-----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, AqDQeO0o7jeraG+08Tiz08dSeX+lB3Dgi1/wm9mveevv8Olf5vtkBNC7FVLyi6zq oZLdsmPMh1v2JcVog4Q6jg== 0000950005-01-000261.txt : 20010223 0000950005-01-000261.hdr.sgml : 20010223 ACCESSION NUMBER: 0000950005-01-000261 CONFORMED SUBMISSION TYPE: SC 13G PUBLIC DOCUMENT COUNT: 1 FILED AS OF DATE: 20010214 SUBJECT COMPANY: 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: SC 13G SEC ACT: SEC FILE NUMBER: 005-59371 FILM NUMBER: 1542651 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 FILED BY: COMPANY DATA: COMPANY CONFORMED NAME: OLYMPIC VENTURE PARTNERS III LP CENTRAL INDEX KEY: 0001055232 STANDARD INDUSTRIAL CLASSIFICATION: [] IRS NUMBER: 911659555 FILING VALUES: FORM TYPE: SC 13G BUSINESS ADDRESS: STREET 1: 2420 CARILLON POINT CITY: KIRKLAND STATE: WA ZIP: 98033 BUSINESS PHONE: 4258899192 MAIL ADDRESS: STREET 2: 2420 CARILLON POINT CITY: KIRKLAND STATE: WA ZIP: 98033 SC 13G 1 0001.txt FORM SC 13G - ------------------- ------------------ CUSIP NO. 92231M109 13G Page 1 of 19 Pages - ------------------- ------------------ SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 Schedule 13G (Rule 13d-102) INFORMATION TO BE INCLUDED IN STATEMENTS FILED PURSUANT TO RULES 13d-1 (b), (c) AND (d) AND AMENDMENTS THERETO FILED PURSUANT TO 13d-2 (b) (Amendment No._______)* Vascular Solutions, Inc. - -------------------------------------------------------------------------------- (Name of Issuer) Common Stock - -------------------------------------------------------------------------------- (Title of Class of Securities) 92231M109 - -------------------------------------------------------------------------------- (CUSIP Number) December 31, 2000 - -------------------------------------------------------------------------------- (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-(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 disclosures provided in a prior cover page. The information required on 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). (Continued on following pages) Page 1 of 19 Pages Exhibit Index Contained on Page 18 - ------------------- ------------------ CUSIP NO. 92231M109 13G Page 2 of 19 Pages - ------------------- ------------------ 1 NAMES OF REPORTING PERSONS I.R.S. IDENTIFICATION NO. OF ABOVE PERSONS (ENTITIES ONLY) Olympic Venture Partners IV L.P. ("OVP IV") Tax ID Number: ----------------------------------------------------------------------------- 2 CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP* (a) [ ] (b) [X] ----------------------------------------------------------------------------- 3 SEC USE ONLY ----------------------------------------------------------------------------- 4 CITIZENSHIP OR PLACE OF ORGANIZATION Delaware ----------------------------------------------------------------------------- 5 SOLE VOTING POWER 724,000 shares, except that OVMC IV, L.L.C. ("OVMC IV"), the general partner of OVP IV, may be deemed to have sole voting power, and George H. Clute ("Clute"), Gerard H. Langeler ("Langeler"), William D. Miller ("Miller") and Charles P. Waite, Jr. ("Waite"), the managing members of OVMC IV, may NUMBER OF be deemed to have shared power to vote these shares. SHARES ------------------------------------------------------------ BENEFICIALLY 6 SHARED VOTING POWER OWNED BY See response to row 5. EACH ------------------------------------------------------------ REPORTING 7 SOLE DISPOSITIVE POWER PERSON 724,000 shares, except that OVMC IV, the general partner of WITH OVP IV, may be deemed to have sole dispositive power, and Clute, Langeler, Miller and Waite, the managing members of OVMC IV, may be deemed to have shared power to dispose of these shares. ------------------------------------------------------------ 8 SHARED DISPOSITIVE POWER See response to row 7. ------------------------------------------------------------ 9 AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON 724,000 ----------------------------------------------------------------------------- 10 CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES* [ ] ----------------------------------------------------------------------------- 