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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).
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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/Day/Year
September 20, 2002
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5. If Amendment, Date of Original (Month/Year)
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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)
Vice President-Operations
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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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1
Table I -- Non-Derivative Securities Acquired, Disposed of,
or Beneficially Owned
6. Owner-
ship
5. Amount of Form: 7. Nature of
Securities Direct Indirect
1. Title of 2. Transaction 3. Transaction 4. Securities Acquired (A) Beneficially (D)or Beneficial
Security Date Code or Disposed of (D) Owned at End Indirect (I) Ownership
(Instr. 3) T(mm/dd/yy) (Instr. 8) (Instr. 3, 4 and 5) (Instr. 3 and 4) (Instr.4) (Instr.4)
Code V Amount (A)or(D) Price
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COMMON STOCK
NO PAR VALUE 06/20/02 G(1) V 80,000 D 204,004 D
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COMMON STOCK
NO PAR VALUE 06/20/02 G(2) V 70,000 70,000 I Revocable
Trust
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Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly.
(1) On September 20, 2002, the reporting person contributed 80,000 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.
(2) On September 20, 2002, the reporting person transferred 70,000 shares of
Merit Medical Systems, Inc. stock from the Bean Family Revocable Trust to the
Rex C. Bean Trust.
