-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, U8twzN86ObZRkF35Y9Vgyq9QrEb5q1QzTyBmixlpgDnryCICz1AgN/3UHZlpHDlS Dh7weqawuxE0O64Cw8ikug== 0000914190-03-000172.txt : 20031202 0000914190-03-000172.hdr.sgml : 20031202 20031202173254 ACCESSION NUMBER: 0000914190-03-000172 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20031106 FILED AS OF DATE: 20031202 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: SURMODICS INC CENTRAL INDEX KEY: 0000924717 STANDARD INDUSTRIAL CLASSIFICATION: ADHESIVES & SEALANTS [2891] IRS NUMBER: 411356149 STATE OF INCORPORATION: MN FISCAL YEAR END: 0930 BUSINESS ADDRESS: STREET 1: 9924 W 74TH ST CITY: EDEN PRAIRIE STATE: MN ZIP: 55344 BUSINESS PHONE: 6128292700 MAIL ADDRESS: STREET 1: 9924 WEST 74TH ST CITY: EDEN PRAIRIE STATE: MN ZIP: 55344 FORMER COMPANY: FORMER CONFORMED NAME: BSI CORP DATE OF NAME CHANGE: 19970506 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: KOCH DAVID A CENTRAL INDEX KEY: 0001066677 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-23837 FILM NUMBER: 031033460 BUSINESS ADDRESS: STREET 1: C/O TRUST U/W CLARISSA GRAY STREET 2: 505 N HIGHWAY 169 SUITE 595 CITY: PLYMOUTH STATE: MN ZIP: 55441 BUSINESS PHONE: 6123402600 MAIL ADDRESS: STREET 1: C/O TRUST U/W CLARISSA GRAY STREET 2: 505 N HIGHWAY 169 SUITE 595 CITY: PLYMOUTH STATE: MN ZIP: 55441 4 1 edgar.xml PRIMARY DOCUMENT X0201 42003-11-06 0000924717 SURMODICS INC SRDX 0001066677 KOCH DAVID A 505 N. HIGHWAY 169 SUITE 595 PLYMOUTH MN 55441 1000Common Stock2003-11-065G05000A764220DCommon Stock2003-11-264P01000020.6436A774220DCommon Stock172000ITrustDirector Stock Option (Right to Buy)6.5632009-05-17Common Stock90009000DDirector Stock Option (Right to Buy)2.502005-09-18Common Stock4000040000DDirector Stock Option (Right to Buy)25.0942010-09-18Common Stock20002000DDirector Stock Option (Right to Buy)34.852011-11-21Common Stock10001000DDirector Stock Option (Right to Buy)29.172013-03-17Common Stock20002000DThese shares are owned by a trust established under the will of Clarissa L. Gray. The wife and children of David A. Koch are among the beneficiaries of the trust. The trustees of the trust are David A. Koch, Paul M. Torgerson and U.S. Bank Trust National Association SD.Exercisable in annual increments of 1,800 shares each commencing 5/17/99.Exercisable in annual increments of 8,000 shares each coommencing 9/18/95.Exercisable in annual increments of 400 shares each commencing 9/18/00.Exercisable in annual increments of 200 shares each commencing 11/21/01.Exercisable in annual increments of 400 shares each comm encing 3/17/03.Revised to reflect correct number of shares which were inadvertently reported as 3,000.David A. Koch2003-12-02 -----END PRIVACY-ENHANCED MESSAGE-----