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U.S. SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 4/A
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).
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1. Name and Address of Reporting Person*
BEAN REX C.
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(Last) (First) (Middle)
1600 West Merit Parkway
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(Street)
South Jordan UT 84095
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(City) (State) (Zip)
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2. Issuer Name and Ticker or Trading Symbol
Merit Medical Systems, Inc. (MMSI)
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3. IRS Identification Number of Reporting Person, if an Entity (Voluntary)
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4. Statement for Month/Year
November 6, 2002
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5. If Amendment, Date of Original (Month/Year)
November 6, 2002
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Page 1 of 2 Pages
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6. Relationship of Reporting Person to Issuer
(Check all applicable)
[X] Director [ ] 10% Owner
[ ] Officer (give title below) [ ] Other (specify below)
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7. Individual or Joint/Group Filing
(Check applicable line)
[X] Form filed by one Reporting Person
[ ] Form filed by more than one Reporting Person
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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.
3. (Instr. 3, 4 and 5) Owned at End Direct Nature of
2. Transaction of Issuer's (D) or Indirect
1. Transaction Code (A) Fiscal Year Indirect Beneficial
Title of Security Date (Instr. 8) Amount or Price (Instr. 3 (I) Ownership
(Instr. 3) (mm/dd/yy) Code V (D) and 4) (Instr.4) (Instr. 4)
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Common Stock 11/06/02 G(1) 60,000 D D
No Par Value
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Common Stock
No Par Value 11/06/02 G 100 D D
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Common Stock
No Par Value 11/06/02 G 450 D D
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Common Stock
No Par Value 133,693(3)
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Common Stock Revocable
No Par Value 70,000 I Trust(2)
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* 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.
Explanation of Responses:
(1) On November 6, 2002, the reporting person contributed 60,000 shares of Merit
Medical Systems, Inc. common stock to a charitable remainder trust of which
the reporting person is NOT a trustee. The reporting person has an 8% annual
interest in the charitable remainder trust and does not have investment or
voting control over the shares held by the trust.
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(2) On November 6, 2002, the reporting person transferred 70,000 shares of Merit
Medical Systems, Inc. from the Bean Family Revocable Trust to the Rex C.
Bean Trust.
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(3) This amendment is being filed to correct an inadvertent mathematical error
in the number of shares reported.
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/s/ REX C. BEAN 02/13/03
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by Greg Barnett
**Signature of Reporting Person Date
Greg Barnett as Attorney-in-Fact pursuant to a Power of Attorney dated September
14, 2002, a manually signed copy of which is on file with the Commission and is
incorporated herein by reference.
** 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.
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