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UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 4
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
Filed pursuant to Section 16(a) of the
Securities Exchange Act of 1934,
Section 17(a) of the Public Utility Holding Company Act of 1935
or Section 30(h) of the Investment Company Act of 1940
| o | Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). |
| 1. | Name and Address of
Reporting Person* |
2. | Issuer Name and Ticker or
Trading Symbol |
3. | I.R.S. Identification
Number of Reporting Person, if an entity (Voluntary) |
|||||||
| Powell, James C. (Last) (First) (Middle) |
SurModics, Inc.
(SRDX) |
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| 9924 West 74th
Street (Street) |
4. | Statement for Month/Day/Year | 5. | If Amendment, Date of Original (Month/Day/Year) | ||||||||
| 2/20/03 |
||||||||||||
| 6. | Relationship of Reporting Person(s) to Issuer (Check All Applicable) |
7. | Individual or Joint/Group
Filing (Check Applicable Line) |
|||||||||
| Eden Prairie, MN 55344 (City) (State) (Zip) |
o | Director | o | 10% Owner | x | Form Filed by One Reporting Person | ||||||
| x | Officer (give title below) | o | Form Filed by More than One Reporting Person | |||||||||
| o | Other (specify below) | |||||||||||
| President |
||||||||||||
| Reminder: | Report on a separate line for each class of securities beneficially owned directly or indirectly. | |
| * | If the form is filed by more than one reporting person, see instruction 4(b)(v). | |
| Table I — Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned | |||||||||||||||||||||||
| 1. | Title of Security (Instr. 3) |
2. | Transaction Date (Month/Day/Year) |
2A. | Deemed Execution Date, if any (Month/Day/Year) |
3. | Transaction Code (Instr. 8) |
4. | Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) |
5. | Amount of Sec- urities Beneficially Owned Following Reported Trans- action(s) (Instr. 3 and 4) |
6. | Ownership Form: Direct (D) or Indirect (I) (Instr. 4) |
7. | Nature
of Indirect Beneficial Ownership (Instr. 4) |
||||||||
| Code | V | Amount | (A) or (D) |
Price | |||||||||||||||||||
| Common Stock | 2/20/03 | M | 4,000 | A | $3.875 | 111,225* | D | ||||||||||||||||
| Common Stock | 26,000 | I | By IRA | ||||||||||||||||||||
| Common Stock | 500 | I | By Spouse | ||||||||||||||||||||
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| Table II — Derivative
Securities Acquired, Disposed of, or Beneficially
Owned (e.g., puts, calls, warrants, options, convertible securities) |
|||||||||||||||||
| 1. | Title of Derivative Security (Instr. 3) |
2. | Conversion or Exercise Price of Derivative Security |
3. | Transaction Date (Month/Day/Year) |
3A. | Deemed Execution Date, if any (Month/Day/Year) |
4. | Transaction Code (Instr. 8) |
5. | Number of Derivative
Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) |
||||||
| Code | V | (A) | (D) | ||||||||||||||
| Employee Stock Option (Right to Buy) | $3.875 | 2/20/02 | M | 4,000 | |||||||||||||
| Employee Stock Option (Right to Buy) | $8.0625 | Previously Reported | |||||||||||||||
| Employee Stock Option (Right to Buy) | 25.094 | Previously Reported | |||||||||||||||
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| Table II — Derivative
Securities Acquired, Disposed of, or Beneficially Owned —
Continued (e.g., puts, calls, warrants, options, convertible securities) |
|||||||||||||||||
| 6. | Date Exercisable and Expiration Date (Month/Day/Year) |
7. | Title and Amount of Underlying Securities (Instr. 3 and 4) |
8. | Price of
Derivative Security (Instr. 5) |
9. | Number of Derivative
Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) |
10. | Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. | Nature
of Indirect Beneficial Ownership (Instr. 4) |
||||||
| Date Exercisable |
Expiration Date |
Title | Amount or Number of Shares |
||||||||||||||
| (1) | 9/21/05 | Common Stock | 20,000 | None | 4,000* | D | |||||||||||
| (2) | 9/20/06 | Common Stock | 30,000 | None | 18,000 | D | |||||||||||
| (3) | 9/18/07 | Common Stock | 14,260 | None | 14,260 | D | |||||||||||
Explanation of Responses:
(1) Exercisable in annual increments of 4,000 shares each, commencing 9/21/99.
(2) Exercisable in annual increments of 6,000 shares each, commencing 9/20/00.
(3) Exercisable in annual increments of 2,852* shares each, commencing 9/18/01.
* Adjusted to reflect correct number of shares.
| /s/ James C. Powell | 2/21/03 | |
**Signature of Reporting Person |
Date |
| ** | Intentional misstatements or omissions of facts constitute Federal Criminal Violations. See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a). | |
| Note: | File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure. | |
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