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