SEC Form 4 · accession 0001209191-15-086447
SURMODICS INC · SRDX
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Charles W Olson
Officer — Senior VP & GM, Med Dev
Period of report
Dec 17, 2015
Accepted (ET)
Dec 21, 2015 · 6:13 pm EST
Rule 10b5-1 plan
unknown — predates the checkbox
Issuer CIK
0000924717
Table I — non-derivative securities
| Security | Date | Code | Shares | Price | A/D | Owned after | D/I | Nature of ownership |
|---|---|---|---|---|---|---|---|---|
| Common StockF1 | Dec 17, 2015 | A | 5,484 | $0.00 | A | 24,874 | D | |
| Common StockF2 | Dec 17, 2015 | F | 1,843 | $20.25 | D | 23,031 | D | |
| Common Stock | holding | — | — | — | 800 | I | By IRA |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Employee Stock Option (right to buy)F3 | $20.25 | Dec 17, 2015 | A | 19,927 | A | — | Dec 17, 2022 | Common Stock | 19,927 | 19,927 | D |
Explanation of responses
- F1Performance shares awarded under long-term incentive plan based on performance during three-year period ended November 30, 2014.
- F2Shares withheld to satisfy taxes incident to vesting of performance share award.
- F3The award vests in four equal installments on each of the first four anniversaries of the December 17, 2015 grant date.