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