-----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, TcIBPWeIPwwh4ItK2TWZv7EQZ723N9rDEZfJ6dj5iUt43UzZmRdSZvHJbTwwFPZd ewA1+SxQzoWM4ueVXZ9Rxg== 0000931731-02-000314.txt : 20020924 0000931731-02-000314.hdr.sgml : 20020924 20020924153248 ACCESSION NUMBER: 0000931731-02-000314 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20020919 FILED AS OF DATE: 20020924 REPORTING-OWNER: COMPANY DATA: COMPANY CONFORMED NAME: BEAN REX C CENTRAL INDEX KEY: 0001184930 RELATIONSHIP: DIRECTOR FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: 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: 02771087 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 rexbean-4.txt REX BEAN 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* Bean Rex C. - -------------------------------------------------------------------------------- (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/Day/Year September 20, 2002 - -------------------------------------------------------------------------------- 5. If Amendment, Date of Original (Month/Year) - -------------------------------------------------------------------------------- 6. Relationship of Reporting Person to Issuer (Check all applicable) [X] Director [ ] 10% Owner [ ] 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 06/20/02 G(1) V 80,000 D 204,004 D - ----------------------------------------------------------------------------------------------------------------------------------- COMMON STOCK NO PAR VALUE 06/20/02 G(2) V 70,000 70,000 I Revocable Trust - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
(1) On September 20, 2002, the reporting person contributed 80,000 shares of Merit Medical Systems, Inc. common stock to a charitable remainder trust of which the reporting person is not a trustee. The reporting person has an 8% annual interest in the charitable remainder trust and does not have investment or voting control over the shares held by the trust. (2) On September 20, 2002, the reporting person transferred 70,000 shares of Merit Medical Systems, Inc. stock from the Bean Family Revocable Trust to the Rex C. Bean Trust. -----END PRIVACY-ENHANCED MESSAGE-----