0001209191-17-063114.txt : 20171130
0001209191-17-063114.hdr.sgml : 20171130
20171130202459
ACCESSION NUMBER: 0001209191-17-063114
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20171128
FILED AS OF DATE: 20171130
DATE AS OF CHANGE: 20171130
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: LaFrence Andrew D. C.
CENTRAL INDEX KEY: 0001569676
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-23837
FILM NUMBER: 171232468
MAIL ADDRESS:
STREET 1: 10475 110TH STREET NORTH
CITY: STILLWATER
STATE: MN
ZIP: 55082
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
4
1
doc4.xml
FORM 4 SUBMISSION
X0306
4
2017-11-28
0
0000924717
SURMODICS INC
SRDX
0001569676
LaFrence Andrew D. C.
9924 WEST 74TH STREET
EDEN PRAIRIE
MN
55344
0
1
0
0
VP of Finance & CFO
Common Stock
2017-11-28
4
A
0
4518
0.00
A
17543
D
Common Stock
2017-11-28
4
A
0
6525
0.00
A
24068
D
Common Stock
2017-11-28
4
F
0
3146
33.20
D
20922
D
Common Stock
2017-11-30
4
F
0
436
33.10
D
20486
D
Employee Stock Option (right to buy)
33.20
2017-11-28
4
A
0
21285
0.00
A
2024-11-28
Common Stock
21285
21285
D
Includes 865 shares acquired through the Employee Stock Purchase Plan for the phase ending February 29, 2016, February 28, 2017 and August 31, 2017.
Shares issued in connection with the vesting of a performance share award under long-term incentive plan based on performance during three-year period ended September 30, 2017.
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 28, 2017 grant date.
/s/ Bryan K. Phillips, on behalf of Andrew D.C. LaFrence
2017-11-30