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