Annual Statement of Changes in Beneficial Ownership (5)
January 29 2020 - 11:06AM
Edgar (US Regulatory)
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
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Form 3 Holdings Reported
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Form 4 Transactions Reported
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
*
Miller Franklin J | 2. Issuer Name and Ticker or Trading SymbolMERIT MEDICAL SYSTEMS INC [MMSI] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
__X__ Director _____ 10% Owner _____ Officer (give title below) _____ Other (specify below)
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(Last)
(First)
(Middle)
1600 W MERIT PARKWAY | 3. Statement for Issuer's Fiscal Year Ended (MM/DD/YYYY) 12/31/2019 |
(Street)
SOUTH JORDAN, UT 84095
(City)
(State)
(Zip)
| 4. If Amendment, Date Original Filed(MM/DD/YYYY) | 6. Individual or Joint/Group Filing(Check Applicable Line)
_X_ Form Filed by One Reporting Person
___ Form Filed by More than One Reporting Person
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Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
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1.Title of Security (Instr. 3) | 2. Trans. Date | 2A. Deemed Execution Date, if any | 3. Trans. Code (Instr. 8) | 4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) | 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) |
Amount | (A) or (D) | Price |
Common Stock, No Par Value | | | | | | | 29897 (1) | I | By the Franklin J. Miller and Bonnie A. Miller Family Trust |
Common Stock, No Par Value | | | | | | | 2334 | D | |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. Code (Instr. 8) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 6. Date Exercisable and Expiration Date (MM/DD/YYYY) | 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) | 8. Price of Derivative Security (Instr. 5) | 9. Number of Derivative Securities Beneficially Owned at End of Issuer's Fiscal Year (Instr. 4) | 10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) |
(A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Non-qualified stock options (right to buy) | $9.95 | | | | | | 5/22/2014 (2) | 5/22/2020 | Common Stock | 20000 | | 20000 | D | |
Non-qualified stock options (right to buy) | $13.99 | | | | | | 6/11/2015 (3) | 6/11/2021 | Common Stock | 25000 | | 25000 | D | |
Non-qualified stock options (right to buy) | $20.27 | | | | | | 5/22/2016 (4) | 5/22/2022 | Common Stock | 25000 | | 25000 | D | |
Non-qualified stock options (right to buy) | $18.80 | | | | | | 5/26/2017 (5) | 5/26/2023 | Common Stock | 25000 | | 25000 | D | |
Non-qualified stock options (right to buy) | $34.40 | | | | | | 5/24/2018 (6) | 5/24/2024 | Common Stock | 25000 | | 25000 | D | |
Non-qualified stock options (right to buy) | $50.5 | | | | | | 6/7/2019 (7) | 6/7/2025 | Common Stock | 25000 | | 25000 | D | |
Non-qualified stock options (right to buy) | $52.17 | | | | | | 5/24/2020 (8) | 5/24/2026 | Common Stock | 13750 | | 13750 | D | |
Non-qualified stock options (right to buy) | $52.17 | | | | | | 5/31/2020 (9) | 5/31/2026 | Common Stock | 7500 | | 7500 | D | |
Explanation of Responses: |
(1) | 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. |
(2) | Becomes exercisable in equal annual installments of 20% commencing 05/22/2014. |
(3) | Becomes exercisable in equal annual installments of 20% commencing 06/11/2015. |
(4) | Becomes exercisable in equal annual installments of 20% commencing 05/22/2016. |
(5) | Becomes exercisable in equal annual installments of 20% commencing 05/26/2017. |
(6) | Becomes exercisable in equal annual installments of 20% commencing 05/24/2018. |
(7) | Becomes exercisable in equal annual installments of 20% commencing 06/07/2019. |
(8) | Becomes exercisable in equal annual installments of 20% commencing 05/24/2020. |
(9) | Becomes exercisable in equal annual installments of 20% commencing 05/31/2020. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Miller Franklin J 1600 W MERIT PARKWAY SOUTH JORDAN, UT 84095 | X |
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Signatures
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Brian G. Lloyd, Attorney-in-Fact | | 1/29/2020 |
**Signature of Reporting Person | Date |
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