0001181431-11-055527.txt : 20111109 0001181431-11-055527.hdr.sgml : 20111109 20111109132123 ACCESSION NUMBER: 0001181431-11-055527 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20111109 FILED AS OF DATE: 20111109 DATE AS OF CHANGE: 20111109 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Chandna Asheem CENTRAL INDEX KEY: 0001392138 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35338 FILM NUMBER: 111190716 MAIL ADDRESS: STREET 1: 3400 BRIDGE PARKWAY, SUITE 200 CITY: REDWOOD SHORES STATE: CA ZIP: 94065 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 rrd325162.xml FORM 4 X0304 4 2011-11-09 0 0001364962 IMPERVA INC IMPV 0001392138 Chandna Asheem C/O GREYLOCK PARTNERS 2550 SAND HILL ROAD MENLO PARK CA 94025 1 0 0 0 Common Stock 107000 D Common Stock 2011-11-09 4 P 0 92568 18.00 A 92568 I See footnote Common Stock 2011-11-09 4 P 0 10285 18.00 A 10285 I See footnote Common Stock 2011-11-09 4 P 0 5413 18.00 A 5413 I See footnote The securities are held directly by Greylock XII Limited Partnership. Greylock XII GP Limited Liability Company is the sole General Partner of Greylock XII Limited Partnership and Greylock XII-A Limited Partnership. Mr. Chandna is a Managing Member of Greylock XII GP Limited Liability Company and a member of Greylock XII Principals LLC and exercises shared voting and investment power over the shares held of record by Greylock XII Limited Partnership, Greylock XII-A Limited Partnership and Greylock XII Principals LLC. Mr. Chandna, a director of the Issuer, disclaims beneficial ownership of such shares, except to the extent of his pecuniary interest therein. The securities are held directly by Greylock XII-A Limited Partnership. Greylock XII GP Limited Liability Company is the sole General Partner of Greylock XII Limited Partnership and Greylock XII-A Limited Partnership. Mr. Chandna is a Managing Member of Greylock XII GP Limited Liability Company and a member of Greylock XII Principals LLC and exercises shared voting and investment power over the shares held of record by Greylock XII Limited Partnership, Greylock XII-A Limited Partnership and Greylock XII Principals LLC. Mr. Chandna, a director of the Issuer, disclaims beneficial ownership of such shares, except to the extent of his pecuniary interest therein. The securities are held directly by Greylock XII Principals LLC. Greylock XII GP Limited Liability Company is the sole General Partner of Greylock XII Limited Partnership and Greylock XII-A Limited Partnership. Mr. Chandna is a Managing Member of Greylock XII GP Limited Liability Company and a member of Greylock XII Principals LLC and exercises shared voting and investment power over the shares held of record by Greylock XII Limited Partnership, Greylock XII-A Limited Partnership and Greylock XII Principals LLC. Mr. Chandna, a director of the Issuer, disclaims beneficial ownership of such shares, except to the extent of his pecuniary interest therein. /s/ Tram Phi, by power of attorney 2011-11-09