4 1 fpl-form4.txt FPL FORM 4 102502 ------------------------------- 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* Lampropoulos Fred P. -------------------------------------------------------------------------------- (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 October 25, 2002 -------------------------------------------------------------------------------- 5. If Amendment, Date of Original (Month/Year) -------------------------------------------------------------------------------- 6. Relationship of Reporting Person to Issuer (Check all applicable) [X] Director [X] 10% Owner [X] Officer (give title below) [ ] Other (specify below) President, Chief Executive Officer -------------------------------------------------------------------------------- 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 10/25/02 S 1,000 D $22.835 D ----------------------------------------------------------------------------------------------------------------------------------- COMMON STOCK NO PAR VALUE 10/25/02 S 1,000 D $22.90 D ----------------------------------------------------------------------------------------------------------------------------------- COMMON STOCK NO PAR VALUE 10/25/02 S 1,000 D $22.95 D ----------------------------------------------------------------------------------------------------------------------------------- COMMON STOCK NO PAR VALUE 10/25/02 S 1,000 D $23.00 D ----------------------------------------------------------------------------------------------------------------------------------- COMMON STOCK NO PAR VALUE 645,258 ----------------------------------------------------------------------------------------------------------------------------------- COMMON STOCK By 401(k) NO PAR VALUE 29,433(1) 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.
/s/ Fred P. Lampropoulos October 25, 2002 ----------------------------------- ------------------- **Signature of Reporting Person Date ** 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