0001179110-17-008108.txt : 20170526 0001179110-17-008108.hdr.sgml : 20170526 20170526163546 ACCESSION NUMBER: 0001179110-17-008108 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20170525 FILED AS OF DATE: 20170526 DATE AS OF CHANGE: 20170526 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: King-Shaw Ruben Jose JR CENTRAL INDEX KEY: 0001295959 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37787 FILM NUMBER: 17874457 MAIL ADDRESS: STREET 1: 465 BRICKELL AVENUE #4203 CITY: MIAMI STATE: FL ZIP: 33131 4 1 edgar.xml FORM 4 - X0306 4 2017-05-25 0 0001657197 Cotiviti Holdings, Inc. COTV 0001295959 King-Shaw Ruben Jose JR C/O COTIVITI HOLDINGS, INC. 115 PERIMETER CENTER PLACE, SUITE 700 ATLANTA GA 30346 1 0 0 0 Common Stock, par value $0.001 per share 2017-05-25 4 M 0 3689 A 3689 D Restricted Stock Units 2017-05-25 4 M 0 3689 0 D Common Stock, par value $0.001 per share 3689 0 D Restricted Stock Units convert into Common Stock on a one-for-one basis. On September 1, 2016, the Reporting Person was granted 3,689 Restricted Stock Units all of which vested on May 25, 2017, the date of Cotiviti Holdings, Inc.'s first annual meeting following the date of grant. /s/ Jonathan Olefson, attorney-in-fact 2017-05-26