-----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, WfGeOCySmGo0lEnDB8CgocpbrD/eOHmhPIIak1ZVB3/zJO/ilf5DvUbJid4wt41g i3WGr8ZtjaNfEyRmyITfbw== 0000931731-01-000044.txt : 20010214 0000931731-01-000044.hdr.sgml : 20010214 ACCESSION NUMBER: 0000931731-01-000044 CONFORMED SUBMISSION TYPE: SC 13G/A PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 20010213 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: MERIT MEDICAL SYSTEMS INC CENTRAL INDEX KEY: 0000856982 STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841] IRS NUMBER: 870447695 STATE OF INCORPORATION: UT FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: SC 13G/A SEC ACT: SEC FILE NUMBER: 005-45861 FILM NUMBER: 1536346 BUSINESS ADDRESS: STREET 1: 1600 WEST MERIT PARK WAY CITY: SOUTH JORDAN STATE: UT ZIP: 84095 BUSINESS PHONE: 8012531600 MAIL ADDRESS: STREET 1: 1600 WEST MERIT PARKWAY CITY: SOUTH JORDAN STATE: UT ZIP: 84095 FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: LAMPROPOULOS FRED P CENTRAL INDEX KEY: 0000901534 STANDARD INDUSTRIAL CLASSIFICATION: [] IRS NUMBER: 870447694 FILING VALUES: FORM TYPE: SC 13G/A BUSINESS ADDRESS: STREET 1: 1600 W MARIT PARKWAY CITY: SO JORDAN STATE: UT ZIP: 84095 BUSINESS PHONE: 84095-1688 SC 13G/A 1 0001.txt ================================================================================ SEC 1745 (3-98) 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 control number. ================================================================================ OMB APPROVAL ------------------------------------- OMB Number 3235-0145 Expire October 31, 2002 Estimated average burden hours per response..............14.90 ------------------------------------- UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 SCHEDULE 13G Under the Securities Exchange Act of 1934 (Amendment No. 10 )* Merit Medical Systems, Inc. - -------------------------------------------------------------------------------- (Name of Issuer) Common Stock, No Par Value - -------------------------------------------------------------------------------- (Title of Class of Securities) 589889-10-4 ------------- (CUSIP Number) December 31, 2000 ----------------------------------------- (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) *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 in 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). 1 CUSIP No. 589889-10-4 - -------------------------------------------------------------------------------- 1. Names of Reporting Persons. I.R.S. Identification Nos. of above persons (entities only). Fred P. Lampropoulos - -------------------------------------------------------------------------------- 2. Check the Appropriate Box if a Member of a Group (See Instructions) (a) [ ] (b) [ ] - -------------------------------------------------------------------------------- 3. SEC Use Only ----------------------------------------------------------- - -------------------------------------------------------------------------------- 4. Citizenship or Place of Organization United States ---------------- - -------------------------------------------------------------------------------- Number of 5. Sole Voting Power 834,248.493 Shares Bene- ficially 6. Shared Voting Power None Owned by Each Reporting 7. Sole Dispositive Power 834,248.493 Person With: 8. Shared Dispositive Power None - -------------------------------------------------------------------------------- 9. Aggregate Amount Beneficially Owned by Each Reporting Person 834,248.493 ------------ 10. Check if the Aggregate Amount in Row (9) Excludes Certain Shares (See Instructions) [ ] 11. Percent of Class Represented by Amount in Row (9) 10.3% --------- 12. Type of Reporting Person (See Instructions) IN ----- 2 CUSIP No. 589889-10-4 - -------------------------------------------------------------------------------- Item 1. (a) Name of Issuer: Merit Medical Systems, Inc. (the "Company") (b) Address of Principal Executive Offices: 1600 West Merit Parkway, South Jordan, UT 84095 Item 2. (a) Name of Person Filing: Fred P. Lampropoulos (the"Reporting Person") (b) Address of Principal Business Office, if none, Residence: 1600 West Merit Parkway, South Jordan, UT 84095 (c) Citizenship: United States (d) Title of Class of Securities: Common Stock, No Par Value (the "Commonn Stock") (e) CUSIP Number: 589889-10-4 Item 3. This statement is not filed pursuant to Sections 240.13d-1(b) or 240.13d-2(b) or (c). Item 4. Ownership (a) Amount Beneficially Owned: As of December 31, 2000, the Reporting Person was the beneficial owner of 834,248.493 shares of the Common Stock, which included 16,547.493 shares owned by the Reporting Person pursuant to the Company's 401(k) Plan, based upon the most recent plan statement timely distributed, and 332,500 shares that the Reporting Person had the right to acquire pursuant to options that were exercisable as of December 31, 2000 or exercisable within the sixty (60) day period following December 31, 2000. (b) Percent of Class: 10.3% (c) Number of shares as to which the Reporting Person has: (i) Sole power to vote or to direct the vote: 834,248.493 shares of the Common Stock (ii) Shared power to vote or to direct the vote: None (iii) Sole power to dispose or to direct the disposition of: 834,248.493 shares of the Common Stock (iv) Shared power to dispose or to direct the disposition of: None 3 CUSIP No. 589889-10-4 - -------------------------------------------------------------------------------- Item 5. Ownership of Five Percent or Less of a Class If this statement is being filed to report the fact that as of the date hereof the reporting person has ceased to be the beneficial owner of more than five percent of the class of securities, check the following [ ] 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 Reporting 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. 4 CUSIP No. 589889-10-4 - -------------------------------------------------------------------------------- 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. Date: February 12, 2001 By /s/ Fred P. Lampropoulos - --------------------------- Fred P. Lampropouos 5 -----END PRIVACY-ENHANCED MESSAGE-----