0001209191-18-040002.txt : 20180629
0001209191-18-040002.hdr.sgml : 20180629
20180629131716
ACCESSION NUMBER: 0001209191-18-040002
CONFORMED SUBMISSION TYPE: 3
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20180619
FILED AS OF DATE: 20180629
DATE AS OF CHANGE: 20180629
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Musallam Ramzi M
CENTRAL INDEX KEY: 0001360891
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37787
FILM NUMBER: 18928486
MAIL ADDRESS:
STREET 1: C/O VERITAS CAPITAL
STREET 2: 590 MADISON AVENUE
CITY: NEW YORK
STATE: NY
ZIP: 10022
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Verisk Health, Inc. / DE
CENTRAL INDEX KEY: 0001603522
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37787
FILM NUMBER: 18928487
BUSINESS ADDRESS:
STREET 1: 545 WASHINGTON BOULEVARD
CITY: JERSEY CITY
STATE: NJ
ZIP: 07310-1686
BUSINESS PHONE: (201) 469-2000
MAIL ADDRESS:
STREET 1: 545 WASHINGTON BOULEVARD
CITY: JERSEY CITY
STATE: NJ
ZIP: 07310-1686
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Verscend Holding Corp.
CENTRAL INDEX KEY: 0001745089
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37787
FILM NUMBER: 18928488
BUSINESS ADDRESS:
STREET 1: C/O VERSCEND TECHNOLOGIES, INC.
STREET 2: 201 JONES ROAD, 4TH FLOOR
CITY: WALTHAM
STATE: MA
ZIP: 02451
BUSINESS PHONE: (781) 693-3700
MAIL ADDRESS:
STREET 1: C/O VERSCEND TECHNOLOGIES, INC.
STREET 2: 201 JONES ROAD, 4TH FLOOR
CITY: WALTHAM
STATE: MA
ZIP: 02451
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Verscend Intermediate Holding Corp.
CENTRAL INDEX KEY: 0001745091
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37787
FILM NUMBER: 18928489
BUSINESS ADDRESS:
STREET 1: C/O VERSCEND TECHNOLOGIES, INC.
STREET 2: 201 JONES ROAD, 4TH FLOOR
CITY: WALTHAM
STATE: MA
ZIP: 02451
BUSINESS PHONE: (781) 693-3700
MAIL ADDRESS:
STREET 1: C/O VERSCEND TECHNOLOGIES, INC.
STREET 2: 201 JONES ROAD, 4TH FLOOR
CITY: WALTHAM
STATE: MA
ZIP: 02451
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Verscend Holding II Corp.
CENTRAL INDEX KEY: 0001745090
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37787
FILM NUMBER: 18928490
BUSINESS ADDRESS:
STREET 1: C/O VERSCEND TECHNOLOGIES, INC.
STREET 2: 201 JONES ROAD, 4TH FLOOR
CITY: WALTHAM
STATE: MA
ZIP: 02451
BUSINESS PHONE: (781) 693-3700
MAIL ADDRESS:
STREET 1: C/O VERSCEND TECHNOLOGIES, INC.
STREET 2: 201 JONES ROAD, 4TH FLOOR
CITY: WALTHAM
STATE: MA
ZIP: 02451
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Verscend Holdings L.L.C.
CENTRAL INDEX KEY: 0001745092
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37787
FILM NUMBER: 18928491
BUSINESS ADDRESS:
STREET 1: C/O VERITAS CAPITAL FUND MANAGEMENT, LLC
STREET 2: 9 WEST 57TH STREET, 29TH FLOOR
CITY: NEW YORK
STATE: NY
ZIP: 10019
BUSINESS PHONE: (212) 415-6700
MAIL ADDRESS:
STREET 1: C/O VERITAS CAPITAL FUND MANAGEMENT, LLC
STREET 2: 9 WEST 57TH STREET, 29TH FLOOR
CITY: NEW YORK
STATE: NY
ZIP: 10019
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Veritas Capital Fund V, L.P.
CENTRAL INDEX KEY: 0001614239
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37787
FILM NUMBER: 18928492
BUSINESS ADDRESS:
STREET 1: 590 MADISON AVENUE
STREET 2: 41ST FLOOR
CITY: NEW YORK
STATE: NY
ZIP: 10022
BUSINESS PHONE: (212) 415-6700
MAIL ADDRESS:
STREET 1: 590 MADISON AVENUE
STREET 2: 41ST FLOOR
CITY: NEW YORK
STATE: NY
ZIP: 10022
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Veritas Capital Partners V, L.L.C.
