0001209191-21-000380.txt : 20210104
0001209191-21-000380.hdr.sgml : 20210104
20210104171744
ACCESSION NUMBER: 0001209191-21-000380
CONFORMED SUBMISSION TYPE: 4/A
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20201118
FILED AS OF DATE: 20210104
DATE AS OF CHANGE: 20210104
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: DANTZKER DAVID
CENTRAL INDEX KEY: 0001245926
FILING VALUES:
FORM TYPE: 4/A
SEC ACT: 1934 Act
SEC FILE NUMBER: 000-23837
FILM NUMBER: 21502753
MAIL ADDRESS:
STREET 1: 80 CUTTERMILL ROAD STE 311
CITY: GREAT NECK
STATE: NY
ZIP: 11021
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/A
1
doc4a.xml
FORM 4/A SUBMISSION
X0306
4/A
2020-11-18
2020-11-13
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
2020-11-18
4
M
0
3575
22.58
A
30471
D
Common Stock
2020-11-18
4
F
0
2163
37.33
D
28308
D
Stock Option (right to buy)
22.58
2020-11-18
4
M
0
3575
0.00
D
2020-11-18
Common Stock
3575
0
D
On November 13, 2020, the reporting person mistakenly filed a Form 4 reporting the exercise of a stock option that did not yet occur. Instead, the transaction occurred on November 18, 2020 and this Form 4 corrects both the transaction date and the numbers of shares that were withheld to satisfy the reporting person's tax liability as of the transaction date.
The amount beneficially owned includes 10,269 restricted stock units (RSUs) that vest on service-based vesting dates and 13,580 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.
Fully vested.
/s/ John Manders, on behalf of David R. Dantzker
2021-01-04