SEC Form 5 · accession 0001179110-16-018994

MERIT MEDICAL SYSTEMS INC · MMSI

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

Reporting owner

Director

Period of report

Dec 31, 2015

Accepted (ET)

Feb 11, 2016 · 4:30 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 29, 2015	G	2,345	—	D	426,346	D
Common Stock, No Par Value^F1	holding	—	—		—	42,116	I	By 401(k) plan
Common Stock, No Par Value^F2	holding	—	—		—	4,271	D
Common Stock, No Par Value^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)^F5	$13.82	holding	—	—	—	Sep 26, 2010	Sep 26, 2016	Common Stock	25,000	25,000	D
Non-qualified stock options (right to buy)^F6	$13.75	holding	—	—	—	Aug 11, 2012	Aug 11, 2018	Common Stock	80,000	80,000	D
Non-qualified stock options (right to buy)^F7	$12.06	holding	—	—	—	Oct 4, 2015	Oct 4, 2021	Common Stock	10,000	10,000	D
Non-qualified stock options (right to buy)^F8	$17.27	holding	—	—	—	Feb 13, 2016	Feb 13, 2022	Common Stock	21,800	21,800	D

F1Represents plan holdings as of 12/31/15.
F2Employee stock purchase plan as of 12/31/15.
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.
F5Becomes exercisable in equal annual installments of 20% commencing 09/26/2010.
F6Becomes exercisable in equal annual installments of 20% commencing 08/11/2012.
F7Becomes exercisable in equal annual installments of 20% commencing 10/04/2015.
F8Becomes exercisable in equal annual installments of 20% commencing 02/13/2016.