0001209191-14-009856.txt : 20140212 0001209191-14-009856.hdr.sgml : 20140212 20140212181321 ACCESSION NUMBER: 0001209191-14-009856 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: AFEYAN NOUBAR CENTRAL INDEX KEY: 0001222012 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36310 FILM NUMBER: 14601943 MAIL ADDRESS: STREET 1: 1 SUNSET RIDGE CITY: LEXINGTON STATE: MA ZIP: 02173 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: KANIA EDWIN M JR CENTRAL INDEX KEY: 0001255927 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36310 FILM NUMBER: 14601942 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Flagship Ventures Fund 2004 L P CENTRAL INDEX KEY: 0001299790 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36310 FILM NUMBER: 14601945 BUSINESS ADDRESS: STREET 1: ONE MEMORIAL DRIVE STREET 2: 7TH FLOOR CITY: CAMBRIDGE STATE: MA ZIP: 02142 BUSINESS PHONE: 617-868-1888 MAIL ADDRESS: STREET 1: ONE MEMORIAL DRIVE STREET 2: 7TH FLOOR CITY: CAMBRIDGE STATE: MA ZIP: 02142 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Flagship Ventures General Partner LLC CENTRAL INDEX KEY: 0001400249 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36310 FILM NUMBER: 14601944 BUSINESS ADDRESS: STREET 1: C/O FLAGSHIP VENTURES STREET 2: ONE MEMORIAL DRIVE, 7TH FLOOR CITY: CAMBRIDGE STATE: MA ZIP: 02142 BUSINESS PHONE: 617 868-1888 MAIL ADDRESS: STREET 1: C/O FLAGSHIP VENTURES STREET 2: ONE MEMORIAL DRIVE, 7TH FLOOR CITY: CAMBRIDGE STATE: MA ZIP: 02142 3 1 doc3.xml FORM 3 SUBMISSION X0206 3 2014-02-12 0 0001367920 CONCERT PHARMACEUTICALS, INC. CNCE 0001299790 Flagship Ventures Fund 2004 L P 1 MEMORIAL DRIVE CAMBRIDGE MA 02142 0 0 1 0 0001400249 Flagship Ventures General Partner LLC 1 MEMORIAL DRIVE CAMBRIDGE MA 02142 0 0 1 0 0001222012 AFEYAN NOUBAR 1 MEMORIAL DRIVE CAMBRIDGE MA 02142 0 0 1 0 0001255927 KANIA EDWIN M JR 1 MEMORIAL DRIVE CAMBRIDGE MA 02142 0 0 1 0 Common Stock 32508 D Series B Convertible Preferred Stock Common Stock 530974 D Series C Convertible Preferred Stock Common Stock 93008 D Reflects a 1-for-5.65 reverse stock split effected on January 29, 2014. 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. /s/ Noubar B. Afeyan, Ph.D., for Flagship Ventures Fund 2004, L.P., as Manager of Flagship Ventures General Partner LLC, its General Partner 2014-02-12 /s/ Noubar B. Afeyan, Ph.D., as Manager of Flagship Ventures General Partner LLC 2014-02-12 /s/ Noubar B. Afeyan, Ph.D. 2014-02-12 /s/ Edwin M. Kania, Jr. 2014-02-12