SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person*
Hirsch David

(Last) (First) (Middle)
C/O LONGITUDE CAPITAL PARTNERS, LLC
800 EL CAMINO REAL, STE. 220

(Street)
MENLO PARK CA 94024

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
05/06/2015
3. Issuer Name and Ticker or Trading Symbol
COLLEGIUM PHARMACEUTICAL, INC [ COLL ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director X 10% Owner
Officer (give title below) Other (specify below)
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Series B Convertible Preferred Stock (1) (1) Common Stock 1,860,570(1) (1) I By: Longitude Venture Partners, L.P.(2)
Series B Convertible Preferred Stock (1) (1) Common Stock 37,290(1) (1) I By: Longitude Capital Associates, L.P.(2)
Series C Convertible Preferred Stock (1) (1) Common Stock 458,102(1) (1) I By: Longitude Venture Partners, L.P.(2)
Series C Convertible Preferred Stock (1) (1) Common Stock 9,182(1) (1) I By: Longitude Capital Associates, L.P.(2)
Series D Convertible Preferred Stock (1) (1) Common Stock 731,214(1) (1) I By: Longitude Venture Partners, L.P.(2)
Series D Convertible Preferred Stock (1) (1) Common Stock 14,656(1) (1) I By: Longitude Capital Associates, L.P.(2)
Explanation of Responses:
1. All series of Convertible Preferred Stock will automatically convert into Collegium Pharmaceutical, Inc. common stock on a 1-for-6.9 basis immediately prior to the closing of the initial public offering and have no expiration date.
2. The shares are held by Longitude Venture Partners, L.P. and Longitude Capital Associates, L.P. (collectively, the "Longitude Funds"). Longitude Capital Partners, LLC is the general partner of the Longitude Funds and may be deemed to have sole voting investment and dispositive power over the shares held by the Longitude Funds. Patrick G. Enright and Juliet Tammenoms Bakker are managing members of Longitude Capital Partners, LLC and in their capacity as such, may be deemed to exercise shared voting and investment power over the shares held by the reporting persons. David Hirsch is a member of Longitude Capital Partners, LLC. Dr. Hirsch disclaims beneficial ownership of such shares except to the extent of his pecuniary interest therein.
Remarks:
/s/ Paul Brannelly as Attorney-In-Fact For David Hirsch 05/06/2015
** 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 5 (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.
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