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