11 PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (9) 5.52% ----------------------------------------------------------------------------- 12 TYPE OF REPORTING PERSON* PN ----------------------------------------------------------------------------- - ------------------- ------------------ CUSIP NO. 92231M109 13G Page 3 of 19 Pages - ------------------- ------------------ 1 NAMES OF REPORTING PERSONS I.R.S. IDENTIFICATION NO. OF ABOVE PERSONS (ENTITIES ONLY) Olympic Venture Partners IV Entrepreneurs Fund L.P. ("OVP IV EF") Tax ID Number: ----------------------------------------------------------------------------- 2 CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP* (a) [ ] (b) [X] ----------------------------------------------------------------------------- 3 SEC USE ONLY ----------------------------------------------------------------------------- 4 CITIZENSHIP OR PLACE OF ORGANIZATION Delaware ----------------------------------------------------------------------------- 5 SOLE VOTING POWER 38,947 shares, except that OVMC IV, the general partner of OVP IV EF, may be deemed to have sole voting power, and Clute, Langeler, Miller and Waite, the managing members of OVMC IV, may be deemed to have shared power to vote these NUMBER OF shares. SHARES ------------------------------------------------------------ BENEFICIALLY 6 SHARED VOTING POWER OWNED BY See response to row 5. EACH ------------------------------------------------------------ REPORTING 7 SOLE DISPOSITIVE POWER PERSON 38,947 shares, except that OVMC IV, the general partner of WITH OVP IV EF, may be deemed to have sole dispositive power, and Clute, Langeler, Miller and Waite, the managing members of OVMC IV, may be deemed to have shared power to dispose of these shares. ------------------------------------------------------------ 8 SHARED DISPOSITIVE POWER See response to row 7. ------------------------------------------------------------ 9 AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON 38,947 ----------------------------------------------------------------------------- 10 CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES* [ ] ----------------------------------------------------------------------------- 11 PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (9) 0.29% ----------------------------------------------------------------------------- 12 TYPE OF REPORTING PERSON* PN ----------------------------------------------------------------------------- - ------------------- ------------------ CUSIP NO. 92231M109 13G Page 4 of 19 Pages - ------------------- ------------------ 1 NAMES OF REPORTING PERSONS I.R.S. IDENTIFICATION NO. OF ABOVE PERSONS (ENTITIES ONLY) Olympic Venture Partners III L.P. ("OVP III") Tax ID Number: ----------------------------------------------------------------------------- 2 CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP* (a) [ ] (b) [X] ----------------------------------------------------------------------------- 3 SEC USE ONLY ----------------------------------------------------------------------------- 4 CITIZENSHIP OR PLACE OF ORGANIZATION Delaware ----------------------------------------------------------------------------- 5 SOLE VOTING POWER 988,190 shares, except that OVMC III L.P. ("OVMC III"), the general partner of OVP III, may be deemed to have sole voting power, and Clute, Langeler and Waite, the general partners of OVMC III, may be deemed to have shared power to NUMBER OF vote these shares. SHARES ------------------------------------------------------------ BENEFICIALLY 6 SHARED VOTING POWER OWNED BY See response to row 5. EACH ------------------------------------------------------------ REPORTING 7 SOLE DISPOSITIVE POWER PERSON 988,190 shares, except that OVMC III, the general partner of WITH OVP III, may be deemed to have sole dispositive power, and Clute, Langeler and Waite, the general partners of OVMC III, may be deemed to have shared power to dispose of these shares. ------------------------------------------------------------ 8 SHARED DISPOSITIVE POWER See response to row 7. ------------------------------------------------------------ 9 AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON 988,190 ----------------------------------------------------------------------------- 10 CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES* [ ] ----------------------------------------------------------------------------- 11 PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (9) 7.54% ----------------------------------------------------------------------------- 12 TYPE OF REPORTING PERSON* PN ----------------------------------------------------------------------------- - ------------------- ------------------ CUSIP NO. 92231M109 13G Page 5 of 19 Pages - ------------------- ------------------ 1 NAMES OF REPORTING PERSONS I.R.S. IDENTIFICATION NO. OF ABOVE PERSONS (ENTITIES ONLY) Olympic Venture Partners III Entrepreneurs Fund L.P. ("OVP III EF") Tax ID Number: ----------------------------------------------------------------------------- 2 CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP* (a) [ ] (b) [X] ----------------------------------------------------------------------------- 3 SEC USE ONLY ----------------------------------------------------------------------------- 4 CITIZENSHIP OR PLACE OF ORGANIZATION Delaware ----------------------------------------------------------------------------- 5 SOLE VOTING POWER 48,863 shares, except that OVMC III, the general partner of OVP III EF, may be deemed to have sole voting power, and Clute, Langeler and Waite, the general partners of OVMC III, NUMBER OF may be deemed to have shared power to vote these shares. SHARES ------------------------------------------------------------ BENEFICIALLY 6 SHARED VOTING POWER OWNED BY See response to row 5. EACH ------------------------------------------------------------ REPORTING 7 SOLE DISPOSITIVE POWER PERSON 48,863 shares, except that OVMC III, the general partner of WITH OVP III EF, may be deemed to have sole dispositive power, and Clute, Langeler and Waite, the general partners of OVMC III, may be deemed to have shared power to dispose of these shares. ------------------------------------------------------------ 8 SHARED DISPOSITIVE POWER See response to row 7. ------------------------------------------------------------ 9 AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON 48,863 ----------------------------------------------------------------------------- 10 CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES* [ ] ----------------------------------------------------------------------------- 11 PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (9) 0.37% ----------------------------------------------------------------------------- 12 TYPE OF REPORTING PERSON* PN ----------------------------------------------------------------------------- - ------------------- ------------------ CUSIP NO. 92231M109 13G Page 6 of 19 Pages - ------------------- ------------------ 1 NAMES OF REPORTING PERSONS I.R.S. IDENTIFICATION NO. OF ABOVE PERSONS (ENTITIES ONLY) OVMC IV L.L.C. ("OVMC IV") Tax ID Number: ----------------------------------------------------------------------------- 2 CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP* (a) [ ] (b) [X] ----------------------------------------------------------------------------- 3 SEC USE ONLY ----------------------------------------------------------------------------- 4 CITIZENSHIP OR PLACE OF ORGANIZATION Delaware ----------------------------------------------------------------------------- 5 SOLE VOTING POWER 762,947 shares, of which 724,000 are directly owned by OVP IV and 38,947 shares are directly owned by OVP IV EF. OVMC IV, the general partner of OVP IV and OVP IV EF, may be deemed to have sole voting power, and Clute, Langeler, Miller and Waite, the managing members of OVMC IV, may be NUMBER OF deemed to have shared power to vote these shares. SHARES ------------------------------------------------------------ BENEFICIALLY 6 SHARED VOTING POWER OWNED BY See response to row 5. EACH ------------------------------------------------------------ REPORTING 7 SOLE DISPOSITIVE POWER PERSON 762,947 shares, of which 724,000 are directly owned by OVP WITH IV and 38,947 shares are directly owned