0001104659-14-009185.txt : 20140212 0001104659-14-009185.hdr.sgml : 20140212 20140212183012 ACCESSION NUMBER: 0001104659-14-009185 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: Freund John Gordon CENTRAL INDEX KEY: 0001296771 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36310 FILM NUMBER: 14602040 MAIL ADDRESS: STREET 1: 125 UNIVERSITY AVE. STREET 2: C/O SKYLINE VENTURES CITY: PALO ALTO STATE: CA ZIP: 94301 3 1 a3.xml 3 X0206 3 2014-02-12 0 0001367920 CONCERT PHARMACEUTICALS, INC. CNCE 0001296771 Freund John Gordon 525 UNIVERSITY AVENUE, SUITE 610 PALO ALTO CA 94301 1 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. is a 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. Dr. Freund disclaims beneficial ownership of such shares, except to the extent of his 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. JOHN G. FREUND, M.D. Kerensa Kenny, Attorney-in-Fact 2014-02-12