0001192482-17-000304.txt : 20171207 0001192482-17-000304.hdr.sgml : 20171207 20171207190508 ACCESSION NUMBER: 0001192482-17-000304 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20171205 FILED AS OF DATE: 20171207 DATE AS OF CHANGE: 20171207 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: KANEKO YASUNORI CENTRAL INDEX KEY: 0001277503 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37372 FILM NUMBER: 171245845 MAIL ADDRESS: STREET 1: 509 ROEHAMPTON CITY: HILLS BOROUGH STATE: CA ZIP: 94010 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 4 1 edgar.xml PRIMARY DOCUMENT X0306 4 2017-12-05 0001267565 COLLEGIUM PHARMACEUTICAL, INC COLL 0001277503 KANEKO YASUNORI C/O SKYLINE VENTURE PARTNERS V, L.P. 525 UNIVERSITY AVE. PALO ALTO CA 94301 0 0 1 0 Common Stock 2017-12-05 4 J 0 800000 0 D 2149916 I By Skyline Venture Partners V, L.P. Common Stock 2017-12-05 4 J 0 270 0 A 270 I By the Kaneko Family Trust Represents a pro rata in-kind distribution of the shares by Skyline Venture Partners V, L.P. without consideration to its limited and general partners. The shares are held by Skyline Venture Partners V, L.P. The general partner of Skyline Venture Partners V, L.P. is Skyline Venture Management V, LLC. John G. Freund and Yasunori Kaneko are managers of Skyline Venture Management V, LLC. These individuals share voting and investment power over the shares held by Skyline Venture Management, LLC. Dr. Kaneko disclaims beneficial ownership of all the shares held by Skyline Venture Partners V, L.P. except to the extent of his proportionate pecuniary interest therein. Represents a pro rata in-kind distribution of the shares by Skyline Venture Partners V, L.P. without consideration to the reporting person. /s/ Kerensa Kenny, Attorney-in-Fact 2017-12-07