View:
-------------------------------
OMB APPROVAL
-------------------------------
OMB Number
Expires:
Estimated average burden
hours per response .........0.5
U.S. SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 4
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934,
Section 17(a) of the Public Utility Holding Company Act of 1935 or
Section 30(f) of the Investment Company Act of 1940
[ ] Check box if no longer subject to Section 16. Form 4 or Form 5 obligations
may continue. See Instruction 1(b).
- --------------------------------------------------------------------------------
1. Name and Address of Reporting Person*
STANGER KENT W.
- --------------------------------------------------------------------------------
(Last) (First) (Middle)
1600 West Merit Parkway
- --------------------------------------------------------------------------------
(Street)
South Jordan UT 84095
- --------------------------------------------------------------------------------
(City) (State) (Zip)
Merit Medical Systems, Inc. (MMSI)
- --------------------------------------------------------------------------------
2. Issuer Name and Ticker or Trading Symbol
- --------------------------------------------------------------------------------
3. IRS Identification Number of Reporting Person, if an Entity (Voluntary)
December 12, 2002
- --------------------------------------------------------------------------------
4. Statement for Month/Year
- --------------------------------------------------------------------------------
5. If Amendment, Date of Original (Month/Year)
Page 1 of 2 Pages
- --------------------------------------------------------------------------------
6. Relationship of Reporting Person to Issuer
(Check all applicable)
[X] Director [ ] 10% Owner
[X] Officer (give title below) [ ] Other (specify below)
Chief Financial Officer
- --------------------------------------------------------------------------------
7. Individual or Joint/Group Filing
(Check applicable line)
[X] Form filed by one Reporting Person
[ ] Form filed by more than one Reporting Person
- --------------------------------------------------------------------------------
Table I -- Non-Derivative Securities Acquired, Disposed of,
or Beneficially Owned
5. 6.
4. Amount of Owner-
Securities Acquired (A) or Securities ship
Disposed of (D) Beneficially Form: 7.
(Instr. 3, 4 and 5) Owned at End Direct Nature of
2. 3. of Issuer's (D) or Indirect
1. Transaction Transaction (A) Fiscal Year Indirect Beneficial
Title of Security Date Code Amount or Price (Instr. 3 (I) Ownership
(Instr. 3) (mm/dd/yy) (Instr. 8) (D) and 4) (Instr.4) (Instr. 4)
===========================================================================================================================
Common Stock,
No Par Value 12/11/02 G 175 D D
- ---------------------------------------------------------------------------------------------------------------------------
Common Stock,
No Par Value 12/12/02 G 230 D D
- ---------------------------------------------------------------------------------------------------------------------------
- ---------------------------------------------------------------------------------------------------------------------------
- ---------------------------------------------------------------------------------------------------------------------------
Common Stock,
No Par Value 385,808
- ---------------------------------------------------------------------------------------------------------------------------
Common Stock, 401(K)
No Par Value N/A 26,078 I Plan(1)
- ---------------------------------------------------------------------------------------------------------------------------
Common Stock, Employee stock
No Par Value N/A 1,923 D purchase plan
- ---------------------------------------------------------------------------------------------------------------------------
Common Stock, By trust
No Par Value N/A 2,906 I (deferred comp
plan)
- ---------------------------------------------------------------------------------------------------------------------------
Explanation of responses:
(1) Represent plan holdings as of 10/28/02
* If the form is filed by more than one Reporting Person, see Instruction
4(b)(v).
Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly.
/s/ Kent W. Stanger 12/13/2002
- ----------------------------------- -----------
**Signature of Reporting Person Date
** Intentional misstatements or omissions of facts constitute Federal Criminal
Violations.
See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Note: File three copies of this form, one of which must be manually signed.
If space provided is insufficient, see Instruction 6 for procedure.
Page 2 of 2 Pages