SEC Form 4 · accession 0001209191-15-086455
SURMODICS INC · SRDX
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Andrew D. C. LaFrence
Officer — VP of Finance & CFO
Period of report
Dec 17, 2015
Accepted (ET)
Dec 21, 2015 · 6:26 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 | 4,679 | $0.00 | A | 8,556 | D | |
| Common StockF2,F3 | Dec 17, 2015 | F | 1,573 | $20.25 | D | 7,260 | D |
Table II — derivative securities
| Security | Conv. / exercise price | Date | Code | Shares | A/D | Exercisable | Expires | Underlying | Underlying shares | Owned after | D/I |
|---|---|---|---|---|---|---|---|---|---|---|---|
| Common StockF4 | $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.
- F3Includes 277 shares acquired through the Employee Stock Purchase Plan for the phase ending 8/31/15.
- F4The award vests in four equal installments on each of the first four anniversaries of the December 17, 2015 grant date.