Initial Statement of Beneficial Ownership (3)
April 29 2022 - 5:59PM
Edgar (US Regulatory)
FORM 3
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UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES
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3235-0104
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Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
*
Peterson Neil |
2. Date of Event Requiring Statement (MM/DD/YYYY)
4/19/2022
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3. Issuer Name and Ticker or Trading Symbol
MERIT MEDICAL SYSTEMS INC [MMSI]
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(Last)
(First)
(Middle)
1600 W MERIT PARKWAY |
4. Relationship of Reporting Person(s) to Issuer (Check all applicable)
_____ Director _____ 10% Owner
___X___ Officer (give title below) _____ Other (specify below)
Chief Operating Officer / |
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(Street)
SOUTH JORDAN, UT 84095
(City)
(State)
(Zip)
| 5. If Amendment, Date Original Filed(MM/DD/YYYY)
| 6. 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 Beneficially Owned
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1.Title of Security
(Instr. 4) | 2. Amount of Securities Beneficially Owned
(Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I)
(Instr. 5) | 4. Nature of Indirect Beneficial Ownership
(Instr. 5) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security
(Instr. 4) | 2. Date Exercisable and Expiration Date
(MM/DD/YYYY) | 3. Title and Amount of Securities Underlying Derivative Security
(Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 5) | 6. Nature of Indirect Beneficial Ownership
(Instr. 5) |
| Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
| Non-qualified stock options (right to buy) | 1/28/2017 (1) | 1/28/2023 | Common Stock | 4000 | $16.05 | D |
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| Non-qualified stock options (right to buy) | 4/14/2018 (2) | 4/14/2024 | Common Stock | 16000 | $28.2 | D |
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| Non-qualified stock options (right to buy) | 3/2/2019 (3) | 3/2/2025 | Common Stock | 15000 | $44.80 | D |
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| Non-qualified stock options (right to buy) | 4/25/2020 (4) | 4/25/2026 | Common Stock | 20000 | $54.40 | D |
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| Non-qualified stock options (right to buy) | 8/19/2022 (5) | 8/19/2028 | Common Stock | 25000 | $68.33 | D |
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| Explanation of Responses: |
| (1) | Became exercisable in equal annual installments of 20% commencing 1/28/2017. |
| (2) | Became exercisable in equal annual installments of 20% commencing 4/14/2018. |
| (3) | Became exercisable in equal annual installments of 20% commencing 3/2/2019. |
| (4) | Became exercisable in equal annual installments of 20% commencing 4/25/2020. |
| (5) | Became exercisable in equal annual installments of 25% commencing 8/19/2022. |
Remarks:
Exhibit List
Exhibit 24 - Power of Attorney |
Reporting Owners
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| Reporting Owner Name / Address | Relationships |
| Director | 10% Owner | Officer | Other |
Peterson Neil
1600 W MERIT PARKWAY
SOUTH JORDAN, UT 84095 |
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| Chief Operating Officer |
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Signatures
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| /s/ Brian G. Lloyd, Attorney-in-Fact | | 4/29/2022 |
| **Signature of Reporting Person | Date |
| Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. |
| * | If the form is filed by more than one reporting person, see Instruction 5(b)(v). |
| ** | 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 is insufficient, see Instruction 6 for procedure. |
| Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB control number. |
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