0001179110-12-013784.txt : 20120907 0001179110-12-013784.hdr.sgml : 20120907 20120907163041 ACCESSION NUMBER: 0001179110-12-013784 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20120906 FILED AS OF DATE: 20120907 DATE AS OF CHANGE: 20120907 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Nelson Arlin D CENTRAL INDEX KEY: 0001382939 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 000-18592 FILM NUMBER: 121080380 MAIL 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 edgar.xml FORM 4 - X0306 4 2012-09-06 0 0000856982 MERIT MEDICAL SYSTEMS INC MMSI 0001382939 Nelson Arlin D 1600 W. MERIT PARKWAY SOUTH JORDAN UT 84095 0 1 0 0 Chief Operating Officer Common Stock, No Par Value 2012-09-06 4 M 0 11111 7.79 A 11411 D Common Stock, No Par Value 2012-09-06 4 S 0 11111 14.61 D 300 D Common Stock, No Par Value 928 I By 401(k) Plan Non-qualified Stock Options (right to buy) 7.79 2012-09-06 4 M 0 11111 0 D 2003-02-06 2013-02-06 Common Stock 11111 0 D Non-qualified Stock Options (right to buy) 17.34 2003-12-13 2013-12-13 Common Stock 4375 4375 D Non-qualified Stock Options (right to buy) 11.05 2004-06-10 2014-06-10 Common Stock 1875 1875 D Non-qualified Stock Options (right to buy) 12.02 2004-12-18 2014-12-18 Common Stock 12500 12500 D Non-qualified Stock Options (right to buy) 9.71 2005-12-28 2015-12-28 Common Stock 12500 12500 D Non-qualified Stock Options (right to buy) 9.70 2008-06-27 2014-06-27 Common Stock 25000 25000 D Non-qualified stock options (right to buy) 11.53 2009-05-21 2015-05-21 Common Stock 31250 31250 D Non-qualified stock options (right to buy) 13.75 2012-08-11 2018-08-11 Common Stock 25000 25000 D Represents plan holdings as of 09/06/12. Becomes exercisable in equal annual installments of 20% commencing 06/27/08. Becomes exercisable in equal annual installments of 20% commencing 05/21/09. Becomes exercisable in equal annual installments of 20% commencing 08/11/12. The price reported in Column 4 is a weighted average price. These shares were sold in multiple transactions at prices ranging from $14.54 to $14.67, inclusive. The reporting person undertakes to provide to Merit Medical Systems, Inc., any security holder of Merit Medical Systems, Inc., or the staff of the Securities and Exchange Commission, upon request, full information regarding the number of shares sold at each separate price within the range set forth in this Form 4. Arlin D. Nelson 2012-09-07