0001104659-14-009173.txt : 20140212 0001104659-14-009173.hdr.sgml : 20140212 20140212180257 ACCESSION NUMBER: 0001104659-14-009173 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: KANEKO YASUNORI CENTRAL INDEX KEY: 0001277503 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36310 FILM NUMBER: 14601853 MAIL ADDRESS: STREET 1: 509 ROEHAMPTON CITY: HILLS BOROUGH STATE: CA ZIP: 94010 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Freund John Gordon CENTRAL INDEX KEY: 0001296771 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36310 FILM NUMBER: 14601854 MAIL ADDRESS: STREET 1: 125 UNIVERSITY AVE. STREET 2: C/O SKYLINE VENTURES CITY: PALO ALTO STATE: CA ZIP: 94301 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Skyline Venture Management IV, LLC CENTRAL INDEX KEY: 0001392103 STATE OF INCORPORATION: CA FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36310 FILM NUMBER: 14601855 BUSINESS ADDRESS: STREET 1: 525 UNIVERSITY AVE. STREET 2: SUITE 520 CITY: PALO ALTO STATE: CA ZIP: 94301 BUSINESS PHONE: 650-462-5800 MAIL ADDRESS: STREET 1: 525 UNIVERSITY AVE. STREET 2: SUITE 520 CITY: PALO ALTO STATE: CA ZIP: 94301 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Skyline Venture Partners Qualified Purchaser Fund IV L P CENTRAL INDEX KEY: 0001324617 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36310 FILM NUMBER: 14601856 BUSINESS ADDRESS: STREET 1: 125 UNIVERSITY AVE CITY: PALO ALTO STATE: CA ZIP: 94301 MAIL ADDRESS: STREET 1: 125 UNIVERSITY AVE CITY: PALO ALTO STATE: CA ZIP: 94301 3 1 a3.xml 3 X0206 3 2014-02-12 0 0001367920 CONCERT PHARMACEUTICALS, INC. CNCE 0001324617 Skyline Venture Partners Qualified Purchaser Fund IV L P 525 UNIVERSITY AVENUE, SUITE 610 PALO ALTO CA 94301 0 0 1 0 0001392103 Skyline Venture Management IV, LLC 525 UNIVERSITY AVENUE, SUITE 610 PALO ALTO CA 94301 0 0 1 0 0001296771 Freund John Gordon 525 UNIVERSITY AVENUE, SUITE 610 PALO ALTO CA 94301 0 0 1 0 0001277503 KANEKO YASUNORI 525 UNIVERSITY AVENUE, SUITE 610 PALO ALTO CA 94301 0 0 1 0 Common Stock 32372 I See footnote Series A Convertible Preferred Stock Common Stock 389380 I See Footnote Series B Convertible Preferred Stock Common Stock 530974 I See Footnote Series C Convertible Preferred Stock Common Stock 106194 I See Footnote Reflects a 1-for-5.65 reverse stock split effected on January 29, 2014. The shares are held by Skyline Venture Partners Qualified Purchaser Fund IV L.P. ("Skyline IV"). John G. Freund, M.D. and Yasunori Kaneko, M.D. are Managing Directors of Skyline Venture Management IV, LLC, the general partner of Skyline IV, and may be deemed to share voting and dispositive power over the shares held by Skyline IV. Each of Drs. Freund and Kaneko disclaims beneficial ownership of such shares, except to the extent of their 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 approximately 0.176991 shares of Common Stock upon the closing of the Issuer's initial public offering. Not applicable. SKYLINE VENTURE PARTNERS QUALIFIED PURCHASER FUND IV, L.P. By: SKYLINE VENTURE MANAGEMENT IV, LLC Its: General Partner Kerensa Kenny, Attorney-in-Fact 2014-02-12 SKYLINE VENTURE MANAGEMENT IV, LLC Kerensa Kenny, Attorney-in-Fact 2014-02-12 JOHN G. FREUND, M.D. Kerensa Kenny, Attorney-in-Fact 2014-02-12 YASUNORI KANEKO, M.D. Kerensa Kenny, Attorney-in-Fact 2014-02-12