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