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