0001209191-18-048843.txt : 20180829 0001209191-18-048843.hdr.sgml : 20180829 20180829174125 ACCESSION NUMBER: 0001209191-18-048843 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20180827 FILED AS OF DATE: 20180829 DATE AS OF CHANGE: 20180829 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Veritas Capital Partners V, L.L.C. CENTRAL INDEX KEY: 0001745093 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37787 FILM NUMBER: 181045092 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: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37787 FILM NUMBER: 181045093 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: Verscend Holdings L.L.C. CENTRAL INDEX KEY: 0001745092 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37787 FILM NUMBER: 181045094 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: Verscend Intermediate Holding Corp. CENTRAL INDEX KEY: 0001745091 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37787 FILM NUMBER: 181045095 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: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37787 FILM NUMBER: 181045096 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 Corp. CENTRAL INDEX KEY: 0001745089 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37787 FILM NUMBER: 181045097 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: Verisk Health, Inc. / DE CENTRAL INDEX KEY: 0001603522 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37787 FILM NUMBER: 181045098 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: Musallam Ramzi M CENTRAL INDEX KEY: 0001360891 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37787 FILM NUMBER: 181045099 MAIL ADDRESS: STREET 1: C/O VERITAS CAPITAL STREET 2: 590 MADISON AVENUE CITY: NEW YORK STATE: NY ZIP: 10022 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 4 1 doc4.xml FORM 4 SUBMISSION X0306 4 2018-08-27 0 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 1 0 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 Common Stock 2018-08-27 4 J 0 94027266 44.75 A 100 I See footnote On August 27, 2018, pursuant to the Agreement and Plan of Merger, dated as of June 19, 2018, by and among the Issuer, Verscend Technologies, Inc., a Delaware corporation ("Verscend"), and Rey Merger Sub, Inc., a Delaware corporation and a wholly owned subsidiary of Verscend ("Merger Sub"), Merger Sub merged (the "Merger") with and into the Issuer, with the Issuer surviving as a wholly owned subsidiary of Verscend. As a result of the effectiveness of the Merger, the common stock, par value $0.001 per share of Cotiviti (the "Shares"), ceased to be traded on the New York Stock Exchange, the registration of the Shares will be terminated pursuant to Section 12(g) of the Exchange Act and Cotiviti will no longer be required to file periodic reports with the SEC. Each of the Reporting Persons disclaims any beneficial ownership of these Securities, except to the extent of its pecuniary interests therein. /s/ Ramzi M. Musallam 2018-08-29 /s/ Emad Rizk, Chief Executive Officer and President of Verscend Technologies, Inc. 2018-08-29 /s/ Emad Rizk, Chief Executive Officer and President of Verscend Holding Corp. 2018-08-29 /s/ Emad Rizk, Chief Executive Officer and President of Verscend Holding II Corp. 2018-08-29 /s/ Emad Rizk, Chief Executive Officer and President of Verscend Intermediate Holding Corp. 2018-08-29 /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 2018-08-29 /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. 2018-08-29 /s/ Ramzi M. Musallam, Managing Partner of Veritas Capital Partners V, L.L.C. 2018-08-29