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*
BEAN REX C

(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
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
09/04/2003
4. If Amendment, Date of Original Filed (Month/Day/Year)
09/08/2003
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 09/03/2003 09/03/2003 S 100(1) D $21.9 193,879(1) D(2)
Common Stock, no par value 08/08/1988 08/08/1988 A 52,584(1) A (4) 52,584 D(4)
Common Stock, no par value 08/08/1988(1) 08/08/1988 A 13,333(1) A (5) 13,333(1) D(5)
Common Stock, no par value 08/08/1988 08/08/1988 A 12,600(1) A (3) 12,600(1) D(3)
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
Nonqualified stock option (right to buy) $2.82(1) 08/08/1988 08/08/1988 A 15,625(1) 05/26/1999 05/26/2004 Common Stock 15,625(1) $2.82(1) 15,625(1) D
Nonqualified stock option (right to buy) $2.16(1) 08/08/1988 08/08/1988 A 15,625(1) 05/26/2000 05/24/2005 Common Stock 15,625(1) $2.16(1) 15,625(1) D
Nonqualified stock option (right to buy) $3.79(1) 08/08/1988 08/08/1988 A 20,833(1) 05/23/2001 05/23/2011 Common Stock 20,833(1) $3.79(1) 20,833(1) D
Nonqualified stock option (right to buy) $12.74(1) 08/08/1988 08/08/1988 A 13,333(1) 05/23/2002 05/23/2012 Common Stock 13,333(1) $12.74(1) 13,333(1) D
Nonqualified stock option (right to buy) $13.96(1) 08/08/1988 08/08/1988 A 20,000(1) 05/22/2003 05/22/2012 Common Stock 20,000(1) $13.96(1) 20,000(1) D
Explanation of Responses:
1. End of month number reflects split (4 for 3) forward split effective 8/15/03.
2. Ownership by Bean Family Investment LLC
3. Ownership by Rex Bean Trust (revocable)
4. Ownership by Rex & Anita Bean Trust
5. Ownership by Rex Bean Cert
Rex C. Bean by Greg Barnett as Atty-in-Fact per Pwr of Atty dtd 9/14/2002, on file with the Commis... 09/09/2003
** 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.