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