FORM 4 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940 |
|
|||||||||||||||
|
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). |
1. Name and Address of Reporting Person*
(Street)
|
2. Issuer Name and Ticker or Trading Symbol
CONCERT PHARMACEUTICALS, INC. [ CNCE ] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
|
||||||||||||||||||||||||
3. Date of Earliest Transaction
(Month/Day/Year) 02/19/2014 | ||||||||||||||||||||||||||
4. If Amendment, Date of Original Filed
(Month/Day/Year) |
6. Individual or Joint/Group Filing (Check Applicable Line)
|
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|
1. Title of Security (Instr. 3) | 2. Transaction Date (Month/Day/Year) | 2A. Deemed Execution Date, if any (Month/Day/Year) | 3. Transaction Code (Instr. 8) | 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) | 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) | 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) | |||
Code | V | Amount | (A) or (D) | Price | ||||||
Common Stock | 02/19/2014 | C | 289,991 | A | (1) | 329,535(2) | D(2) | |||
Common Stock | 02/19/2014 | C | 560,211 | A | (1) | 889,746(2) | D(2) | |||
Common Stock | 02/19/2014 | C | 148,936 | A | (1) | 1,038,682(2) | D(2) | |||
Common Stock | 02/19/2014 | C | 99,389 | A | (1) | 112,942(3) | I | By TVM Life Sciences Ventures VI LP(3) | ||
Common Stock | 02/19/2014 | C | 192,003 | A | (1) | 304,945(3) | I | By TVM Life Sciences Ventures VI LP(3) | ||
Common Stock | 02/19/2014 | C | 51,045 | A | (1) | 355,990(3) | I | By TVM Life Sciences Ventures VI LP(3) | ||
Common Stock | 02/19/2014 | P | 66,287 | A | $14 | 1,104,969(2) | D(2) | |||
Common Stock | 02/19/2014 | P | 22,713 | A | $14 | 378,703(3) | I | By TVM Life Sciences Ventures VI LP(3) |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
1. Title of Derivative Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 6. Date Exercisable and Expiration Date (Month/Day/Year) | 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) | 8. Price of Derivative Security (Instr. 5) | 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) | 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) | ||||
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||||||
Series A Convertible Preferred Stock | (1) | 02/19/2014 | C | 1,638,450 | (1) | (4) | Common Stock | 289,991 | $0.00 | 0 | D(2) | ||||
Series B Convertible Preferred Stock | (1) | 02/19/2014 | C | 3,165,187 | (1) | (4) | Common Stock | 560,211 | $0.00 | 0 | D(2) | ||||
Series C Convertible Preferred Stock | (1) | 02/19/2014 | C | 841,493 | (1) | (4) | Common Stock | 148,936 | $0.00 | 0 | D(2) | ||||
Series A Convertible Preferred Stock | (1) | 02/19/2014 | C | 561,550 | (1) | (4) | Common Stock | 99,389 | $0.00 | 0 | I | By TVM Life Sciences Ventures VI LP(3) | |||
Series B Convertible Preferred Stock | (1) | 02/19/2014 | C | 1,084,813 | (1) | (4) | Common Stock | 192,003 | $0.00 | 0 | I | By TVM Life Sciences Ventures VI LP(3) | |||
Series C Convertible Preferred Stock | (1) | 02/19/2014 | C | 288,407 | (1) | (4) | Common Stock | 51,045 | $0.00 | 0 | I | By TVM Life Sciences Ventures VI LP(3) |
1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
| ||||||||||||||||||||||||
1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
| ||||||||||||||||||||||||
1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
| ||||||||||||||||||||||||
1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
| ||||||||||||||||||||||||
1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
| ||||||||||||||||||||||||
1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
| ||||||||||||||||||||||||
1. Name and Address of Reporting Person*
(Street)
Relationship of Reporting Person(s) to Issuer
|
Explanation of Responses: |
1. The Series A, Series B and Series C 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. |
2. The shares are directly held by TVM Life Sciences Ventures VI GMBH & Co. KG ("TVM VI"). Alexandra Goll ("Goll"), Helmut Schuhsler ("Schuhsler"), Hubert Birner ("Birner"), Stefan Fischer ("Fischer") and Alex Polack ("Polack") are members of the investment committee of TVM Life Sciences Ventures VI Management VI Limited Partnership ("TVM VI Management"), a special limited partner of TVM VI, with voting and dispositive power over the shares held by TVM VI. TVM VI Management and these individuals each disclaim beneficial ownership of the shares held by TVM VI except to the extent of any pecuniary interest therein. |
3. The shares are directly held by TVM Life Sciences Ventures VI LP ("TVM VI LP"). Goll, Schuhsler, Birner, Fischer and Polack are members of the investment committee of TVM VI Management, a special limited partner of TVM VI LP, with voting and dispositive power over the shares held by TVM VI LP. TVM VI Management and these individuals each disclaim beneficial ownership of the shares held by TVM VI LP except to the extent of any pecuniary interest therein. |
4. Not applicable. |
Remarks: |
/s/ Stefan Fischer, Authorized Officer /s/ Josef Moosholzer, Authorized Officer | 02/20/2014 | |
/s/ Rolf Starck, Attorney-in-Fact for Hubert Birner | 02/20/2014 | |
/s/ Rolf Starck, Attorney-in-Fact for Stefan Fischer | 02/20/2014 | |
/s/ Rolf Starck, Attorney-in-Fact for Alexandra Goll | 02/20/2014 | |
/s/ Rolf Starck, Attorney-in-Fact for Axel Polack | 02/20/2014 | |
/s/ Rolf Starck, Attorney-in-Fact for Helmut Schuhsler | 02/20/2014 | |
/s/ Stefan Fischer, Director /s/ Josef Moosholzer, Officer | 02/20/2014 | |
** Signature of Reporting Person | Date | |
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | ||
* If the form is filed by more than one reporting person, see Instruction 4 (b)(v). | ||
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). | ||
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. | ||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. |