Statement of Changes in Beneficial Ownership (4)
June 21 2021 - 7:09PM
Edgar (US Regulatory)
FORM 4
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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).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
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
*
Millner F. Ann |
2. Issuer Name and Ticker or Trading Symbol
MERIT MEDICAL SYSTEMS INC
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MMSI
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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 WEST MERIT PARKWAY |
3. Date of Earliest Transaction
(MM/DD/YYYY)
6/17/2021 |
(Street)
SOUTH JORDAN, UT 84095
(City)
(State)
(Zip)
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4. If Amendment, Date Original Filed
(MM/DD/YYYY)
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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)
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2. Trans. Date
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2A. Deemed Execution Date, if any
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3. Trans. Code (Instr. 8)
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4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5)
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5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4)
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6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)
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7. Nature of Indirect Beneficial Ownership (Instr. 4)
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Code
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V
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Amount
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(A) or (D)
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Price
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Common Stock, No Par Value | 6/17/2021 | | A | | 2914 | A | $0 | 21026 (1) | D | |
Table II - Derivative Securities 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 | 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 Following Reported Transaction(s) (Instr. 4) | 10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) |
Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Non-qualified stock options (right to buy) | $18.8 | | | | | | | 5/26/2017 (2) | 5/26/2023 | Common Stock | 10000 | | 10000 | D | |
Non-qualified stock options (right to buy) | $34.4 | | | | | | | 5/24/2018 (3) | 5/24/2024 | Common Stock | 20000 | | 20000 | D | |
Non-qualified stock options (right to buy) | $50.5 | | | | | | | 6/7/2019 (4) | 6/7/2025 | Common Stock | 25000 | | 25000 | D | |
Non-qualified stock options (right to buy) | $52.17 | | | | | | | 5/24/2020 (5) | 5/24/2026 | Common Stock | 13750 | | 13750 | D | |
Non-qualified stock options (right to buy) | $52.17 | | | | | | | 5/31/2020 (6) | 5/31/2026 | Common Stock | 7500 | | 7500 | D | |
Explanation of Responses: |
(1) | The reported transaction involved the reporting person's receipt of a grant of 2,914 restricted stock units under the Merit Medical System, Inc. 2018 Long-Term Incentive Plan. The reporting person has reported prior awards of restricted stock units in Table II of Form 4. The total reported in Column 5 of Table I includes the 2,914 newly awarded restricted stock units that vest on June 17, 2022, 4,188 previously reported time-vesting restricted stock units that vest on June 22, 2021, and 13,924 shares of common stock. Vesting of restricted stock units is subject to continued service to the issuer through the vesting date. |
(2) | Becomes exercisable in equal annual installments of 20% commencing 05/26/2017. |
(3) | Becomes exercisable in equal annual installments of 20% commencing 05/24/2018. |
(4) | Becomes exercisable in equal annual installments of 20% commencing 06/07/2019. |
(5) | Becomes exercisable in equal annual installments of 33% commencing 05/24/2020. |
(6) | Becomes exercisable in equal annual installments of 33% commencing 05/31/2020. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Millner F. Ann 1600 WEST MERIT PARKWAY SOUTH JORDAN, UT 84095 | X |
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Signatures
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/s/ Brian G. Lloyd, Attorney-in-Fact | | 6/21/2021 |
**Signature of Reporting Person | Date |
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