SEC Form 4 · accession 0001209191-17-063119
SURMODICS INC · SRDX
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Charles W Olson
Officer — Senior VP of Bus Dev, Med Dev
Period of report
Nov 28, 2017
Accepted (ET)
Nov 30, 2017 · 8:26 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 Stock | Nov 28, 2017 | A | 3,915 | $0.00 | A | 35,362 | D | |
| Common StockF1 | Nov 28, 2017 | A | 6,525 | $0.00 | A | 41,887 | D | |
| Common StockF2 | Nov 28, 2017 | F | 3,146 | $33.20 | D | 38,741 | D | |
| Common Stock | Nov 30, 2017 | F | 436 | $33.10 | D | 38,305 | 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 | $33.20 | Nov 28, 2017 | A | 18,447 | A | — | Nov 28, 2024 | Common Stock | 18,447 | 18,447 | D |
Explanation of responses
- F1Shares issued in connection with the vesting of a performance share award under long-term incentive plan based on performance during three-year period ended September 30, 2017.
- 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 28, 2017 grant date.