-----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, JqQ3q6YbTyh+M/wCzUvRVyx4RU7DyS6cp1Lgh1+x7yPk/+o7qPR72Iwo6x76lJ0O 8eNsMRNOgtWs91OFoDxVHw== 0000931731-04-000067.txt : 20040316 0000931731-04-000067.hdr.sgml : 20040316 20040316120420 ACCESSION NUMBER: 0000931731-04-000067 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20040312 FILED AS OF DATE: 20040316 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: STILLABOWER MICHAEL E CENTRAL INDEX KEY: 0001192955 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-18592 FILM NUMBER: 04671613 BUSINESS ADDRESS: STREET 1: C/O MERIT MEDICAL SYSTEMS INC STREET 2: 1600 W MERIT PARKWAY CITY: SOUTH JORDAN STATE: UT ZIP: 84095 BUSINESS PHONE: 8012531600 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-mstillabower031204_ex.xml X0201 4 2004-03-12 0 0000856982 MERIT MEDICAL SYSTEMS INC MMSI 0001192955 STILLABOWER MICHAEL E C/O MERIT MEDICAL SYSTEMS INC 1600 W MERIT PARKWAY SOUTH JORDAN UT 84095 1 0 0 0 Common Stock, no par value 2004-03-12 2004-03-12 4 M 0 20833 1.62 A 43055 D Common Stock, no par value 2004-03-12 2004-03-12 4 S 0 20833 22.5832 A 22222 D Nonqualified Stock Options (right to buy) 1.62 2004-03-12 2004-03-12 4 M 0 20833 1.62 D 2000-05-24 2005-05-24 Common Stock 20833 0 D Nonqualified Stock Options (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 Options (right to buy) 9.56 1988-08-08 1988-08-08 4 M 0 17777 2.85 A 2002-05-23 2012-05-23 Common Stock 17777 17777 D Nonqualified 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 Nonqualified Stock Options (right to buy) 21.67 1988-08-08 1988-08-08 4 M 0 15000 21.67 A 2003-12-13 2013-12-13 Common Stock 15000 15000 D Michael Stillabower by Greg Barnett, Atty-in-Fact, per Pwr of Atty dtd 09/14/2002, a manually signed copy of which is on file with the Commission and is incorporated herein by reference. 2004-03-15 -----END PRIVACY-ENHANCED MESSAGE-----