exv10w12



 





EXHIBIT 10.12




[date]___________, 20__




[name]_____________________

[address]___________________

___________________________




Dear __________________:




On behalf of SurModics, it is a pleasure to offer you the full-time position of
_________________________ responsible for the ______________________ activities
of SurModics.




Listed below are the terms of our offer:




	 	 	 	 	 
	

	 	Start Date:
	 	A mutually agreeable start date to be determined upon
acceptance of this offer.
	

	 	 	 	 
	

	 	Division/Department:
	 	                                                                                               
	

	 	 	 	 
	

	 	Title:
	 	                                                                                               
	

	 	 	 	 
	

	 	Supervisor or Manager:
	 	                                                                                               
	

	 	 	 	 
	

	 	Compensation:
	 	$                                       per month, paid semi-monthly on the 15th and last
day of the month. In addition, you will be eligible to
participate in our                     Incentive Compensation program. We
will guarantee a first year deferred payment or bonus equal to
                   % of salary.
	

	 	 	 	 
	

	 	Stock Sign-on Bonus:
	 	You will receive                                shares of Surmodics restricted stock.
	

	 	 	 	 
	

	 	Cash Sign-on Bonus:
	 	You will receive a one-time $                                       sign-on bonus, less
applicable taxes, to be paid within the first                     days
of the start of your employment. If your employment
terminates voluntarily within                     years of your start
date, you will be expected to repay                     % of
the sign-on bonus.
	

	 	 	 	 
	

	 	Stock Options:
	 	Subject to Board approval, you will be granted stock options
for the purchase of                    shares of SurModics’ stock and
you will be granted                    shares of SurModics restricted
stock.







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	 	Relocation:
	 	SurModics will provide up to a maximum of $                                       for
your relocation expenses. The relocation allowance covers
moving costs, expenses incurred in selling your home and the
purchase of a new home, travel expenses, gross-up of taxes
and miscellaneous costs associated with relocation. The
relocation reimbursement will be made at a time mutually
agreeable to you and the Company. If, for any reason, your
relocation expenses exceed the maximum allowance, we will
authorize additional reimbursements on a case-by-case
basis.
	

	 	Status:
	 	Exempt
	

	 	 	 	 
	

	 	Benefits:
	 	You will be eligible for all benefits presently provided by
SurModics, in accordance with eligibility and Company policy.
Company policy is subject to change at the discretion of
management, and as such there could be changes in the
benefit policies at some future date. A list of employee
benefit costs is enclosed.







In addition, you will be eligible for                     hours of Personal Time Off (PTO) per
year. You will also receive                     paid holidays and will be eligible to
participate in our 401(K) savings plan, including employer matching program,
beginning with the first calendar quarter following employment.




SurModics is an Equal Opportunity Employer. Your employment with SurModics is
“at will”, which means that either you or the Company can terminate the
employment relationship at any time for any reason without notice.
Additionally, you will be required to adhere to all company policies, practices
and procedures.




Please indicate your acceptance of this offer by signing the enclosed copy and
returning it as soon as possible. If you have any questions, please contact
me.




Sincerely,




                                                                                               




ACKNOWLEDGED AND AGREED:                                                                                               




DATE:                                                                                               





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