0001209191-14-009831.txt : 20140212 0001209191-14-009831.hdr.sgml : 20140212 20140212180012 ACCESSION NUMBER: 0001209191-14-009831 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 2 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: ALDRICH RICHARD CENTRAL INDEX KEY: 0001185039 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36310 FILM NUMBER: 14601831 MAIL ADDRESS: STREET 1: 1365 MAIN STREET CITY: WALTHAM STATE: MA ZIP: 02451 3 1 doc3.xml FORM 3 SUBMISSION X0206 3 2014-02-12 0 0001367920 CONCERT PHARMACEUTICALS, INC. CNCE 0001185039 ALDRICH RICHARD C/O CONCERT PHARMACEUTICALS, INC. 99 HAYDEN AVENUE, SUITE 500 LEXINGTON MA 02421 1 0 1 0 Common Stock 286963 D Common Stock 102417 I By Richard H. Aldrich 2011 GRAT Series A Convertible Preferred Stock Common Stock 53097 I By RA Capital Associates, Inc. Series B Convertible Preferred Stock Common Stock 8849 I By RA Capital Associates, Inc. Non-qualified Stock Option (right to buy) 2.88 2022-11-12 Common Stock 5309 D Non-qualified Stock Option (right to buy) 3.50 2021-11-01 Common Stock 5309 D Non-qualified Stock Option (right to buy) 3.79 2020-12-03 Common Stock 5309 D Non-qualified Stock Option (right to buy) 4.41 2019-12-10 Common Stock 5309 D Reflects a 1-for-5.65 reverse stock split effected on January 29, 2014. Shares held by Richard H. Aldrich 2011 GRAT. Mr. Aldrich is the sole trustee of the Richard H. Aldrich 2011 GRAT. Mr. Aldrich disclaims beneficial ownership of such shares except to the extent of any pecuniary interest therein. 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. Not applicable. Shares held by RA Capital Associates, Inc. Mr. Aldrich is the sole stockholder of the RA Capital Associates, Inc. Mr. Aldrich disclaims beneficial ownership of such shares except to the extent of any pecuniary interest therein. Immediately. /s/ Richard H. Aldrich 2014-02-12 EX-24.3_506604 2 poa.txt POA DOCUMENT LIMITED POWER OF ATTORNEY FOR SECTION 16 REPORTING OBLIGATIONS Know all by these presents, that the undersigned hereby makes, constitutes and appoints each of Roger D. Tung, D. Ryan Daws, Nancy Stuart and Robert Silverman, signing singly and each acting individually, as the undersigned's true and lawful attorney in fact with full power and authority as hereinafter described to: (1) execute for and on behalf of the undersigned, in the undersigned's capacity as an officer and/or director of Concert Pharmaceuticals, Inc. (the "Company"), Forms 3, 4, and 5 (including any amendments thereto) in accordance with Section 16(a) of the Securities Exchange Act of 1934 and the rules thereunder (the "Exchange Act"); (2) do and perform any and all acts for and on behalf of the undersigned which may be necessary or desirable to prepare, complete and execute any such Form 3, 4, or 5, prepare, complete and execute any amendment or amendments thereto, and timely deliver and file such form with the United States Securities and Exchange Commission (the "SEC") and any stock exchange or similar authority, including without limitation the filing of a Form ID or any other application materials to enable the undersigned to gain or maintain access to the Electronic Data Gathering, Analysis and Retrieval system of the SEC; (3) seek or obtain, as the undersigned's representative and on the undersigned's behalf, information regarding transactions in the Company's securities from any third party, including brokers, employee benefit plan administrators and trustees, and the undersigned hereby authorizes any such person to release any such information to such attorney in fact and approves and ratifies any such release of information; and (4) take any other action of any type whatsoever in connection with the foregoing which, in the opinion of such attorney in fact, may be of benefit to, in the best interest of, or legally required by, the undersigned, it being understood that the documents executed by such attorney in fact on behalf of the undersigned pursuant to this Power of Attorney shall be in such form and shall contain such terms and conditions as such attorney in fact may approve in such attorney in fact's discretion. The undersigned hereby grants to each such attorney in fact full power and authority to do and perform any and every act and thing whatsoever requisite, necessary, or proper to be done in the exercise of any of the rights and powers herein granted, as fully to all intents and purposes as the undersigned might or could do if personally present, with full power of substitution or revocation, hereby ratifying and confirming all that such attorney in fact, or such attorney in fact's substitute or substitutes, shall lawfully do or cause to be done by virtue of this power of attorney and the rights and powers herein granted. The undersigned acknowledges that the foregoing attorneys in fact, in serving in such capacity at the request of the undersigned, are not assuming nor relieving, nor is the Company assuming nor relieving, any of the undersigned's responsibilities to comply with Section 16 of the Exchange Act. The undersigned acknowledges that neither the Company nor the foregoing attorneys in fact assume (i) any liability for the undersigned's responsibility to comply with the requirement of the Exchange Act, (ii) any liability of the undersigned for any failure to comply with such requirements, or (iii) any obligation or liability of the undersigned for profit disgorgement under Section 16(b) of the Exchange Act. This Power of Attorney shall remain in full force and effect until the undersigned is no longer required to file Forms 3, 4, and 5 with respect to the undersigned's holdings of and transactions in securities issued by the Company, unless earlier revoked by the undersigned in a signed writing delivered to the foregoing attorneys in fact. IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be executed as of this 7th day of February, 2014. /s/ Richard H. Aldrich _________________________________ Signature Richard H. Aldrich _________________________________ Print Name