-----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, QvBOawYc/dVei+VCPoazrIfmy/4h1vB6EwiZCa8083Z7wJzcxIIVA86K2ZmoPQG6 R8xHFVLWndOOrujzDMdPoQ== 0000931731-04-000020.txt : 20040205 0000931731-04-000020.hdr.sgml : 20040205 20040205121012 ACCESSION NUMBER: 0000931731-04-000020 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20040204 FILED AS OF DATE: 20040205 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: FERRAND BRIAN L CENTRAL INDEX KEY: 0001184964 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-18592 FILM NUMBER: 04569168 BUSINESS ADDRESS: STREET 1: MERIT MEDICAL SYSTEMS INC STREET 2: 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 1 form4-blf020404_ex.xml X0201 4 2004-02-04 0 0000856982 MERIT MEDICAL SYSTEMS INC MMSI 0001184964 FERRAND BRIAN L MERIT MEDICAL SYSTEMS INC 1600 W. MERIT PARKWAY SOUTH JORDAN UT 84095 0 1 0 0 Director of Sales Common Stock, no par value 1988-08-08 1988-08-08 4 M 0 20527 A 20527 I by 401(k) Plan Employee Stock Option (right to buy) 2.07 1988-08-08 1988-08-08 4 M 0 25001 2.07 A 2002-02-12 2011-02-12 Common Stock 25001 25001 D Employee Stock Option (right to buy) 7.61 1988-08-08 1988-08-08 4 M 0 26666 7.61 A 2002-12-08 2011-12-08 Common Stock 26666 26666 D Employee Stock Option (right to buy) 9.56 1988-08-08 1988-08-08 4 M 0 14222 9.56 A 2003-05-23 2012-05-23 Common Stock 14222 14222 D Employee Stock Option (right to buy) 9.74 1988-08-08 1988-08-08 4 M 0 35556 9.74 A 2004-02-06 2013-02-06 Common Stock 35556 35556 D Employee Stock Option (right to buy) 21.67 2003-12-13 2003-12-13 4 M 0 14000 21.67 A 2004-12-13 2013-12-13 Common Stock 14000 14000 D Represent plan holdings as of 02/03/04 based upon most recent plan statement timely distributed. Become exercisable in equal annual installments of 20% commencing 02/12/02 Become exercisable in equal annual installments of 20% commencing 12/08/02 Become exercisable in equal annual installments of 20% commencing 05/23/03 Become exercisable in equal annual installments of 20% commencing 02/06/04 Become exercisable in equal annual installments of 20% commencing 12/13/04 Numbers reflect (4 for 3) forward split effective 12/13/03 per 4019K) Plan Brian Ferrand per Greg Barnett as Attorney-in-Fact per Pwr of Atty dtd 09/14/02, a manually signed copy of which is on file with the SEC and is incorporated herein by reference 2004-02-04 -----END PRIVACY-ENHANCED MESSAGE-----