U.S. SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 5/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*
STANGER KENT W.
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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
December 31, 2002
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5. If Amendment, Date of Original (Month/Year)
December 31, 2002
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Page 1 of 3 Pages
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6. Relationship of Reporting Person to Issuer
(Check all applicable)
[X] Director [ ] 10% Owner [X] Officer (give title below) [ ] Other
(specify below)
Chief Financial Officer
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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
No Par Value 12/31/02 G V 70,000 D D
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Common Stock
No Par Value
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Common Stock
No Par Value
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Common Stock
No Par Value 225,672(6) D
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Common Stock Family limited
No Par Value 85,173 I partnership
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Common Stock 401(k
No Par Value N/A 26,078 I plan (1)
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Common Stock Emp stock pur-
No Par Value N/A 1,923 D chase Plan(2)
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Page 2 of 3 Pages
FORM 4 (continued)
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Table II -- Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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9.
10.
Number
Owner-
of
ship
2. Deriv- of
Conver- 5. 7. ative Deriv- 11.
sion Number of Title and Amount Secur- ative Nature
or Derivative 6. of Underlying 8. ities Secur- of
Exer- Securities Date Securities Price Bene- ity: In-
cise 3. Acquired (A) Exercisable and (Instr. 3 and 4) of ficially Direct direct
Price Trans- 4. or Disposed Expiration Date Deriv- Owned (D) or Bene-
1. of action Trans- of (D) (Month/Day/Year) Amount ative at End In- ficial
Title of Deriv- Date action (Instr. 3, or Secur- of direct Owner
Derivative ative (Month /Code 4 and 5) Date Expira- Number ity Year (I) -ship
Security Secur- Day/ (Instr. 8 Exer- tion of (Instr.(Instr. (Instr. (Instr.
(Instr. 3) ity Year) Code V (A) (D) cisable Date Title Shares 5) 4) 4) 4)
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Non-qualified $3.68 N/A 09/30/99 03/31/04 Common 15,625 D
stock options (7) Stock
(Right to Buy)
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Non-qualified $3.76 N/A 05/26/99 05/26/04 Common 11,719 D
stock options Stock
(Right to Buy)
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Non-qualified $4.1997 N/A 04/23/00 10/23/04 Common 13,673 D
stock options (8) Stock
(Right to Buy)
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Non-qualified $2.88 N/A 05/24/00 05/24/05 Common 11,719 D
stock options Stock
(Right to Buy)
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Non-qualified $2.88 N/A 01/24/01 05/24/05 Common 31,250 D
stock options Stock
(Right to Buy)
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Non-qualified $3.68 N/A 02/12/02 02/12/11 Common 31,250 D
stock options (9) Stock
(Right to Buy)
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Non-qualified $5.0624 N/A 05/23/01 05/23/11 Common 15,625 D
stock options Stock
(Right to Buy)
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Non-qualified $13.528 N/A 12/08/02 12/08/11 Common 25,000 D
stock options (5) Stock
(Right to Buy)
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Non-qualified $16.99 N/A 05/23/02 05/23/12 Common 10,000 D
stock options Stock
(Right to Buy)
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Explanation of Responses:
(1) Represents plan holdings as of 10/28/02
(5) Becomes exercisable in equal installments of 20% commencing 12/08/02
(6) This amendment is being filed to correct an inadvertent error in the number
of shares reported.
(7) Becomes exercisable in equal installments of 20% commencing 09/30/99
(8) Becomes exercisable in equal installments of 20% commencing 04/23/00
(9) Becomes exercisable in equal installments of 20% commencing 02/12/02
/s/ KENT W. STANGER 02/14/03
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**Signature of Reporting Person Date
** 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.
Page 3 of 3 Pages