-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, J3JU01R23He8jACEWu3alCT4l1LouxGyHz7j4m7XEiU+zDkVYIAnMe7fIew5ap/c STNHVBEfwkl4d+ZyZl32/w== 0000950134-06-002676.txt : 20060214 0000950134-06-002676.hdr.sgml : 20060214 20060213190748 ACCESSION NUMBER: 0000950134-06-002676 CONFORMED SUBMISSION TYPE: SC 13G/A PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 20060214 DATE AS OF CHANGE: 20060213 FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: OLSETH DALE R CENTRAL INDEX KEY: 0001077511 FILING VALUES: FORM TYPE: SC 13G/A BUSINESS ADDRESS: BUSINESS PHONE: 6128292700 MAIL ADDRESS: STREET 1: 9924 WEST 74TH STREET CITY: EDEN PRAIRIE STATE: MN ZIP: 55344 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: SURMODICS INC CENTRAL INDEX KEY: 0000924717 STANDARD INDUSTRIAL CLASSIFICATION: PATENT OWNERS & LESSORS [6794] IRS NUMBER: 411356149 STATE OF INCORPORATION: MN FISCAL YEAR END: 0930 FILING VALUES: FORM TYPE: SC 13G/A SEC ACT: 1934 Act SEC FILE NUMBER: 005-55203 FILM NUMBER: 06605907 BUSINESS ADDRESS: STREET 1: 9924 W 74TH ST CITY: EDEN PRAIRIE STATE: MN ZIP: 55344 BUSINESS PHONE: 6128292700 MAIL ADDRESS: STREET 1: 9924 WEST 74TH ST CITY: EDEN PRAIRIE STATE: MN ZIP: 55344 FORMER COMPANY: FORMER CONFORMED NAME: BSI CORP DATE OF NAME CHANGE: 19970506 SC 13G/A 1 c02412sc13gza.htm AMENDMENT TO SCHEUDLE 13G sc13gza
 

     
 
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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. 7)*

SurModics, Inc.
(Name of Issuer)
Common Stock, $.05 par value
(Title of Class of Securities)
868873 10 0
(CUSIP Number)
December 31, 2005
(Date of Event Which Requires Filing of this Statement)

Check the appropriate box to designate the rule pursuant to which this Schedule is filed:

     o Rule 13d-1(b)

     o Rule 13d-1(c)

     þ Rule 13d-1(d)

* The remainder of this cover page shall be filled out for a reporting person’s initial filing on this form with respect to the subject class of securities, and for any subsequent amendment containing information which would alter the disclosures provided in a prior cover page.

The information required in the remainder of this cover page shall not be deemed to be “filed” for the purpose of Section 18 of the Securities Exchange Act of 1934 (“Act”) or otherwise subject to the liabilities of that section of the Act but shall be subject to all other provisions of the Act (however, see the Notes).

Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number.

 
 

Page 1 of 4 Pages


 

                     
CUSIP No.
 
868873 10 0 
  Page  
  of   

 

           
1   NAMES OF REPORTING PERSONS:
Dale R. Olseth
   
  I.R.S. IDENTIFICATION NOS. OF ABOVE PERSONS (ENTITIES ONLY): 
   
     
2   CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP (SEE INSTRUCTIONS):

  (a)   o
  (b)   o
     
3   SEC USE ONLY:
   
   
     
4   CITIZENSHIP OR PLACE OF ORGANIZATION:
   
  U.S.A.
       
  5   SOLE VOTING POWER:
     
NUMBER OF   1,379,280 (includes 68,280 shares which may be purchased upon exercise of options)
       
SHARES 6   SHARED VOTING POWER:
BENEFICIALLY    
OWNED BY   5,000
       
EACH 7   SOLE DISPOSITIVE POWER:
REPORTING    
PERSON   1,379,280 (includes 68,280 shares which may be purchased upon exercise of options)
       
WITH: 8   SHARED DISPOSITIVE POWER:
     
    5,000
     
9   AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON:
   
  1,384,280 (includes 68,280 shares which may be purchased upon exercise of options)
     
10   CHECK IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES (SEE INSTRUCTIONS):
   
  o
     
11   PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (9):
   
  7.4%
     
12   TYPE OF REPORTING PERSON (SEE INSTRUCTIONS):
   
  IN


 

Answer every item. If an item is inapplicable or the answer is in the negative, so state.
     
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
 
   
Item 2(a)
  Name of Person Filing:
 
   
 
  See Cover Page Item 1
 
   
Item 2(b)
  Address of Principal Business Office or, if none, residence:
 
   
 
  9924 West 74th Street
 
  Eden Prairie, MN 55344
 
   
Item 2(c)
  Citizenship:
 
   
 
  See Cover Page Item 4
 
   
Item 2(d)
  Title of Class of Securities:
 
   
 
  Common Stock, $.05 par value
 
   
Item 2(e)
  CUSIP No.:
 
   
 
  See Cover Page
 
   
Item 3
  Statement filed pursuant to Rule 13d-1(b), or 13d-2(b) or (c):
 
   
 
  Not applicable
 
   
Item 4
  Ownership
 
   
 
  See Cover Page Items 5 through 11
 
   
Item 5
  Ownership of Five Percent or Less of a Class:
 
   
 
  If this statement is being filed to report the fact that as of the date hereof the reporting person has ceased to be the beneficial owner of more than five percent of the class of securities, check the following o.

Page 3 of 4 Pages


 

     
Item 6
  Ownership of More than Five 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:
 
   
 
  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
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 as of December 31, 2005.
     
 
  February 9, 2006
 
   
 
  (Date)
 
   
 
  /s/ Dale R. Olseth
 
   
 
  (Signature)
 
   
 
  Dale R. Olseth
 
   
 
  (Name and title)

Page 4 of 4 Pages

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