CENTRAL INDEX KEY: 0001745093
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37787
FILM NUMBER: 18928493
BUSINESS ADDRESS:
STREET 1: C/O VERITAS CAPITAL FUND MANAGEMENT, LLC
STREET 2: 9 WEST 57TH STREET, 29TH FLOOR
CITY: NEW YORK
STATE: NY
ZIP: 10019
BUSINESS PHONE: (212) 415-6700
MAIL ADDRESS:
STREET 1: C/O VERITAS CAPITAL FUND MANAGEMENT, LLC
STREET 2: 9 WEST 57TH STREET, 29TH FLOOR
CITY: NEW YORK
STATE: NY
ZIP: 10019
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
3
1
doc3.xml
FORM 3 SUBMISSION
X0206
3
2018-06-19
1
0001657197
Cotiviti Holdings, Inc.
COTV
0001360891
Musallam Ramzi M
C/O VERITAS CAPITAL FUND MANAGEMENT, LLC
9 WEST 57TH STREET, 29TH FLOOR
NEW YORK
NY
10019
0
0
0
1
See Remarks
0001603522
Verisk Health, Inc. / DE
C/O VERSCEND TECHNOLOGIES, INC.
201 JONES ROAD, 4TH FLOOR
WALTHAM
MA
02451
0
0
0
1
See Remarks
0001745089
Verscend Holding Corp.
C/O VERSCEND TECHNOLOGIES, INC.
201 JONES ROAD, 4TH FLOOR
WALTHAM
MA
02451
0
0
0
1
See Remarks
0001745090
Verscend Holding II Corp.
C/O VERSCEND TECHNOLOGIES, INC.
201 JONES ROAD, 4TH FLOOR
WALTHAM
MA
02451
0
0
0
1
See Remarks
0001745091
Verscend Intermediate Holding Corp.
C/O VERSCEND TECHNOLOGIES, INC.
201 JONES ROAD, 4TH FLOOR
WALTHAM
MA
02451
0
0
0
1
See Remarks
0001745092
Verscend Holdings L.L.C.
C/O VERITAS CAPITAL FUND MANAGEMENT, LLC
9 WEST 57TH STREET, 29TH FLOOR
NEW YORK
NY
10019
0
0
0
1
See Remarks
0001614239
Veritas Capital Fund V, L.P.
C/O VERITAS CAPITAL FUND MANAGEMENT, LLC
9 WEST 57TH STREET, 29TH FLOOR
NEW YORK
NY
10019
0
0
0
1
See Remarks
0001745093
Veritas Capital Partners V, L.L.C.
C/O VERITAS CAPITAL FUND MANAGEMENT, LLC
9 WEST 57TH STREET, 29TH FLOOR
NEW YORK
NY
10019
0
0
0
1
See Remarks
As a result of certain provisions of that certain Voting and Support Agreement, dated as of June 19, 2018 (the "Voting Agreement") by and among Verscend Technologies, Inc. and the stockholders of Cotiviti Holdings, Inc. ("Cotiviti") party thereto described in the Schedule 13D filed by the Reporting Persons on June 29, 2018, the Reporting Persons may be deemed to have beneficial ownership of the Common Stock, par value $0.001 per share of Cotiviti (the "Shares") subject to the Voting Agreement for purposes of Section 13(d) of the Securities Exchange Act of 1934, as amended (the "Exchange Act"). Each Reporting Person expressly disclaims any beneficial ownership for purposes of the Schedule 13D referenced above. Each Reporting Person also expressly disclaims any beneficial ownership of the securities reported herein, and none of the Reporting Persons has any pecuniary interest (as defined in Rule 16a-1(a)(2) of the Exchange Act) in any of the Shares subject to the Voting Agreement. The Reporting Persons declare that the filing of this Form 3 shall not be construed as an admission that any Reporting Person is the beneficial owner of any securities reported in this Form 3.
/s/ Ramzi M. Musallam
2018-06-29
/s/ Emad Rizk, Chief Executive Officer and President of Verscend Technologies, Inc.
2018-06-29
/s/ Emad Rizk, Chief Executive Officer and President of Verscend Holding Corp.
2018-06-29
/s/ Emad Rizk, Chief Executive Officer and President of Verscend Holding II Corp.
2018-06-29
/s/ Emad Rizk, Chief Executive Officer and President of Verscend Intermediate Holding Corp.
2018-06-29
/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
2018-06-29
/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
2018-06-29
/s/ Ramzi M. Musallam, Managing Partner of Veritas Capital Partners V, L.L.C.
2018-06-29