SEC Form 4 · accession 0001179110-16-029217
MERIT MEDICAL SYSTEMS INC · MMSI
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
A Scott Anderson
Director
Period of report
Aug 30, 2016
Accepted (ET)
Sep 1, 2016 · 5:45 pm EDT
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 | Aug 30, 2016 | M | 5,000 | $9.95 | A | 9,400 | D | |
| Common Stock, No Par Value | Aug 30, 2016 | M | 4,000 | $12.91 | A | 13,400 | D | |
| Common Stock, No Par Value | Aug 30, 2016 | M | 5,000 | $13.99 | A | 18,400 | D | |
| Common Stock, No Par ValueF6 | Aug 30, 2016 | S | 12,000 | $24.095 | D | 6,400 | D |
Table II — derivative securities
| 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)F1 | $12.91 | Aug 30, 2016 | M | 4,000 | D | May 23, 2013 | May 23, 2019 | Common Stock | 4,000 | 4,000 | D |
| Non-qualified stock options (right to buy)F2 | $9.95 | Aug 30, 2016 | M | 5,000 | D | May 22, 2014 | May 22, 2020 | Common Stock | 5,000 | 10,000 | D |
| Non-qualified stock options (right to buy)F3 | $13.99 | Aug 30, 2016 | M | 5,000 | D | Jun 11, 2015 | Jun 11, 2021 | Common Stock | 5,000 | 15,000 | D |
| Non-qualified stock options (right to buy)F4 | $20.27 | holding | — | — | — | May 22, 2016 | May 22, 2022 | Common Stock | 25,000 | 25,000 | D |
| Non-qualified stock options (right to buy)F5 | $18.80 | holding | — | — | — | May 26, 2017 | May 26, 2023 | Common Stock | 25,000 | 25,000 | D |
Explanation of responses
- F1Becomes exercisable in equal annual installments of 20% commencing 05/23/2013.
- F2Becomes exercisable in equal annual installments of 20% commencing 05/22/2014.
- F3Becomes exercisable in equal annual installments of 20% commencing 06/11/2015.
- F4Becomes exercisable in equal annual installments of 20% commencing 05/22/2016.
- F5Becomes exercisable in equal annual installments of 20% commencing 05/26/2017.
- F6The price reported in Column 4 of Table 1 is a weighted average price. These shares were sold in multiple transactions at prices ranging from $23.960 to 24.270, inclusive. The reporting person undertakes to provide to Merit Medical Systems, Inc., any security holder of Merit Medical Systems, Inc., or the staff of the Securities and Exchange Commission, upon request, full information regarding the number of shares sold at each separate price within the range set forth in this Form 4.