0001209191-12-057795.txt : 20121214 0001209191-12-057795.hdr.sgml : 20121214 20121214164300 ACCESSION NUMBER: 0001209191-12-057795 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20121212 FILED AS OF DATE: 20121214 DATE AS OF CHANGE: 20121214 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: SURMODICS INC CENTRAL INDEX KEY: 0000924717 STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841] 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: DANTZKER DAVID CENTRAL INDEX KEY: 0001245926 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-23837 FILM NUMBER: 121266098 MAIL ADDRESS: STREET 1: 80 CUTTERMILL ROAD STE 311 CITY: GREAT NECK STATE: NY ZIP: 11021 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2012-12-12 0 0000924717 SURMODICS INC SRDX 0001245926 DANTZKER DAVID C/O WHEATLEY PARTNERS, L.P. 80 CUTTERMILL ROAD GREAT NECK NY 11021 1 0 0 0 Common Stock 2012-12-12 4 A 0 1472 0.00 A 1972 D Stock Option (Right to Buy) 20.37 2012-12-12 4 A 0 3537 0.00 A 2019-12-12 Common Stock 3537 3537 D Represents a stock option award granted pursuant to the issuer's Board Compensation Policy, amended and restated as of February 8, 2010. The award vests in four equal installments on each of the first four anniversaries of the December 12, 2012 grant date. /s/ Bryan K. Phillips, on behalf of David R. Dantzker 2012-12-14