0001140361-12-046146.txt : 20121107 0001140361-12-046146.hdr.sgml : 20121107 20121107185851 ACCESSION NUMBER: 0001140361-12-046146 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20121105 FILED AS OF DATE: 20121107 DATE AS OF CHANGE: 20121107 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: GOUW RANZETTA THERESIA CENTRAL INDEX KEY: 0001219234 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35338 FILM NUMBER: 121188074 MAIL ADDRESS: STREET 1: 428 UNIVERSITY AVE CITY: PALO ALTO STATE: CA ZIP: 94301 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 doc1.xml FORM 4 X0306 4 2012-11-05 0 0001364962 IMPERVA INC IMPV 0001219234 GOUW RANZETTA THERESIA C/O IMPERVA, INC. 3400 BRIDGE PARKWAY, STE. 200 REDWOOD SHORES CA 94065 1 0 0 0 Common Stock 2012-11-05 4 J 0 1599607 0 D 0 I See footnote Common Stock 2012-11-05 4 J 0 314216 0 D 0 I See footnote Common Stock 2012-11-05 4 J 0 138534 0 D 0 I See footnote Common Stock 2012-11-05 4 J 0 34910 0 A 76468 I See footnote Represents a pro rata distribution for no consideration of all remaining shares previously held by Accel VIII L.P. to its general and limited partners. 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. The Reporting Person, a director of the Issuer, is one of the Managing Members of and shares voting and investment powers in such entities. The Reporting Person disclaims beneficial ownership of all shares held by the foregoing entities except to the extent of her pecuniary interest therein. Represents a pro rata distribution of all remaining shares previously held by Accel Internet Fund IV L.P. to its general and limited partners without consideration. A8A is the General Partner of Accel Internet Fund IV L.P. and has the sole voting and investment power with respect to such entity. The Reporting Person, a director of the Issuer, is one of the Managing Members of and shares voting and investment powers in such entity. The Reporting Person disclaims beneficial ownership of all shares held by the foregoing entities except to the extent of her pecuniary interest therein. Represents a pro rata distribution for no consideration of all remaining shares previously held by Accel Investors 2002 L.L.C. to its members. The Reporting Person, a director of the Issuer, is one of the Managing Members of and shares voting and investment powers in Accel Investors 2002 L.L.C. The Reporting Person disclaims beneficial ownership of all shares held by the foregoing entity except to the extent of her pecuniary interest therein. Pro rata distribution by Accel VIII L.P., Accel Investors 2002 L.L.C. and Accel Internet Fund IV L.P. without consideration. Shares are directly owned by the Brookline Living Trust, dated August 7, 2003. The Reporting Person is a Trustee of the Trust and shares voting and investment powers. The Reporting Person disclaims beneficial ownership except to the extent of her pecuniary interest therein. Tram Phi, as Attorney-in-Fact 2012-11-07