0000899243-16-019283.txt : 20160505 0000899243-16-019283.hdr.sgml : 20160505 20160505160541 ACCESSION NUMBER: 0000899243-16-019283 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20160504 FILED AS OF DATE: 20160505 DATE AS OF CHANGE: 20160505 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: QUALYS, INC. CENTRAL INDEX KEY: 0001107843 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-PREPACKAGED SOFTWARE [7372] IRS NUMBER: 770534145 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 1600 BRIDGE PARKWAY CITY: REDWOOD SHORES STATE: CA ZIP: 94065 BUSINESS PHONE: 650-801-6100 MAIL ADDRESS: STREET 1: 1600 BRIDGE PARKWAY CITY: REDWOOD SHORES STATE: CA ZIP: 94065 FORMER COMPANY: FORMER CONFORMED NAME: QUALYS INC DATE OF NAME CHANGE: 20000225 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: DIXON DONALD R CENTRAL INDEX KEY: 0001045434 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-35662 FILM NUMBER: 161623653 MAIL ADDRESS: STREET 1: 2480 SAND HILL RD STREET 2: STE 201 CITY: MENLO PARK STATE: CA ZIP: 94025 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2016-05-04 0 0001107843 QUALYS, INC. QLYS 0001045434 DIXON DONALD R 505 HAMILTON AVENUE, SUITE 200 PALO ALTO CA 94301 1 0 0 0 Common Stock 2016-05-04 4 J 0 1409826 0.00 D 0 I See footnote Common Stock 2016-05-04 4 J 0 107106 0.00 D 0 I See footnote Common Stock 2016-05-04 4 J 0 39214 0.00 D 0 I See footnote Common Stock 2016-05-04 4 J 0 8191 0.00 D 0 I See footnote Common Stock 2016-05-04 4 J 0 7818 0.00 D 0 I See footnote Common Stock 2016-05-04 4 J 0 49213 0.00 A 193391 D Common Stock 2016-05-04 4 J 0 42242 0.00 A 165074 I See footnote Common Stock 2016-05-04 4 J 0 320 0.00 A 1283 I See footnote Represents an in-kind distribution to the partners of the applicable partnership in accordance with the partners' relative economic interests in such partnership and includes subsequent distributions by general partners or managing members to their respective partners or members. The shares are held directly by Trident Capital Fund-V, L.P. 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 Principals Fund, L.P., Trident Capital Fund-V Affiliates Fund, L.P., and Trident Capital Fund-V Affiliates Fund (Q), L.P., and as 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. Additionally, Donald R. Dixon, as a member of TCMV, may be deemed to share beneficial ownership in securities beneficially owned by TCMV. TCMV and Mr. Dixon each disclaim beneficial ownership of these securities except to the extent of their respective 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. The shares are held directly by Trident Capital Parallel Fund-V, C.V. The shares are held directly by Trident Capital Fund-V Principals Fund, L.P. The shares are held directly by Trident Capital Fund-V Affiliates Fund, L.P. The shares are held directly by Trident Capital Fund-V Affiliates Fund (Q), L.P. Represents the receipt of shares by virtue of the distributions described in footnotes (2), (4) and (5) above as follows: (i) 34,905 shares from Trident Capital Fund-V, L.P., (ii) 2,646 shares from Trident Capital Parallel Fund-V, C.V., and (iii) 11,662 shares from Trident Capital Fund-V Principals Fund, L.P. The acquisition of such shares was exempt under Rule 16a-9 and Rule 16a-13. Represents the receipt of shares by virtue of the distributions described in footnotes (2) and (4) above as follows: 39,266 shares from Trident Capital Fund-V, L.P., and (ii) 2,976 shares from Trident Capital Parallel Fund-V, C.V. The acquisition of such shares was exempt under Rule 16a-9 and Rule 16a-13. The shares are held directly by Donald and Elizabeth Dixon Family Limited Partnership, for which the Reporting Person and his spouse serve as general partners. Represents the receipt of shares by virtue of the distribution described in footnote (6) above. The acquisition of such shares was exempt under Rule 16a-9 and Rule 16a-13. The shares are held directly by Dixon Family Trust U/A Dated 6/18/88, for which the Reporting Person and his spouse serve as settlors. /s/ Donald R. Dixon 2016-05-05