-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, PfZ6W7CE6TOKEpD8zz4wP3o+aczAb5YjrQCEHkZUCsMBGxT8Vpsi+ov8ARK1lY8+ T/crTS3wyPNzU1CRdl4YHQ== 0001045969-99-000744.txt : 19991018 0001045969-99-000744.hdr.sgml : 19991018 ACCESSION NUMBER: 0001045969-99-000744 CONFORMED SUBMISSION TYPE: 8-A12G PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 19991012 FILER: COMPANY DATA: COMPANY CONFORMED NAME: VASCULAR SOLUTIONS INC CENTRAL INDEX KEY: 0001030206 STANDARD INDUSTRIAL CLASSIFICATION: SURGICAL & MEDICAL INSTRUMENTS & APPARATUS [3841] IRS NUMBER: 411859679 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 8-A12G SEC ACT: SEC FILE NUMBER: 000-27605 FILM NUMBER: 99726201 BUSINESS ADDRESS: STREET 1: 2495 XENIUM LANE NORTH CITY: MINNEAPOLIS STATE: MN ZIP: 55441 BUSINESS PHONE: 6125532970 MAIL ADDRESS: STREET 1: 2495 XENIUM LANE NORTH CITY: MINNEAPOLIS STATE: MN ZIP: 55441 8-A12G 1 FORM 8-A SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 FORM 8-A For Registration of Certain Classes of Securities Pursuant to Section 12(b) or (g) of the Securities Exchange Act of 1934 VASCULAR SOLUTIONS, INC. (Exact name of registrant as specified in its charter) Minnesota 41-1859679 (State of incorporation (I.R.S. Employer or organization) Identification No.) 2495 Xenium Lane North Minneapolis, Minnesota 55441 (Address of principal executive offices) (Zip Code) If this Form relates to the registration of a class of debt securities and is effective upon filing pursuant to General Instruction A.(c)(1), please check the following box. [ ] If this Form relates to the registration of a class of debt securities and is to become effective simultaneously with the effectiveness of a concurrent registration statement under the Securities Act of 1933 pursuant to General Instruction A.(c)(2), please check the following box. [ ] If this form relates to the registration of a class of securities pursuant to Section 12(b) of the Exchange Act and is effective pursuant to General Instruction A.(c), check the following box. [ ] If this form relates to the registration of a class of securities pursuant to Section 12(g) of the Exchange Act and is effective pursuant to General Instruction A.(d), check the following box. [X] Securities Act registration statement file number to which this Form relates: 333-84089 Securities to be registered pursuant to Section 12(b) of the Act: Title of each class Name of each exchange on which to be so registered each class is to be registered Not Applicable Not Applicable Securities to be registered pursuant to Section 12(g) of the Act: Common Stock, $0.01 par value (Title of class) Item 1. Description of Registrant's Securities to be Registered. -------------------------------------------------------- The description of Vascular Solutions, Inc.'s (the "Company's"), Common Stock, $0.01 par value, included in the Description of Capital Stock section of the Company's Registration Statement on Form S-1 (File No. 333-84089), as amended, which Registration Statement was initially filed on July 30, 1999, is hereby incorporated herein by reference. Item 2. Exhibits. --------- Number Description - ------ ----------- 3.1* Articles of Incorporation of the Company, as currently in effect 3.2* Bylaws of the Company, as currently in effect 4.1* Specimen of Common Stock certificate 4.2* Form of warrant dated January 31 and February 14, 1997 issued to representatives of Miller, Johnson & Kuehn, Incorporated 4.3* Form of warrant dated December 29, 1997 issued to representatives of Miller, Johnson & Kuehn, Incorporated 4.4* Amended and Restated Investors' Rights Agreement dated December 9, 1998, by and between the Company and the purchasers of Series A and Series B preferred stock 4.5* Amended and Restated Right of First Refusal and Co-Sale Agreement dated December 9, 1998 4.6* Put and Option Agreement dated December 9, 1998 by and among the Company, Stephens Vascular Preferred, LLC and Stephens Vascular Options, LLC 4.7* Stock Purchase Warrant dated June 10, 1999 by and between the Company and Jones Pharma, Incorporated * Incorporated by reference to the exhibit of the same number in the Company's Registration Statement on Form S-1 (File No. 333-84089). -2- SIGNATURE Pursuant to the requirements of Section 12 of the Securities Exchange Act of 1934, the Registrant has duly caused this Registration Statement to be signed on its behalf by the undersigned, thereunto duly authorized. VASCULAR SOLUTIONS, INC. Date: October 12, 1999 By /s/ Howard Root ---------------- Howard Root Chief Executive Officer EXHIBIT INDEX ------------- Number Description - ------ ----------- 3.1* Articles of Incorporation of the Company, as currently in effect 3.2* Bylaws of the Company, as currently in effect 4.1* Specimen of Common Stock certificate 4.2* Form of warrant dated January 31 and February 14, 1997 issued to representatives of Miller, Johnson & Kuehn, Incorporated 4.3* Form of warrant dated December 29, 1997 issued to representatives of Miller, Johnson & Kuehn, Incorporated 4.4* Amended and Restated Investors' Rights Agreement dated December 9, 1998, by and between the Company and the purchasers of Series A and Series B preferred stock 4.5* Amended and Restated Right of First Refusal and Co-Sale Agreement dated December 9, 1998 4.6* Put and Option Agreement dated December 9, 1998 by and among the Company, Stephens Vascular Preferred, LLC and Stephens Vascular Options, LLC 4.7* Stock Purchase Warrant dated June 10, 1999 by and between the Company and Jones Pharma, Incorporated * Incorporated by reference to the exhibit of the same number in the Company's Registration Statement on Form S-1 (File No. 333-84089). -----END PRIVACY-ENHANCED MESSAGE-----