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