SEC Form 5 · accession 0001179110-15-002534

MERIT MEDICAL SYSTEMS INC · MMSI

Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗

Reporting owner

Officer — Chief Financial Officer · Director

Period of report

Dec 31, 2014

Accepted (ET)

Feb 13, 2015 · 5:47 pm EST

Rule 10b5-1 plan

unknown — predates the checkbox

Issuer CIK

0000856982

Table I — non-derivative securities

Security	Date	Code	Shares	Price	A/D	Owned after	D/I	Nature of ownership
Common Stock, No Par Value^F4	Dec 18, 2014	G	1,320	—	D	508,171	D
Common Stock, No Par Value^F4,F5	Dec 30, 2014	G	585	—	D	402,091	D
Common Stock, No Par Value^F1	holding	—	—		—	80,366	I	By 401(k) plan
Common Stock, No Par Value^F2	holding	—	—		—	4,271	D
Common Stock, No Par Value^F5,F3	holding	—	—		—	29,524	I	Family Limited Partnership

Security	Conv. / exercise price	Date	Code	Shares	A/D	Exercisable	Expires	Underlying	Underlying shares	Owned after	D/I
Non-qualified stock options (right to buy)	$11.41	holding	—	—	—	May 25, 2005	May 25, 2015	Common Stock	18,750	18,750	D
Non-qualified stock options (right to buy)	$9.71	holding	—	—	—	Dec 28, 2005	Dec 28, 2015	Common Stock	25,000	25,000	D
Non-qualified stock options (right to buy)^F6	$11.53	holding	—	—	—	May 21, 2009	May 21, 2015	Common Stock	43,750	43,750	D
Non-qualified stock options (right to buy)^F7	$13.82	holding	—	—	—	Sep 26, 2010	Sep 26, 2016	Common Stock	25,000	25,000	D
Non-qualified stock options (right to buy)^F8	$13.75	holding	—	—	—	Aug 11, 2012	Aug 11, 2018	Common Stock	80,000	80,000	D
Non-qualified stock options (right to buy)^F9	$12.06	holding	—	—	—	Oct 4, 2015	Oct 4, 2021	Common Stock	10,000	10,000	D

F1Represents plan holdings as of 12/31/14.
F2Employee stock purchase plan as of 12/31/14.
F3This 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.
F4This is a gift.
F5Since the date of the reporting person's last ownership report, he transferred 105,495 shares of common stock and K.W.S. Properties LC transferred 30,477 shares of common stock to the reporting person's ex-wife pursuant to a domestic relations order. The reporting person no longer reports as beneficially owned any securities owned by his ex-wife.
F6Becomes exercisable in equal annual installments of 20% commmencing 05/21/2009.
F7Becomes exercisable in equal annual installments of 20% commmencing 09/26/2010.
F8Becomes exercisable in equal annual installments of 20% commmencing 08/11/2012.
F9Becomes exercisable in equal annual installments of 20% commmencing 10/04/2015.