0001209191-21-067524.txt : 20211202 0001209191-21-067524.hdr.sgml : 20211202 20211202151028 ACCESSION NUMBER: 0001209191-21-067524 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20211130 FILED AS OF DATE: 20211202 DATE AS OF CHANGE: 20211202 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Sultana Nusrath CENTRAL INDEX KEY: 0001802470 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-23837 FILM NUMBER: 211466236 MAIL ADDRESS: STREET 1: 9924 WEST 74TH STREET CITY: EDEN PRAIRIE STATE: MN ZIP: 55344 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 2021-11-30 0 0000924717 SURMODICS INC SRDX 0001802470 Sultana Nusrath 9924 WEST 74TH STREET EDEN PRAIRIE MN 55344 0 1 0 0 VP, Clinical Affairs Common Stock 2021-11-30 4 F 0 431 43.93 D 6382 D Common Stock 2021-11-30 4 A 0 910 0.00 A 7292 D Employee Stock Option (right to buy) 43.93 2021-11-30 4 A 0 3667 0.00 A 2028-11-30 Common Stock 3667 3667 D Includes 98 shares acquired for the phase ending August 31, 2020 through the Employee Stock Purchase Plan, 78 shares acquired for the phase ending February 26, 2021, and 71 shares acquired for the phase ending August 31, 2021. The award vests in four equal installments on each of the first four anniversaries of the November 30, 2021 grant date. /s/ John Manders on behalf of Nusrath Sultana 2021-12-02