0001209191-14-009841.txt : 20140212
0001209191-14-009841.hdr.sgml : 20140212
20140212180325
ACCESSION NUMBER: 0001209191-14-009841
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: Greylock XII-A Limited Partnership
CENTRAL INDEX KEY: 0001496057
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36310
FILM NUMBER: 14601864
BUSINESS ADDRESS:
STREET 1: ONE BRATTLE SQUARE
STREET 2: FLOOR 4
CITY: CAMBRIDGE
STATE: MA
ZIP: 02138
BUSINESS PHONE: 781-622-2200
MAIL ADDRESS:
STREET 1: ONE BRATTLE SQUARE
STREET 2: FLOOR 4
CITY: CAMBRIDGE
STATE: MA
ZIP: 02138
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Greylock XII Limited Partnership
CENTRAL INDEX KEY: 0001413950
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36310
FILM NUMBER: 14601865
BUSINESS ADDRESS:
STREET 1: ONE BRATTLE SQUARE
STREET 2: 4TH FLOOR
CITY: CAMBRIDGE
STATE: MA
ZIP: 02138
BUSINESS PHONE: 781-622-2200
MAIL ADDRESS:
STREET 1: ONE BRATTLE SQUARE
STREET 2: 4TH FLOOR
CITY: CAMBRIDGE
STATE: MA
ZIP: 02138
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Greylock XII GP LLC
CENTRAL INDEX KEY: 0001413877
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36310
FILM NUMBER: 14601866
BUSINESS ADDRESS:
STREET 1: ONE BRATTLE SQUARE
STREET 2: 4TH FLOOR
CITY: CAMBRIDGE
STATE: MA
ZIP: 02138
BUSINESS PHONE: 781-622-2200
MAIL ADDRESS:
STREET 1: ONE BRATTLE SQUARE
STREET 2: 4TH FLOOR
CITY: CAMBRIDGE
STATE: MA
ZIP: 02138
3
1
doc3.xml
FORM 3 SUBMISSION
X0206
3
2014-02-12
0
0001367920
CONCERT PHARMACEUTICALS, INC.
CNCE
0001413877
Greylock XII GP LLC
2550 SAND HILL ROAD
MENLO PARK
CA
94025
0
0
1
0
0001413950
Greylock XII Limited Partnership
2550 SAND HILL ROAD
MENLO PARK
CA
94025
0
0
1
0
0001496057
Greylock XII-A Limited Partnership
2550 SAND HILL ROAD
MENLO PARK
CA
94025
0
0
1
0
Series A Convertible Preferred Stock
Common Stock
242124
I
By Greylock XII Limited Partnership
Series A Convertible Preferred Stock
Common Stock
26902
I
By Greylock XII-A Limited Partnership
Series B Convertible Preferred Stock
Common Stock
302655
I
By Greylock XII Limited Partnership
Series B Convertible Preferred Stock
Common Stock
33629
I
By Greylock XII-A Limited Partnership
Series C Convertible Preferred Stock
Common Stock
60530
I
By Greylock XII Limited Partnership
Series C Convertible Preferred Stock
Common Stock
6725
I
By Greylock XII-A Limited Partnership
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.
Shares held directly by Greylock XII Limited Partnership. Greylock XII GP Limited Liability Company is the sole General Partner of Greylock XII Limited Partnership and may be deemed to share voting and dispositive power with respect to the shares held by Greylock XII Limited Partnership. Greylock XII GP Limited Liability Company disclaims beneficial ownership of the securities held by Greylock XII Limited Partnership except to the extent of any pecuniary interest therein.
Shares held directly by Greylock XII-A Limited Partnership. Greylock XII GP Limited Liability Company is the sole General Partner of Greylock XII-A Limited Partnership and may be deemed to share voting and dispositive power with respect to the shares held by Greylock XII-A Limited Partnership. Greylock XII GP Limited Liability Company disclaims beneficial ownership of the securities held by Greylock XII-A Limited Partnership except to the extent of any pecuniary interest therein.
/s/ Donald A. Sullivan, as Administrative Member of Greylock XII GP Limited Liability Company
2014-02-12
/s/ Donald A. Sullivan, as Administrative Member of Greylock XII GP Limited Liability Company, sole general partner of Greylock XII Limited Partnership
2014-02-12
/s/ Donald A. Sullivan, as Administrative Member of Greylock XII GP Limited Liability Company, sole general partner of Greylock XII-A Limited Partnership
2014-02-12