0001209191-11-056005.txt : 20111115
0001209191-11-056005.hdr.sgml : 20111115
20111115120222
ACCESSION NUMBER: 0001209191-11-056005
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: GOUW RANZETTA THERESIA
CENTRAL INDEX KEY: 0001219234
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-35338
FILM NUMBER: 111206237
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
c24147_4x0.xml
MAIN DOCUMENT DESCRIPTION
X0304
4
2011-11-15
0001364962
IMPERVA INC
IMPV
0001219234
GOUW RANZETTA THERESIA
C/O ACCEL PARTNERS
428 UNIVERSITY AVENUE
PALO ALTO
CA
94301
1
0
1
0
Common Stock
2011-11-15
4
C
0
1558800
A
1788941
I
See footnote
Common Stock
2011-11-15
4
C
0
907091
A
2696032
I
See footnote
Common Stock
2011-11-15
4
C
0
213884
A
2909916
I
See footnote
Common Stock
2011-11-15
4
C
0
289298
A
3199214
I
See footnote
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
I
See footnote
Series B Convertible Preferred Stock
2011-11-15
4
C
0
907091
D
Common Stock
907091
0
I
See footnote
Series C Convertible Preferred Stock
2011-11-15
4
C
0
213884
D
Common Stock
213884
0
I
See footnote
Series D Convertible Preferred Stock
2011-11-15
4
C
0
289298
D
Common Stock
289298
0
I
See footnote
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. The Reporting Person is one of the managing members of A8A and shares voting and investment powers. The Reporting Person disclaims beneficial ownership of all shares held by the foregoing entities except to the extent of her 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. The Reporting Person is one of the managing members of A8A and shares voting and investment powers in. The Reporting Person disclaims beneficial ownership of all shares held by the foregoing entities except to the extent of her pecuniary interest therein.
The securities are held by Accel Investors 2002 L.L.C. ("AI2002"). The Reporting Person is one of the Managing Members of AI2002 and shares voting and investment powers. The Reporting Person disclaims beneficial ownership of all shares held by the foregoing entities except to the extent of her pecuniary interest therein.
/s/ Tram Phi, by power of attorney
2011-11-15