0001209191-17-011506.txt : 20170216 0001209191-17-011506.hdr.sgml : 20170216 20170216164914 ACCESSION NUMBER: 0001209191-17-011506 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20170214 FILED AS OF DATE: 20170216 DATE AS OF CHANGE: 20170216 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: DANTZKER DAVID CENTRAL INDEX KEY: 0001245926 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-23837 FILM NUMBER: 17618526 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 2017-02-14 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 2017-02-14 4 A 0 1252 0.00 A 15407 D Stock Option (right to buy) 23.95 2017-02-14 4 A 0 3932 0.00 A 2024-02-14 Common Stock 3932 3932 D The amount beneficially owned includes 6,945 restricted stock units (RSUs) that vest on service-based vesting dates and 7,962 DSUs that are vested upon issuance, each of which will be settled in shares of the issuer's common stock on a 1 for 1 basis when the reporting person's service as a director ends. The award will vest in full on February 14, 2018. /s/ Bryan K. Phillips, on behalf of David R. Dantzker 2017-02-16