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*
FERRAND BRIAN L

(Last) (First) (Middle)
MERIT MEDICAL SYSTEMS INC
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)
Director 10% Owner
X Officer (give title below) Other (specify below)
Director of Sales
3. Date of Earliest Transaction (Month/Day/Year)
11/17/2003
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 11/14/2003 11/14/2003 M 5,000 A $10.146 5,000 D
Common Stock, no par value 11/14/2003 11/14/2003 S 5,000 D $28 0 D
Common Stock, no par value 11/14/2003 11/14/2003 M 2,666 A $12.7425 2,666 D
Common Stock, no par value 11/14/2003 11/14/2003 M 2,666 D $28 0 D
Common Stock, no par value 08/08/1988 11/14/2003 M 15,174 A (1) 15,174(1) I by 401(k) Plan(1)
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
Employee stock option (right to buy) $2.76 08/08/1988 08/08/1988 M 18,751 02/12/2002(2) 02/12/2011 Common Stock 18,751 $2.76 18,751 D
Employee stock option (right to buy) $10.15 11/14/2003 11/14/2003 M 5,000 12/08/2002(3) 12/08/2011 Common Stock 5,000 $10.15 20,000 D
Employee stock option (right to buy) $12.74 11/14/2003 11/14/2003 M 2,666 05/23/2003(4) 05/23/2012 Common Stock 2,666 $12.74 10,667 D
Employee stock option (right to buy) $12.99 08/08/1988 08/08/1988 M 26,667 02/06/2004(5) 02/06/2013 Common Stock 26,667 $12.99 26,667 D
Explanation of Responses:
1. Represents plan holdings as of 09/04/03 per most recent plan statement timely distributed.
2. Become exercisable in equal installments of 20% commencing 02/12/02
3. Become exercisable in equal installments of 20% commencing 12/08/02
4. Become exercisable in equal installments of 20% commencing 05/23/03
5. Become exercisable in equal installments of 20% commencing 02/06/04
Brian Ferrand by Kent W. Stanger as Attorney-in-Fact per Pwr of Atty dated Augsut 10, 1992, a manually signed copy of which is 11/17/2003
** 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.