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