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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)
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Item 1. Description of Registrant's Securities to be Registered.
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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.
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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-
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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
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Howard Root
Chief Executive Officer
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EXHIBIT INDEX
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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).
