0001179110-20-000862.txt : 20200129 0001179110-20-000862.hdr.sgml : 20200129 20200129110519 ACCESSION NUMBER: 0001179110-20-000862 CONFORMED SUBMISSION TYPE: 5 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20191231 FILED AS OF DATE: 20200129 DATE AS OF CHANGE: 20200129 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Miller Franklin J CENTRAL INDEX KEY: 0001327767 FILING VALUES: FORM TYPE: 5 SEC ACT: 1934 Act SEC FILE NUMBER: 000-18592 FILM NUMBER: 20556933 MAIL ADDRESS: STREET 1: 1600 WEST 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 5 1 edgar.xml FORM 5 - X0306 5 2019-12-31 0 0 0 0000856982 MERIT MEDICAL SYSTEMS INC MMSI 0001327767 Miller Franklin J 1600 W MERIT PARKWAY SOUTH JORDAN UT 84095 1 0 0 0 Common Stock, No Par Value 29897 I By the Franklin J. Miller and Bonnie A. Miller Family Trust Common Stock, No Par Value 2334 D Non-qualified stock options (right to buy) 9.95 2014-05-22 2020-05-22 Common Stock 20000 20000 D Non-qualified stock options (right to buy) 13.99 2015-06-11 2021-06-11 Common Stock 25000 25000 D Non-qualified stock options (right to buy) 20.27 2016-05-22 2022-05-22 Common Stock 25000 25000 D Non-qualified stock options (right to buy) 18.80 2017-05-26 2023-05-26 Common Stock 25000 25000 D Non-qualified stock options (right to buy) 34.40 2018-05-24 2024-05-24 Common Stock 25000 25000 D Non-qualified stock options (right to buy) 50.5 2019-06-07 2025-06-07 Common Stock 25000 25000 D Non-qualified stock options (right to buy) 52.17 2020-05-24 2026-05-24 Common Stock 13750 13750 D Non-qualified stock options (right to buy) 52.17 2020-05-31 2026-05-31 Common Stock 7500 7500 D This Form 5 is being filed to report the transfer of 11,704 shares transferred into the Franklin J. Miller and Bonnie A. Miller Family Trust from the reporting person's directly held shares, a transaction exempt form Section 16 reporting pursuant to Rule 16a-13. Becomes exercisable in equal annual installments of 20% commencing 05/22/2014. Becomes exercisable in equal annual installments of 20% commencing 06/11/2015. Becomes exercisable in equal annual installments of 20% commencing 05/22/2016. Becomes exercisable in equal annual installments of 20% commencing 05/26/2017. Becomes exercisable in equal annual installments of 20% commencing 05/24/2018. Becomes exercisable in equal annual installments of 20% commencing 06/07/2019. Becomes exercisable in equal annual installments of 20% commencing 05/24/2020. Becomes exercisable in equal annual installments of 20% commencing 05/31/2020. Brian G. Lloyd, Attorney-in-Fact 2020-01-29