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