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UNITED STATES SECURITIES AND EXCHANGE COMMISSION Washington, D.C. 20549STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP OF SECURITIES Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940 |
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Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly. | |||
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 control number. | SEC 1474 (9-02) |
1. Title of Derivative Security (Instr. 3) |
2. Conversion or Exercise Price of Derivative Security | 3. Transaction Date (Month/Day/Year) | 3A. Deemed Execution Date, if any (Month/Day/Year) | 4. Transaction Code (Instr. 8) |
5. Number of Derivative Securities Acquired (A) or Disposed of (D) (Instr. 3, 4, and 5) |
6. Date Exercisable and Expiration Date (Month/Day/Year) |
7. Title and Amount of Underlying Securities (Instr. 3 and 4) |
8. Price of Derivative Security (Instr. 5) |
9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s) (Instr. 4) |
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I) (Instr. 4) |
11. Nature of Indirect Beneficial Ownership (Instr. 4) |
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Code | V | (A) | (D) | Date Exercisable | Expiration Date | Title | Amount or Number of Shares |
Reporting Owner Name / Address | Relationships | |||
Director | 10% Owner | Officer | Other | |
GOUW RANZETTA THERESIA C/O IMPERVA, INC. 3400 BRIDGE PARKWAY, STE. 200 REDWOOD SHORES, CA 94065 |
X |
Tram Phi, as Attorney-in-Fact | 11/07/2012 | |
**Signature of Reporting Person | Date |
* | If the form is filed by more than one reporting person, see Instruction 4(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). |
(1) | Represents a pro rata distribution for no consideration of all remaining shares previously held by Accel VIII L.P. to its general and limited partners. |
(2) | Accel VIII Associates L.L.C.("A8A") is the General Partner of Accel VIII L.P. and has the sole voting and investment power with respect to the shares. The Reporting Person, a director of the Issuer, is one of the Managing Members of and shares voting and investment powers in such entities. The Reporting Person disclaims beneficial ownership of all shares held by the foregoing entities except to the extent of her pecuniary interest therein. |
(3) | Represents a pro rata distribution of all remaining shares previously held by Accel Internet Fund IV L.P. to its general and limited partners without consideration. |
(4) | A8A is the General Partner of Accel Internet Fund IV L.P. and has the sole voting and investment power with respect to such entity. The Reporting Person, a director of the Issuer, is one of the Managing Members of and shares voting and investment powers in such entity. The Reporting Person disclaims beneficial ownership of all shares held by the foregoing entities except to the extent of her pecuniary interest therein. |
(5) | Represents a pro rata distribution for no consideration of all remaining shares previously held by Accel Investors 2002 L.L.C. to its members. |
(6) | The Reporting Person, a director of the Issuer, is one of the Managing Members of and shares voting and investment powers in Accel Investors 2002 L.L.C. The Reporting Person disclaims beneficial ownership of all shares held by the foregoing entity except to the extent of her pecuniary interest therein. |
(7) | Pro rata distribution by Accel VIII L.P., Accel Investors 2002 L.L.C. and Accel Internet Fund IV L.P. without consideration. |
(8) | Shares are directly owned by the Brookline Living Trust, dated August 7, 2003. The Reporting Person is a Trustee of the Trust and shares voting and investment powers. The Reporting Person disclaims beneficial ownership except to the extent of her pecuniary interest therein. |