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