0001209191-17-048748.txt : 20170814 0001209191-17-048748.hdr.sgml : 20170814 20170814160852 ACCESSION NUMBER: 0001209191-17-048748 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20170810 FILED AS OF DATE: 20170814 DATE AS OF CHANGE: 20170814 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Maldonado John L. CENTRAL INDEX KEY: 0001544918 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37787 FILM NUMBER: 171030186 MAIL ADDRESS: STREET 1: C/O ADVENT INTERNATIONAL CORPORATION STREET 2: 75 STATE STREET, 29TH FLOOR CITY: BOSTON STATE: MA ZIP: 02109 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 2017-08-10 0 0001657197 Cotiviti Holdings, Inc. COTV 0001544918 Maldonado John L. C/O ADVENT INTERNATIONAL CORPORATION 75 STATE STREET, 29TH FLOOR BOSTON MA 02109 1 0 0 0 Common Stock 2017-08-10 4 S 0 9257651 36.87 D 41433699 I See Footnotes The Reporting Person is a Managing Partner at Advent International Corporation ("AIC") and in addition may have limited partnership or other interests in one or more of the Advent Entities (as defined below). AIC manages funds that collectively own 41,433,699 shares (the "Shares"), which are represented as follows: 17,778,618 shares held directly by Advent-Cotiviti Acquisition Limited Partnership, 18,817,920 held directly by Advent-Cotiviti Acquisition II Limited Partnership, 918,209 shares directly owned by Advent International GPE VI-C Limited Partnership, 875,864 shares directly owned by Advent International GPE VI-D Limited Partnership, 2,215,460 shares directly owned by Advent International GPE VI-E Limited Partnership, 651,453 shares directly owned by Advent Partners GPE VI 2008 Limited Partnership, (CONTINUED IN NEXT FOOTNOTE) CONTINUED FROM PREVIOUS FOOTNOTE) 19,762 shares directly owned by Advent Partners GPE VI 2009 Limited Partnership 46,608 shares directly owned by Advent Partners GPE VI 2010 Limited Partnership, 51,762 shares directly owned by Advent Partners GPE VI-A 2010 Limited Partnership and 58,043 shares directly owned by Advent Partners GPE VI-A Limited Partnership (collectively and together with certain other affiliates of Advent, the "Advent Entities"). The Reporting Person disclaims Section 16 beneficial ownership of the Shares except to the extent of his pecuniary interest therein, if any, and the reference to these Shares in this report shall not be deemed an admission of beneficial ownership of all of the Shares for purposes of Section 16 or any other purpose. /s/ Richard Terranova, Attorney-in-Fact 2017-08-14