02-19
4
C
0
51045
A
355990
I
By TVM Life Sciences Ventures VI LP
Common Stock
2014-02-19
4
P
0
66287
14.00
A
1104969
D
Common Stock
2014-02-19
4
P
0
22713
14.00
A
378703
I
By TVM Life Sciences Ventures VI LP
Series A Convertible Preferred Stock
2014-02-19
4
C
0
1638450
0.00
D
Common Stock
289991
0
D
Series B Convertible Preferred Stock
2014-02-19
4
C
0
3165187
0.00
D
Common Stock
560211
0
D
Series C Convertible Preferred Stock
2014-02-19
4
C
0
841493
0.00
D
Common Stock
148936
0
D
Series A Convertible Preferred Stock
2014-02-19
4
C
0
561550
0.00
D
Common Stock
99389
0
I
By TVM Life Sciences Ventures VI LP
Series B Convertible Preferred Stock
2014-02-19
4
C
0
1084813
0.00
D
Common Stock
192003
0
I
By TVM Life Sciences Ventures VI LP
Series C Convertible Preferred Stock
2014-02-19
4
C
0
288407
0.00
D
Common Stock
51045
0
I
By TVM Life Sciences Ventures VI LP
The Series A, Series B and Series C Convertible Preferred Stock converted into Common Stock on a 1-for-5.65 basis upon the closing of the issuer's initial public offering without payment of consideration.
The shares are directly held by TVM Life Sciences Ventures VI GMBH & Co. KG ("TVM VI"). Alexandra Goll ("Goll"), Helmut Schuhsler ("Schuhsler"), Hubert Birner ("Birner"), Stefan Fischer ("Fischer") and Alex Polack ("Polack") are members of the investment committee of TVM Life Sciences Ventures VI Management VI Limited Partnership ("TVM VI Management"), a special limited partner of TVM VI, with voting and dispositive power over the shares held by TVM VI. TVM VI Management and these individuals each disclaim beneficial ownership of the shares held by TVM VI except to the extent of any pecuniary interest therein.
The shares are directly held by TVM Life Sciences Ventures VI LP ("TVM VI LP"). Goll, Schuhsler, Birner, Fischer and Polack are members of the investment committee of TVM VI Management, a special limited partner of TVM VI LP, with voting and dispositive power over the shares held by TVM VI LP. TVM VI Management and these individuals each disclaim beneficial ownership of the shares held by TVM VI LP except to the extent of any pecuniary interest therein.
Not applicable.
/s/ Stefan Fischer, Authorized Officer
/s/ Josef Moosholzer, Authorized Officer
2014-02-20
/s/ Rolf Starck, Attorney-in-Fact for Hubert Birner
2014-02-20
/s/ Rolf Starck, Attorney-in-Fact for Stefan Fischer
2014-02-20
/s/ Rolf Starck, Attorney-in-Fact for Alexandra Goll
2014-02-20
/s/ Rolf Starck, Attorney-in-Fact for Axel Polack
2014-02-20
/s/ Rolf Starck, Attorney-in-Fact for Helmut Schuhsler
2014-02-20
/s/ Stefan Fischer, Director /s/ Josef Moosholzer, Officer
2014-02-20