0001192482-15-000159.txt : 20150506 0001192482-15-000159.hdr.sgml : 20150506 20150506161107 ACCESSION NUMBER: 0001192482-15-000159 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20150506 FILED AS OF DATE: 20150506 DATE AS OF CHANGE: 20150506 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: COLLEGIUM PHARMACEUTICAL, INC CENTRAL INDEX KEY: 0001267565 STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834] IRS NUMBER: 000000000 STATE OF INCORPORATION: VA FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 780 DEDHAM STREET, SUITE 800 CITY: CANTON STATE: MA ZIP: 02021 BUSINESS PHONE: 781-713-3699 MAIL ADDRESS: STREET 1: 780 DEDHAM STREET, SUITE 800 CITY: CANTON STATE: MA ZIP: 02021 FORMER COMPANY: FORMER CONFORMED NAME: COLLEGIUM PHARMACEUTICAL INC DATE OF NAME CHANGE: 20031020 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Every Nathan R CENTRAL INDEX KEY: 0001531105 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37372 FILM NUMBER: 15837073 MAIL ADDRESS: STREET 1: FRAZIER HEALTHCARE VENTURES STREET 2: 601 UNION TWO UNION SQUARE SUITE 3200 CITY: SEATTLE STATE: WA ZIP: 98101 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Topper James N CENTRAL INDEX KEY: 0001341382 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37372 FILM NUMBER: 15837074 MAIL ADDRESS: STREET 1: 550 HAMILTON AVENUE, SUITE 100 CITY: PALO ALTO STATE: CA ZIP: 94301 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Naini Nader J CENTRAL INDEX KEY: 0001344203 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37372 FILM NUMBER: 15837075 MAIL ADDRESS: STREET 1: 601 UNION STREET, SUITE 3200 CITY: SEATTLE STATE: WA ZIP: 98101 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: FRAZIER ALAN D CENTRAL INDEX KEY: 0001018534 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37372 FILM NUMBER: 15837076 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: FHM VI, L.L.C. CENTRAL INDEX KEY: 0001456654 STATE OF INCORPORATION: DE FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37372 FILM NUMBER: 15837077 BUSINESS ADDRESS: STREET 1: 601 UNION STREET, SUITE 3200 CITY: SEATTLE STATE: WA ZIP: 98101 BUSINESS PHONE: 206-621-7200 MAIL ADDRESS: STREET 1: 601 UNION STREET, SUITE 3200 CITY: SEATTLE STATE: WA ZIP: 98101 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: FHM VI, L.P. CENTRAL INDEX KEY: 0001456655 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37372 FILM NUMBER: 15837078 BUSINESS ADDRESS: STREET 1: 601 UNION STREET, SUITE 3200 CITY: SEATTLE STATE: WA ZIP: 98101 BUSINESS PHONE: 206-621-7200 MAIL ADDRESS: STREET 1: 601 UNION STREET, SUITE 3200 CITY: SEATTLE STATE: WA ZIP: 98101 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Frazier Healthcare VI, L.P. CENTRAL INDEX KEY: 0001456656 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37372 FILM NUMBER: 15837079 BUSINESS ADDRESS: STREET 1: 601 UNION STREET, SUITE 3200 CITY: SEATTLE STATE: WA ZIP: 98101 BUSINESS PHONE: 206-621-7200 MAIL ADDRESS: STREET 1: 601 UNION STREET, SUITE 3200 CITY: SEATTLE STATE: WA ZIP: 98101 3 1 edgar.xml PRIMARY DOCUMENT X0206 3 2015-05-06 0 0001267565 COLLEGIUM PHARMACEUTICAL, INC COLL 0001456656 Frazier Healthcare VI, L.P. 601 UNION STREET, SUITE 3200 SEATTLE WA 98101 0 0 1 0 0001456655 FHM VI, L.P. 601 UNION STREET, SUITE 3200 SEATTLE WA 98101 0 0 1 0 0001456654 FHM VI, L.L.C. 601 UNION STREET, SUITE 