-----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, MzQ6s8AdAJLZdAPlp5gAnYkfPyWoIFGDjQrT47OxzYhvdS+zmqgcoCeZ1S+F/DVx pAelVsizc+mwCbBcjJHjvw== 0000931731-02-000308.txt : 20020919 0000931731-02-000308.hdr.sgml : 20020919 20020919152800 ACCESSION NUMBER: 0000931731-02-000308 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20020919 FILED AS OF DATE: 20020919 REPORTING-OWNER: COMPANY DATA: COMPANY CONFORMED NAME: WEINTRAUB B LEIGH CENTRAL INDEX KEY: 0001184965 RELATIONSHIP: DIRECTOR FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: MERIT MEDICAL SYSTEMS INC STREET 2: 1600 W. MERIT PARKWAY CITY: SOUTH JORDAN STATE: UT ZIP: 84095 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: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-18592 FILM NUMBER: 02767762 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 4 1 mmsiform4.txt L. WEINTRAUB FORM 4 ------------------------------- OMB APPROVAL ------------------------------- OMB Number Expires: Estimated average burden hours per response .........0.5 U.S. SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 FORM 4 STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP 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 [ ] Check box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b). - -------------------------------------------------------------------------------- 1. Name and Address of Reporting Person* Weintraub B. Leigh - -------------------------------------------------------------------------------- (Last) (First) (Middle) 1600 West Merit Parkway - -------------------------------------------------------------------------------- (Street) South Jordan UT 84095 - -------------------------------------------------------------------------------- (City) (State) (Zip) - -------------------------------------------------------------------------------- 2. Issuer Name and Ticker or Trading Symbol Merit Medical Systems, Inc. MMSI - -------------------------------------------------------------------------------- 3. IRS Identification Number of Reporting Person, if an Entity (Voluntary) - -------------------------------------------------------------------------------- 4. Statement for Month/Year September 2002 - -------------------------------------------------------------------------------- 5. If Amendment, Date of Original (Month/Year) - -------------------------------------------------------------------------------- 6. Relationship of Reporting Person to Issuer (Check all applicable) [ ] Director [ ] 10% Owner [X] Officer (give title below) [ ] Other (specify below) Vice President-Operations - -------------------------------------------------------------------------------- 7. Individual or Joint/Group Filing (Check applicable line) [X] Form filed by one Reporting Person [ ] Form filed by more than one Reporting Person - --------------------------------------------------------------------------------
1 Table I -- Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned 6. Owner- ship 5. Amount of Form: 7. Nature of Securities Direct Indirect 1. Title of 2. Transaction 3. Transaction 4. Securities Acquired (A) Beneficially (D)or Beneficial Security Date Code or Disposed of (D) Owned at End Indirect (I) Ownership (Instr. 3) T(mm/dd/yy) (Instr. 8) (Instr. 3, 4 and 5) (Instr. 3 and 4) (Instr.4) (Instr.4) Code V Amount (A)or(D) Price =================================================================================================================================== COMMON STOCK NO PAR VALUE 09/18/02 M 3,125 A $ 3.72 - ----------------------------------------------------------------------------------------------------------------------------------- COMMON STOCK NO PAR VALUE 09/18/02 3,125 D $18,25 - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- COMMON STOCK NO PAR VALUE 1,305 - ----------------------------------------------------------------------------------------------------------------------------------- COMMON STOCK By Employee NO PAR VALUE 2,568 D stock purchase (2) - ----------------------------------------------------------------------------------------------------------------------------------- COMMON STOCK By 401 (k) NO PAR VALUE 3,500 plan (1) - ----------------------------------------------------------------------------------------------------------------------------------- * If the form is filed by more than one Reporting Person, see Instruction 4(b)(v). Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
2 FORM 4 (continued) ================================================================================ Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) ================================================================================
9. 10. Number Owner- of ship 2. Deriv- of Conver- 5. 7. ative Deriv- 11. sion Number of Title and Amount Secur- ative Nature or Derivative 6. of Underlying 8. ities Secur- of Exer- Securities Date Securities Price Bene- ity: In- cise 3. Acquired (A) Exercisable and (Instr. 3 and 4) of ficially Direct direct Price Trans- 4. or Disposed Expiration Date Deriv- Owned (D) or Bene- 1. of action Trans- of (D) (Month/Day/Year) Amount ative at End In- ficial Title of Deriv- Date action (Instr. 3, or Secur- of direct Owner Derivative ative (Month/ Code 4 and 5) Date Expira- Number ity Year (I) -ship Security Secur- Day/ (Instr.8) Exer- tion of (Instr.(Instr. (Instr. (Instr. (Instr. 3) ity Year) Code V (A) (D) cisable Date Title Shares 5) 4) 4) 4) =================================================================================================================================== Non-qualified $13.5280 N/A l2/08/02 12/08/11 Common 25,000 D stock-option (3) Stock (Right to buy) - ------------------------------------------------------------------------------------------------------------------------------------ Non-qualified $3.68 N/A 02/12/02 12/12/11 Common 28,455 D stock-option (7) Stock (Right to buy) - ------------------------------------------------------------------------------------------------------------------------------------ Non-qualified $4.1997 N/A 04/23/00 10/23/04 Common 5,470 D stock-option (6) Stock (Right to buy) - ------------------------------------------------------------------------------------------------------------------------------------ Non-qualified $3.68 N/A 09/30/99 03/31/04 Common 6,250 D stock-option (5) Stock (Right to buy) - ------------------------------------------------------------------------------------------------------------------------------------ Non-qualified $3.72 N/A M 3,125 06/18/98 02/18/02 Common 0 D stock-option (4) Stock (Right to buy) ===================================================================================================================================
/s/ B. Leigh Weintraub September 19, 2002 - ----------------------------------- ------------------- **Signature of Reporting Person Date Explanation of Responses: 1. Represent plan holdings as of 12/21/01 based upon most recent plan statement timely distributed 2. Purchase of 2,054 Shares from the Employee Stock Puchase Plan 3. Become exercisable in equal annual installments of 20% commencing 12/08/02 4. Become exersisable in equal annual installments of 20% commencing 06/18/98 5. Become exercisable in equal annual installments of 20% commencing 09/30/99 6. Become exercisable in equal annual installments of 20% commencing 04/23/00 7. Become exercisable in equal annual installments of 20% commencing 02/12/02 ** 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 provided is insufficient, see Instruction 6 for procedure. 3 -----END PRIVACY-ENHANCED MESSAGE-----