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