SEC Form 4 · accession 0001179110-17-007330
MERIT MEDICAL SYSTEMS INC · MMSI
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
Franklin J Miller
Director
Period of report
May 15, 2017
Accepted (ET)
May 16, 2017 · 5:52 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 ValueF8 | May 15, 2017 | M | 25,000 | $13.16 | A | 27,334 | D | |
| Common Stock, No Par ValueF8,F9 | May 15, 2017 | S | 16,090 | $33.9521 | D | 11,244 | D | |
| Common Stock, No Par Value | holding | — | — | — | 18,193 | I | By the Franklin J. Miller and Bonnie A. Miller Family Trust |
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 | $13.16 | May 15, 2017 | M | 25,000 | D | Jun 25, 2011 | Jun 25, 2017 | Common Stock | 25,000 | 0 | D |
| Non-qualified stock options (right to buy)F2 | $13.75 | holding | — | — | — | Aug 11, 2012 | Aug 11, 2018 | Common Stock | 20,000 | 20,000 | D |
| Non-qualified stock options (right to buy)F3 | $12.91 | holding | — | — | — | May 23, 2013 | May 23, 2019 | Common Stock | 20,000 | 20,000 | D |
| Non-qualified stock options (right to buy)F4 | $9.95 | holding | — | — | — | May 22, 2014 | May 22, 2020 | Common Stock | 25,000 | 25,000 | D |
| Non-qualified stock options (right to buy)F5 | $13.99 | holding | — | — | — | Jun 11, 2015 | Jun 11, 2021 | Common Stock | 25,000 | 25,000 | D |
| Non-qualified stock options (right to buy)F6 | $20.27 | holding | — | — | — | May 22, 2016 | May 22, 2022 | Common Stock | 25,000 | 25,000 | D |
| Non-qualified stock options (right to buy)F7 | $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 06/25/2011.
- F2Becomes exercisable in equal annual installments of 20% commencing 08/11/2012.
- F3Becomes exercisable in equal annual installments of 20% commencing 05/23/2013.
- F4Becomes exercisable in equal annual installments of 20% commencing 05/22/2014.
- F5Becomes exercisable in equal annual installments of 20% commencing 06/11/2015.
- F6Becomes exercisable in equal annual installments of 20% commencing 05/22/2016.
- F7Becomes exercisable in equal annual installments of 20% commencing 05/26/2017.
- F8The reporting person paid the exercise price on a cashless basis, resulting in the Issuer's withholding of 16,090 of such shares to pay the exercise price and taxes and issuing the remaining 8,910 shares to the reporting person.
- F9The price reported in Column 4 of Table 1 is a weighted average price. These shares were sold in multiple transactions at prices ranging from $33.90 to $34.03, 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.