0001209191-15-042578.txt : 20150513
0001209191-15-042578.hdr.sgml : 20150513
20150513214112
ACCESSION NUMBER: 0001209191-15-042578
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20150512
FILED AS OF DATE: 20150513
DATE AS OF CHANGE: 20150513
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: KANEKO YASUNORI
CENTRAL INDEX KEY: 0001277503
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37372
FILM NUMBER: 15860083
MAIL ADDRESS:
STREET 1: 509 ROEHAMPTON
CITY: HILLS BOROUGH
STATE: CA
ZIP: 94010
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Skyline Venture Management V, LLC
CENTRAL INDEX KEY: 0001434887
STATE OF INCORPORATION: CA
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37372
FILM NUMBER: 15860084
BUSINESS ADDRESS:
STREET 1: 525 UNIVERSITY AVENUE
CITY: PALO ALTO
STATE: CA
ZIP: 94301
BUSINESS PHONE: 650-475-0144
MAIL ADDRESS:
STREET 1: 525 UNIVERSITY AVENUE
CITY: PALO ALTO
STATE: CA
ZIP: 94301
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Skyline Venture Partners V LP
CENTRAL INDEX KEY: 0001419187
STATE OF INCORPORATION: DE
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37372
FILM NUMBER: 15860085
BUSINESS ADDRESS:
STREET 1: 525 University Avenue
STREET 2: Suite 520
CITY: Palo Alto
STATE: CA
ZIP: 94301
MAIL ADDRESS:
STREET 1: 525 University Avenue
STREET 2: Suite 520
CITY: Palo Alto
STATE: CA
ZIP: 94301
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2015-05-12
0
0001267565
COLLEGIUM PHARMACEUTICAL, INC
COLL
0001419187
Skyline Venture Partners V LP
525 UNIVERSITY AVENUE, SUITE 610
PALO ALTO
CA
94301
0
0
1
0
0001434887
Skyline Venture Management V, LLC
525 UNIVERSITY AVENUE, SUITE 610
PALO ALTO
CA
94301
0
0
1
0
0001277503
KANEKO YASUNORI
525 UNIVERSITY AVENUE, SUITE 610
PALO ALTO
CA
94301
0
0
1
0
Common Stock
2015-05-12
4
C
0
1552795
A
1552795
I
see footnote
Common Stock
2015-05-12
4
C
0
382323
A
1935118
I
see footnote
Common Stock
2015-05-12
4
C
0
864798
A
2799916
I
see footnote
Common Stock
2015-05-12
4
P
0
150000
12.00
A
2949916
I
see footnote
Series B Convertible Preferred Stock
2015-05-12
4
C
0
10714286
0.00
D
Common Stock
1552795
0
I
see footnote
Series C Convertible Preferred Stock
2015-05-12
4
C
0
2638030
0.00
D
Common Stock
382323
0
I
see footnote
Series D Convertible Preferred Stock
2015-05-12
4
C
0
5881724
0.00
D
Common Stock
864798
0
I
see footnote
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 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 and disclaim beneficial ownership of all the shares held by Skyline Venture Partners V, L.P. except to the extent of their proportionate pecuniary interest therein. Dr. Freund is a director of the Issuer and, accordingly, files separate Section 16 reports.
/s/ Kerensa Kenny, Attorney-in-Fact
2015-05-13