SEC Form 4 · accession 0001209191-15-042578

COLLEGIUM PHARMACEUTICAL, INC · COLL

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

Reporting owners

10% Owner

10% Owner

10% Owner

Period of report

May 12, 2015

Accepted (ET)

May 13, 2015 · 9:41 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	1,552,795	—	A	1,552,795	I	see footnote
Common Stock^F1,F2,F3	May 12, 2015	C	382,323	—	A	1,935,118	I	see footnote
Common Stock^F1,F2,F3	May 12, 2015	C	864,798	—	A	2,799,916	I	see footnote
Common Stock^F3	May 12, 2015	P	150,000	$12.00	A	2,949,916	I	see footnote

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	D/I
Series B Convertible Preferred Stock^F3,F1	—	May 12, 2015	C	10,714,286	D	—	—	Common Stock	1,552,795	I
Series C Convertible Preferred Stock^F3,F1	—	May 12, 2015	C	2,638,030	D	—	—	Common Stock	382,323	I
Series D Convertible Preferred Stock^F3,F1	—	May 12, 2015	C	5,881,724	D	—	—	Common Stock	864,798	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 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.