Insider filing report for Changes in Beneficial Ownership
- Schedule 13G & 13D forms are used to report a party's ownership of stock which exceeds 5% of a company's total stock issue.
- Schedule 13G is a shorter version of Schedule 13D with fewer reporting requirements.
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UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
Schedule 13G
Under the Securities Exchange Act of 1934
(Amendment No. 10)
SurModics, Inc.
| (Name of Issuer) |
Common Stock, $.05 par value
| (Title of Class of Securities) |
868873 10 0
| (CUSIP Number) |
December 31, 2008
| (Date of Event Which Requires Filing of this Statement) |
Check the appropriate box to designate the rule pursuant to which this Schedule is filed:
¨ Rule 13d-1(b)
¨ Rule 13d-1(c)
x Rule 13d-1(d)
Page 2 of 5
CUSIP NO. 868873 10 0
| Name of reporting persons: I.R.S. Identification Nos. of above persons (entities only):
David A. Koch |
||||
| 1. | Check the appropriate box if a member of a group: (a) ¨ (b) ¨ |
|||
| 2. | SEC use only:
|
|||
| 3. | Citizenship or place of organization:
USA |
|
Number of shares beneficially owned by each reporting person with:
|
4. Sole voting power:
290,003 (includes 4,000 shares which may be purchased upon the exercise of options) | |
| 5. Shared voting power:
35,000 | ||
| 6. Sole dispositive power:
290,003 (includes 4,000 shares which may be purchased upon the exercise of options) | ||
| 7. Shared dispositive power:
35,000 |
| 8. | Aggregate amount beneficially owned by each reporting person:
325,003 (includes 4,000 shares which may be purchased upon the exercise of options) |
|||
| 9. | Check if the aggregate amount in Row (9) excludes certain shares
|
¨
| ||
| 10. | Percent of class represented by amount in Row 9:
1.8% |
|||
| 11. | Type of reporting person:
IN |
Page 3 of 5
CUSIP NO. 868873 10 0
| Item 1 | (a). |
Name of issuer: | ||||||||||
| SurModics, Inc. | ||||||||||||
| Item 1 | (b). |
Address of issuer’s principal executive offices: | ||||||||||
| 9924 West 74th Street Eden Prairie, MN 55344-3523 |
||||||||||||
| Item 2 | (a). |
Names of person filing: | ||||||||||
| David A. Koch | ||||||||||||
| Item 2 | (b). |
Address of principal business office: | ||||||||||
| 505 N Highway 169 Suite 595 Plymouth, MN 55441 |
||||||||||||
| Item 2 | (c). |
Citizenship: | ||||||||||
| USA | ||||||||||||
| Item 2 | (d). |
Title of class of securities: | ||||||||||
| Common Stock, $.05 par value | ||||||||||||
| Item 2 | (e). |
CUSIP No.: | ||||||||||
| 868873 10 0 | ||||||||||||
| Item 3. | If this statement is filed pursuant to Secs. 240.13d-1(b) or 240.13d-2(b) or (c), check whether the person filing is a: | |||||||||||
| Not applicable | ||||||||||||
Page 4 of 5
CUSIP NO. 868873 10 0
| Item 4. | Ownership | |||||||||
| (a) | Amount beneficially owned: 325,003 | |||||||||
| (b) | Percent of class: 1.8% | |||||||||
| (c) | Number of shares as to which the person has: | |||||||||
| (i) | Sole power to vote or to direct the vote: 290,003 (includes 4,000 shares which may be purchased upon the exercise of options) | |||||||||
| (ii) | Shared power to vote or to direct the vote: 35,000 | |||||||||
| (iii) | Sole power to dispose or to direct the disposition of: 290,003 (includes 4,000 shares which may be purchased upon the exercise of options) | |||||||||
| (iv) | Shared power to dispose or to direct the disposition of: 35,000 | |||||||||
| Item 5. | Ownership of 5 percent or Less of a Class: x | |||||||||
| Item 6. | Ownership of More than 5 Percent on Behalf of Another Person: Not applicable | |||||||||
| Item 7. | Identification and Classification of the Subsidiary Which Acquired the Security Being Reported on by the Parent Holding Company or Control Person: Not applicable | |||||||||
| Item 8. | Identification and Classification of Members of the Group: Not applicable | |||||||||
| Item 9. | Notice of Dissolution of Group: Not applicable | |||||||||
| Item 10. | Certifications Not applicable | |||||||||
Page 5 of 5
Signature
After reasonable inquiry and to the best of my knowledge and belief, I certify that the information set forth in this statement is true, complete and correct.
Dated: January 20, 2009
| /s/ David A. Koch |
| Signature |
| David A. Koch |
| Name/Title |