0001179110-17-001436.txt : 20170201 0001179110-17-001436.hdr.sgml : 20170201 20170201155105 ACCESSION NUMBER: 0001179110-17-001436 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20161231 FILED AS OF DATE: 20170201 DATE AS OF CHANGE: 20170201 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 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: 17564854 5 1 edgar.xml FORM 5 - X0306 5 2016-12-31 0 0 0 0000856982 MERIT MEDICAL SYSTEMS INC MMSI 0000901531 STANGER KENT W 1600 W MERIT PARKWAY SOUTH JORDAN UT 84095 1 0 0 0 Common Stock, No Par Value 42250 I By 401(k) plan Common Stock, No Par Value 4271 D Common Stock, No Par Value 29524 I Family Limited Partnership Common Stock, No Par Value 2016-12-30 5 G 0 2812 D 411534 D Non-qualified stock options (right to buy) 13.75 2012-08-11 2018-08-11 Common Stock 64000 64000 D Non-qualified stock options (right to buy) 12.06 2015-10-04 2021-10-04 Common Stock 2000 2000 D Non-qualified stock options (right to buy) 19.72 2017-05-02 2023-05-02 Common Stock 9375 9375 D Non-qualified stock options (right to buy) 18.80 2017-05-26 2023-05-26 Common Stock 25000 25000 D Represents plan holdings as of 12/31/16. Employee stock purchase plan as of 12/31/16. This report shall not be deemed an admission that the reporting person is the beneficial owner of the securities held by K.W.S. Properties LC. This is a gift. Becomes exercisable in equal annual installments of 20% commencing on 08/11/2012. Becomes exercisable in equal annual installments of 20% commencing on 10/04/2015. Becomes exercisable in equal annual installments of 20% commencing on 05/02/2017. Becomes exercisable in equal annual installments of 20% commencing on 05/26/2017. Kent W. Stanger 2017-02-01