0001209191-17-020714.txt : 20170315 0001209191-17-020714.hdr.sgml : 20170315 20170315121024 ACCESSION NUMBER: 0001209191-17-020714 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20170313 FILED AS OF DATE: 20170315 DATE AS OF CHANGE: 20170315 ISSUER: COMPANY DATA: COMPANY CONFORMED NAME: Cotiviti Holdings, Inc. CENTRAL INDEX KEY: 0001657197 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-BUSINESS SERVICES, NEC [7389] IRS NUMBER: 460595918 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 BUSINESS ADDRESS: STREET 1: 115 PERIMETER CENTER PLACE STREET 2: SUITE 700 CITY: ATLANTA STATE: GA ZIP: 30346 BUSINESS PHONE: 770 379-2800 MAIL ADDRESS: STREET 1: 115 PERIMETER CENTER PLACE STREET 2: SUITE 700 CITY: ATLANTA STATE: GA ZIP: 30346 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: ADVENT INTERNATIONAL GPE VI-G LP CENTRAL INDEX KEY: 0001432552 STATE OF INCORPORATION: XX FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37787 FILM NUMBER: 17690397 BUSINESS ADDRESS: STREET 1: C/O ADVENT INTERNATIONAL CORP STREET 2: 75 STATE STREET CITY: BOSTON STATE: MA ZIP: 02109 BUSINESS PHONE: 617-951-9400 MAIL ADDRESS: STREET 1: C/O ADVENT INTERNATIONAL CORP STREET 2: 75 STATE STREET CITY: BOSTON STATE: MA ZIP: 02109 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: ADVENT INTERNATIONAL GPE VI-F LP CENTRAL INDEX KEY: 0001430922 STATE OF INCORPORATION: XX FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37787 FILM NUMBER: 17690398 BUSINESS ADDRESS: STREET 1: C/O ADVENT INTERNATIONAL CORP STREET 2: 75 STATE STREET CITY: BOSTON STATE: MA ZIP: 02109 BUSINESS PHONE: 617 951-9400 MAIL ADDRESS: STREET 1: C/O ADVENT INTERNATIONAL CORP STREET 2: 75 STATE STREET CITY: BOSTON STATE: MA ZIP: 02109 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: ADVENT INTERNATIONAL GPE VI-C LP CENTRAL INDEX KEY: 0001430925 STATE OF INCORPORATION: DE FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37787 FILM NUMBER: 17690401 BUSINESS ADDRESS: STREET 1: C/O ADVENT INTERNATIONAL CORP STREET 2: 75 STATE STREET CITY: BOSTON STATE: MA ZIP: 02109 BUSINESS PHONE: 617 951-9400 MAIL ADDRESS: STREET 1: C/O ADVENT INTERNATIONAL CORP STREET 2: 75 STATE STREET CITY: BOSTON STATE: MA ZIP: 02109 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: ADVENT INTERNATIONAL GPE VI-B LP CENTRAL INDEX KEY: 0001430926 STATE OF INCORPORATION: XX FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37787 FILM NUMBER: 17690402 BUSINESS ADDRESS: STREET 1: C/O ADVENT INTERNATIONAL CORP STREET 2: 75 STATE STREET CITY: BOSTON STATE: MA ZIP: 02109 BUSINESS PHONE: 617 951-9400 MAIL ADDRESS: STREET 1: C/O ADVENT INTERNATIONAL CORP STREET 2: 75 STATE STREET CITY: BOSTON STATE: MA ZIP: 02109 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: ADVENT INTERNATIONAL LLC CENTRAL INDEX KEY: 0001227759 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37787 FILM NUMBER: 17690405 BUSINESS ADDRESS: STREET 1: 75 STATE STREET CITY: BOSTON STATE: MA ZIP: 02109 BUSINESS PHONE: 6179519400 MAIL ADDRESS: STREET 1: C/O ADVENT INTERNATIONAL CORPORATION STREET 2: 75 STATE STREET, 29TH FLOOR CITY: BOSTON STATE: MA ZIP: 02109 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: ADVENT INTERNATIONAL CORP/MA CENTRAL INDEX KEY: 0001034196 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37787 FILM NUMBER: 17690406 BUSINESS ADDRESS: STREET 1: 75 STATE STREET CITY: BOSTON STATE: MA ZIP: 02109 BUSINESS PHONE: 6179510555 MAIL ADDRESS: STREET 1: 75 STATE STREET CITY: BOSTON STATE: MA ZIP: 02109 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: ADVENT INTERNATIONAL GPE VI-E LP CENTRAL INDEX KEY: 0001430921 STATE OF INCORPORATION: DE FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37787 FILM