by OVP IV EF. OVMC IV, the general partner of OVP IV and OVP IV EF, may be deemed to have sole dispositive power, and Clute, Langeler, Miller and Waite, the managing members of OVMC IV may be deemed to have shared power to dispose of these shares. ------------------------------------------------------------ 8 SHARED DISPOSITIVE POWER See response to row 7. ------------------------------------------------------------ 9 AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON 762,947 ----------------------------------------------------------------------------- 10 CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES* [ ] ----------------------------------------------------------------------------- 11 PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (9) 5.82% ----------------------------------------------------------------------------- 12 TYPE OF REPORTING PERSON* OO ----------------------------------------------------------------------------- - ------------------- ------------------ CUSIP NO. 92231M109 13G Page 7 of 19 Pages - ------------------- ------------------ 1 NAMES OF REPORTING PERSONS I.R.S. IDENTIFICATION NO. OF ABOVE PERSONS (ENTITIES ONLY) OVMC III L.L.C. ("OVMC III") Tax ID Number: ----------------------------------------------------------------------------- 2 CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP* (a) [ ] (b) [X] ----------------------------------------------------------------------------- 3 SEC USE ONLY ----------------------------------------------------------------------------- 4 CITIZENSHIP OR PLACE OF ORGANIZATION Delaware ----------------------------------------------------------------------------- 5 SOLE VOTING POWER 1,037,053 shares, of which 988,190 are directly owned by OVP III and 48,863 shares are directly owned by OVP III EF. OVMC III, the general partner of OVP III and OVP III EF, may be deemed to have sole voting power, and Clute, Langeler and Waite, the general partners of OVMC III, may be deemed to NUMBER OF have shared power to vote these shares. SHARES ------------------------------------------------------------ BENEFICIALLY 6 SHARED VOTING POWER OWNED BY See response to row 5. EACH ------------------------------------------------------------ REPORTING 7 SOLE DISPOSITIVE POWER PERSON 1,037,053 shares, of which 988,190 are directly owned by OVP WITH III and 48,863 shares are directly owned by OVP III EF. OVMC III, the general partner of OVP III and OVP III EF, may be deemed to have sole dispositive power, and Clute, Langeler and Waite, the general partners of OVMC III may be deemed to have shared power to dispose of these shares. ------------------------------------------------------------ 8 SHARED DISPOSITIVE POWER See response to row 7. ------------------------------------------------------------ 9 AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON 1,037,053 ----------------------------------------------------------------------------- 10 CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES* [ ] ----------------------------------------------------------------------------- 11 PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (9) 7.92% ----------------------------------------------------------------------------- 12 TYPE OF REPORTING PERSON* OO ----------------------------------------------------------------------------- - ------------------- ------------------ CUSIP NO. 92231M109 13G Page 8 of 19 Pages - ------------------- ------------------ 1 NAMES OF REPORTING PERSONS I.R.S. IDENTIFICATION NO. OF ABOVE PERSONS (ENTITIES ONLY) George H. Clute ("Clute") ----------------------------------------------------------------------------- 2 CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP* (a) [ ] (b) [X] ----------------------------------------------------------------------------- 3 SEC USE ONLY ----------------------------------------------------------------------------- 4 CITIZENSHIP OR PLACE OF ORGANIZATION U.S. Citizen ----------------------------------------------------------------------------- 5 SOLE VOTING POWER 0 shares ------------------------------------------------------------ 6 SHARED VOTING POWER 1,800,000 shares, of