0001209191-14-012994.txt : 20140221
0001209191-14-012994.hdr.sgml : 20140221
20140221151828
ACCESSION NUMBER: 0001209191-14-012994
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20140219
FILED AS OF DATE: 20140221
DATE AS OF CHANGE: 20140221
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: CONCERT PHARMACEUTICALS, INC.
CENTRAL INDEX KEY: 0001367920
STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834]
IRS NUMBER: 000000000
FISCAL YEAR END: 1231
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: WAN MARK A
CENTRAL INDEX KEY: 0001190472
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36310
FILM NUMBER: 14633274
MAIL ADDRESS:
STREET 1: C/O THREE ARCH PARTNERS
STREET 2: 3200 ALPINE RD
CITY: PORTOLA VALLEY
STATE: CA
ZIP: 94028
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: THREE ARCH PARTNERS IV LP
CENTRAL INDEX KEY: 0001269801
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36310
FILM NUMBER: 14633275
BUSINESS ADDRESS:
STREET 1: 3200 ALPINE ROAD
CITY: PORTOLA VALLEY
STATE: CA
ZIP: 94028
BUSINESS PHONE: 6176191737
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: THREE ARCH ASSOCIATES IV LP
CENTRAL INDEX KEY: 0001276986
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36310
FILM NUMBER: 14633276
MAIL ADDRESS:
STREET 1: 3200 ALPINE ROAD
CITY: PORTOLA VALLEY
STATE: CA
ZIP: 94028
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: JAEGER WILFRED E
CENTRAL INDEX KEY: 0001190474
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36310
FILM NUMBER: 14633277
MAIL ADDRESS:
STREET 1: C/O THREE ARCH PARTNERS
STREET 2: 3200 ALPINE RD
CITY: PORTOLA VALLEY
STATE: CA
ZIP: 94028
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Three Arch Management IV, L.L.C.
CENTRAL INDEX KEY: 0001365429
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-36310
FILM NUMBER: 14633278
BUSINESS ADDRESS:
STREET 1: 3200 APLINE ROAD
CITY: PORTOLA VALLEY
STATE: CA
ZIP: 94028
BUSINESS PHONE: (650) 529-8000
MAIL ADDRESS:
STREET 1: 3200 APLINE ROAD
CITY: PORTOLA VALLEY
STATE: CA
ZIP: 94028
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2014-02-19
1
0001367920
CONCERT PHARMACEUTICALS, INC.
CNCE
0001365429
Three Arch Management IV, L.L.C.
3200 ALPINE ROAD
PORTOLA VALLEY
CA
94028
1
0
1
0
0001190474
JAEGER WILFRED E
C/O THREE ARCH PARTNERS
3200 ALPINE ROAD
PORTOLA VALLEY
CA
94028
1
0
1
0
0001276986
THREE ARCH ASSOCIATES IV LP
3200 ALPINE ROAD
PORTOLA VALLEY
CA
94028
0
0
1
0
0001269801
THREE ARCH PARTNERS IV LP
3200 ALPINE ROAD
PORTOLA VALLEY
CA
94028
0
0
1
0
0001190472
WAN MARK A
C/O THREE ARCH PARTNERS
3200 ALPINE ROAD
PORTOLA VALLEY
CA
94028
0
0
1
0
Common Stock
2014-02-19
4
C
0
5735
A
6289
I
See footnote
Common Stock
2014-02-19
4
C
0
7647
A
13936
I
See footnote
Common Stock
2014-02-19
4
C
0
1529
A
15465
I
See footnote
Common Stock
2014-02-19
4
C
0
259751
A
284860
I
See footnote
Common Stock
2014-02-19
4
C
0
346335
A
631195
I
See footnote
Common Stock
2014-02-19
4
C
0
69267
A
700462
I
See footnote
Common Stock
2014-02-19
4
P
0
2236
14.00
A
17701
I
See footnote
Common Stock
2014-02-19
4
P
0
101264
14.00
A
801726
I
See footnote
Series A Convertible Preferred Stock
2014-02-19
4
C
0
32405
0.00
D
Common Stock
5735
0
I
See footnote
Series B Convertible Preferred Stock
2014-02-19
4
C
0
43206
0.00
D
Common Stock
7647
0
I
See footnote
Series C Convertible Preferred Stock
2014-02-19
4
C
0
8641
0.00
D
Common Stock
1529
0
I
See footnote
Series A Convertible Preferred Stock
2014-02-19
4
C
0
1467595
0.00
D
Common Stock
259751
0
I
See footnote
Series B Convertible Preferred Stock
2014-02-19
4
C
0
1956794
0.00
D
Common Stock
346335
0
I
See footnote
Series C Convertible Preferred Stock
2014-02-19
4
C
0
391359
0.00
D
Common Stock
69267
0
I
See footnote
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.
These shares are owned directly by Three Arch Associates IV, L.P. ("TAA IV"). Three Arch Management IV, L.L.C. ("TAM IV") is the general partner of TAA IV, and Wilfred Jaeger and Mark Wan, the Managing Members of TAM IV, may be deemed to share voting and dispositive power over the shares held by TAA IV. Such persons and entities disclaim beneficial ownership of the shares held by TAA IV except to the extent of any pecuniary interest therein.
These shares are owned directly by Three Arch Partners IV, L.P. ("TAP IV"). Three Arch Management IV, L.L.C. ("TAM IV") is the general partner of TAP IV, and Wilfred Jaeger and Mark Wan, the Managing Members of TAM IV, may be deemed to share voting and dispositive power over the shares held by TAP IV. Such persons and entities disclaim beneficial ownership of the shares held by TAP IV except to the extent of any pecuniary interest therein.
Not applicable.
/s/ Wilfred Jaeger, as Managing Member of Three Arch Management IV, L.L.C.
2014-02-21
/s/ Wilfred Jaeger
2014-02-21
/s/ Wilfred Jaeger, as Managing Member of Three Arch Management IV, L.L.C., general partner of Three Arch Associates IV, L.P.
2014-02-21
/s/ Wilfred Jaeger, as Managing Member of Three Arch Management IV, L.L.C., general partner of Three Arch Partners IV, L.P.
2014-02-21
/s/ Mark Wan
2014-02-21