1. Name and Address of Reporting Person*
C/O VERITAS CAPITAL FUND MANAGEMENT, LLC |
9 WEST 57TH STREET, 29TH FLOOR |
(Street)
|
2. Issuer Name and Ticker or Trading Symbol
Cotiviti Holdings, Inc.
[ COTV ]
|
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) 08/27/2018
|
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 |
|
1. Name and Address of Reporting Person*
C/O VERITAS CAPITAL FUND MANAGEMENT, LLC |
9 WEST 57TH STREET, 29TH FLOOR |
(Street)
Relationship of Reporting Person(s) to Issuer
|
Director |
X |
10% Owner |
|
Officer (give title below) |
|
Other (specify below) |
|
|
|
|
|
1. Name and Address of Reporting Person*
C/O VERSCEND TECHNOLOGIES, INC. |
201 JONES ROAD, 4TH FLOOR |
(Street)
Relationship of Reporting Person(s) to Issuer
|
Director |
|
10% Owner |
|
Officer (give title below) |
X |
Other (specify below) |
|
|
|
See Remarks |
|
1. Name and Address of Reporting Person*
C/O VERSCEND TECHNOLOGIES, INC. |
201 JONES ROAD, 4TH FLOOR |
(Street)
Relationship of Reporting Person(s) to Issuer
|
Director |
|
10% Owner |
|
Officer (give title below) |
X |
Other (specify below) |
|
|
|
See Remarks |
|
1. Name and Address of Reporting Person*
C/O VERSCEND TECHNOLOGIES, INC. |
201 JONES ROAD, 4TH FLOOR |
(Street)
Relationship of Reporting Person(s) to Issuer
|
Director |
|
10% Owner |
|
Officer (give title below) |
X |
Other (specify below) |
|
|
|
See Remarks |
|
1. Name and Address of Reporting Person*
C/O VERSCEND TECHNOLOGIES, INC. |
201 JONES ROAD, 4TH FLOOR |
(Street)
Relationship of Reporting Person(s) to Issuer
|
Director |
|
10% Owner |
|
Officer (give title below) |
X |
Other (specify below) |
|
|
|
See Remarks |
|
1. Name and Address of Reporting Person*
C/O VERITAS CAPITAL FUND MANAGEMENT, LLC |
9 WEST 57TH STREET, 29TH FLOOR |
(Street)
Relationship of Reporting Person(s) to Issuer
|
Director |
|
10% Owner |
|
Officer (give title below) |
X |
Other (specify below) |
|
|
|
See Remarks |
|
1. Name and Address of Reporting Person*
C/O VERITAS CAPITAL FUND MANAGEMENT, LLC |
9 WEST 57TH STREET, 29TH FLOOR |
(Street)
Relationship of Reporting Person(s) to Issuer
|
Director |
|
10% Owner |
|
Officer (give title below) |
X |
Other (specify below) |
|
|
|
See Remarks |
|
1. Name and Address of Reporting Person*
C/O VERITAS CAPITAL FUND MANAGEMENT, LLC |
9 WEST 57TH STREET, 29TH FLOOR |
(Street)
Relationship of Reporting Person(s) to Issuer
|
Director |
|
10% Owner |
|
Officer (give title below) |
X |
Other (specify below) |
|
|
|
See Remarks |
|
|
/s/ Ramzi M. Musallam |
08/29/2018 |
|
/s/ Emad Rizk, Chief Executive Officer and President of Verscend Technologies, Inc. |
08/29/2018 |
|
/s/ Emad Rizk, Chief Executive Officer and President of Verscend Holding Corp. |
08/29/2018 |
|
/s/ Emad Rizk, Chief Executive Officer and President of Verscend Holding II Corp. |
08/29/2018 |
|
/s/ Emad Rizk, Chief Executive Officer and President of Verscend Intermediate Holding Corp. |
08/29/2018 |
|
/s/ Ramzi M. Musallam, Chief Executive Officer and Managing Partner of Veritas Capital Fund Management, L.L.C., the non-member manager of Verscend Holdings LLC |
08/29/2018 |
|
/s/ Ramzi M. Musallam, Managing Partner of Veritas Capital Partners V, L.L.C., the general partner of The Veritas Capital Fund V, L.P. |
08/29/2018 |
|
/s/ Ramzi M. Musallam, Managing Partner of Veritas Capital Partners V, L.L.C. |
08/29/2018 |
|
** 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. |