SC 13G/A 1 c67047asc13ga.htm AMENDMENT #3 TO SCHEDULE 13G Amendment to Schedule 13G
 

SCHEDULE 13G

(RULE 13d-102)

Information to be Included in Statements Filed Pursuant to Rule 13d-1(b), (c)
and (d) and Amendments Thereto Filed Pursuant to Rule 13d-2.

SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, DC 20549

SCHEDULE 13G

Under the Securities Exchange Act of 1934
(Amendment No. 3)*

SurModics, Inc.
(Name of Issuer)

Common Stock, $.05 par value
(Title of Class of Securities)

868873 10 0
(CUSIP Number)

December 31, 2001
(Date of Event Which Requires Filing of this Statement)

      Check the appropriate box to designate the rule pursuant to which this Schedule is filed:

     
OPEN BALLOT BOX Rule 13d-1(b)
OPEN BALLOT BOX Rule 13d-1(c)
X IN A BALLOT Rule 13d-1(d)

*      The remainder of this cover page shall be filled out for a reporting person’s initial filing on this form with respect to the subject class of securities, and for any subsequent amendment containing information which would alter the disclosures provided in a prior cover page.

         The information required in the remainder of this cover page shall not be deemed to be “filed” for the purpose of Section 18 of the Securities Exchange Act of 1934 (“Act”) or otherwise subject to the liabilities of that section of the Act, but shall be subject to all other provisions of the Act (however, see the Notes).


 

                 
CUSIP NO. 868873 10 0 13G PAGE 2 OF 4 PAGES

  1 Names of Reporting Persons/I.R.S. Identification Nos. of Above Persons (Entities Only)

David A. Koch


  2 Check the Appropriate Box if a Member of a Group
(See Instructions)

(a)   OPEN BALLOT BOX

(b)   OPEN BALLOT BOX

 


  3 SEC Use Only

 


  4 Citizenship or Place of Organization

U.S.A.

 


  5   Sole Voting Power
Number of     810,960 (includes 46,400 shares which may be purchased upon exercise of options)
   
Shares   6   Shared Voting Power
    192,000
Beneficially        
   
Owned By Each   7   Sole Dispositive Power
    810,960 (includes 46,400 shares which may be purchased upon exercise of options)
Reporting      
   
Person   8   Shared Dispositive Power
    192,000
With      

  9 Aggregate Amount Beneficially Owned by Each Reporting Person

1,002,960 (includes 46,400 shares which may be purchased upon exercise of options)


  10 Check if the Aggregate Amount in Row (9) Excludes Certain Shares
(See Instructions)

OPEN BALLOT BOX

 


  11 Percent of Class Represented by Amount In Row (9)

6.0%


  12 Type Of Reporting Person (See Instructions)

IN

 



 

Answer every item. If an item is inapplicable or the answer is in the negative, so state.

     
Item 1(a)   Name of Issuer:
 
    SurModics, Inc.
 
Item 1(b)   Address of Issuer’s Principal Executive Offices:
 
    9924 West 74th Street
Eden Prairie, MN 55344
 
Item 2(a)   Name of Person Filing:
 
    See Cover Page Item 1
 
Item 2(b)   Address of Principal Business Office or, if none, residence:
 
    1582A Homestead Trail
Long Lake, MN 55356
 
Item 2(c)   Citizenship:
 
    See Cover Page Item 4
 
Item 2(d)   Title of Class of Securities:
 
    Common Stock, $.05 par value
 
Item 2(e)   CUSIP No.:
 
    See Cover Page
 
Item 3   Statement filed pursuant to Rule 13d-1(b), or 13d-2(b) or (c):
 
    Not applicable
 
Item 4   Ownership
 
    See Cover Page Items 5 through 11
 
Item 5   Ownership of Five Percent or Less of a Class:
 
    If this statement is being filed to report the fact that as of the date hereof the reporting person has ceased to be the beneficial owner of more than five percent of the class of securities, check the following OPEN BALLOT BOX

Page 3 of 4 Pages


 

     
Item 6   Ownership of More than Five Percent on Behalf of Another Person:
 
    Not applicable
 
Item 7   Identification and Classification of the Subsidiary Which Acquired the Security Being Reported on by the Parent Holding Company:
 
    Not applicable
 
Item 8   Identification and Classification of Members of the Group:
 
    Not applicable
 
Item 9   Notice of Dissolution of Group:
 
    Not applicable
 
Item 10   Certifications:
 
    Not applicable

SIGNATURE

     After reasonable inquiry and to the best of my knowledge and belief, I certify that the information set forth in this statement is true, complete and correct as of December 31, 2001.

 
January 16, 2002
(Date)
 
/s/ David A. Koch
(Signature)
 
David A. Koch
(Name and title)

Page 4 of 4 Pages