NUMBER: 17690399 BUSINESS ADDRESS: STREET 1: C/O ADVENT INTERNATIONAL CORP STREET 2: 75 STATE STREET CITY: BOSTON STATE: MA ZIP: 02109 BUSINESS PHONE: 617 951-9400 MAIL ADDRESS: STREET 1: C/O ADVENT INTERNATIONAL CORP STREET 2: 75 STATE STREET CITY: BOSTON STATE: MA ZIP: 02109 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: ADVENT INTERNATIONAL GPE VI-A LP CENTRAL INDEX KEY: 0001430920 STATE OF INCORPORATION: XX FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37787 FILM NUMBER: 17690403 BUSINESS ADDRESS: STREET 1: C/O ADVENT INTERNATIONAL CORP STREET 2: 75 STATE STREET CITY: BOSTON STATE: MA ZIP: 02109 BUSINESS PHONE: 617 951-9400 MAIL ADDRESS: STREET 1: C/O ADVENT INTERNATIONAL CORP STREET 2: 75 STATE STREET CITY: BOSTON STATE: MA ZIP: 02109 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: ADVENT INTERNATIONAL GPE VI-D LP CENTRAL INDEX KEY: 0001430923 STATE OF INCORPORATION: DE FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37787 FILM NUMBER: 17690400 BUSINESS ADDRESS: STREET 1: C/O ADVENT INTERNATIONAL CORP STREET 2: 75 STATE STREET CITY: BOSTON STATE: MA ZIP: 02109 BUSINESS PHONE: 617 951-9400 MAIL ADDRESS: STREET 1: C/O ADVENT INTERNATIONAL CORP STREET 2: 75 STATE STREET CITY: BOSTON STATE: MA ZIP: 02109 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: ADVENT INTERNATIONAL GPE VI LP CENTRAL INDEX KEY: 0001430919 STATE OF INCORPORATION: XX FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37787 FILM NUMBER: 17690404 BUSINESS ADDRESS: STREET 1: C/O ADVENT INTERNTAIONAL CORP STREET 2: 75 STATE STREET CITY: BOSTON STATE: MA ZIP: 02109 BUSINESS PHONE: 617 951-9400 MAIL ADDRESS: STREET 1: C/O ADVENT INTERNTAIONAL CORP STREET 2: 75 STATE STREET CITY: BOSTON STATE: MA ZIP: 02109 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2017-03-13 0 0001657197 Cotiviti Holdings, Inc. COTV 0001034196 ADVENT INTERNATIONAL CORP/MA C/O ADVENT INTERNATIONAL CORPORATION 75 STATE STREET, 29TH FLOOR BOSTON MA 02109 0 0 1 0 0001227759 ADVENT INTERNATIONAL LLC C/O ADVENT INTERNATIONAL CORPORATION 75 STATE STREET, 29TH FLOOR BOSTON MA 02109 0 0 1 0 0001430919 ADVENT INTERNATIONAL GPE VI LP C/O ADVENT INTERNATIONAL CORPORATION 75 STATE STREET, 29TH FLOOR BOSTON MA 02109 0 0 1 0 0001430920 ADVENT INTERNATIONAL GPE VI-A LP C/O ADVENT INTERNATIONAL CORPORATION 75 STATE STREET, 29TH FLOOR BOSTON MA 02109 0 0 1 0 0001430926 ADVENT INTERNATIONAL GPE VI-B LP C/O ADVENT INTERNATIONAL CORPORATION 75 STATE STREET, 29TH FLOOR BOSTON MA 02109 0 0 1 0 0001430925 ADVENT INTERNATIONAL GPE VI-C LP C/O ADVENT INTERNATIONAL CORPORATION 75 STATE STREET, 29TH FLOOR BOSTON MA 02109 0 0 1 0 0001430923 ADVENT INTERNATIONAL GPE VI-D LP C/O ADVENT INTERNATIONAL CORPORATION 75 STATE STREET, 29TH FLOOR BOSTON MA 02109 0 0 1 0 0001430921 ADVENT INTERNATIONAL GPE VI-E LP C/O ADVENT INTERNATIONAL CORPORATION 75 STATE STREET, 29TH FLOOR BOSTON MA 02109 0 0 1 0 0001430922 ADVENT INTERNATIONAL GPE VI-F LP C/O ADVENT INTERNATIONAL CORPORATION 75 STATE STREET, 29TH FLOOR BOSTON MA 02109 0 0 1 0 0001432552 ADVENT INTERNATIONAL GPE VI-G LP C/O ADVENT INTERNATIONAL CORPORATION 75 STATE STREET, 29TH FLOOR BOSTON MA 02109 0 0 1 0 Common Stock 2017-03-13 4 S 0 8011580 34.38 D 50691350 I See Footnotes Represents 21,750,944 shares held directly by Advent-Cotiviti Acquisition Limited Partnership ("ACA LP"), 23,022,463 shares held directly by Advent-Cotiviti Acquisition II Limited Partnership ("ACA II LP"), 1,123,367 shares directly owned by Advent International GPE VI-C Limited Partnership ("AI GPE VI-C"), 1,071,561 shares directly owned by Advent International GPE VI-D Limited Partnership ("AI GPE VI-D"), 2,710,467 shares directly owned by Advent International GPE VI-E Limited