-----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, NSp9e4ohd21bBh9wgUcIY55y6x6/qudnaMIsSrox1J4Fd1hnqGXm3mLjf+KAduvL dabdO7gcxiUW197PhgjsEQ== 0000931731-03-000082.txt : 20030325 0000931731-03-000082.hdr.sgml : 20030325 20030325132117 ACCESSION NUMBER: 0000931731-03-000082 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20030324 FILED AS OF DATE: 20030325 REPORTING-OWNER: COMPANY DATA: COMPANY CONFORMED NAME: LAMPROPOULOS FRED P CENTRAL INDEX KEY: 0000901534 RELATIONSHIP: OFFICER IRS NUMBER: 870447694 FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: 1600 W MARIT PARKWAY CITY: SO JORDAN STATE: UT ZIP: 84095 BUSINESS PHONE: 84095-1688 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: 03615450 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-fpl032403.txt FORM 4 - FPL - 032403 ------------------------------- 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 March 24, 2003 - -------------------------------------------------------------------------------- 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 [X] 10% Owner [X] Officer (give title below) [ ] Other (specify below) President, CEO - -------------------------------------------------------------------------------- 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 03/24/03 G 5,000 D D - --------------------------------------------------------------------------------------------------------------------------- - --------------------------------------------------------------------------------------------------------------------------- - --------------------------------------------------------------------------------------------------------------------------- - --------------------------------------------------------------------------------------------------------------------------- Common Stock No Par Value 623,908 - --------------------------------------------------------------------------------------------------------------------------- Common Stock by 401(k) No Par Value 29,656(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.
Explanation of Responses: /S/ FRED P. LAMPROPOULOS 03/24/03 - ----------------------------------- ----------- **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-----