FORM 4
U.S. SECURITIES AND EXCHANGE COMMISSION
WASHINGTON, DC 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
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Check box if no longer subject to | |
| Section 16. Form 4 or Form 5 obligations may | ||
| continue. See Instruction 1(b). |
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(f) of the Investment Company Act of 1940
| 1. Name and Address of Reporting Person* | 2. Issuer Name and Ticker or Trading Symbol | 6. Relationship of Reporting Person | |||
| Hathaway Stephen C. | SurModics, Inc. (SRDX) | to Issuer (Check all applicable) | |||
(Last) (First) (Middle) |
Director 10% Owner |
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 Officer (give title below) |
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| 3. IRS Identification Number of Reporting Person, if an Entity (Voluntary) | Other (specify below) |
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| 9924 West 74th Street | Vice President and Chief Financial Officer | ||||
(Street) |
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| 4. Statement for Month/Year | 7. Individual or Joint/Group Filing | ||||
| Eden Prairie MN 55344 | August 2002 | (Check applicable line) | |||
(City) (State) (Zip) |
Form Filed by One Reporting Person |
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| Form Filed by More than One Reporting Person |
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| 5. If Amendment, Date of Original (Month/Year) | |||||
TABLE I — NON-DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED
| 4. Securities Acquired (A) | ||||||||||||
| 3. Transaction Code | or Disposed of (D) | |||||||||||
| 2. Transaction Date | (Instr. 8) | (Instr. 3, 4 and 5) | ||||||||||
| (A) | ||||||||||||
| or | ||||||||||||
| 1. Title of Security (Instr. 3) | (Month/Day/Year) | Code | V | Amount | (D) | Price | ||||||
| Common Stock | 8/9/02 | G | V | 600 | D | None | ||||||
| Common Stock | ||||||||||||
[Additional columns below]
[Continued from above table]
| 5. Amount of | 6. Ownership Form: | |||
| Securities Beneficially | Direct (D) or | 7. Nature of Indirect | ||
| Owned at End of Month | Indirect (I) | Beneficial Ownership | ||
| (Instr. 3 and 4) | (Instr. 4) | (Instr. 4) | ||
| 66,886 | ||||
| 28,000 | I | By Spouse | ||
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).
FORM 4 (CONTINUED)
TABLE II — DERIVATIVE SECURITIES ACQUIRED, DISPOSED OF, OR BENEFICIALLY OWNED
(E.G., PUTS, CALLS, WARRANTS, OPTIONS, CONVERTIBLE SECURITIES)
| 5. Number of | ||||||||||||||||
| Derivative | ||||||||||||||||
| Securities | ||||||||||||||||
| Acquired (A) or | ||||||||||||||||
| 4. Transaction | Disposed of (D) | |||||||||||||||
| Code | (Instr. 3, 4, | |||||||||||||||
| 2. Conversion or | (Instr. 8) | and 5) | ||||||||||||||
| 1. Title of Derivative | Exercise Price of | 3. Transaction Date | ||||||||||||||
| Security (Instr. 3) | Derivative Security | (Month/Day/Year) | Code | V | (A) | (D) | ||||||||||
| Employee Stock Option (Right to Buy) |
$2.50 | Previously Reported | ||||||||||||||
| Employee Stock Option (Right to Buy) |
$3.875 | Previously Reported | ||||||||||||||
| Employee Stock Option (Right to Buy) |
$8.0625 | Previously Reported | ||||||||||||||
| Employee Stock Option (Right to Buy) |
$25.094 | Previously Reported | ||||||||||||||
[Additional columns below]
[Continued from above table]
| 6. Date Exercisable | 7. Title and Amount | ||||||||
| and Expiration | of Underlying | ||||||||
| Date (Month/Day/ | Securities | ||||||||
| Year) | (Instr. 3 and 4) | ||||||||
| 8. Price of | |||||||||
| Amount or | Derivative | ||||||||
| Date | Expiration | Number of | Security | ||||||
| Exercisable | Date | Title | Shares | (Instr. 5) | |||||
| (1) | 11/18/03 | Common Stock | 60,000 | None | |||||
| (2) | 9/21/05 | Common Stock | 10,000 | None | |||||
| (3) | 9/20/06 | Common Stock | 16,000 | None | |||||
| (4) | 9/18/07 | Common Stock | 12,000 | None | |||||
| 9. Number of | 10. Ownership | |||
| Derivative | Form of | |||
| Securities | Derivative | 11. Nature of | ||
| Beneficially | Securities | Indirect | ||
| Owned at End | Beneficially | Beneficial | ||
| of Month | owned at end of month | Ownership | ||
| (Instr. 4) | (Instr. 4) | (Instr. 4) | ||
| 15,900 | ||||
| 10,000 | D | |||
| 16,000 | D | |||
| 12,000 | D |
Explanation of
Responses:
(1) Exercisable in annual increments of 12,000 shares each
commencing 11/18/98.
(2) Exercisable in annual increments of 2,000
shares each commencing 9/21/99.
(3) Exercisable in annual increments
of 3,200 shares each commencing 9/20/00.
(4) Exercisable in
annual increments of 2,400 shares each commencing 9/18/01.
| /s/ Stephen C. Hathaway | August 19, 2002 | |
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| Signature of Reporting Person(1) | Date |
(1)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.
Potential persons who are to
respond to the collection of information contained in this form are
not
required to respond unless the form displays a currently valid OMB Number.
Page 2
(Print or Type Responses)