0001179110-17-004573.txt : 20170314 0001179110-17-004573.hdr.sgml : 20170314 20170314173129 ACCESSION NUMBER: 0001179110-17-004573 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20170313 FILED AS OF DATE: 20170314 DATE AS OF CHANGE: 20170314 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 REPORTING-OWNER: OWNER DATA: COMPANY CONFORMED NAME: Alexander Elizabeth Connolly CENTRAL INDEX KEY: 0001673364 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-37787 FILM NUMBER: 17689072 MAIL ADDRESS: STREET 1: C/O COTIVITI HOLDINGS, INC. STREET 2: 115 PERIMETER CENTER PLACE, SUITE 700 CITY: ATLANTA STATE: GA ZIP: 30346 4 1 edgar.xml FORM 4 - X0306 4 2017-03-13 0 0001657197 Cotiviti Holdings, Inc. COTV 0001673364 Alexander Elizabeth Connolly C/O COTIVITI HOLDINGS, INC. 115 PERIMETER CENTER PLACE, SUITE 700 ATLANTA GA 30346 1 0 0 0 Common Stock, par value $0.001 per share 2017-03-13 4 S 0 352622 36.00 D 1609494 D Common Stock, par value $0.001 per share 2017-03-13 4 S 0 88156 36.00 D 402363 I By family trust for son Common Stock, par value $0.001 per share 2017-03-13 4 S 0 88156 36.00 D 402373 I By family trust for daughter Common Stock, par value $0.001 per share 2017-03-13 4 S 0 88156 36.00 D 402373 I By family trust for daughter Common Stock, par value $0.001 per share 1048096 I By limited liability company The shares were sold in a registered underwritten secondary offering pursuant to an underwriting agreement entered into on March 7, 2017. Represents public offering price of $36.00 per share. Held directly by a family irrevocable trust of which a son of the Reporting Person is the beneficiary, and of which the trustees are an institution and the Reporting Person's spouse. The Reporting Person disclaims beneficial ownership of these securities, and the filing of this report is not an admission that the Reporting Person is the beneficial owner of these securities for purposes of Section 16 or for any other purpose. Held directly by a family irrevocable trust of which a daughter of the Reporting Person is the beneficiary, and of which the trustees are an institution and the Reporting Person's spouse. The Reporting Person disclaims beneficial ownership of these securities, and the filing of this report is not an admission that the Reporting Person is the beneficial owner of these securities for purposes of Section 16 or for any other purpose. Held directly by a family irrevocable trust of which a daughter of the Reporting Person is the beneficiary, and of which the trustees are an institution and the Reporting Person's spouse. The Reporting Person disclaims beneficial ownership of these securities, and the filing of this report is not an admission that the Reporting Person is the beneficial owner of these securities for purposes of Section 16 or for any other purpose. These shares are held by Milton Harbor View, LLC, of which the Reporting Person and her spouse are the sole managers and of which she is a member. The Reporting Person disclaims beneficial ownership of the reported securities except to the extent of her pecuniary interest therein. /s/ Jonathan Olefson, attorney-in-fact 2017-03-14