Sec Form 4 Filing - Millner F. Ann @ MERIT MEDICAL SYSTEMS INC - 2019-05-31

Insider filing report for Changes in Beneficial Ownership
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FORM 4
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
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(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
Millner F. Ann
2. Issuer Name and Ticker or Trading Symbol
MERIT MEDICAL SYSTEMS INC [ MMSI]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X __ Director _____ 10% Owner
_____ Officer (give title below) _____ Other (specify below)
(Last) (First) (Middle)
1600 WEST MERIT PARKWAY
3. Date of Earliest Transaction (MM/DD/YY)
05/31/2019
(Street)
SOUTH JORDAN, UT84095
4. If Amendment, Date Original Filed (MM/DD/YY)
6. Individual or Joint/Group Filing (Check Applicable Line)
__ X __ Form filed by One Reporting Person
_____ Form filed by More than One Reporting Person
(City) (State) (Zip)
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security
(Instr. 3)
2. Transaction Date (MM/DD/YY) 2A. Deemed Execution Date, if any (MM/DD/YY) 3. Transaction 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)
Code V Amount (A) or (D) Price
Common Stock, No Par Value 8,298 D
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
( e.g. , puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security
(Instr. 3)
2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (MM/DD/YY) 3A. Deemed Execution Date, if any (MM/DD/YY) 4. Transaction 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/YY)
7. Title and Amount of Underlying Securities
(Instr. 3 and 4)
8. Price of Derivative Security
(Instr. 5)
9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 4)
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 4)
11. Nature of Indirect Beneficial Ownership
(Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Non-qualified stock options (right to buy) $ 21.98 07/16/2016( 1 ) 07/16/2022 Common Stock 8,492 8,492 D
Non-qualified stock options (right to buy) $ 18.8 05/26/2017( 2 ) 05/26/2023 Common Stock 15,000 15,000 D
Non-qualified stock options (right to buy) $ 34.4 05/24/2018( 3 ) 05/24/2024 Common Stock 20,000 20,000 D
Non-qualified stock options (right to buy) $ 50.5 06/07/2019( 4 ) 06/07/2025 Common Stock 25,000 25,000 D
Non-qualified stock options (right to buy) $ 52.17 05/24/2020( 5 ) 05/24/2026 Common Stock 13,750 13,750 D
Non-qualified stock options (right to buy) $ 52.17 05/31/2019 A 7,500 05/31/2020( 6 ) 05/31/2026 Common Stock 7,500 $ 0 7,500 D
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
Millner F. Ann
1600 WEST MERIT PARKWAY
SOUTH JORDAN, UT84095
X
Signatures
Brian G. Lloyd, Attorney-in-Fact 06/04/2019
Signature of Reporting Person Date
Explanation of Responses:
( 1 )Becomes exercisable in equal annual installments of 20% commencing 07/16/2016.
( 2 )Becomes exercisable in equal annual installments of 20% commencing 05/26/2017.
( 3 )Becomes exercisable in equal annual installments of 20% commencing 05/24/2018.
( 4 )Becomes exercisable in equal annual installments of 20% commencing 06/07/2019.
( 5 )Becomes exercisable in equal annual installments of 33% commencing 05/24/2020.
( 6 )Becomes exercisable in equal annual installments of 33% commencing 05/31/2020.

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 4(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).

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