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