3200 SEATTLE WA 98101 0 0 1 0 0001018534 FRAZIER ALAN D C/O FRAZIER HEALTHCARE VI, L.P. 601 UNION STREET, SUITE 3200 SEATTLE WA 98101 0 0 1 0 0001344203 Naini Nader J C/O FRAZIER HEALTHCARE VI, L.P. 601 UNION STREET, SUITE 3200 SEATTLE WA 98101 0 0 1 0 0001341382 Topper James N C/O FRAZIER HEALTHCARE VI, L.P. 601 UNION STREET, SUITE 3200 SEATTLE WA 98101 0 0 1 0 0001531105 Every Nathan R C/O FRAZIER HEALTHCARE VI, L.P. 601 UNION STREET, SUITE 3200 SEATTLE WA 98101 0 0 1 0 Series A Convertible Preferred Stock Common Stock 582490 I By: Frazier Healthcare VI, L.P. Series B Convertible Preferred Stock Common Stock 222231 I By: Frazier Healthcare VI, L.P. Series C Convertible Preferred Stock Common Stock 392113 I By: Frazier Healthcare VI, L.P. Series D Convertible Preferred Stock Common Stock 532764 I By: Frazier Healthcare VI, L.P. All series of Convertible Preferred Stock will automatically convert into Collegium Pharmaceutical, Inc. (the "Issuer") common stock on a 1-for-6.9 basis immediately prior to the closing of the initial public offering and have no expiration date. This report is filed jointly by Frazier Healthcare VI, L.P. ("FHVI"), FHM VI, L.P. ("FHM LP"), FHM VI, L.L.C. ("FHM LLC"), Nathan Every ("Every"), Alan Frazier ("Frazier"), Nader Naini ("Naini") and James Topper ("Topper"), all of whom share beneficial ownership of more than 10% of the capital stock of the Issuer. FHVI is the record holder of 4,019,183 shares of Series A Convertible Preferred Stock, which will automatically convert into 582,490 shares of common stock upon the closing of the Issuer's initial public offering. FHVI is the record holder of 1,533,399 shares of Series B Convertible Preferred Stock, which will automatically convert into 222,231 shares of common stock upon the closing of the Issuer's initial public offering. (continued in footnote 3) FHVI is the record holder of 1,533,399 shares of Series B Convertible Preferred Stock, which will automatically convert into 222,231 shares of common stock upon the closing of the Issuer's initial public offering. FHVI is the record holder of 2,705,585 shares of Series C Convertible Preferred Stock, which will automatically convert into 392,113 shares of common stock upon the closing of the Issuer's initial public offering. FHVI is the record holder of 3,676,078 shares of Series D Convertible Preferred Stock, which will automatically convert into 532,764 shares of common stock upon the closing of the Issuer's initial public offering. The shares are held by FHVI. The general partner of FHVI is FHM LP, a limited partnership, the general partner of which is FHM LLC. The members of FHM LLC are Every, Frazier, Naini, Heron, and Topper. These individuals share voting and investment power over the shares held by FHVI. Each of these individuals disclaims beneficial ownership of such shares, except to the extent of his pecuniary interest. Frazier Healthcare VI, L.P., By: FHM VI, L.P., its general partner, By FHM VI, L.L.C., its general partner, By: /s/ Steve Bailey, Chief Financial Officer 2015-05-06 FHM VI, L.P., By: FHM VI, L.L.C., its general partner, By: /s/ Steve Bailey, Chief Financial Officer 2015-05-06 FHM VI, L.L.C., By: /s/ Steve Bailey, Chief Financial Officer 2015-05-06 /s/ Alan Frazier 2015-05-06 /s/ Nader Naini 2015-05-06 /s/ James Topper 2015-05-06 /s/ Nathan Every 2015-05-06