which 724,000 are directly owned by OVP IV, 38,947 are directly owned by OVP IV EF, 988,190 are directly owned by OVP III, and 48,863 shares are directly owned by OVP III EF. OVMC IV is the general partner of OVP IV and OVP IV EF; OVMC III is the general partner of OVP III and OVP III EF; and Clute, a managing member of OVMC IV and NUMBER OF a general partner of OVMC III, may be deemed to have shared SHARES power to vote these shares. BENEFICIALLY ------------------------------------------------------------ OWNED BY 7 SOLE DISPOSITIVE POWER EACH 0 shares REPORTING ------------------------------------------------------------ PERSON 8 SHARED DISPOSITIVE POWER WITH 1,800,000 shares, of which 724,000 are directly owned by OVP IV, 38,947 are directly owned by OVP IV EF, 988,190 are directly owned by OVP III, and 48,863 shares are directly owned by OVP III EF. OVMC IV is the general partner of OVP IV and OVP IV EF; OVMC III is the general partner of OVP III and OVP III EF; and Clute, a managing member of OVMC IV and a general partner of OVMC III, may be deemed to have shared power to dispose of these shares. ------------------------------------------------------------ 9 AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON 1,800,000 ----------------------------------------------------------------------------- 10 CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES* [ ] ----------------------------------------------------------------------------- 11 PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (9) 13.75% ----------------------------------------------------------------------------- 12 TYPE OF REPORTING PERSON* IN ----------------------------------------------------------------------------- - ------------------- ------------------ CUSIP NO. 92231M109 13G Page 9 of 19 Pages - ------------------- ------------------ 1 NAMES OF REPORTING PERSONS I.R.S. IDENTIFICATION NO. OF ABOVE PERSONS (ENTITIES ONLY) Gerard H. Langeler ("Langeler") ----------------------------------------------------------------------------- 2 CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP* (a) [ ] (b) [X] ----------------------------------------------------------------------------- 3 SEC USE ONLY ----------------------------------------------------------------------------- 4 CITIZENSHIP OR PLACE OF ORGANIZATION U.S. Citizen ----------------------------------------------------------------------------- 5 SOLE VOTING POWER 10,000 shares ------------------------------------------------------------ 6 SHARED VOTING POWER 1,800,000 shares, of which 724,000 are directly owned by OVP IV, 38,947 are directly owned by OVP IV EF, 988,190 are directly owned by OVP III, and 48,863 shares are directly owned by OVP III EF. OVMC IV is the general partner of OVP IV and OVP IV EF; OVMC III is the general partner of OVP III and OVP III EF; and Langeler, a managing member of OVMC IV NUMBER OF and general partner of OVMC III, may be deemed to have SHARES shared power to vote these shares. BENEFICIALLY ------------------------------------------------------------ OWNED BY 7 SOLE DISPOSITIVE POWER EACH 10,000 shares REPORTING ------------------------------------------------------------ PERSON 8 SHARED DISPOSITIVE POWER WITH 1,800,000 shares, of which 724,000 are directly owned by OVP IV, 38,947 are directly owned by OVP IV EF, 988,190 are directly owned by OVP III, and 48,863 shares are directly owned by OVP III EF. OVMC IV is the general partner of OVP IV and OVP IV EF; OVMC III is the general partner of OVP III and OVP III EF; and Langeler, a managing member of OVMC IV and a general partner of OVMC III, may be deemed to have shared power to dispose of these shares. ------------------------------------------------------------ 9 AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON 1,810,000 ----------------------------------------------------------------------------- 10 CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES* [ ] ----------------------------------------------------------------------------- 11 PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (9) 13.82% ----------------------------------------------------------------------------- 