0001179110-13-001454.txt : 20130130 0001179110-13-001454.hdr.sgml : 20130130 20130130172938 ACCESSION NUMBER: 0001179110-13-001454 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20121231 FILED AS OF DATE: 20130130 DATE AS OF CHANGE: 20130130 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: STANGER KENT W CENTRAL INDEX KEY: 0000901531 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 000-18592 FILM NUMBER: 13560020 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 5 1 edgar.xml FORM 5 - X0306 5 2012-12-31 0 0 0 0000856982 MERIT MEDICAL SYSTEMS INC MMSI 0000901531 STANGER KENT W 1600 W MERIT PARKWAY SOUTH JORDAN UT 84095 1 1 0 0 Chief Financial Officer Common Stock, No Par Value 76303 I By 401(k) plan Common Stock, No Par Value 185051 I Family Limited Partnership Common Stock, No Par Value 4271 D Common Stock, No Par Value 2012-12-21 5 G 0 2631 0 D 610936 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) 17.34 2004-12-13 2013-12-13 Common Stock 17500 17500 D Non-qualified stock options (right to buy) 11.05 2004-06-10 2014-06-10 Common Stock 7500 7500 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) 12.02 2004-12-18 2014-12-18 Common Stock 25000 25000 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) 9.71 2005-12-28 2015-12-28 Common Stock 25000 25000 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) 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 43750 43750 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) 13.75 2012-08-11 2018-08-11 Common Stock 80000 80000 D Represents plan holdings as of 12/31/12. Employee stock purchase plan as of 12/31/12. Becomes exercisable in equal annual installments of 20% commmencing 06/27/2008. Becomes exercisable in equal annual installments of 20% commmencing 05/21/2009. Becomes exercisable in equal annual installments of 20% commmencing 09/26/2010. Becomes exercisable in equal annual installments of 20% commmencing 08/11/2012. Reflects two gifts to two unaffiliated parties. Kent W. Stanger 2013-01-30