-----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, Uom7O2s95D8PuM3DqoVWEE5y+/70UWfgAxTdon8slf92MXOYrdC1u3yZDTPCn0Ss 56pEGcH2fTeHdFcDCc5tIg== 0000931731-02-000367.txt : 20021104 0000931731-02-000367.hdr.sgml : 20021104 20021104141734 ACCESSION NUMBER: 0000931731-02-000367 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20021101 FILED AS OF DATE: 20021104 REPORTING-OWNER: COMPANY DATA: COMPANY CONFORMED NAME: FERRAND BRIAN L CENTRAL INDEX KEY: 0001184964 RELATIONSHIP: OFFICER 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: 02807992 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 brianf-form4.txt BRIAN F - FORM 4 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* FERREND BRIAN - -------------------------------------------------------------------------------- (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 November 1, 2002 - -------------------------------------------------------------------------------- 5. If Amendment, Date of Original (Month/Year) Page 1 of 3 Pages - -------------------------------------------------------------------------------- 6. Relationship of Reporting Person to Issuer (Check all applicable) [ ] Director [ ] 10% Owner [X] Officer (give title below) [ ] Other (specify below) Vice President of Sales - -------------------------------------------------------------------------------- 7. Individual or Joint/Group Filing (Check applicable line) [X] Form filed by one Reporting Person [ ] Form filed by more than one Reporting Person - --------------------------------------------------------------------------------
Table I -- Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned 5. 6. 4. Amount of Owner- Securities Acquired (A) or Securities ship Disposed of (D) Beneficially Form: 7. 3. (Instr. 3, 4 and 5) Owned at End Direct Nature of 2. Transaction of Issuer's (D) or Indirect 1. Transaction Code (A) Fiscal Year Indirect Beneficial Title of Security Date (Instr. 8) Amount or Price (Instr. 3 (I) Ownership (Instr. 3) (mm/dd/yy) Code V (D) and 4) (Instr.4) (Instr. 4) =========================================================================================================================== Common Stock 11/01/02 M 3,125 A $3.68 D No Par Value - --------------------------------------------------------------------------------------------------------------------------- Common Stock No Par Value 10/30/02 S 3,125 D $23.8569 D - --------------------------------------------------------------------------------------------------------------------------- - --------------------------------------------------------------------------------------------------------------------------- - --------------------------------------------------------------------------------------------------------------------------- - --------------------------------------------------------------------------------------------------------------------------- - --------------------------------------------------------------------------------------------------------------------------- - --------------------------------------------------------------------------------------------------------------------------- - --------------------------------------------------------------------------------------------------------------------------- - --------------------------------------------------------------------------------------------------------------------------- Common Stock by 401(k) No Par Value 4,314(1) I 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.
Page 2 of 3 Pages 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 $3.68 N/A M 3,125 09/30/99 03/31/04 Common 3,125 D stock options (7) Stock (Right to Buy) - ----------------------------------------------------------------------------------------------------------------------------------- Non-qualified $3.68 N/A 02/12/02 02/12/11 Common 18,751 D stock options (2) Stock (Right to Buy) - ----------------------------------------------------------------------------------------------------------------------------------- Non-qualified $13.528 N/A 12/08/02 12/08/11 Common 18,750 D stock options (3) Stock (Right to Buy) - ----------------------------------------------------------------------------------------------------------------------------------- Non-qualified $16.99 N/A 05/23/03 05/23/12 Common 10,000 D stock options (4) Stock (Right to Buy) - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- - ----------------------------------------------------------------------------------------------------------------------------------- ===================================================================================================================================
Explanation of Responses: (1) Represent plan holdings as of 12/31/01 based upon most recent plan statement timely distributed (2) Become Exercisable in equal annual installments of 20% commencing 02/12/02 (3) Become Exercisable in equal annual installments of 20% commencing 12/08/02 (4) Become Exercisable in equal annual installments of 20% commencing 05/23/03 (7) Become Exercisable in equal annual installments of 20% commencing 09/30/99 /s/ KENT W. STANGER 11/01/02 - ------------------------------------------- ----------- **Signature of Reporting Person Date Kent W. Stanger as Attorney-in-Fact pursuant to a Power of Attorney dated August 10, 1992, a manually signed copy of which is on file with the Commission and is incorporated herein by reference. ** 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. Page 3 of 3 Pages -----END PRIVACY-ENHANCED MESSAGE-----