Investor Relations - SEC Filing

SEC FORM 4 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^*

TRIDENT CAPITAL MANAGEMENT V LLC

(Last)

(First)

(Middle)

505 HAMILTON AVENUE, SUITE 200

(Street)

PALO ALTO

94301

(City)

(State)

(Zip)

2. Issuer Name and Ticker or Trading Symbol
QUALYS, INC. [ QLYS ]

5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)

Director	X	10% Owner
Officer (give title below)		Other (specify below)

3. Date of Earliest Transaction (Month/Day/Year)
10/03/2012

4. 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 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)
1. Title of Security (Instr. 3)	2. Transaction Date (Month/Day/Year)	2A. Deemed Execution Date, if any (Month/Day/Year)	Code	V	Amount	(A) or (D)	Price		6. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)	7. Nature of Indirect Beneficial Ownership (Instr. 4)
Common Stock	10/03/2012		C		5,360,320	A	⁽¹⁾	5,639,301	I	See footnotes⁽²⁾⁽⁷⁾
Common Stock	10/03/2012		C		407,238	A	⁽¹⁾	428,430	I	See footnotes⁽³⁾⁽⁷⁾
Common Stock	10/03/2012		C		148,783	A	⁽¹⁾	156,856	I	See footnotes⁽⁴⁾⁽⁷⁾
Common Stock	10/03/2012		C		31,150	A	⁽¹⁾	32,770	I	See footnotes⁽⁵⁾⁽⁷⁾
Common Stock	10/03/2012		C		29,724	A	⁽¹⁾	31,269	I	See footnotes⁽⁶⁾⁽⁷⁾

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)
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)	Code	V	(A)	(D)	Date Exercisable	Expiration Date	Title	Amount or Number of Shares	8. Price of Derivative Security (Instr. 5)		10. Ownership Form: Direct (D) or Indirect (I) (Instr. 4)	11. Nature of Indirect Beneficial Ownership (Instr. 4)
Series A Preferred Stock	⁽¹⁾	10/03/2012		C			1,346,877	⁽¹⁾	⁽¹⁾	Common Stock	1,346,877	$0	0	I	See footnotes⁽²⁾⁽⁷⁾
Series A Preferred Stock	⁽¹⁾	10/03/2012		C			102,325	⁽¹⁾	⁽¹⁾	Common Stock	102,325	$0	0	I	See footnotes⁽³⁾⁽⁷⁾
Series A Preferred Stock	⁽¹⁾	10/03/2012		C			32,622	⁽¹⁾	⁽¹⁾	Common Stock	32,622	$0	0	I	See footnotes⁽⁴⁾⁽⁷⁾
Series A Preferred Stock	⁽¹⁾	10/03/2012		C			7,826	⁽¹⁾	⁽¹⁾	Common Stock	7,826	$0	0	I	See footnotes⁽⁵⁾⁽⁷⁾
Series A Preferred Stock	⁽¹⁾	10/03/2012		C			7,468	⁽¹⁾	⁽¹⁾	Common Stock	7,468	$0	0	I	See footnotes⁽⁶⁾⁽⁷⁾
Series B Preferred Stock	⁽¹⁾	10/03/2012		C			3,743,844	⁽¹⁾	⁽¹⁾	Common Stock	3,743,844	$0	0	I	See footnotes⁽²⁾⁽⁷⁾
Series B Preferred Stock	⁽¹⁾	10/03/2012		C			284,432	⁽¹⁾	⁽¹⁾	Common Stock	284,432	$0	0	I	See footnotes⁽³⁾⁽⁷⁾
Series B Preferred Stock	⁽¹⁾	10/03/2012		C			108,359	⁽¹⁾	⁽¹⁾	Common Stock	108,359	$0	0	I	See footnotes⁽⁴⁾⁽⁷⁾
Series B Preferred Stock	⁽¹⁾	10/03/2012		C			21,758	⁽¹⁾	⁽¹⁾	Common Stock	21,758	$0	0	I	See footnotes⁽⁵⁾⁽⁷⁾
Series B Preferred Stock	⁽¹⁾	10/03/2012		C			20,762	⁽¹⁾	⁽¹⁾	Common Stock	20,762	$0	0	I	See footnotes⁽⁶⁾⁽⁷⁾
Series C Preferred Stock	⁽¹⁾	10/03/2012		C			269,599	⁽¹⁾	⁽¹⁾	Common Stock	269,599	$0	0	I	See footnotes⁽²⁾⁽⁷⁾
Series C Preferred Stock	⁽¹⁾	10/03/2012		C			20,481	⁽¹⁾	⁽¹⁾	Common Stock	20,481	$0	0	I	See footnotes⁽³⁾⁽⁷⁾
Series C Preferred Stock	⁽¹⁾	10/03/2012		C			7,802	⁽¹⁾	⁽¹⁾	Common Stock	7,802	$0	0	I	See footnotes⁽⁴⁾⁽⁷⁾
Series C Preferred Stock	⁽¹⁾	10/03/2012		C			1,566	⁽¹⁾	⁽¹⁾	Common Stock	1,566	$0	0	I	See footnotes⁽⁵⁾⁽⁷⁾
Series C Preferred Stock	⁽¹⁾	10/03/2012		C			1,494	⁽¹⁾	⁽¹⁾	Common Stock	1,494	$0	0	I	See footnotes⁽⁶⁾⁽⁷⁾

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)

Explanation of Responses:

1. Each share of Series A Preferred Stock, Series B Preferred Stock and Series C Preferred Stock automatically converted into Common Stock on a 1-for-1 basis upon the completion of the Issuer's initial public offering of Common Stock and had no expiration date.

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. 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.

	/s/ Donald R. Dixon, a Managing Director of Trident Capital Management-V, L.L.C.	10/03/2012
	/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.	10/03/2012
	/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.	10/03/2012
	/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.	10/03/2012
	/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.	10/03/2012
	** 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 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).
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