U.S. SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
FORM 4/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
November 5, 2002
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5. If Amendment, Date of Original (Month/Year)
November 5, 2002
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Page 1 of 2 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)
Director of Sales
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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 11/05/02 G 670(2) D D
No Par Value
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Common Stock
No Par Value 11/05/02 G 2,000 D D
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Common Stock
No Par Value 386,150(2)
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Common Stock by 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
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Common Stock By trust
No Par Value N/A 2,906 I (deferred comp
plan)
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Explanation of Responses:
(1) Represent plan holdings as of 10/28/02
(2) This amendment is being filed to correct an inadvertent mathematical error
concerning the shares as disposed of by gift.
* If the form is filed by more than one Reporting Person, see Instruction
4(b)(v).
Reminder: Report on a separate line for each class of securities beneficially
owned directly or indirectly.
Explanation of Responses:
(1) Represents plan holdings as of 10/28/02
(2) This amendment is being filed to correct an inadvertent mathematical error
concerning the shasres as disposed of by gift.
(5) Become exercisable in equal annual installments of 20% commencing 12/08/02
(7) Become exercisable in equal annual installments of 20% commencing 09/30/99
(8) Become exercisable in equal annual installments of 20% commencing 04/23/00
(9) Become exercisable in equal annual installments of 20% commencing 02/12/02
/s/ KENT W. STANGER 02/17/03
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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 2 of 2 Pages