0001209191-16-153156.txt : 20161202 0001209191-16-153156.hdr.sgml : 20161202 20161202183731 ACCESSION NUMBER: 0001209191-16-153156 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20161130 FILED AS OF DATE: 20161202 DATE AS OF CHANGE: 20161202 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: 9525007000 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: Arens Timothy J. CENTRAL INDEX KEY: 0001506586 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-23837 FILM NUMBER: 162032362 MAIL ADDRESS: STREET 1: 9924 WEST 74TH STREET CITY: EDEN PRAIRIE STATE: X1 ZIP: 55344 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2016-11-30 0 0000924717 SURMODICS INC SRDX 0001506586 Arens Timothy J. 9924 WEST 74TH STREET EDEN PRAIRIE MN 55344 0 1 0 0 VP-Corporate Dev. and Strategy Common Stock 2016-11-30 4 A 0 2713 0.00 A 21425 D Common Stock 2016-11-30 4 A 0 4881 0.00 A 26306 D Common Stock 2016-11-30 4 F 0 2353 23.95 D 23953 D Employee Stock Option (right to buy) 23.95 2016-11-30 4 A 0 17121 0.00 A 2023-11-30 Common Stock 17121 17121 D Performance shares awarded under long-term incentive plan based on performance during three-year period ended September 30, 2016. Shares withheld to satisfy taxes incident to vesting of performance share award. The award vests in four equal installments on each of the first four anniversaries of the November 30, 2016 grant date. /s/ Bryan K. Phillips on behalf of Timothy J. Arens 2016-12-02