SEC Form 4 · accession 0001179110-17-009778
MERIT MEDICAL SYSTEMS INC · MMSI
Statement of changes in beneficial ownership, as filed. Original on EDGAR ↗
Reporting owner
F. Ann Millner
Director
Period of report
Jun 28, 2017
Accepted (ET)
Jun 29, 2017 · 4:54 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 | Jun 28, 2017 | M | 4,247 | $21.98 | A | 4,247 | D | |
| Common Stock, No Par Value | Jun 28, 2017 | M | 5,000 | $18.80 | A | 9,247 | D | |
| Common Stock, No Par ValueF1 | Jun 28, 2017 | S | 6,744 | $38.152 | D | 2,503 | 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)F2 | $21.98 | Jun 28, 2017 | M | 4,247 | D | Jul 16, 2016 | Jul 16, 2022 | Common Stock | 4,247 | 16,986 | D |
| Non-qualified stock options (right to buy)F3 | $18.80 | Jun 28, 2017 | M | 5,000 | D | May 26, 2017 | May 26, 2023 | Common Stock | 5,000 | 20,000 | D |
| Non-qualified stock options (right to buy)F4 | $34.40 | holding | — | — | — | May 24, 2018 | May 24, 2024 | Common Stock | 25,000 | 25,000 | D |
Explanation of responses
- F1The price reported in Column 4 of Table 1 is a weighted average price. These shares were sold in multiple transactions at prices ranging from $38.00 to 38.33, 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.
- F2Becomes exercisable in equal annual installments of 20% commencing 7/16/2016.
- F3Becomes exercisable in equal annual installments of 20% commencing 5/26/2017.
- F4Becomes exercisable in equal annual installments of 20% commencing 5/24/2018.