SEC FORM 5 SEC Form 5
FORM 5 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
 
OMB APPROVAL
OMB Number: 3235-0362
Estimated average burden
hours per response: 1.0
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
Form 3 Holdings Reported.
Form 4 Transactions Reported.
1. Name and Address of Reporting Person*
Anderson Aron B

(Last) (First) (Middle)
9924 WEST 74TH STREET

(Street)
EDEN PRAIRIE MN 55344-3523

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
SURMODICS INC [ SRDX ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director 10% Owner
X Officer (give title below) Other (specify below)
VP & Chief Scientific Officer
3. Statement for Issuer's Fiscal Year Ended (Month/Day/Year)
09/30/2005
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
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 Securities Beneficially Owned at end of Issuer's Fiscal Year (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Amount (A) or (D) Price
Common Stock 04/11/2005 G 200 D $0 29,397(7) D
Common Stock 10/11/2005 G 200 D $0 29,137(7) D
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) 6. Date Exercisable and Expiration Date (Month/Day/Year) 7. Title and Amount of Securities Underlying Derivative Security (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: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
(A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Incentive Stock Option (Right to Buy) $8.063 (1) 09/20/2006 Common Stock 2,000 400 D
Incentive Stock Option (Right to Buy) $25.094 (2) 09/18/2007 Common Stock 4,000 4,000 D
Incentive Stock Option (Right to Buy) $34.85 (3) 11/12/2008 Common Stock 2,500 2,500 D
Incentive Stock Option (Right to Buy) $29.5 (4) 01/15/2010 Common Stock 3,000 3,000 D
Incentive Stock Option (Right to Buy) $21.82 (5) 05/17/2011 Common Stock 3,000 3,000 D
Non-Qualified Stock Option (Right to Buy) $29.37 (6) 01/31/2012 Common Stock 10,000 10,000 D
Explanation of Responses:
1. Exercisable in annual increments of 400 shares each commencing on 9/20/00.
2. Exercisable in annual increments of 800 shares each commencing on 9/18/01.
3. Exercisable in annual increments of 500 shares each commencing on 11/12/02.
4. Exercisable in annual increments of 600 shares each commencing on 1/15/04.
5. Exercisable in annual increments of 600 shares each commencing on 5/17/05.
6. Exercisable in annual increments of 2,000 shares each commencing 1/31/06.
7. Includes 580 shares acquired through Employee Stock Purchase Plan for the phase ended 2/28/05.
Remarks:
/s/ Aron B. Anderson 11/14/2005
** Signature of Reporting Person Date
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).
** 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.
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 Number.