SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
SCHEDULE 13G
Under the Securities Exchange Act of 1934
(Amendment No. ___)*
SurModics, Inc.
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(Name of Issuer)
Common Stock, $.05 par value
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(Title of Class of Securities)
868873 10 0
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(CUSIP Number)
*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 on 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).
(Continued on following page(s))
Page 1 of 4 Pages
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SCHEDULE 13G
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CUSIP No. 868873 10 0 Page 2 of 4 Pages
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1 NAMES OF REPORTING PERSONS/
I.R.S. IDENTIFICATION NOS. OF ABOVE PERSONS (ENTITIES ONLY)
Dale R. Olseth
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2 CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP* (a) [ ]
(b) [ ]
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3 SEC USE ONLY
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4 CITIZENSHIP OR PLACE OF ORGANIZATION
U.S.A.
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NUMBER OF 5 SOLE VOTING POWER
SHARES 594,000 (includes 192,000 shares which may
BENEFICIALLY be purchased upon exercise of options)
OWNED BY
EACH
REPORTING
PERSON
WITH --------- --------------------------------------------
6 SHARED VOTING POWER
1,500
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7 SOLE DISPOSITIVE POWER
594,000 (includes 192,000 shares which may
be purchased upon exercise of options)
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8 SHARED DISPOSITIVE POWER
1,500
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9 AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON
595,500 (includes 192,000 shares which may be purchased upon
exercise of options)
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10 CHECK IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN
SHARES* ____
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11 PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (9)
8.0%
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12 TYPE OF REPORTING PERSON (SEE INSTRUCTIONS)
IN
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<PAGE>
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 Rules 13d-1(b) or 13d-2(b):
Not applicable
Item 4(a) Amount Beneficially Owned:
See Cover Page Item 9
Item 4(b) Percent of Class:
See Cover Page Item 11
Item 4(c) Number of Shares as to Which Such Person Has:
(i) sole power to vote or to direct the vote: See Cover
Page Item 5
(ii) shared power to vote or to direct the vote: See
Cover Page Item 6
Page 3 of 4 Pages
<PAGE>
(iii) sole power to dispose or to direct the disposition
of: See Cover Page Item 7
(iv) shared power to dispose or to direct the disposition
of: See Cover Page Item 8
Item 5 Ownership of Five Percent or Less of a Class:
Not applicable
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 Certification:
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, 1998.
Dated: January 27, 1999
/s/ Dale R. Olseth
Dale R. Olseth
Page 4 of 4 Pages