12 TYPE OF REPORTING PERSON* IN ----------------------------------------------------------------------------- - ------------------- ------------------- CUSIP NO. 92231M109 13G Page 10 of 19 Pages - ------------------- ------------------- 1 NAMES OF REPORTING PERSONS I.R.S. IDENTIFICATION NO. OF ABOVE PERSONS (ENTITIES ONLY) William D. Miller ("Miller") ----------------------------------------------------------------------------- 2 CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP* (a) [ ] (b) [X] ----------------------------------------------------------------------------- 3 SEC USE ONLY ----------------------------------------------------------------------------- 4 CITIZENSHIP OR PLACE OF ORGANIZATION U.S. Citizen ----------------------------------------------------------------------------- 5 SOLE VOTING POWER 0 shares ------------------------------------------------------------ 6 SHARED VOTING POWER 762,947 shares, of which 724,000 are directly owned by OVP IV and 38,947 are directly owned by OVP IV EF. OVMC IV is the general partner of OVP IV and OVP IV EF; and Miller, a NUMBER OF managing member of OVMC IV, may be deemed to have shared SHARES power to vote these shares. BENEFICIALLY ------------------------------------------------------------ OWNED BY 7 SOLE DISPOSITIVE POWER EACH 0 shares REPORTING ------------------------------------------------------------ PERSON 8 SHARED DISPOSITIVE POWER WITH 762,947 shares, of which 724,000 are directly owned by OVP IV and 38,947 are directly owned by OVP IV EF. OVMC IV is the general partner of OVP IV and OVP IV EF; and Miller, a managing member of OVMC IV, may be deemed to have shared power to dispose of these shares. ------------------------------------------------------------ 9 AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON 762,947 ----------------------------------------------------------------------------- 10 CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES* [ ] ----------------------------------------------------------------------------- 11 PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (9) 5.83% ----------------------------------------------------------------------------- 12 TYPE OF REPORTING PERSON* IN ----------------------------------------------------------------------------- - ------------------- ------------------- CUSIP NO. 92231M109 13G Page 11 of 19 Pages - ------------------- ------------------- 1 NAMES OF REPORTING PERSONS I.R.S. IDENTIFICATION NO. OF ABOVE PERSONS (ENTITIES ONLY) Charles P. Waite, Jr. ("Waite") ----------------------------------------------------------------------------- 2 CHECK THE APPROPRIATE BOX IF A MEMBER OF A GROUP* (a) [ ] (b) [X] ----------------------------------------------------------------------------- 3 SEC USE ONLY ----------------------------------------------------------------------------- 4 CITIZENSHIP OR PLACE OF ORGANIZATION U.S. Citizen ----------------------------------------------------------------------------- 5 SOLE VOTING POWER 0 shares ------------------------------------------------------------ 6 SHARED VOTING POWER 1,800,000 shares, of which 724,000 are directly owned by OVP IV, 38,947 are directly owned by OVP IV EF, 988,190 are directly owned by OVP III, and 48,863 shares are directly owned by OVP III EF. OVMC IV is the general partner of OVP IV and OVP IV EF; OVMC III is the general partner of OVP III and OVP III EF; and Waite, a managing member of OVMC IV and NUMBER OF general partner of OVMC III, may be deemed to have shared SHARES power to vote these shares. BENEFICIALLY ------------------------------------------------------------ OWNED BY 7 SOLE DISPOSITIVE POWER EACH 0 shares REPORTING ------------------------------------------------------------ PERSON 8 SHARED DISPOSITIVE POWER WITH 1,800,000 shares, of which 724,000 are directly owned by OVP IV, 38,947 are directly owned by OVP IV EF, 988,190 are directly owned by OVP III, and 48,863 shares are directly owned by OVP III EF. OVMC IV is the general partner of OVP IV and OVP IV EF; OVMC III is the general partner of OVP III and OVP III EF; and Waite, a managing member of OVMC