FORM 3 |
UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549 INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934 or Section 30(h) of the Investment Company Act of 1940 |
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1. Name and Address of Reporting Person*
(Street)
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2. Date of Event Requiring Statement
(Month/Day/Year) 06/24/2014 |
3. Issuer Name and Ticker or Trading Symbol
Imprivata Inc [ IMPR ] |
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4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
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5. If Amendment, Date of Original Filed
(Month/Day/Year) |
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6. Individual or Joint/Group Filing (Check Applicable Line)
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Table I - Non-Derivative Securities Beneficially Owned | |||
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1. Title of Security (Instr. 4) | 2. Amount of Securities Beneficially Owned (Instr. 4) | 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 4. Nature of Indirect Beneficial Ownership (Instr. 5) |
Table II - Derivative Securities Beneficially Owned (e.g., puts, calls, warrants, options, convertible securities) | |||||||
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1. Title of Derivative Security (Instr. 4) | 2. Date Exercisable and Expiration Date (Month/Day/Year) | 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) | 4. Conversion or Exercise Price of Derivative Security | 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) | 6. Nature of Indirect Beneficial Ownership (Instr. 5) | ||
Date Exercisable | Expiration Date | Title | Amount or Number of Shares | ||||
Series A Convertible Preferred Stock | (1) | (1) | Common Stock | 1,558,065 | (1) | I | By Highland Capital Partners VI Limited Partnership(2) |
Series B Convertible Preferred Stock | (1) | (1) | Common Stock | 756,401 | (1) | I | By Highland Capital Partners VI Limited Partnership(2) |
Series C Convertible Preferred Stock | (1) | (1) | Common Stock | 480,426 | (1) | I | By Highland Capital Partners VI Limited Partnership(2) |
Series A Convertible Preferred Stock | (1) | (1) | Common Stock | 853,699 | (1) | I | By Highland Capital Partners VI-B Limited Partnership(3) |
Series B Convertible Preferred Stock | (1) | (1) | Common Stock | 414,684 | (1) | I | By Highland Capital Partners VI-B Limited Partnership(3) |
Series C Convertible Preferred Stock | (1) | (1) | Common Stock | 263,385 | (1) | I | By Highland Capital Partners VI-B Limited Partnership(3) |
Series A Convertible Preferred Stock | (1) | (1) | Common Stock | 77,155 | (1) | I | By Highland Entrepreneurs? Fund VI Limited Partnership(4) |
Series B Convertible Preferred Stock | (1) | (1) | Common Stock | 37,465 | (1) | I | By Highland Entrepreneurs? Fund VI Limited Partnership(4) |
Series C Convertible Preferred Stock | (1) | (1) | Common Stock | 23,796 | (1) | I | By Highland Entrepreneurs? Fund VI Limited Partnership(4) |
Explanation of Responses: |
1. The Series A, B and C Convertible Preferred Stock is convertible at any time at the option of the holder, and will automatically convert into shares of Common Stock on a 1.5-for-1 basis upon the closing of the Issuer's initial public offering. The securities have no expiration date. |
2. The shares are held directly by Highland Capital Partners VI Limited Partnership ("Highland Capital VI"). Highland Management Partners VI Limited Partnership ("HMP") is the general partner of Highland Capital VI. Highland Management Partners VI, Inc.("Highland Management") is the general partner of HMP. The Reporting Person is one of the managing directors of Highland Management. Highland Management, as the general partner of the general partner of Highland Capital VI, may be deemed to have indirect beneficial ownership of the shares held by the Highland Capital VI. The Reporting Person may be deemed the indirect owner of all the shares held by the Highland Capital VI. The Reporting Person disclaims beneficial ownership of such securities, except to the extent of his pecuniary interest therein. This report shall not be deemed to be an admission that the Reporting Person is the beneficial owner of such securities for purposes of Section 16 or for any other purpose. |
3. The shares are held directly by Highland Capital Partners VI-B Limited Partnership ("Highland Capital VI-B"). Highland Management Partners VI Limited Partnership ("HMP") is the general partner of Highland Capital VI-B. Highland Management Partners VI, Inc.("Highland Management") is the general partner of HMP. The Reporting Person is one of the managing directors of Highland Management. Highland Management, as the general partner of the general partners of the Highland Investing Entities, may be deemed to have beneficial ownership of the shares held by the Highland Capital VI-B. The Reporting Person may be deemed the indirect owner of all the shares held by the Highland Capital VI-B. The Reporting Person disclaims beneficial ownership of such securities, except to the extent of his pecuniary interest therein. This report shall not be deemed to be an admission that the Reporting Person is the beneficial owner of such securities for purposes of Section 16 or for any other purpose. |
4. The shares are held directly by Highland Entrepreneurs' Fund VI Limited Partnership ("Entrepreneurs' Fund"). HEF VI Limited Partnership ("HEF") is the general partner of Entrepreneurs' Fund. Highland Management Partners VI, Inc.("Highland Management" is the general partner of HEF). The Reporting Person is one of the managing directors of Highland Management. Highland Management, as the general partner of the general partners of the Entrepreneurs' Fund, may be deemed to have beneficial ownership of the shares held by the Entrepreneurs' Fund. The Reporting Person may be deemed the indirect owner of all the shares held by the Entrepreneurs' Fund. The Reporting Person disclaims beneficial ownership of such securities, except to the extent of his pecuniary interest therein. This report shall not be deemed to be an admission that the Reporting Person is the beneficial owner of such securities for purposes of Section 16 or for any other purpose. |
Remarks: |
/s/ John Milton, Attorney-in-Fact | 06/24/2014 | |
** Signature of Reporting Person | Date | |
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | ||
* If the form is filed by more than one reporting person, see Instruction 5 (b)(v). | ||
** 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 is insufficient, see Instruction 6 for procedure. | ||
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number. |