-----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, IbZVIyYAI34FYJYtLkrVGc1ekQm4bromUibItxKjwsTo/+nX0vo9O1c7ozQFv3D8 TTKDJpCuWzELnBB5Y9TpiQ== 0000931731-04-000021.txt : 20040205 0000931731-04-000021.hdr.sgml : 20040205 20040205122252 ACCESSION NUMBER: 0000931731-04-000021 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: EDELMAN RICHARD W CENTRAL INDEX KEY: 0001184931 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-18592 FILM NUMBER: 04569201 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 1 form4-rwe020404_ex.xml X0201 4 2004-02-04 0 0000856982 MERIT MEDICAL SYSTEMS INC MMSI 0001184931 EDELMAN RICHARD W 1600 W. MERIT PARKWAY SOUTH JORDAN UT 84095 1 0 0 0 Non-qualified Stock Options (right to buy) 9.56 1988-08-08 1988-08-08 4 M 0 11109 9.56 A 2002-05-23 2012-05-23 Common Stock 11109 11109 D Non-qualified Stock Options (right to buy) 10.47 1988-08-08 1988-08-08 4 M 0 26667 10.47 A 2003-05-22 2013-05-22 Common Stock 26667 26667 D Non-qualified Stock Options (right to buy) 21.67 2003-12-13 2003-12-13 4 M 0 15000 21.67 A 2003-12-13 2013-12-13 Common Stock 15000 15000 D Number reflects (4 for 3) forward stock split effective 12/03/03. Richard W. Edelman by Greg Barnett, Atty-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 2004-02-05 -----END PRIVACY-ENHANCED MESSAGE-----