-----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, M1d+yE/L7d/NyWXzlU4jUYUUyjqFJYnGCyO//T9BRHicVP5KFsnF49N1Uk3sKXGR IhGrtZZV+IIRA0Pm3TVMRg== 0000914190-05-000446.txt : 20051114 0000914190-05-000446.hdr.sgml : 20051111 20051114160301 ACCESSION NUMBER: 0000914190-05-000446 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20050930 FILED AS OF DATE: 20051114 DATE AS OF CHANGE: 20051114 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: KOCH DAVID A CENTRAL INDEX KEY: 0001066677 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 000-23837 FILM NUMBER: 051201507 BUSINESS ADDRESS: 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 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: SURMODICS INC CENTRAL INDEX KEY: 0000924717 STANDARD INDUSTRIAL CLASSIFICATION: PATENT OWNERS & LESSORS [6794] 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 5 1 edgar.xml PRIMARY DOCUMENT X0202 5 2005-09-30 0 0 0000924717 SURMODICS INC SRDX 0001066677 KOCH DAVID A 505 N. HIGHWAY 169 SUITE 595 PLYMOUTH MN 55441 1 0 0 0 Common Stock 2005-08-25 5 G 0 1800 0 D 781420 D Common Stock 2005-09-26 5 G 0 650 0 D 780770 D Common Stock 2005-10-14 5 G 0 6225 0 D 774545 D Common Stock 2005-11-03 5 G 0 4250 0 D 770295 D Common Stock 172000 I Trust Director Stock Option (Right to Buy) 6.563 2009-05-17 Common Stock 9000 9000 D Director Stock Option (Right to Buy) 25.094 2010-09-18 Common Stock 2000 2000 D Director Stock Option (Right to Buy) 34.85 2011-11-21 Common Stock 1000 1000 D Director Stock Option (Right to Buy) 29.17 2013-03-17 Common Stock 2000 2000 D Director Stock Option (Right to Buy) 21.82 2014-05-17 Common Stock 5000 5000 D These 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 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 commencing 3/17/03. Exercisable in annual increments of 1,000 shares each commencing 5/17/04. /s/ David A. Koch 2005-11-14 -----END PRIVACY-ENHANCED MESSAGE-----