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