SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
OMB APPROVAL
OMB Number: 3235-0104
Estimated average burden
hours per response: 0.5
1. Name and Address of Reporting Person*
Ting David

(Last) (First) (Middle)
C/O IMPRIVATA, INC.
10 MAGUIRE ROAD, BUILDING 1, SUITE 125

(Street)
LEXINGTON MA 02421

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
06/24/2014
3. Issuer Name and Ticker or Trading Symbol
Imprivata Inc [ IMPR ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
X Officer (give title below) Other (specify below)
Chief Technology Officer
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Common Stock 313,104 D
Common Stock 166,666 I By Trust(1)
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Stock Option (Right to Buy) (2) 05/03/2016 Common Stock 13,333 $0.57 D
Stock Option (Right to Buy) (2) 02/12/2018 Common Stock 53,333 $1.4 D
Stock Option (Right to Buy) (3) 09/29/2021 Common Stock 220,234 $1.92 D
Stock Option (Right to Buy) (4) 11/05/2023 Common Stock 16,666 $7.98 D
Explanation of Responses:
1. Held directly by The David M. T. Ting 2013 Grantor Retained Annuity Trust, Under Instrument Dated December 24, 2013, and indirectly by the Reporting Person as trustee of the trust.
2. The stock option is fully vested and exercisable.
3. The stock option was immediately exercisable as of the date of grant, and early-exercised option shares are subject to a repurchase right in favor of the Issuer. The stock option vests over a four-year period at the rate of 25% of the option on September 30, 2012 and an additional 2.0833% for each month of the Reporting Person's continuous service to the company thereafter for 36 additional months.
4. The stock option was immediately exercisable as of the date of grant, and early-exercised option shares are subject to a repurchase right in favor of the Issuer. The stock option vests over a four-year period at the rate of 2.0833% for each month of the Reporting Person's continuous service to the Issuer after November 6, 2013.
Remarks:
/s/ John Milton, Attorney-in-Fact 06/24/2014
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* If the form is filed by more than one reporting person, see Instruction 5 (b)(v).
** Intentional misstatements or omissions of facts constitute Federal Criminal Violations See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.