0001209191-11-055093.txt : 20111108 0001209191-11-055093.hdr.sgml : 20111108 20111108211956 ACCESSION NUMBER: 0001209191-11-055093 CONFORMED SUBMISSION TYPE: 3 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20111108 FILED AS OF DATE: 20111108 DATE AS OF CHANGE: 20111108 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: BREYER JAMES CENTRAL INDEX KEY: 0001194696 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35338 FILM NUMBER: 111189335 MAIL ADDRESS: STREET 1: ACCEL PARTNERS STREET 2: 428 UNIVERSITY AVE CITY: PALO ALTO STATE: CA ZIP: 94301 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: PATTERSON ARTHUR C CENTRAL INDEX KEY: 0001219233 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35338 FILM NUMBER: 111189333 MAIL ADDRESS: STREET 1: 428 UNIVERSITY AVE CITY: PALO ALTO STATE: CA ZIP: 94301 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: SWARTZ JAMES R CENTRAL INDEX KEY: 0001219237 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35338 FILM NUMBER: 111189332 MAIL ADDRESS: STREET 1: P O BOX 2816 CITY: PARK CIRY STATE: UT ZIP: 84060 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: ACCEL VIII LP CENTRAL INDEX KEY: 0001115786 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35338 FILM NUMBER: 111189338 BUSINESS ADDRESS: STREET 1: ONE PALMER SQUARE CITY: PRINCETON STATE: NJ ZIP: 08542 MAIL ADDRESS: STREET 1: 428 UNIVERSITYI AVENUE CITY: PALO ALTO STATE: CA ZIP: 94301 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: ACCEL INTERNET FUND IV LP CENTRAL INDEX KEY: 0001119932 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35338 FILM NUMBER: 111189337 BUSINESS ADDRESS: STREET 1: ONE PALMER SQUARE CITY: PRINCETON STATE: NJ ZIP: 08542 MAIL ADDRESS: STREET 1: 428 UNIVERSITY AVENUE CITY: PALO ALTO STATE: CA ZIP: 94301 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: ACCEL INVESTORS 2002 LLC CENTRAL INDEX KEY: 0001248474 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35338 FILM NUMBER: 111189336 BUSINESS ADDRESS: STREET 1: 428 UNIVERSITY AVENUE CITY: PALO ALTO STATE: CA ZIP: 94301 BUSINESS PHONE: 6506144800 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: ACCEL VIII ASSOCIATES LLC CENTRAL INDEX KEY: 0001248538 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 3 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35338 FILM NUMBER: 111189334 BUSINESS ADDRESS: STREET 1: 428 UNIVERSITY AVENUE CITY: PALO ALTO STATE: CA ZIP: 94301 BUSINESS PHONE: 6506144800 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: IMPERVA INC CENTRAL INDEX KEY: 0001364962 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-PREPACKAGED SOFTWARE [7372] IRS NUMBER: 030460133 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 3400 BRIDGE PARKWAY, SUITE 200 CITY: REDWOOD SHORES STATE: CA ZIP: 94065 BUSINESS PHONE: 650-345-9000 MAIL ADDRESS: STREET 1: 3400 BRIDGE PARKWAY, SUITE 200 CITY: REDWOOD SHORES STATE: CA ZIP: 94065 3 1 c24146_3x0.xml MAIN DOCUMENT DESCRIPTION X0204 3 2011-11-08 0 0001364962 IMPERVA INC IMPV 0001115786 ACCEL VIII LP ACCEL PARTNERS 428 UNIVERSITY AVENUE PALO ALTO CA 94301 0 0 1 0 0001119932 ACCEL INTERNET FUND IV LP ACCEL PARTNERS 428 UNIVERSITY AVENUE PALO ALTO CA 94301 0 0 1 0 0001248474 ACCEL INVESTORS 2002 LLC ACCEL PARTNERS 428 UNIVERSITY AVENUE PALO ALTO CA 94301 0 0 1 0 0001194696 BREYER JAMES C/O ACCEL PARTNERS 428 UNIVERSITY AVENUE PALO ALTO CA 94301 0 0 1 0 0001248538 ACCEL VIII ASSOCIATES LLC C/O ACCEL PARTNERS 428 UNIVERSITY AVENUE PALO ALTO CA 94301 0 0 1 0 0001219233 PATTERSON ARTHUR C C/O ACCEL PARTNERS 428 UNIVERSITY AVENUE PALO ALTO CA 94301 0 0 1 0 0001219237 SWARTZ JAMES R C/O ACCEL PARTNERS 428 UNIVERSITY AVE PALO ALTO CA 94301 0 0 1 0 Series A Convertible Preferred Stock Common Stock 1558800 D Series B Convertible Preferred Stock Common Stock 907091 D Series C Convertible Preferred Stock Common Stock 213884 D Series D Convertible Preferred Stock Common Stock 289298 D Series A Convertible Preferred Stock Common Stock 306200 I See footnote Series B Convertible Preferred Stock Common Stock 178183 I See footnote Series C Convertible Preferred Stock Common Stock 42014 I See footnote Series D Convertible Preferred Stock Common Stock 56827 I See footnote Series A Convertible Preferred Stock Common Stock 135000 I See footnote Series B Convertible Preferred Stock Common Stock 78559 I See footnote Series C Convertible Preferred Stock Common Stock 18523 I See footnote Series D Convertible Preferred Stock Common Stock 25054 I See footnote The Series A Convertible Preferred Stock is convertible into Common Stock on a one-for-one basis at any time at the holder's election, and automatically upon the closing of the Issuer's initial public offering, and has no expiration date. Not applicable. The Series B Convertible Preferred Stock is convertible into Common Stock on a one-for-one basis at any time at the holder's election, and automatically upon the closing of the Issuer's initial public offering, and has no expiration date. The Series C Convertible Preferred Stock is convertible into Common Stock on a one-for-one basis at any time at the holder's election, and automatically upon the closing of the Issuer's initial public offering, and has no expiration date. The Series D Convertible Preferred Stock is convertible into Common Stock on a one-for-one basis at any time at the holder's election, and automatically upon the closing of the Issuer's initial public offering, and has no expiration date. The securities are held by Accel VIII L.P. Accel VIII Associates L.L.C. ("A8A") is the General Partner of Accel VIII L.P. and has the sole voting and investment power with respect to the shares. James W. Breyer, Arthur C. Patterson, Theresia Gouw Ranzetta, a director of the Issuer, and James R. Swartz are the Managing Members of and share voting and investment powers in such entities. Each Reporting Person disclaims beneficial ownership of all shares held by the foregoing entities except to the extent of its pecuniary interest therein. The securities are held by Accel Internet Fund IV L.P. A8A is the General Partner of Accel Internet Fund IV L.P. and has the sole voting and investment power with respect to those entities. James W. Breyer, Arthur C. Patterson, Theresia Gouw Ranzetta, a director of the Issuer, and James R. Swartz are the Managing Members of and share voting and investment powers in such entities. Each Reporting Person disclaims beneficial ownership of all shares held by the foregoing entities except to the extent of its pecuniary interest therein. The securities are held by Accel Investors 2002 L.L.C. ("AI2002"). James W. Breyer, Arthur C. Patterson, Theresia Gouw Ranzetta, a director of the Issuer, and James R. Swartz are the Managing Members of and share voting and investment powers in such entities. Each Reporting Person disclaims beneficial ownership of all shares held by the foregoing entities except to the extent of its pecuniary interest therein. /s/ Tracy L. Sedlock, attorney in fact to Reporting Person 2011-11-08