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