0001209191-14-011640.txt : 20140219 0001209191-14-011640.hdr.sgml : 20140219 20140219131033 ACCESSION NUMBER: 0001209191-14-011640 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20140219 FILED AS OF DATE: 20140219 DATE AS OF CHANGE: 20140219 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: Tung Roger D CENTRAL INDEX KEY: 0001594857 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36310 FILM NUMBER: 14624920 MAIL ADDRESS: STREET 1: 99 HAYDEN AVENUE, SUITE 500 CITY: LEXINGTON STATE: MA ZIP: 02421 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2014-02-19 0 0001367920 CONCERT PHARMACEUTICALS, INC. CNCE 0001594857 Tung Roger D C/O CONCERT PHARMACEUTICALS, INC. 99 HAYDEN AVENUE, SUITE 500 LEXINGTON MA 02421 1 1 1 0 Chief Executive Officer Common Stock 2014-02-19 4 C 0 17699 A 401522 D Common Stock 2014-02-19 4 C 0 8850 A 8850 I By Tung Family Investment Trust Common Stock 2014-02-19 4 C 0 4424 A 13274 I By Tung Family Investment Trust Common Stock 134761 I By Roger D. Tung 2011 GRAT Common Stock 12389 I By RD Tung Irrevocable Trust Series A Convertible Preferred Stock 2014-02-19 4 C 0 100000 0.00 D Common Stock 17699 0 D Series A Convertible Preferred Stock 2014-02-19 4 C 0 50000 0.00 D Common Stock 8850 0 I By Tung Family Investment Trust Series B Convertible Preferred Stock 2014-02-19 4 C 0 25000 0.00 D Common Stock 4424 0 I By Tung Family Investment Trust The Series A and Series B Convertible Preferred Stock converted into Common Stock on a 1-for-5.65 basis upon the closing of the issuer's initial public offering without payment of consideration. Shares held by the Tung Family Investment Trust. Dr. Tung is a co-trustee of the Tung Family Investment Trust. Dr. Tung disclaims beneficial ownership of such shares except to the extent of any pecuniary interest therein. Shares held by Roger D. Tung 2011 GRAT. Dr. Tung is the sole trustee of the Roger D. Tung 2011 GRAT. Dr. Tung disclaims beneficial ownership of such shares except to the extent of any pecuniary interest therein. Shares held by the RD Tung Irrevocable Trust. Dr. Tung's spouse is a co-trustee of the RD Tung Irrevocable Trust. Dr. Tung disclaims beneficial ownership of such shares except to the extent of any pecuniary interest therein. Not applicable. /s/ Roger D. Tung 2014-02-19