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