Investor Relations - SEC Filing

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

OMB APPROVAL

OMB Number:			3235-0104
Estimated average burden
hours per response:			0.5

1. Name and Address of Reporting Person^*

TRIDENT CAPITAL MANAGEMENT V LLC

(Last)

(First)

(Middle)

505 HAMILTON AVENUE, SUITE 200

(Street)

PALO ALTO

94301

(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)
Common Stock	278,981	I	See footnotes⁽¹⁾⁽²⁾
Common Stock	21,192	I	See footnotes⁽¹⁾⁽³⁾
Common Stock	8,073	I	See footnotes⁽¹⁾⁽⁴⁾
Common Stock	1,620	I	See footnotes⁽¹⁾⁽⁵⁾
Common Stock	1,545	I	See footnotes⁽¹⁾⁽⁶⁾

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)
1. Title of Derivative Security (Instr. 4)	Date Exercisable	Expiration Date	Title	Amount or Number of Shares	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)
Series A Preferred Stock	⁽⁷⁾	⁽⁷⁾	Common Stock	1,346,877	⁽⁷⁾	I	See footnotes⁽¹⁾⁽²⁾
Series A Preferred Stock	⁽⁷⁾	⁽⁷⁾	Common Stock	102,325	⁽⁷⁾	I	See footnotes⁽¹⁾⁽³⁾
Series A Preferred Stock	⁽⁷⁾	⁽⁷⁾	Common Stock	32,622	⁽⁷⁾	I	See footnotes⁽¹⁾⁽⁴⁾
Series A Preferred Stock	⁽⁷⁾	⁽⁷⁾	Common Stock	7,826	⁽⁷⁾	I	See footnotes⁽¹⁾⁽⁵⁾
Series A Preferred Stock	⁽⁷⁾	⁽⁷⁾	Common Stock	7,468	⁽⁷⁾	I	See footnotes⁽¹⁾⁽⁶⁾
Series B Preferred Stock	⁽⁷⁾	⁽⁷⁾	Common Stock	3,743,844	⁽⁷⁾	I	See footnotes⁽¹⁾⁽²⁾
Series B Preferred Stock	⁽⁷⁾	⁽⁷⁾	Common Stock	284,432	⁽⁷⁾	I	See footnotes⁽¹⁾⁽³⁾
Series B Preferred Stock	⁽⁷⁾	⁽⁷⁾	Common Stock	108,359	⁽⁷⁾	I	See footnotes⁽¹⁾⁽⁴⁾
Series B Preferred Stock	⁽⁷⁾	⁽⁷⁾	Common Stock	21,758	⁽⁷⁾	I	See footnotes⁽¹⁾⁽⁵⁾
Series B Preferred Stock	⁽⁷⁾	⁽⁷⁾	Common Stock	20,762	⁽⁷⁾	I	See footnotes⁽¹⁾⁽⁶⁾
Series C Preferred Stock	⁽⁷⁾	⁽⁷⁾	Common Stock	269,599	⁽⁷⁾	I	See footnotes⁽¹⁾⁽²⁾
Series C Preferred Stock	⁽⁷⁾	⁽⁷⁾	Common Stock	20,481	⁽⁷⁾	I	See footnotes⁽¹⁾⁽³⁾
Series C Preferred Stock	⁽⁷⁾	⁽⁷⁾	Common Stock	7,802	⁽⁷⁾	I	See footnotes⁽¹⁾⁽⁴⁾
Series C Preferred Stock	⁽⁷⁾	⁽⁷⁾	Common Stock	1,566	⁽⁷⁾	I	See footnotes⁽¹⁾⁽⁵⁾
Series C Preferred Stock	⁽⁷⁾	⁽⁷⁾	Common Stock	1,494	⁽⁷⁾	I	See footnotes⁽¹⁾⁽⁶⁾

1. Name and Address of Reporting Person^*

TRIDENT CAPITAL MANAGEMENT V LLC

(Last)

(First)

(Middle)

505 HAMILTON AVENUE, SUITE 200

(Street)

PALO ALTO

94301

(City)

(State)

(Zip)

1. Name and Address of Reporting Person^*

TRIDENT CAPITAL FUND V LP

(Last)

(First)

(Middle)

505 HAMILTON AVENUE, SUITE 200

(Street)

PALO ALTO

94301

(City)

(State)

(Zip)

1. Name and Address of Reporting Person^*

TRIDENT CAPITAL PARALLEL FUND V CV

(Last)

(First)

(Middle)

505 HAMILTON AVENUE, SUITE 200

(Street)

PALO ALTO

94301

(City)

(State)

(Zip)

1. Name and Address of Reporting Person^*

TRIDENT CAPITAL FUND V PRINCIPALS FUND L P

(Last)

(First)

(Middle)

505 HAMILTON AVENUE, SUITE 200

(Street)

PALO ALTO

94301

(City)

(State)

(Zip)

1. Name and Address of Reporting Person^*

TRIDENT CAPITAL FUND V AFFILIATES FUND LP

(Last)

(First)

(Middle)

505 HAMILTON AVENUE, SUITE 200

(Street)

PALO ALTO

94301

(City)

(State)

(Zip)

1. Name and Address of Reporting Person^*

TRIDENT CAPITAL FUND V AFFILIATES FUND Q LP

(Last)

(First)

(Middle)

505 HAMILTON AVENUE, SUITE 200

(Street)

PALO ALTO

94301

(City)

(State)

(Zip)

Explanation of Responses:

1. Trident Capital Management-V, L.L.C. ("TCMV") serves as the general partner of each of Trident Capital Fund-V, L.P., Trident Capital Fund-V Affiliates Fund, L.P., Trident Capital Fund-V Affiliates Fund (Q), L.P. and Trident Capital Fund-V Principals Fund, L.P. and the sole investment general partner of Trident Capital Parallel Fund-V, C.V. As such, TCMV may be deemed to be the beneficial owner of the shares held directly by each of these Trident entities. TCMV disclaims beneficial ownership of these securities except to the extent of its pecuniary interest therein, and the inclusion of these securities in this report shall not be deemed an admission of beneficial ownership of the reported securities for purposes of Section 16 or for any other purpose.

2. The reported securities are held directly by Trident Capital Fund-V, L.P.

3. The reported securities are held directly by Trident Capital Parallel Fund-V, C.V.

4. The reported securities are held directly by Trident Capital Fund-V Principals Fund, L.P.

5. The reported securities are held directly by Trident Capital Fund-V Affiliates Fund, L.P.

6. The reported securities are held directly by Trident Capital Fund-V Affiliates Fund (Q), L.P.

7. Each share of Series A Preferred Stock, 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/ Donald R. Dixon, a Managing Director of Trident Capital Management-V, L.L.C.	09/27/2012
	/s/ Donald R. Dixon, a Managing Director of Trident Capital Management-V, L.L.C., the General Partner of Trident Capital Fund-V, L.P.	09/27/2012
	/s/ Donald R. Dixon, a Managing Director of Trident Capital Management-V, L.L.C., the General Partner of Trident Capital Parallel Fund-V, C.V.	09/27/2012
	/s/ Donald R. Dixon, a Managing Director of Trident Capital Management-V, L.L.C., the General Partner of Trident Capital Fund-V Principals Fund, L.P.	09/27/2012
	/s/ Donald R. Dixon, a Managing Director of Trident Capital Management-V, L.L.C., the General Partner of Trident Capital Fund-V Affiliates Fund, L.P.	09/27/2012
	/s/ Donald R. Dixon, a Managing Director of Trident Capital Management-V, L.L.C., the General Partner of Trident Capital Fund-V Affiliates Fund (Q), 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.
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.