IV and a general partner of OVMC III, may be deemed to have shared power to dispose of these shares. ------------------------------------------------------------ 9 AGGREGATE AMOUNT BENEFICIALLY OWNED BY EACH REPORTING PERSON 1,800,000 ----------------------------------------------------------------------------- 10 CHECK BOX IF THE AGGREGATE AMOUNT IN ROW (9) EXCLUDES CERTAIN SHARES* [ ] ----------------------------------------------------------------------------- 11 PERCENT OF CLASS REPRESENTED BY AMOUNT IN ROW (9) 13.75% ----------------------------------------------------------------------------- 12 TYPE OF REPORTING PERSON* IN ----------------------------------------------------------------------------- - ------------------- ------------------- CUSIP NO. 92231M109 13G Page 12 of 19 Pages - ------------------- ------------------- ITEM 1(A). NAME OF ISSUER Vascular Solutions, Inc. ITEM 1(B). ADDRESS OF ISSUER'S PRINCIPAL EXECUTIVE OFFICES 2495 Xenium Lane North Minneapolis, MN 55441 ITEM 2(A). NAME OF PERSONS FILING This Statement is filed by Olympic Venture Partners IV, L.P., a Delaware limited partnership ("OVP IV"), Olympic Venture Partners IV Entrepreneurs Fund, L.P., a Delaware limited partnership ("OVP IV EF"), Olympic Venture Partners III, L.P., a Delaware limited partnership ("OVP III"), Olympic Venture Partners III Entrepreneurs Fund, L.P. a Delaware limited partnership ("OVP III EF), OVMC IV, L.L.C., a Delaware limited liability company ("OVMC IV"), OVMC III, L.P., a Delaware limited partnership ("OVMC III"), George H. Clute ("Clute"), Gerard H. Langeler ("Langeler"), William D. Miller ("Miller") and Charles P. Waite, Jr. ("Waite"). The foregoing entities and individuals are collectively referred to as the "Reporting Persons." OVMC IV is the general partner of OVP IV and OVP IV EF, and may be deemed to have indirect beneficial ownership of shares of the issuer directly owned by OVP IV and OVP IV EF. OVMC III is the general partner of OVP III and OVP III EF, and may be deemed to have indirect beneficial ownership of shares of the issuer directly owned by OVP III and OVP III EF. Clute, Langeler, Miller and Waite are managing members of OVMC IV and may be deemed to have indirect beneficial ownership of shares of the issuer directly owned by OVP IV and OVP IV EF. Clute, Langeler and Waite are general partners of OVMC III and may be deemed to have indirect beneficial ownership of shares of the issuer directly owned by OVP III and OVP III EF. ITEM 2(B). ADDRESS OF PRINCIPAL OFFICE The address for each of the Reporting Persons is: OVP Venture Partners 2420 Carillon Point Kirkland, Washington 98033 ITEM 2(C) CITIZENSHIP OVP IV, OVP IV EF, OVP III and OVP III EF, are Delaware limited partnerships. OVMC IV is a Delaware limited liability company and OVMC III is a Delaware limited partnership. Clute, Langeler, Miller and Waite are United States citizens. ITEM 2(D). TITLE OF CLASS OF SECURITIES Common Stock ITEM 2(E). CUSIP NUMBER CUSIP # 92231M109 ITEM 3. Not Applicable - ------------------- ------------------- CUSIP NO. 92231M109 13G Page 13 of 19 Pages - ------------------- ------------------- ITEM 4. OWNERSHIP The following information with respect to the ownership of the Common Stock of the issuer by the persons filing this Statement is provided as of December 31, 2000: (a) Amount beneficially owned: See Row 9 of cover page for each Reporting Person. (b) Percent of Class: See Row 11 of cover page for each Reporting Person. (c) Number of shares as to which such person has: (i) Sole power to vote or to direct the vote: See Row 5 of cover page for each Reporting Person. (ii) Shared power to vote or to direct the vote: See Row 6 of cover page for each Reporting Person. (iii) Sole power to dispose or to direct the disposition of: See Row 7 of cover page for each Reporting Person. (iv) Shared power to dispose or to direct the disposition of: See Row 8 of cover page for each Reporting Person. - ------------------- ------------------- CUSIP NO. 92231M109 13G Page 14 of 19 Pages - ------------------- ------------------- 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. Under certain circumstances