Partnership ("AI GPE VI-E"), 797,009 shares directly owned by Advent Partners GPE VI 2008 Limited Partnership ("AP GPE VI 2008"), TO BE CONTINUED IN NEXT FOOTNOTE CONTINUTED FROM PREVIOUS FOOTNOTE: 24,178 directly owned by Advent Partners GPE VI 2009 Limited Partnership ("AP GPE VI 2009"), 57,022 shares directly owned by Advent Partners GPE VI 2010 Limited Partnership ("AP GPE VI 2010"), 63,327 shares directly owned by Advent Partners GPE VI-A 2010 Limited Partnership ("AP GPE VI-A 2010") and 71,012 shares directly owned by Advent Partners GPE VI-A Limited Partnership ("AP GPE VI-A"). Advent International Corporation ("AIC") is the manager of Advent International LLC ("AILLC"), which is the general partner of each of GPE VI GP Limited Partnership ("GPE VI GP"), GPE VI GP (Delaware) Limited Partnership ("GPE VI (DE) GP"), AP GPE VI 2008, AP GPE VI 2009, AP GPE VI 2010, AP GPE VI-A and AP GPE VI-A 2010 (AP GPE VI 2008, AP GPE VI 2009, AP GPE VI 2010, AP GPE VI-A and AP GPE VI-A 2010 are collectively the "AP Funds"). Advent-Cotiviti GP Corporation ("AC GP") is the general partner of ACA LP and ACA II LP. Advent International GPE VI Limited Partnership ("AI GPE VI"), Advent International GPE VI-A Limited Partnership ("AI GPE VI-A"), Advent International GPE VI-B Limited Partnership ("AI GPE VI-B"), Advent International GPE VI-F Limited Partnership ("AI GPE VI-F") and Advent International GPE VI-G Limited Partnership ("AI GPE VI-G" and, together with AI GPE VI, AI GPE VI-A, AI GPE VI-B and AI GPE VI-F, the "GPE VI GP Funds") collectively own 100% of AC GP. AI GPE VI owns 100% of the limited partnership interests in ACA LP and the other GPE VI GP Funds collectively own 100% of the limited partnership interests in ACA II LP. GPE VI GP is the general partner of the GPE VI GP Funds. GPE VI (DE) GP is the general partner of AI GPE VI-C, AI GPE VI-D and AI GPE VI-E (collectively, the "GPE VI (DE) GP Funds" and together with the GPE VI GP Funds and the AP Funds, the "Advent Funds"). Each of AIC, AILLC, GPE VI GP, GPE VI (DE) GP, ACA LP, ACA II LP, AC GP and the Advent Funds are referred to herein as the "Reporting Persons". Each Reporting Person disclaims Section 16 beneficial ownership of the shares reported herein except to the extent of its respective pecuniary interest therein, if any, and the inclusion of these shares in their report shall not be deemed an admission of beneficial ownership of all of the reported shares for purposes of Section 16 or any other purpose. This Form 4 is the first of three Forms 4 being filed relating to the same event. The Form 4 has been split into three filings because there are more than 10 Reporting Persons in total, and the SEC's EDGAR filing system limits a single Form 4 to a maximum of 10 Reporting Persons. Each Form 4 will be filed by Designated Filer Advent International Corporation. /s/ Richard Terranova, Attorney-in-Fact for Advent International Corp 2017-03-15 /s/ Richard Terranova, Attorney-in-Fact for Advent International LLC 2017-03-15 /s/ Richard Terranova, Attorney-in-Fact for Advent International GPE VI LP 2017-03-15 /s/ Richard Terranova, Attorney-in-Fact for Advent International GPE VI-A LP 2017-03-15 /s/ Richard Terranova, Attorney-in-Fact for Advent International GPE VI-B LP 2017-03-15 /s/ Richard Terranova, Attorney-in-Fact for Advent International VI-C LP 2017-03-15 /s/ Richard Terranova, Attorney-in-Fact for Advent International GPE VI-D LP 2017-03-15 /s/ Richard Terranova, Attorney-in-Fact for Advent International GPE VI-E LP 2017-03-15 /s/ Richard Terranova, Attorney-in-Fact for Advent International GPE VI-F LP 2017-03-15 /s/ Richard Terranova, Attorney-in-Fact for Advent International GPE VI-G LP 2017-03-15