Statement of Changes in Beneficial Ownership (4)
June 21 2021 - 7:11PM
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
*
Gunderson Thomas James |
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 | 7102 (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) | $34.4 | | | | | | | 5/24/2018 (2) | 5/24/2024 | Common Stock | 25000 | | 25000 | D | |
Non-qualified stock options (right to buy) | $50.5 | | | | | | | 6/7/2019 (3) | 6/7/2025 | Common Stock | 25000 | | 25000 | D | |
Non-qualified stock options (right to buy) | $52.17 | | | | | | | 5/24/2020 (4) | 5/24/2026 | Common Stock | 13750 | | 13750 | D | |
Non-qualified stock options (right to buy) | $52.17 | | | | | | | 5/31/2020 (5) | 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 and 4,188 previously reported time-vesting restricted stock units that vest on June 22, 2021. 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 05/24/2018. |
(3) | Becomes exercisable in equal annual installments of 20% commencing 06/07/2019. |
(4) | Becomes exercisable in equal annual installments of 33% commencing 05/24/2020. |
(5) | 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 |
Gunderson Thomas James 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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