set forth in the limited partnership agreements of OVP IV, OVP IV EF, OVP III and OVP III EF, and the limited liability company agreement of OVMC IV and the limited partnership agreement of OVMC III, the general and limited partners or members, as the case may be, of each of such entities may be deemed to have the right to receive dividends from, or the proceeds from, the sale of shares of the issuer owned by each such entity of which they are a partner. ITEM 7. IDENTIFICATION AND CLASSIFICATION OF THE SUBSIDIARY WHICH ACQUIRED THE SECURITY BEING REPORTED ON BY THE PARENT HOLDING COMPANY Not applicable. ITEM 8. IDENTIFICATION AND CLASSIFICATION OF MEMBERS OF THE GROUP. Not applicable. ITEM 9. NOTICE OF DISSOLUTION OF GROUP. Not applicable. ITEM 10. CERTIFICATION. Not applicable. - ------------------- ------------------- CUSIP NO. 92231M109 13G Page 15 of 19 Pages - ------------------- ------------------- SIGNATURES 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. Date: February 13, 2001 OLYMPIC VENTURE PARTNERS IV L.P., a Delaware Limited Partnership By: OVMC IV L.L.C., a Delaware Limited Liability Company Its: General Partner OLYMPIC VENTURE PARTNERS IV ENTREPRENEURS FUND L.P., a Delaware Limited Partnership By: OVMC IV L.L.C., a Delaware Limited Liability Company Its: General Partner OVMC IV L.L.C., a Delaware Limited Liability Company By: /s/ George H. Clute ------------------------------------ George H. Clute Its: Managing Member OLYMPIC VENTURE PARTNERS III L.P., a Delaware Limited Partnership By: OVMC III L.P., a Delaware Limited Partnership Its: General Partner OLYMPIC VENTURE PARTNERS IV ENTREPRENEURS FUND L.P., a Delaware Limited Partnership By: OVMC III L.P., a Delaware Limited Partnership Its: General Partner OVMC III L.P., a Delaware Limited Partnership By: /s/ George H. Clute ------------------------------------ George H. Clute Its: General Partner Page 16 of 19 Pages GEORGE H. CLUTE By: /s/ George H. Clute ------------------------------------ George H. Clute GERARD H. LANGELER By: /s/ Gerard H. Langeler ------------------------------------ Gerard H. Langeler WILLIAM D. MILLER By: /s/ William D. Miller ------------------------------------ William D. Miller Charles P. Waite, Jr. By: /s/ Charles P. Waite, Jr. ------------------------------------ Charles P. Waite, Jr. Page 17 of 19 Pages EXHIBIT INDEX Found on Sequentially Exhibit Numbered Page - ------- ------------- Exhibit A: Agreement of Joint Filing 18 Page 18 of 19 Pages EXHIBIT A Agreement of Joint Filing The undersigned hereby agree that a single Schedule 13G (or any amendment thereto) relating to the Common Stock of Vascular Solutions, Inc. shall be filed on behalf of each of the undersigned and that this Agreement shall be filed as an exhibit to such Schedule 13G. Date: February 13, 2001 OLYMPIC VENTURE PARTNERS IV L.P., a Delaware Limited Partnership By: OVMC IV L.L.C., a Delaware Limited Liability Company Its: General Partner OLYMPIC VENTURE PARTNERS IV ENTREPRENEURS FUND L.P., a Delaware Limited Partnership By: OVMC IV L.L.C., a Delaware Limited Liability Company Its: General Partner OVMC IV L.L.C., a Delaware Limited Liability Company By: /s/ George H. Clute ------------------------------------ George H. Clute Its: Managing Member OLYMPIC VENTURE PARTNERS III L.P., a Delaware Limited Partnership By: OVMC III L.P., a Delaware Limited Partnership Its: General Partner OLYMPIC VENTURE PARTNERS IV ENTREPRENEURS FUND L.P., a Delaware Limited Partnership By: OVMC III L.P., a Delaware Limited Partnership Its: General Partner OVMC III L.P., a Delaware Limited Partnership By: /s/ George H. Clute ------------------------------------ George H. Clute Its: General Partner Page 19 of 19 Pages GEORGE H. CLUTE By: /s/ George H. Clute ------------------------------------ George H. Clute GERARD H. LANGELER By: /s/ Gerard H. Langeler ------------------------------------ Gerard H. Langeler WILLIAM D. MILLER By: /s/ William D. Miller ------------------------------------ William D. Miller Charles P. Waite, Jr. By: /s/ Charles P. Waite, Jr. ------------------------------------ Charles P. Waite, Jr. -----END PRIVACY-ENHANCED MESSAGE-----