-----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, KqvmrTLe4eoDVfUGySqAy8bEM1JvTLUt0W840E21EfgnZbbOpHpvmov97YQTld6Y 80qOSCkLVBoCD9N0omAhmw== 0001193125-09-008290.txt : 20090120 0001193125-09-008290.hdr.sgml : 20090119 20090120143803 ACCESSION NUMBER: 0001193125-09-008290 CONFORMED SUBMISSION TYPE: SC 13G/A PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 20090120 DATE AS OF CHANGE: 20090120 FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: KOCH DAVID A CENTRAL INDEX KEY: 0001066677 FILING VALUES: FORM TYPE: SC 13G/A 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 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: SURMODICS INC CENTRAL INDEX KEY: 0000924717 STANDARD INDUSTRIAL CLASSIFICATION: PHARMACEUTICAL PREPARATIONS [2834] IRS NUMBER: 411356149 STATE OF INCORPORATION: MN FISCAL YEAR END: 0930 FILING VALUES: FORM TYPE: SC 13G/A SEC ACT: 1934 Act SEC FILE NUMBER: 005-55203 FILM NUMBER: 09533906 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 SC 13G/A 1 dsc13ga.htm SCHEDULE 13G AMENDMENT NO. 10 Schedule 13G Amendment No. 10

UNITED STATES

SECURITIES AND EXCHANGE COMMISSION

Washington, D.C. 20549

 

Schedule 13G

 

Under the Securities Exchange Act of 1934

(Amendment No. 10)

 

 

 

 

SurModics, Inc.

(Name of Issuer)

 

 

Common Stock, $.05 par value

(Title of Class of Securities)

 

 

868873 10 0

(CUSIP Number)

 

 

December 31, 2008

(Date of Event Which Requires Filing of this Statement)

 

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

¨ Rule 13d-1(b)

¨ Rule 13d-1(c)

x Rule 13d-1(d)


Page 2 of 5

CUSIP NO. 868873 10 0

 

   

Name of reporting persons:

I.R.S. Identification Nos. of above persons (entities only):

 

            David A. Koch

   
  1.  

Check the appropriate box if a member of a group:

(a)  ¨

(b)  ¨

   
  2.  

SEC use only:

 

   
  3.  

Citizenship or place of organization:

 

            USA

   

 

Number of  

shares  

beneficially  

owned by  

each  

reporting  

person  

with:  

 

 

  4.    Sole voting power:

 

            290,003 (includes 4,000 shares which may be purchased upon the exercise of options)

 

  5.    Shared voting power:

 

            35,000

 

  6.    Sole dispositive power:

 

            290,003 (includes 4,000 shares which may be purchased upon the exercise of options)

 

  7.    Shared dispositive power:

 

            35,000

  8.  

Aggregate amount beneficially owned by each reporting person:

 

            325,003 (includes 4,000 shares which may be purchased upon the exercise of options)

   
9.  

Check if the aggregate amount in Row (9) excludes certain shares

 

 

 

¨

 

10.  

Percent of class represented by amount in Row 9:

 

            1.8%

   
11.  

Type of reporting person:

 

            IN

   

 


Page 3 of 5

CUSIP NO. 868873 10 0

 

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 55344-3523

     
Item 2  

(a).

   Names of person filing:      
     David A. Koch      
Item 2  

(b).

   Address of principal business office:      
    

505 N Highway 169

Suite 595

Plymouth, MN 55441

     
Item 2  

(c).

   Citizenship:      
     USA      
Item 2  

(d).

   Title of class of securities:      
     Common Stock, $.05 par value      
Item 2  

(e).

   CUSIP No.:      
     868873 10 0      
Item 3.   If this statement is filed pursuant to Secs. 240.13d-1(b) or 240.13d-2(b) or (c), check whether the person filing is a:   
  Not applicable   


Page 4 of 5

CUSIP NO. 868873 10 0

 

Item 4.    Ownership      
   (a)    Amount beneficially owned: 325,003      
   (b)    Percent of class: 1.8%      
   (c)    Number of shares as to which the person has:      
      (i)    Sole power to vote or to direct the vote: 290,003 (includes 4,000 shares which may be purchased upon the exercise of options)      
      (ii)    Shared power to vote or to direct the vote: 35,000      
      (iii)    Sole power to dispose or to direct the disposition of: 290,003 (includes 4,000 shares which may be purchased upon the exercise of options)      
      (iv)    Shared power to dispose or to direct the disposition of: 35,000      
Item 5.    Ownership of 5 percent or Less of a Class:    x   
Item 6.    Ownership of More than 5 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 or Control Person: 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      


Page 5 of 5

 

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.

Dated: January 20, 2009

 

/s/ David A. Koch

Signature

David A. Koch

Name/Title
-----END PRIVACY-ENHANCED MESSAGE-----