0001209191-14-044417.txt : 20140630 0001209191-14-044417.hdr.sgml : 20140630 20140630165742 ACCESSION NUMBER: 0001209191-14-044417 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20140630 FILED AS OF DATE: 20140630 DATE AS OF CHANGE: 20140630 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Imprivata Inc CENTRAL INDEX KEY: 0001328015 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-PREPACKAGED SOFTWARE [7372] IRS NUMBER: 000000000 BUSINESS ADDRESS: STREET 1: 19 MAGUIRE RD SUITE 232 CITY: LEXINGTON STATE: MA ZIP: 02421 BUSINESS PHONE: 781-674-2700 MAIL ADDRESS: STREET 1: 19 MAGUIRE RD SUITE 232 CITY: LEXINGTON STATE: MA ZIP: 02421 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: POLARIS VENTURE PARTNERS III LP CENTRAL INDEX KEY: 0001104639 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36516 FILM NUMBER: 14949706 BUSINESS ADDRESS: STREET 1: 1000 WINTER STREET STREET 2: SUITE 3350 CITY: WALLTHAM STATE: MA ZIP: 02451-1215 BUSINESS PHONE: 7812900770 MAIL ADDRESS: STREET 1: 1000 WINTER STREET STREET 2: SUITE 3350 CITY: WALTHAM STATE: MA ZIP: 02451 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: POLARIS VENTURE PARTNERS FOUNDERS FUND III LP CENTRAL INDEX KEY: 0001114437 FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36516 FILM NUMBER: 14949707 BUSINESS ADDRESS: STREET 1: 1000 WINTER STREET STREET 2: SUITE 3350 CITY: WALTHAM STATE: MA ZIP: 02451 BUSINESS PHONE: 7812900770 MAIL ADDRESS: STREET 1: 1000 WINTER STREET STREET 2: SUITE 3350 CITY: WALTHAM STATE: MA ZIP: 02451 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: POLARIS VENTURE PARTNERS ENTREPRENEURS FUND III LP CENTRAL INDEX KEY: 0001114889 FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36516 FILM NUMBER: 14949708 BUSINESS ADDRESS: STREET 1: 1000 WINTER STREET STREET 2: SUITE 3350 CITY: WALTHAM STATE: MA ZIP: 02451-1215 BUSINESS PHONE: 7812900770 MAIL ADDRESS: STREET 1: 1000 WINTER STREET STREET 2: SUITE 3350 CITY: WALTHAM STATE: MA ZIP: 02451 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: POLARIS VENTURE MANAGEMENT CO III LLC CENTRAL INDEX KEY: 0001114126 FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-36516 FILM NUMBER: 14949709 BUSINESS ADDRESS: STREET 1: 1000 WINTER STREET SUITE 3350 CITY: WALTHAM STATE: MA ZIP: 02451-1215 BUSINESS PHONE: 7812900770 MAIL ADDRESS: STREET 1: 1000 WINTER STREET STREET 2: SUITE 3350 CITY: WALTHAM STATE: MA ZIP: 02451 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2014-06-30 0 0001328015 Imprivata Inc IMPR 0001114126 POLARIS VENTURE MANAGEMENT CO III LLC 1000 WINTER STREET, SUITE 3350 WALTHAM MA 02451 0 0 1 0 0001114889 POLARIS VENTURE PARTNERS ENTREPRENEURS FUND III LP 1000 WINTER STREET, SUITE 3350 WALTHAM MA 02451 0 0 1 0 0001114437 POLARIS VENTURE PARTNERS FOUNDERS FUND III LP 1000 WINTER STREET, SUITE 3350 WALTHAM MA 02451 0 0 1 0 0001104639 POLARIS VENTURE PARTNERS III LP 1000 WINTER STREET, SUITE 3350 WALTHAM MA 02451 0 0 1 0 Common Stock 2014-06-30 4 C 0 4287790 A 4287790 I See footnote Common Stock 2014-06-30 4 C 0 110250 A 110250 I See footnote Common Stock 2014-06-30 4 C 0 67036 A 67036 I See footnote Series A Convertible Preferred Stock 2014-06-30 4 C 0 2389540 D Common Stock 2389540 0 I See footnote Series B Convertible Preferred Stock 2014-06-30 4 C 0 1160895 D Common Stock 1160895 0 I See footnote Series C Convertible Preferred Stock 2014-06-30 4 C 0 737355 D Common Stock 737355 0 I See footnote Series A Convertible Preferred Stock 2014-06-30 4 C 0 61829 D Common Stock 61829 0 I See footnote Series B Convertible Preferred Stock 2014-06-30 4 C 0 29623 D Common Stock 29623 0 I See footnote Series C Convertible Preferred Stock 2014-06-30 4 C 0 18798 D Common Stock 18798 0 I See footnote Series A Convertible Preferred Stock 2014-06-30 4 C 0 37551 D Common Stock 37551 0 I See footnote Series B Convertible Preferred Stock 2014-06-30 4 C 0 18032 D Common Stock 18032 0 I See footnote Series C Convertible Preferred Stock 2014-06-30 4 C 0 11453 D Common Stock 11453 0 I See footnote The Series A, B and C Convertible Preferred Stock converted 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. The shares are held directly by Polaris Venture Partners III, L.P. Polaris Venture Management Co. III, L.L.C. is the general partner of Polaris Venture Partners III, L.P. and has the voting and investment power over such shares and may be deemed the indirect beneficial owner of such shares. The Reporting Person disclaims beneficial ownership of these shares, except to the extent of its pecuniary interest therein, and this report shall not be deemed an admission that the Reporting Person is the beneficial owner of such securities for Section 16 or any other purpose. The shares are held directly by Polaris Venture Partners Entrepreneurs' Fund III, L.P. Polaris Venture Management Co. III, L.L.C. is the general partner of Polaris Venture Partners Entrepreneurs' Fund III, L.P. and has the voting and investment power over such shares and may be deemed the indirect beneficial owner of such shares. The Reporting Person disclaims beneficial ownership of these shares, except to the extent of its pecuniary interest therein, and this report shall not be deemed an admission that the Reporting Person is the beneficial owner of such securities for Section 16 or any other purpose. The shares are held directly by Polaris Venture Partners Founders' Fund III, L.P. Polaris Venture Management Co. III, L.L.C. is the general partner of Polaris Venture Partners Founders' Fund III, L.P. and has the voting and investment power over such shares and may be deemed the indirect beneficial owner of such shares. The Reporting Person disclaims beneficial ownership of these shares, except to the extent of its pecuniary interest therein, and this report shall not be deemed an admission that the Reporting Person is the beneficial owner of such securities for Section 16 or any other purpose. Polaris Venture Management Co. III, L.L.C., /s/ John Gannon, Attorney-in-Fact 2014-06-30 Polaris Venture Partners Entrepreneurs' Fund III, L.P., By: Polaris Venture Management Co. III, L.L.C., Its General Partner, /s/ John Gannon, Attorney-in-Fact 2014-06-30 Polaris Venture Partners Founders' Fund III, L.P., By: Polaris Venture Management Co. III., L.L.C., its General Partner, /s/ John Gannon, Attorney-in-Fact 2014-06-30 Polaris Venture Partners III, L.P., By: Polaris Venture Management Co. III, L.L.C., Its General Partner, /s/ John Gannon, Attorney-in-Fact 2014-06-30