SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
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Check this 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 W MERIT PARKWAY

(Street)
SOUTH JORDAN UT 84095

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
MERIT MEDICAL SYSTEMS INC [ MMSI ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
X Officer (give title below) Other (specify below)
President & CEO
3. Date of Earliest Transaction (Month/Day/Year)
05/15/2015
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. 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
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Common Stock, No Par Value 90,711 I By 401(k) Plan(1)
Common Stock, No Par Value 90 I By spouse as custodian for child.
Common Stock, No Par Value 11,817 I By spouse.
Common Stock, No Par Value 05/15/2015 M(2) 93,750 A $14.39 1,117,027 D
Common Stock, No Par Value 05/15/2015 F(2) 74,545 D $20.64 1,042,482 D
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 3) 2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (Month/Day/Year) 3A. Deemed Execution Date, if any (Month/Day/Year) 4. Transaction Code (Instr. 8) 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) 6. Date Exercisable and Expiration Date (Month/Day/Year) 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) 8. Price of Derivative Security (Instr. 5) 9. Number of derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) 10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Non-qualified stock options (right to buy) $14.39 05/15/2015 M 93,750 07/15/2005 07/15/2015 Common Stock 93,750 $0 0 D
Non-qualified stock options (right to buy) $9.71 12/28/2005 12/28/2015 Common Stock 50,000 50,000 D
Non-qualified stock options (right to buy) $13.82 09/26/2010(3) 09/26/2016 Common Stock 25,000 25,000 D
Non-qualified stock options (right to buy) $13.75 08/11/2012(4) 08/11/2018 Common Stock 120,000 120,000 D
Non-qualified stock options (right to buy) $12.06 10/04/2015(5) 10/04/2021 Common Stock 50,000 50,000 D
Non-qualified stock options (right to buy) $17.27 02/13/2016(6) 02/13/2022 Common Stock 50,000 50,000 D
Non-qualified stock options (right to buy) $17.27 02/13/2016(6) 02/13/2022 Common Stock 5,000 5,000 I Please refer to footnote number seven.(7)
Explanation of Responses:
1. Represents plan holdings as of 5/15/2015.
2. Stock options were exercised in a swap transaction with the Company. 74,545 shares of common stock were surrendered for payroll taxes and payment of the option price. No shares were sold in the open market.
3. Becomes exercisable in equal annual installments of 20% commencing 9/26/2010.
4. Becomes exercisable in equal annual installments of 20% commencing 8/11/2012.
5. Becomes exercisable in equal annual installments of 20% commencing 10/4/2015.
6. Becomes exercisable in equal annual installments of 20% commencing 2/13/2016.
7. Represents derivative securities held by the spouse of the reporting person. The reporting person expressly disclaims beneficial ownership of the securities owned by his spouse.
Gregory L. Barnett, Attorney-in-Fact 05/19/2015
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 4 (b)(v).
** 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 is insufficient, see Instruction 6 for procedure.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.