Sec Form 4 Filing - Musallam Ramzi M @ Cotiviti Holdings, Inc. - 2018-08-27

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FORM 4
Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
UNITED STATES SECURITIES AND EXCHANGE COMMISSION
Washington, D.C. 20549
STATEMENT OF CHANGES IN BENEFICIAL OWNERSHIP
Filed pursuant to Section 16(a) of the Securities Exchange Act of 1934, Section 17(a) of the Public Utility Holding Company Act of 1935 or Section 30(h) of the Investment Company Act of 1940
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1. Name and Address of Reporting Person
Musallam Ramzi M
2. Issuer Name and Ticker or Trading Symbol
Cotiviti Holdings, Inc. [ COTV]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
_____ Director X __ 10% Owner
_____ Officer (give title below) _____ Other (specify below)
(Last) (First) (Middle)
C/O VERITAS CAPITAL FUND MANAGEMENT, LLC, 9 WEST 57TH STREET, 29TH FLOOR
3. Date of Earliest Transaction (MM/DD/YY)
08/27/2018
(Street)
NEW YORK, NY10019
4. If Amendment, Date Original Filed (MM/DD/YY)
6. Individual or Joint/Group Filing (Check Applicable Line)
_____ Form filed by One Reporting Person
__ X __ Form filed by More than One Reporting Person
(City) (State) (Zip)
Table I - Non-Derivative Securities Acquired, Disposed of, or Beneficially Owned
1.Title of Security
(Instr. 3)
2. Transaction Date (MM/DD/YY) 2A. Deemed Execution Date, if any (MM/DD/YY) 3. Transaction Code
(Instr. 8)
4. Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4 and 5)
5. Amount of Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 3 and 4)
6. Ownership Form: Direct (D) or Indirect (I)
(Instr. 4)
7. Nature of Indirect Beneficial Ownership
(Instr. 4)
Code V Amount (A) or (D) Price
Common Stock 08/27/2018 J( 1 ) 94,027,266 ( 1 ) ( 2 ) A $ 44.75 100 ( 2 ) I See footnote ( 2 )
Table II - Derivative Securities Acquired, Disposed of, or Beneficially Owned
( e.g. , puts, calls, warrants, options, convertible securities)
1. Title of Derivative Security
(Instr. 3)
2. Conversion or Exercise Price of Derivative Security 3. Transaction Date (MM/DD/YY) 3A. Deemed Execution Date, if any (MM/DD/YY) 4. Transaction Code
(Instr. 8)
5. Number of Derivative Securities Acquired (A) or Disposed of (D)
(Instr. 3, 4, and 5)
6. Date Exercisable and Expiration Date
(MM/DD/YY)
7. Title and Amount of Underlying Securities
(Instr. 3 and 4)
8. Price of Derivative Security
(Instr. 5)
9. Number of Derivative Securities Beneficially Owned Following Reported Transaction(s)
(Instr. 4)
10. Ownership Form of Derivative Security: Direct (D) or Indirect (I)
(Instr. 4)
11. Nature of Indirect Beneficial Ownership
(Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Reporting Owners
Reporting Owner Name / Address Relationships
Director 10% Owner Officer Other
Musallam Ramzi M
C/O VERITAS CAPITAL FUND MANAGEMENT, LLC
9 WEST 57TH STREET, 29TH FLOOR
NEW YORK, NY10019
X
Verisk Health, Inc. / DE
C/O VERSCEND TECHNOLOGIES, INC.
201 JONES ROAD, 4TH FLOOR
WALTHAM, MA02451
See Remarks
Verscend Holding Corp.
C/O VERSCEND TECHNOLOGIES, INC.
201 JONES ROAD, 4TH FLOOR
WALTHAM, MA02451
See Remarks
Verscend Holding II Corp.
C/O VERSCEND TECHNOLOGIES, INC.
201 JONES ROAD, 4TH FLOOR
WALTHAM, MA02451
See Remarks
Verscend Intermediate Holding Corp.
C/O VERSCEND TECHNOLOGIES, INC.
201 JONES ROAD, 4TH FLOOR
WALTHAM, MA02451
See Remarks
Verscend Holdings L.L.C.
C/O VERITAS CAPITAL FUND MANAGEMENT, LLC
9 WEST 57TH STREET, 29TH FLOOR
NEW YORK, NY10019
See Remarks
Veritas Capital Fund V, L.P.
C/O VERITAS CAPITAL FUND MANAGEMENT, LLC
9 WEST 57TH STREET, 29TH FLOOR
NEW YORK, NY10019
See Remarks
Veritas Capital Partners V, L.L.C.
C/O VERITAS CAPITAL FUND MANAGEMENT, LLC
9 WEST 57TH STREET, 29TH FLOOR
NEW YORK, NY10019
See Remarks
Signatures
/s/ Ramzi M. Musallam 08/29/2018
Signature of Reporting Person Date
/s/ Emad Rizk, Chief Executive Officer and President of Verscend Technologies, Inc. 08/29/2018
Signature of Reporting Person Date
/s/ Emad Rizk, Chief Executive Officer and President of Verscend Holding Corp. 08/29/2018
Signature of Reporting Person Date
/s/ Emad Rizk, Chief Executive Officer and President of Verscend Holding II Corp. 08/29/2018
Signature of Reporting Person Date
/s/ Emad Rizk, Chief Executive Officer and President of Verscend Intermediate Holding Corp. 08/29/2018
Signature of Reporting Person Date
/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 08/29/2018
Signature of Reporting Person Date
/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. 08/29/2018
Signature of Reporting Person Date
/s/ Ramzi M. Musallam, Managing Partner of Veritas Capital Partners V, L.L.C. 08/29/2018
Signature of Reporting Person Date
Explanation of Responses:
( 1 )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.
( 2 )Each of the Reporting Persons disclaims any beneficial ownership of these Securities, except to the extent of its pecuniary interests therein.

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