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