-----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, CwR7H21R/KE+xK55Q1xd1KtnS5+MY18Wq3heckhpPpH5nETr3vRHA5Fo7NWH/190 xac/WtX6A6Q6cpF1yC/XXw== 0000931731-03-000187.txt : 20030530 0000931731-03-000187.hdr.sgml : 20030530 20030530155244 ACCESSION NUMBER: 0000931731-03-000187 CONFORMED SUBMISSION TYPE: 4/A PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20030521 FILED AS OF DATE: 20030530 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: BEAN REX C CENTRAL INDEX KEY: 0001184930 FILING VALUES: FORM TYPE: 4/A SEC ACT: 1934 Act SEC FILE NUMBER: 000-18592 FILM NUMBER: 03725959 BUSINESS ADDRESS: STREET 1: 1600 W. MERIT PARKWAY CITY: SOUTH JORDAN STATE: UT ZIP: 84095 ISSUER: 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 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/A 1 form4a-rcbean052103_ex.xml X0101 4/A 2003-05-21 2003-05-29 0000856982 MERIT MEDICAL SYSTEMS INC MMSI 0001184930 BEAN REX C 1 0 0 0 Common Stock, no par value 2003-05-21 2003-05-21 4 M 0 11719 4.80 A 148524 D Common Stock, no par value 2003-05-21 2003-05-21 4 F 0 3040 18.50 D 145484 D Common Stock, no par value 1988-08-08 1988-08-08 4 A 0 9450 174825 A 9450 D Common Stock, no par value 1988-08-08 1988-08-08 4 A 0 39438 729603 A 39438 D Common Stock, no par value 1988-08-08 1988-08-08 4 A 0 10000 185000 A 10000 D Rex C. Bean 2003-05-31 EX-99 3 ex99rcbform4.txt DERIVATIVE SECURITIES - RCB EXHIBIT 99 REX BEAN FORM 4A (05-23-2001) (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 Exer- tion of (Instr. (Instr. (Instr. (Instr. (Instr. 3) ity Year) 8) (A) (D) cisable Date Title Shares 5) 4) 4) 4) ==================================================================================================================================== Non-qualified $4.80 05/21/03 M 11,719 05/27/98 05/27/03 Common 11,719 0 D Stock Option Stock (right to buy) - ------------------------------------------------------------------------------------------------------------------------------------ Non-qualified $3.76 N/A 05/26/99 05/26/04 Common 11,719 D Stock Option Stock (right to buy) - ------------------------------------------------------------------------------------------------------------------------------------ Non-qualified $2.88 N/A 05/24/00 05/24/05 Common 11,719 D Stock Option Stock (right to buy) - ------------------------------------------------------------------------------------------------------------------------------------ Non-qualified $5.0624 N/A 05/23/01 05/23/11 Common 15,625 D Stock Option Stock (right to buy) - ------------------------------------------------------------------------------------------------------------------------------------ Non-qualified $16.99 N/A 05/23/02 05/23/12 Common 10,000 D Stock Option Stock (right to buy) ====================================================================================================================================
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