0001225450-11-000030.txt : 20111115
0001225450-11-000030.hdr.sgml : 20111115
20111115171141
ACCESSION NUMBER: 0001225450-11-000030
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20111115
FILED AS OF DATE: 20111115
DATE AS OF CHANGE: 20111115
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
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: KRAUSZ STEVEN M
CENTRAL INDEX KEY: 0001190636
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35338
FILM NUMBER: 111208008
MAIL ADDRESS:
STREET 1: 2735 SAND HILL ROAD
CITY: MENLO PARK
STATE: CA
ZIP: 94025
4
1
edgar.xml
PRIMARY DOCUMENT
X0304
4
2011-11-15
0001364962
IMPERVA INC
IMPV
0001190636
KRAUSZ STEVEN M
2735 SAND HILL ROAD
MENLO PARK
CA
94025
1
0
0
0
Common Stock
2011-11-15
4
C
0
1927377
A
2078200
I
Directly owned by USVP VIII
Common Stock
2011-11-15
4
C
0
18604
A
18604
I
Directly owned by AFF VIII
Common Stock
2011-11-15
4
C
0
17814
A
19206
I
Directly owned by EP VIII-A
Common Stock
2011-11-15
4
C
0
9029
A
9733
I
Directly owned by EP VIII-B
Series B Convertible Preferred Stock
2011-11-15
4
C
0
1279659
D
Common Stock
1279659
0
I
Directly owned by USVP VIII
Series C Convertible Preferred Stock
2011-11-15
4
C
0
459921
D
Common Stock
459921
0
I
Directly owned by USVP VIII
Series D Convertible Preferred Stock
2011-11-15
4
C
0
187797
D
Common Stock
187797
0
I
Directly owned by USVP VIII
Series B Convertible Preferred Stock
2011-11-15
4
C
0
12352
D
Common Stock
12352
0
I
Directly owned by AFF VIII
Series C Convertible Preferred Stock
2011-11-15
4
C
0
4439
D
Common Stock
4439
0
I
Directly owned by AFF VIII
Series D Convertible Preferred Stock
2011-11-15
4
C
0
1813
D
Common Stock
1813
0
I
Directly owned by AFF VIII
Series B Convertible Preferred Stock
2011-11-15
4
C
0
11827
D
Common Stock
11827
0
I
Directly owned by EP VIII-A
Series C Convertible Preferred Stock
2011-11-15
4
C
0
4251
D
Common Stock
4251
0
I
Directly owned by EP VIII-A
Series D Convertible Preferred Stock
2011-11-15
4
C
0
1736
D
Common Stock
1736
0
I
Directly owned by EP VIII-A
Series B Convertible Preferred Stock
2011-11-15
4
C
0
5995
D
Common Stock
5995
0
I
Directly owned by EP VIII-B
Series C Convertible Preferred Stock
2011-11-15
4
C
0
2154
D
Common Stock
2154
0
I
Directly owned by EP VIII-B
Series D Convertible Preferred Stock
2011-11-15
4
C
0
880
D
Common Stock
880
0
I
Directly owned by EP VIII-B
The shares of Convertible Preferred Stock shall convert on a 1-for-1 basis into Common Stock upon the closing of the Issuer's initial public offering.
This report is one of three reports each on a separate Form 4, but are related to the same transaction being filed by the reporting persons. Presidio Management Group VIII, LLC ("PMG VIII") is the general partner of US Venture Partners VIII, L.P. ("USVP VIII"), USVP Entrepreneur Partners VIII-A, L.P. ("EP VIII-A"), USVP Entrepreneur Partners VIII-B, L.P. ("EP VIII-B"), and USVP VIII Affiliates Fund, L.P. ("AFF VIII"), and Irwin Federman, Winston S. Fu, Steven M. Krausz, David E. Liddle, Jonathan D. Root, Christopher Rust, Casey M. Tansey, and Philip M. Young, the managing members of PMG VIII, may be deemed to share voting and dispositive power over the shares held by USVP VIII, EP VIII-A, EP VIII-B and AFF VIII. Such persons and entities disclaim beneficial ownership of shares held by USVP VIII, EP VIII-A, EP VIII-B and AFF VIII except to the extent of any pecuniary interest therein.
Not Applicable.
The Shares of Series B, Series C and Series D Convertible Preferred Stock have no expiration date.
Michael P. Maher - Attorney in Fact for the reporting person
2011-11-15