0001192482-15-000207.txt : 20150514 0001192482-15-000207.hdr.sgml : 20150514 20150514160649 ACCESSION NUMBER: 0001192482-15-000207 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20150512 FILED AS OF DATE: 20150514 DATE AS OF CHANGE: 20150514 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: Heron Patrick J CENTRAL INDEX KEY: 0001365617 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37372 FILM NUMBER: 15862870 MAIL ADDRESS: STREET 1: 550 HAMILTON AVE., SUITE 100 CITY: PALO ALTO STATE: CA ZIP: 94301 4 1 edgar.xml PRIMARY DOCUMENT X0306 4 2015-05-12 0001267565 COLLEGIUM PHARMACEUTICAL, INC COLL 0001365617 Heron Patrick J C/O FRAZIER HEALTHCARE VI, L.P. 601 UNION STREET, SUITE 3200 SEATTLE WA 98101 1 0 1 0 Common Stock 2015-05-12 4 C 0 582490 A 582490 I By Frazier Healthcare VI, L.P. Common Stock 2015-05-12 4 C 0 222231 A 804721 I By Frazier Healthcare VI, L.P. Common Stock 2015-05-12 4 C 0 392113 A 1196834 I By Frazier Healthcare VI, L.P. Common Stock 2015-05-12 4 C 0 540498 A 1737332 I By Frazier Healthcare VI, L.P. Common Stock 2015-05-12 4 P 0 150000 12.00 A 1887332 I By Frazier Healthcare VI, L.P. Series A Convertible Stock 2015-05-12 4 C 0 4019183 0 D Common Stock 582490 0 I By Frazier Healthcare VI, L.P. Series B Convertible Stock 2015-05-12 4 C 0 1533399 0 D Common Stock 222231 0 I By Frazier Healthcare VI, L.P. Series C Convertible Stock 2015-05-12 4 C 0 2705585 0 D Common Stock 392113 0 I By Frazier Healthcare VI, L.P. Series D Convertible Stock 2015-05-12 4 C 0 3676078 0 D Common Stock 540498 0 I By Frazier Healthcare VI, L.P. All series of Convertible Preferred Stock automatically converted into Collegium Pharmaceutical, Inc. common stock on a 1-for-6.9 basis immediately prior to the closing of the initial public offering and had no expiration date. Reflects the conversion of preferred stock into Collegium Pharmaceutical, Inc. common stock on a 1-for-6.9 basis which became effective on May 12, 2015. The shares are held by Frazier Healthcare VI, L.P. The general partner of Frazier Healthcare VI, L.P. is FHM VI, L.P., a limited partnership, the general partner of which is FHM VI, LLC. The members of FHM VI, LLC are Dr. Nathan Every, Alan Frazier, Nader Naini, Patrick Heron, and Dr. James Topper. These individuals share voting and investment power over the shares held by Frazier Healthcare VI, L.P. Mr. Heron disclaims beneficial ownership of such shares, except to the extent of his pecuniary interest. /s/ Paul Brannelly as Attorney-In-Fact For Patrick Heron 2015-05-13