SEC Form 4 · accession 0001209191-16-153169
SURMODICS INC · SRDX
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Joseph J. Stich
Officer — VP, Bus Ops & GM, IVD
Period of report
Nov 30, 2016
Accepted (ET)
Dec 2, 2016 · 6:49 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 Stock | Nov 30, 2016 | A | 2,713 | $0.00 | A | 40,834 | D | |
| Common StockF1 | Nov 30, 2016 | A | 4,881 | $0.00 | A | 45,715 | D | |
| Common StockF2 | Nov 30, 2016 | F | 2,353 | $23.95 | D | 43,362 | D |
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 | $23.95 | Nov 30, 2016 | A | 17,121 | A | — | Nov 30, 2023 | Common Stock | 17,121 | 17,121 | D |
Explanation of responses
- 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.
- F3The award vests in four equal installments on each of the first four anniversaries of the November 30, 2016 grant date.