0001209191-11-056004.txt : 20111115 0001209191-11-056004.hdr.sgml : 20111115 20111115115825 ACCESSION NUMBER: 0001209191-11-056004 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20111115 FILED AS OF DATE: 20111115 DATE AS OF CHANGE: 20111115 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: BREYER JAMES CENTRAL INDEX KEY: 0001194696 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35338 FILM NUMBER: 111206221 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: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35338 FILM NUMBER: 111206219 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: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35338 FILM NUMBER: 111206218 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: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35338 FILM NUMBER: 111206224 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: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35338 FILM NUMBER: 111206223 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: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35338 FILM NUMBER: 111206222 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: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35338 FILM NUMBER: 111206220 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 4 1 c24145_4x0.xml MAIN DOCUMENT DESCRIPTION X0304 4 2011-11-15 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 97301 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 AVENUE PALO ALTO CA 94301 0 0 1 0 Common Stock 2011-11-15 4 C 0 1558800 A 1788941 D Common Stock 2011-11-15 4 C 0 907091 A 2696032 D Common Stock 2011-11-15 4 C 0 213884 A 2909916 D Common Stock 2011-11-15 4 C 0 289298 A 3199214 D Common Stock 2011-11-15 4 C 0 306200 A 351408 I See footnote Common Stock 2011-11-15 4 C 0 178183 A 529591 I See footnote Common Stock 2011-11-15 4 C 0 42014 A 571605 I See footnote Common Stock 2011-11-15 4 C 0 56827 A 628432 I See footnote Common Stock 2011-11-15 4 C 0 135000 A 154932 I See footnote Common Stock 2011-11-15 4 C 0 78559 A 233491 I See footnote Common Stock 2011-11-15 4 C 0 18523 A 252014 I See footnote Common Stock 2011-11-15 4 C 0 25054 A 277068 I See footnote Series A Convertible Preferred Stock 2011-11-15 4 C 0 1558800 D Common Stock 1558800 0 D Series B Convertible Preferred Stock 2011-11-15 4 C 0 907091 D Common Stock 907091 0 D Series C Convertible Preferred Stock 2011-11-15 4 C 0 213884 D Common Stock 213884 0 D Series D Convertible Preferred Stock 2011-11-15 4 C 0 289298 D Common Stock 289298 0 D Series A Convertible Preferred Stock 2011-11-15 4 C 0 306200 D Common Stock 306200 0 I See footnote Series B Convertible Preferred Stock 2011-11-15 4 C 0 178183 D Common Stock 178183 0 I See footnote Series C Convertible Preferred Stock 2011-11-15 4 C 0 42014 D Common Stock 42014 0 I See footnote Series D Convertible Preferred Stock 2011-11-15 4 C 0 56827 D Common Stock 56827 0 I See footnote Series A Convertible Preferred Stock 2011-11-15 4 C 0 135000 D Common Stock 135000 0 I See footnote Series B Convertible Preferred Stock 2011-11-15 4 C 0 78559 D Common Stock 78559 0 I See footnote Series C Convertible Preferred Stock 2011-11-15 4 C 0 18523 D Common Stock 18523 0 I See footnote Series D Convertible Preferred Stock 2011-11-15 4 C 0 25054 D Common Stock 25054 0 I See footnote Not applicable. Each share of Series A Convertible Preferred Stock was automatically converted into one share of Common Stock upon the closing of the Issuer's initial public offering. The Series A Convertible Preferred Stock, Series B Convertible Preferred Stock, Series C Convertible Preferred Stock and Series D Convertible Preferred Stock have no expiration date. Each share of Series B Convertible Preferred Stock was automatically converted into one share of Common Stock upon the closing of the Issuer's initial public offering. Each share of Series C Convertible Preferred Stock was automatically converted into one share of Common Stock upon the closing of the Issuer's initial public offering. Each share of Series D Convertible Preferred Stock was automatically converted into one share of Common Stock upon the closing of the Issuer's initial public offering. 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 2011-11-15