SEC Form 4
FORM 4 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP

Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934
or Section 30(h) of the Investment Company Act of 1940
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
TESSLER ALLAN R

(Last) (First) (Middle)
C/O INTERNATIONAL FINANCIAL GROUP
2500 MOOSE-WILSON ROAD

(Street)
WILSON WY 83014

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
IMPERVA INC [ IMPV ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
12/18/2018
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1. Title of Security (Instr. 3) 2. Transaction Date (Month/Day/Year) 2A. Deemed Execution Date, if any (Month/Day/Year) 3. Transaction Code (Instr. 8) 4. Securities Acquired (A) or Disposed Of (D) (Instr. 3, 4 and 5) 5. Amount of Securities Beneficially Owned Following Reported Transaction(s) (Instr. 3 and 4) 6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4) 7. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V Amount (A) or (D) Price
Common Stock 12/18/2018 G(1) 897(1) D $0.00(2) 34,103 I See Footnote(3)
Common Stock 12/18/2018 G(4) 449(4) D $0.00(2) 33,654 I See Footnote(5)
Common Stock 12/19/2018 G(6) 1,794(6) D $0.00(2) 31,860 I See Footnote(7)
Common Stock 13,557 D
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
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 Securities Underlying Derivative Security (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: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Explanation of Responses:
1. Bona fide gift by the Reporting Person of 897 shares to the Trust for Public Land.
2. Price is not applicable to acquisitions or dispositions resulting from a bona fide gift.
3. The shares are owned of record as follows: (A) 2,353 shares are held by International Financial GP of Nevada, of which the Reporting Person is the sole owner and Chair/CEO; (B) 7,500 shares are held by the Allan R. Tessler Charitable Remainder Unitrust #1 u/a/d 121696, of which the Reporting Person is the sole trustee; (C) 7,500 Shares are held by the Allan R. Tessler Charitable Remainder Unitrust #2 u/a/d 121696, of which the Reporting Person is the sole trustee; (D) 6,750 shares are held by Tessler Family Limited of which the Reporting Person is a limited partner; and (E) 10,000 shares are held by the ART FGT Family Partners Limited, of which the Reporting Person is a limited partner.
4. Bona fide gift by the Reporting Person of 449 shares to the Hudson Institue.
5. The shares are owned of record as follows: (A) 1,904 shares are held by International Financial GP of Nevada, of which the Reporting Person is the sole owner and Chair/CEO; (B) 7,500 shares are held by the Allan R. Tessler Charitable Remainder Unitrust #1 u/a/d 121696, of which the Reporting Person is the sole trustee; (C) 7,500 Shares are held by the Allan R. Tessler Charitable Remainder Unitrust #2 u/a/d 121696, of which the Reporting Person is the sole trustee; (D) 6,750 shares are held by Tessler Family Limited of which the Reporting Person is a limited partner; and (E) 10,000 shares are held by the ART FGT Family Partners Limited, of which the Reporting Person is a limited partner.
6. Bona fide gift by the Reporting Person of 1,794 shares to the Grand Teton Music Festival.
7. The shares are owned of record as follows: (A) 110 shares are held by International Financial GP of Nevada, of which the Reporting Person is the sole owner and Chair/CEO; (B) 7,500 shares are held by the Allan R. Tessler Charitable Remainder Unitrust #1 u/a/d 121696, of which the Reporting Person is the sole trustee; (C) 7,500 Shares are held by the Allan R. Tessler Charitable Remainder Unitrust #2 u/a/d 121696, of which the Reporting Person is the sole trustee; (D) 6,750 shares are held by Tessler Family Limited of which the Reporting Person is a limited partner; and (E) 10,000 shares are held by the ART FGT Family Partners Limited, of which the Reporting Person is a limited partner.
Remarks:
/s/ Shulamite White, Attorney-in-Fact 12/20/2018
** Signature of Reporting Person Date
Reminder: Report on a separate line for each class of securities beneficially owned directly or indirectly.
* 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).
Note: File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure.
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 Number.