0001209191-12-031451.txt : 20120531 0001209191-12-031451.hdr.sgml : 20120531 20120531192318 ACCESSION NUMBER: 0001209191-12-031451 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20120530 FILED AS OF DATE: 20120531 DATE AS OF CHANGE: 20120531 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: 12881552 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 doc4.xml FORM 4 SUBMISSION X0305 4 2012-05-30 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 2012-05-30 4 J 0 19023 0.00 A 126023 D Common Stock 2012-05-30 4 J 0 749 0.00 A 749 I See footnote Common Stock 639040 I See footnote Common Stock 71003 I See footnote Common Stock 37370 I See footnote Entities affiliated with Greylock Partners made a pro rata distribution for no consideration of an aggregate of 749,000 shares of common stock of the issuer to its partners on May 30, 2012. Aggregate of pro rata distributions from Greylock XII GP Limited Liability Company, of which the Reporting Person is a Managing Member. Pro rata distribution from Greylock XII Principals LLC, of which the Reporting Person is a member. These shares are held by Asheem Chandna and Aarti Chandna, as Trustees of the Chandna Family Revocable Trust of April 13, 1998. Aarti Chandna has voting and investment control with respect to the shares held by the trust. These are the number of securities held directly by Greylock XII Limited Partnership following the pro rata distribution for no consideration to its partners on May 30, 2012. 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. These are the number of securities held directly by Greylock XII-A Limited Partnership following the pro rata distribution for no consideration to its partners on May 30, 2012. 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. These are the number of securities held directly by Greylock XII Principals LLC following the pro rata distribution for no consideration to its members on May 30, 2012. 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, Attorney-in-Fact 2012-05-31