-----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, HWq8bxQMD6ScJaIYVWNlxgtGsW6VLG9EYZrNBJVzUMyB83mbNevcRhc2j76872KK BX89WNyJyXf/r62xBG56nA== 0001144204-08-014664.txt : 20080312 0001144204-08-014664.hdr.sgml : 20080312 20080312112219 ACCESSION NUMBER: 0001144204-08-014664 CONFORMED SUBMISSION TYPE: SC 13G/A PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 20080312 DATE AS OF CHANGE: 20080312 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: 08682722 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 FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: KOCH DAVID A CENTRAL INDEX KEY: 0001066677 FILING VALUES: FORM TYPE: SC 13G/A BUSINESS ADDRESS: BUSINESS PHONE: 6123402600 MAIL ADDRESS: STREET 1: C/O TRUST U/W CLARISSA GRAY STREET 2: 505 N HIGHWAY 169 SUITE 595 CITY: PLYMOUTH STATE: MN ZIP: 55441 SC 13G/A 1 v106656_sc13ga.txt UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 Schedule 13G Under the Securities Exchange Act of 1934 (Amendment No. 9) Surmodics, Inc. - -------------------------------------------------------------------------------- (Name of Issuer) Common Stock, $.05 par value - -------------------------------------------------------------------------------- (Title of Class of Securities) 867773 10 0 - -------------------------------------------------------------------------------- (CUSIP Number) December 31, 2007 - -------------------------------------------------------------------------------- (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 4 CUSIP NO. 868873 10 0 - -------------------------------------------------------------------------------- 1 NAME OF REPORTING PERSON I.R.S. IDENTIFICATION NOS. OF ABOVE PERSON (ENTITIES ONLY). David A. Koch - -------------------------------------------------------------------------------- 2 CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP (a) |_| (b) |_| - -------------------------------------------------------------------------------- 3 SEC USE ONLY - -------------------------------------------------------------------------------- 4 CITIZENSHIP OR PLACE OF ORGANIZATION USA - -------------------------------------------------------------------------------- 5 SOLE VOTING POWER 839,583 (includes 24,000 shares which may be purchased upon the exercise of options) ----------------------------------------------------------------- NUMBER OF 6 SHARED VOTING POWER SHARES BENEFICIALLY 125,000 OWNED BY ----------------------------------------------------------------- EACH 7 SOLE DISPOSITIVE POWER REPORTING PERSON 839,583 (includes 24,000 shares which may be purchased upon the exercise of options) WITH: ----------------------------------------------------------------- 8 SHARED DISPOSITIVE POWER 125,000 - -------------------------------------------------------------------------------- 9 AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON 964,583 (includes 24,000 shares which may be purchased upon the exercise of options) - -------------------------------------------------------------------------------- 10 CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES (SEE INSTRUCTIONS) |_| - -------------------------------------------------------------------------------- 11 PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (9) 5.28% - -------------------------------------------------------------------------------- 12 TYPE OF REPORTING PERSON IN - -------------------------------------------------------------------------------- Page 3 of 4 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 Item 4. Ownership (a) Amount beneficially owned: 964,583 (includes 24,000 shares which may be purchased upon the exercise of options) (b) Percent of class: 5.28% (c) Number of shares as to which the person has: (i) Sole power to vote or to direct the vote: 839,583 (incudes 24,000 shares which may be purchased upon exercise of options) (ii) Shared power to vote or to direct the vote: 125,000 (iii) Sole power to dispose or to direct the disposition of: 839,583 (incudes 24,000 shares which may be purchased upon exercise of options) (iv) Shared power to dispose or to direct the disposition of: 125,000 Item 5. Ownership of 5 percent or Less of a Class: Not applicable. 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 4 of 4 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: March 12, 2008 /s/ David A. Koch ------------------------------------- Signature David A. Koch ------------------------------------- Name/Title -----END PRIVACY-ENHANCED MESSAGE-----