0001179110-12-015705.txt : 20121105 0001179110-12-015705.hdr.sgml : 20121105 20121105181515 ACCESSION NUMBER: 0001179110-12-015705 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20121101 FILED AS OF DATE: 20121105 DATE AS OF CHANGE: 20121105 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: 121181309 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 2012-11-01 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 2012-11-01 4 G 0 14000 0 D 46696 I Rex C. Bean Trust dated 8/8/02 Common Stock, No Par Value 158279 I Bean Family Investments, LLC Common Stock, No Par Value 500 I Bean Family Foundation Common Stock, No Par Value 2012-11-01 4 G 0 14000 0 A 69203 I Rex C. Bean Charitable Remainder Trust Common Stock, No Par Value 35149 I Bean Family Revocable Trust dated 6/24/94 Non-qualified stock options (right to buy) 8.38 2003-05-22 2013-05-22 Common Stock 5977 26801 D Non-qualified stock options (right to buy) 17.34 2003-12-13 2013-12-13 Common Stock 18750 18750 D Non-qualified stock options (right to buy) 11.05 2004-06-10 2014-06-10 Common Stock 18750 18750 D Non-qualified stock options (right to buy) 11.41 2005-05-25 2015-05-25 Common Stock 18750 18750 D Non-qualified stock options (right to buy) 9.22 2006-05-25 2013-05-25 Common Stock 18750 18750 D Non-qualified stock options (right to buy) 9.70 2008-06-27 2014-06-27 Common Stock 18750 18750 D Non-qualified stock options (right to buy) 11.53 2009-05-21 2015-05-21 Common Stock 18750 18750 D Non-qualified stock options (right to buy) 13.82 2010-09-26 2016-09-26 Common Stock 25000 25000 D Non-qualified stock options (right to buy) 13.16 2011-06-25 2017-06-25 Common Stock 25000 25000 D Non-qualified stock options (right to buy) 13.75 2012-08-11 2018-08-11 Common Stock 20000 20000 D Non-qualified stock options (right to buy) 12.91 2013-05-23 2019-05-23 Common Stock 20000 20000 D Becomes exercisable in equal annual installments of 20% commencing 06/27/2008. Becomes exercisable in equal annual installments of 20% commencing 05/21/2009. Becomes exercisable in equal annual installments of 20% commencing 09/26/2010. Becomes exercisable in equal annual installments of 20% commencing 06/25/2011. Becomes exercisable in equal annual installments of 20% commencing 08/11/2012. Becomes exercisable in equal annual installments of 20% commencing 05/23/2013. Gregory L. Barnett, Attorney-in-Fact 2012-11-05