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