-----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, DyJX8y3ZLcxtTYCtdmE+Y5ZiDEWr3ozgQz9AEt6iSwewvyKmXrBQyK5K6H3DCjSu AiRv77hYmnz/Bjqz3D6TJQ== 0000931731-04-000028.txt : 20040205 0000931731-04-000028.hdr.sgml : 20040205 20040205122739 ACCESSION NUMBER: 0000931731-04-000028 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20040202 FILED AS OF DATE: 20040205 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: BEAN REX C CENTRAL INDEX KEY: 0001184930 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-18592 FILM NUMBER: 04569230 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-rcbean020404_ex.xml X0201 4 2004-02-02 0 0000856982 MERIT MEDICAL SYSTEMS INC MMSI 0001184930 BEAN REX C 1600 W. MERIT PARKWAY SOUTH JORDAN UT 84095 1 0 0 0 Common Stock, no par value 1988-08-08 1988-08-08 4 M 0 245172 A 245172 D Common Stock, no par value 1988-08-08 1988-08-08 4 M 0 16800 A 16800 D Common Stock, no par value 1988-08-08 1988-08-08 4 M 0 70112 A 70112 D Common Stock, no par value 1988-08-08 1988-08-08 4 M 0 17777 A 17777 D Nonqualified Stock Option (right to buy) 2.12 1988-08-08 1988-08-08 4 M 0 20833 2.12 A 1999-05-26 2004-05-26 Common Stock 20833 20833 D Nonqualified Stock Option (right to buy) 1.62 1988-08-08 1988-08-08 4 M 0 20833 1.62 A 2000-05-24 2005-05-24 Common Stock 20833 20833 D Nonqualified Stock Option (right to buy) 2.85 1988-08-08 1988-08-08 4 M 0 27777 2.85 A 2001-05-23 2011-05-23 Common Stock 27777 27777 D Nonqualified Stock Option (right to buy) 9.56 1988-08-08 1988-08-08 4 M 0 17777 9.56 A 2002-05-23 2012-05-23 Common Stock 17777 17777 D Nonqualified Stock Option (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 Nonqualified Stock Option (right to buy) 21.67 2003-12-13 2003-12-13 4 A 0 15000 21.67 A 2003-12-13 2013-12-13 Common Stock 15000 15000 D Numbers reflect (4 for 3) forward stock split effective 12/03/03 Bean Family Investment LLC Rex Bean Trust (revocable) Rex & Anita Bean Trust Rex Bean Cert Rex C. Bean by Greg Barnett, Atty-in-Fact, per Pwr of Atty dated 9/14/02, 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-----