Annual Statement of Changes in Beneficial Ownership (5)
February 14 2022 - 11:28AM
Edgar (US Regulatory)
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
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Form 3 Holdings Reported
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Form 4 Transactions Reported
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
ANNUAL STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES
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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
*
Lloyd Brian G. | 2. Issuer Name and Ticker or Trading SymbolMERIT MEDICAL SYSTEMS INC [MMSI] |
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director _____ 10% Owner __X__ Officer (give title below) _____ Other (specify below) CHIEF LEGAL OFFICER, SECRETARY |
(Last)
(First)
(Middle)
1600 WEST MERIT PARKWAY | 3. Statement for Issuer's Fiscal Year Ended (MM/DD/YYYY) 12/31/2021 |
(Street)
SOUTH JORDAN, UT 84095
(City)
(State)
(Zip)
| 4. 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 Acquired, Disposed of, or Beneficially Owned
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1.Title of Security (Instr. 3) | 2. Trans. Date | 2A. Deemed Execution Date, if any | 3. Trans. Code (Instr. 8) | 4. Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) | 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) | 7. Nature of Indirect Beneficial Ownership (Instr. 4) |
Amount | (A) or (D) | Price |
Common Stock, No Par Value | 12/28/2021 | | G | 1850 | D | $0 | 4846 | D | |
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities)
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1. Title of Derivate Security (Instr. 3) | 2. Conversion or Exercise Price of Derivative Security | 3. Trans. Date | 3A. Deemed Execution Date, if any | 4. Trans. Code (Instr. 8) | 5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4 and 5) | 6. Date Exercisable and Expiration Date (MM/DD/YYYY) | 7. Title and Amount of Securities Underlying Derivative Security (Instr. 3 and 4) | 8. Price of Derivative Security (Instr. 5) | 9. Number of Derivative Securities Beneficially Owned at End of Issuer's Fiscal Year (Instr. 4) | 10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) | 11. Nature of Indirect Beneficial Ownership (Instr. 4) |
(A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Non-qualified stock options (right to buy) | $28.2 | | | | | | 4/14/2018 (1) | 4/14/2024 | Common Stock | 16364 | | 30000 | D | |
Non-qualified stock options (right to buy) | $44.8 | | | | | | 3/2/2019 (2) | 3/2/2025 | Common Stock | 25000 | | 25000 | D | |
Non-qualified stock options (right to buy) | $55.73 | | | | | | 3/1/2020 (3) | 3/1/2026 | Common Stock | 30000 | | 30000 | D | |
Non-qualified stock options (right to buy) | $37.71 | | | | | | 2/26/2021 (4) | 2/26/2027 | Common Stock | 16722 | | 16722 | D | |
Non-qualified stock options (right to buy) | $56.25 | | | | | | 3/19/2022 (5) | 3/19/2028 | Common Stock | 9681 | | 9681 | D | |
Explanation of Responses: |
(1) | Become exercisable in equal annual installments of 20% commencing on 04/14/2018. |
(2) | Become exercisable in equal annual installments of 20% commencing on 03/02/2019. |
(3) | Become exercisable in equal annual installments of 20% commencing on 03/01/2020. |
(4) | Become exercisable in equal annual installments of 25% commencing on 02/26/2021. |
(5) | Become exercisable in equal annual installments of 25% commencing on 03/19/2022. |
Reporting Owners
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Reporting Owner Name / Address | Relationships |
Director | 10% Owner | Officer | Other |
Lloyd Brian G. 1600 WEST MERIT PARKWAY SOUTH JORDAN, UT 84095 |
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| CHIEF LEGAL OFFICER, SECRETARY |
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Signatures
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/s/ Brian G. Lloyd | | 2/14/2022 |
**Signature of Reporting Person | Date |
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