SEC Form 4 · accession 0001192482-15-000207

COLLEGIUM PHARMACEUTICAL, INC · COLL

Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗

Reporting owner

Director · 10% Owner

Period of report

May 12, 2015

Accepted (ET)

May 14, 2015 · 4:06 pm EDT

Rule 10b5-1 plan

unknown — predates the checkbox

Issuer CIK

0001267565

Table I — non-derivative securities

Security	Date	Code	Shares	Price	A/D	Owned after	D/I	Nature of ownership
Common Stock^F1,F2,F3	May 12, 2015	C	582,490	—	A	582,490	I	By Frazier Healthcare VI, L.P.
Common Stock^F1,F2,F3	May 12, 2015	C	222,231	—	A	804,721	I	By Frazier Healthcare VI, L.P.
Common Stock^F1,F2,F3	May 12, 2015	C	392,113	—	A	1,196,834	I	By Frazier Healthcare VI, L.P.
Common Stock^F1,F2,F3	May 12, 2015	C	540,498	—	A	1,737,332	I	By Frazier Healthcare VI, L.P.
Common Stock^F3	May 12, 2015	P	150,000	$12.00	A	1,887,332	I	By Frazier Healthcare VI, L.P.

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	D/I
Series A Convertible Stock^F3,F1,F2	—	May 12, 2015	C	4,019,183	D	—	—	Common Stock	582,490	I
Series B Convertible Stock^F3,F1,F2	—	May 12, 2015	C	1,533,399	D	—	—	Common Stock	222,231	I
Series C Convertible Stock^F3,F1,F2	—	May 12, 2015	C	2,705,585	D	—	—	Common Stock	392,113	I
Series D Convertible Stock^F3,F1,F2	—	May 12, 2015	C	3,676,078	D	—	—	Common Stock	540,498	I

F1All 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.
F2Reflects 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.
F3The 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.