-----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, GbQ2c740UFL7JYzxmE8LtpyC5VxPXcACkNSRnE0eqJA9AFolc2ihz2V9r0LuOL8w /j+VBXahPF9KZv2qNwvcVw== 0000931731-02-000424.txt : 20021213 0000931731-02-000424.hdr.sgml : 20021213 20021213170557 ACCESSION NUMBER: 0000931731-02-000424 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20021212 FILED AS OF DATE: 20021213 REPORTING-OWNER: COMPANY DATA: COMPANY CONFORMED NAME: STANGER KENT W CENTRAL INDEX KEY: 0000901531 RELATIONSHIP: OFFICER IRS NUMBER: 870447695 FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: 79 WEST 4500 SOUTH STREET 2: SUITE 9 CITY: SALT LAKE CITY STATE: UT ZIP: 84107 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: 02857549 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 form4-kent.txt FORM 4 - KENT STANGER ------------------------------- 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* STANGER KENT W. - -------------------------------------------------------------------------------- (Last) (First) (Middle) 1600 West Merit Parkway - -------------------------------------------------------------------------------- (Street) South Jordan UT 84095 - -------------------------------------------------------------------------------- (City) (State) (Zip) Merit Medical Systems, Inc. (MMSI) - -------------------------------------------------------------------------------- 2. Issuer Name and Ticker or Trading Symbol - -------------------------------------------------------------------------------- 3. IRS Identification Number of Reporting Person, if an Entity (Voluntary) December 12, 2002 - -------------------------------------------------------------------------------- 4. Statement for Month/Year - -------------------------------------------------------------------------------- 5. If Amendment, Date of Original (Month/Year) Page 1 of 2 Pages - -------------------------------------------------------------------------------- 6. Relationship of Reporting Person to Issuer (Check all applicable) [X] Director [ ] 10% Owner [X] Officer (give title below) [ ] Other (specify below) Chief Financial 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 - --------------------------------------------------------------------------------
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. (Instr. 3, 4 and 5) Owned at End Direct Nature of 2. 3. of Issuer's (D) or Indirect 1. Transaction Transaction (A) Fiscal Year Indirect Beneficial Title of Security Date Code Amount or Price (Instr. 3 (I) Ownership (Instr. 3) (mm/dd/yy) (Instr. 8) (D) and 4) (Instr.4) (Instr. 4) =========================================================================================================================== Common Stock, No Par Value 12/11/02 G 175 D D - --------------------------------------------------------------------------------------------------------------------------- Common Stock, No Par Value 12/12/02 G 230 D D - --------------------------------------------------------------------------------------------------------------------------- - --------------------------------------------------------------------------------------------------------------------------- - --------------------------------------------------------------------------------------------------------------------------- Common Stock, No Par Value 385,808 - --------------------------------------------------------------------------------------------------------------------------- Common Stock, 401(K) No Par Value N/A 26,078 I Plan(1) - --------------------------------------------------------------------------------------------------------------------------- Common Stock, Employee stock No Par Value N/A 1,923 D purchase plan - --------------------------------------------------------------------------------------------------------------------------- Common Stock, By trust No Par Value N/A 2,906 I (deferred comp plan) - --------------------------------------------------------------------------------------------------------------------------- Explanation of responses: (1) Represent plan holdings as of 10/28/02 * 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/ Kent W. Stanger 12/13/2002 - ----------------------------------- ----------- **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. Page 2 of 2 Pages -----END PRIVACY-ENHANCED MESSAGE-----