SEC FORM 3 SEC Form 3
FORM 3 UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549

INITIAL STATEMENT OF BENEFICIAL OWNERSHIP OF SECURITIES

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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1. Name and Address of Reporting Person*
AOS Partners, LP

(Last) (First) (Middle)
2121 AVENUE OF THE STARS, SUITE 1630

(Street)
LOS ANGELES CA 90067

(City) (State) (Zip)
2. Date of Event Requiring Statement (Month/Day/Year)
09/27/2012
3. Issuer Name and Ticker or Trading Symbol
QUALYS, INC. [ QLYS ]
4. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
Director X 10% Owner
Officer (give title below) Other (specify below)
5. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
Form filed by One Reporting Person
X Form filed by More than One Reporting Person
Table I - Non-Derivative Securities Beneficially Owned
1. Title of Security (Instr. 4) 2. Amount of Securities Beneficially Owned (Instr. 4) 3. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 4. Nature of Indirect Beneficial Ownership (Instr. 5)
Table II - Derivative Securities Beneficially Owned
(e.g., puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security (Instr. 4) 2. Date Exercisable and Expiration Date (Month/Day/Year) 3. Title and Amount of Securities Underlying Derivative Security (Instr. 4) 4. Conversion or Exercise Price of Derivative Security 5. Ownership Form: Direct (D) or Indirect (I) (Instr. 5) 6. Nature of Indirect Beneficial Ownership (Instr. 5)
Date Exercisable Expiration Date Title Amount or Number of Shares
Series B Preferred Stock (1) (1) Common Stock 1,016,185 (1) D
Series B Preferred Stock (1) (1) Common Stock 353,045 (1) I By GRPVC, L.P.
Series B Preferred Stock (1) (1) Common Stock 123,076 (1) I By GRP II Investors, L.P.
Series B Preferred Stock (1) (1) Common Stock 46,153 (1) I By GRP II Partners, L.P.
Series C Preferred Stock (1) (1) Common Stock 641,538 (1) D
Series C Preferred Stock (1) (1) Common Stock 222,884 (1) I By GRPVC, L.P.
Series C Preferred Stock (1) (1) Common Stock 77,700 (1) I By GRP II Investors, L.P.
Series C Preferred Stock (1) (1) Common Stock 29,136 (1) I By GRP II Partners, L.P.
1. Name and Address of Reporting Person*
AOS Partners, LP

(Last) (First) (Middle)
2121 AVENUE OF THE STARS, SUITE 1630

(Street)
LOS ANGELES CA 90067

(City) (State) (Zip)
1. Name and Address of Reporting Person*
GRPVC, L.P.

(Last) (First) (Middle)
2121 AVENUE OF THE STARS, SUITE 1630

(Street)
LOS ANGELES CA 90067

(City) (State) (Zip)
1. Name and Address of Reporting Person*
GRP II Investors, L.P.

(Last) (First) (Middle)
2121 AVENUE OF THE STARS, SUITE 1630

(Street)
LOS ANGELES CA 90067

(City) (State) (Zip)
1. Name and Address of Reporting Person*
GRP II Partners, L.P.

(Last) (First) (Middle)
2121 AVENUE OF THE STARS, SUITE 1630

(Street)
LOS ANGELES CA 90067

(City) (State) (Zip)
Explanation of Responses:
1. Each share of Series B Preferred Stock and Series C Preferred Stock shall automatically convert into Common Stock on a 1-for-1 basis upon the completion of the Issuer's initial public offering of Common Stock and has no expiration date.
/s/ Dana Kibler, for Hique, Inc., the General Partner of AOS Partners, L.P. 09/27/2012
/s/ Dana Kibler, for GRP Management Services Corp., the General Partner of GRPVC, L.P. 09/27/2012
/s/ Dana Kibler, for GRP Management Services Corp., the General Partner of GRP II Investors, L.P. 09/27/2012
/s/ Dana Kibler, for GRPVC, L.P., the General Partner of GRP II Partners, L.P. 09/27/2012
** 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 5 (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.
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