OMB APPROVAL
-------------------------------------
OMB Number 3235-0145
Expire October 31, 2002
Estimated average burden
hours per response..............14.90
-------------------------------------
UNITED STATES
SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
SCHEDULE 13G
Under the Securities Exchange Act of 1934
(Amendment No. 11)*
Merit Medical Systems, Inc.
--------------------------------------------------------------------------------
(Name of Issuer)
Common Stock, No Par Value
--------------------------------------------------------------------------------
(Title of Class of Securities)
589889-10-4
-------------
(CUSIP Number)
December 31, 2001
-----------------------------------------
(Date of Event Which Requires Filing of this Statement)
Check the appropriate box to designate the rule pursuant to which this Schedule
is filed:
[ ] Rule 13d-1(b)
[ ] Rule 13d-1(c)
[X] Rule 13d-1(d)
*The remainder of this cover page shall be filled out for a reporting person's
initial filing on this form with respect to the subject class of securities, and
for any subsequent amendment containing information which would alter the
disclosures provided in a prior cover page.
The information required in the remainder of this cover page shall not be deemed
to be "filed" for the purpose of Section 18 of the Securities Exchange Act of
1934 ("Act") or otherwise subject to the liabilities of that section of the Act
but shall be subject to all other provisions of the Act (however, see the
Notes).
1
CUSIP No. 589889-10-4
--------------------------------------------------------------------------------
1. Names of Reporting Persons.
I.R.S. Identification Nos. of above persons (entities only).
Fred P. Lampropoulos
--------------------------------------------------------------------------------
2. Check the Appropriate Box if a Member of a Group (See Instructions)
(a) [ ]
(b) [ ]
--------------------------------------------------------------------------------
3. SEC Use Only
-----------------------------------------------------------
--------------------------------------------------------------------------------
4. Citizenship or Place of Organization United States
----------------
--------------------------------------------------------------------------------
Number of 5. Sole Voting Power 766,379
Shares Bene-
ficially 6. Shared Voting Power None
Owned by Each
Reporting 7. Sole Dispositive Power 766,379
Person With:
8. Shared Dispositive Power None
--------------------------------------------------------------------------------
9. Aggregate Amount Beneficially Owned by Each Reporting Person 766,379
------------
10. Check if the Aggregate Amount in Row (9) Excludes Certain Shares
(See Instructions) [ ]
11. Percent of Class Represented by Amount in Row (9) 7.1%
---------
12. Type of Reporting Person (See Instructions) IN
-----
2
CUSIP No. 589889-10-4
--------------------------------------------------------------------------------
Item 1.
(a) Name of Issuer: Merit Medical Systems, Inc.
(b) Address of Issuer's Principal Executive Offices:
1600 West Merit Parkway, South Jordan, UT 84095
Item 2.
(a) Name of Persons Filing: Fred P. Lampropoulos
(the "Reporting Person")
(b) Address of Principal Business Office, if none, Residence:
1600 West Merit Parkway, South Jordan, UT 84095
(c) Citizenship: United States
(d) Title of Class of Securities:
Common Stock, No Par Value (the "Common Stock")
(e) CUSIP Number: 589889-10-4
Item 3.
This statement is not filed pursuant to Sections 240.13d-1(b) or 240.13d-2(b) or
(c).
Item 4. Ownership
(a) Amount Beneficially Owned: As of December 31, 2001, the Reporting
Person was the beneficial owner of 766,379 shares of the Common Stock,
which included 23,546 shares owned by the Reporting Person pursuant to
the Issuer's 401(k) Plan, based upon the most recent plan statement
timely distributed, and 215,625 shares that the Reporting Person had
the right to acquire pursuant to options that were exercisable as of
December 31, 2001 or exercisable within the sixty (60) day period
following December 31, 2001.
(b) Percent of Class: 7.1%
(c) Number of shares as to which the person has:
(i) Sole power to vote or to direct the vote: 766,379 shares of
the Common Stock
(ii) Shared power to vote or to direct the vote: None
(iii) Sole power to dispose or to direct the disposition of:
766,379 shares of the Common Stock
(iv) Shared power to dispose or to direct the disposition of:
None
Item 5. Ownership of Five Percent or Less of a Class
Not applicable.
Item 6. Ownership of More than Five Percent on Behalf of Another Person
Not applicable.
Item 7. Identification and Classification of the Subsidiary Which Acquired the
Security Being Reported on By the Parent Holding Company or Control
Person
Not applicable.
3
CUSIP No. 589889-10-4
--------------------------------------------------------------------------------
Item 8. Identification and Classification of Members of the Group
Not applicable.
Item 9. Notice of Dissolution of Group
Not applicable.
Item 10. Certifications
Not applicable.
4
SIGNATURE
After reasonable inquiry and to the best of my knowledge and belief, I
certify that the information set forth in this statement is true, complete and
correct.
DATED: January 29, 2002
/s/ FRED P. LAMPROPOULOS
------------------------
Signature
Fred P. Lampropoulos
--------------------
Name/Title
6