SEC Form 4 · accession 0001209191-16-153167

SURMODICS INC · SRDX

Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗

Reporting owner

Officer — SVP, Gen Counsel & Secretary

Period of report

Nov 30, 2016

Accepted (ET)

Dec 2, 2016 · 6:47 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
Common Stock	Nov 30, 2016	A	2,713	$0.00	A	29,170	D
Common Stock^F1	Nov 30, 2016	A	4,881	$0.00	A	34,051	D
Common Stock^F2	Nov 30, 2016	F	2,353	$23.95	D	31,698	D
Common Stock^F4	Dec 2, 2016	S	1,264	$23.9049	D	30,434	D

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	Owned after	D/I
Employee Stock Option (right to buy)^F5	$23.95	Nov 30, 2016	A	17,121	A	—	Nov 30, 2023	Common Stock	17,121	17,121	D

F1Performance shares awarded under long-term incentive plan based on performance during three-year period ended September 30, 2016.
F2Shares withheld to satisfy taxes incident to vesting of performance share award.
F3Sales effected pursuant to a Rule 10b5-1 trading plan adopted by the reporting person on May 31, 2016.
F4Reflects the weighted average price of 1,264 shares of common stock of Surmodics,Inc. sold by the reporting person in multiple transactions on December 2, 2016 with sale prices ranging from $23.75 to $24.075 per share. The reporting person undertakes to provide upon request by the U.S. Securities and Exchange Commission staff, the issuer, or a security holder of the issuer, full information regarding the number of shares sold at each separate price.
F5The award vests in four equal installments on each of the first four anniversaries of the November 30, 2016 grant date.