0001209191-16-123338.txt : 20160525
0001209191-16-123338.hdr.sgml : 20160525
20160525185139
ACCESSION NUMBER: 0001209191-16-123338
CONFORMED SUBMISSION TYPE: 3
PUBLIC DOCUMENT COUNT: 2
CONFORMED PERIOD OF REPORT: 20160525
FILED AS OF DATE: 20160525
DATE AS OF CHANGE: 20160525
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: Advent-Cotiviti GP Corp
CENTRAL INDEX KEY: 0001675037
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37787
FILM NUMBER: 161675848
BUSINESS ADDRESS:
STREET 1: 75 STATE STREET
CITY: BOSTON
STATE: MA
ZIP: 02129
BUSINESS PHONE: 617-951-9400
MAIL ADDRESS:
STREET 1: 75 STATE STREET
CITY: BOSTON
STATE: MA
ZIP: 02129
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Advent-Cotiviti Acquisition II Limited Partnership
CENTRAL INDEX KEY: 0001675440
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37787
FILM NUMBER: 161675849
BUSINESS ADDRESS:
STREET 1: 75 STATE STREET
CITY: BOSTON
STATE: MA
ZIP: 02109
BUSINESS PHONE: 617-951-9400
MAIL ADDRESS:
STREET 1: 75 STATE STREET
CITY: BOSTON
STATE: MA
ZIP: 02109
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Advent-Cotiviti Acquisition Limited Partnership
CENTRAL INDEX KEY: 0001675002
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37787
FILM NUMBER: 161675850
BUSINESS ADDRESS:
STREET 1: 75 STATE STREET
CITY: BOSTON
STATE: MA
ZIP: 02129
BUSINESS PHONE: 617-951-9400
MAIL ADDRESS:
STREET 1: 75 STATE STREET
CITY: BOSTON
STATE: MA
ZIP: 02129
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: ADVENT INTERNATIONAL CORP/MA
CENTRAL INDEX KEY: 0001034196
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
FILING VALUES:
FORM TYPE: 3
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-37787
FILM NUMBER: 161675851
BUSINESS ADDRESS:
STREET 1: 75 STATE STREET
CITY: BOSTON
STATE: MA
ZIP: 02109
BUSINESS PHONE: 6179510555
MAIL ADDRESS:
STREET 1: 75 STATE STREET
CITY: BOSTON
STATE: MA
ZIP: 02109
3
1
doc3.xml
FORM 3 SUBMISSION
X0206
3
2016-05-25
0
0001657197
Cotiviti Holdings, Inc.
COTV
0001034196
ADVENT INTERNATIONAL CORP/MA
C/O ADVENT INTERNATIONAL CORPORATION
75 STATE STREET, 29TH FLOOR
BOSTON
MA
02109
0
0
1
0
0001675002
Advent-Cotiviti Acquisition Limited Partnership
C/O ADVENT INTERNATIONAL CORPORATION
75 STATE STREET, 29TH FLOOR
BOSTON
MA
02109
0
0
1
0
0001675440
Advent-Cotiviti Acquisition II Limited Partnership
C/O ADVENT INTERNATIONAL CORPORATION
75 STATE STREET, 29TH FLOOR
BOSTON
MA
02109
0
0
1
0
0001675037
Advent-Cotiviti GP Corp
C/O ADVENT INTERNATIONAL CORPORATION
75 STATE STREET, 29TH FLOOR
BOSTON
MA
02109
0
0
1
0
Common Stock
58702930
I
See Footnotes
Represents 25,188,602 shares held directly by Advent-Cotiviti Acquisition Limited Partnership ("ACA LP"), 26,661,078 shares held directly by Advent-Cotiviti Acquisition II Limited Partnership ("ACA II LP"), 1,300,911 shares directly owned by Advent International GPE VI-C Limited Partnership ("AI GPE VI-C"), 1,240,917 shares directly owned by Advent International GPE VI-D Limited Partnership ("AI GPE VI-D"), 3,138,847 shares directly owned by Advent International GPE VI-E Limited Partnership ("AI GPE VI-E"), 922,973 shares directly owned by Advent Partners GPE VI 2008 Limited Partnership ("AP GPE VI 2008"), (CONTINUED IN NEXT FOOTNOTE)
(CONTINUED FROM PREVIOUS FOOTNOTE) 27,999 shares directly owned by Advent Partners GPE VI 2009 Limited Partnership ("AP GPE VI 2009"), 66,033 shares directly owned by Advent Partners GPE VI 2010 Limited Partnership ("AP GPE VI 2010"), 73,335 shares directly owned by Advent Partners GPE VI-A 2010 Limited Partnership ("AP GPE VI-A 2010") and 82,235 shares directly owned by Advent Partners GPE VI-A Limited Partnership ("AP GPE VI-A").
Advent International Corporation ("AIC") is the manager of Advent International LLC ("AILLC"), which is the general partner of each of GPE VI GP Limited Partnership ("GPE VI GP"), GPE VI GP (Delaware) Limited Partnership ("GPE VI (DE) GP"), AP GPE VI 2008, AP GPE VI 2009, AP GPE VI 2010, AP GPE VI-A and AP GPE VI-A 2010 (AP GPE VI 2008, AP GPE VI 2009, AP GPE VI 2010, AP GPE VI-A and AP GPE VI-A 2010 are collectively the "AP Funds").
Advent-Cotiviti GP Corporation ("AC GP") is the general partner of ACA LP and ACA II LP. Advent International GPE VI Limited Partnership ("AI GPE VI"), Advent International GPE VI-A Limited Partnership ("AI GPE VI-A"), Advent International GPE VI-B Limited Partnership ("AI GPE VI-B"), Advent International GPE VI-F Limited Partnership ("AI GPE VI-F") and Advent International GPE VI-G Limited Partnership ("AI GPE VI-G" and, together with AI GPE VI, AI GPE VI-A, AI GPE VI-B and AI GPE VI-F, the "GPE VI GP Funds") collectively own 100% of AC GP. AI GPE VI owns 100% of the limited partnership interests in ACA LP and the other GPE VI GP Funds collectively own 100% of the limited partnership interests in ACA II LP.
GPE VI GP is the general partner of the GPE VI GP Funds. GPE VI (DE) GP is the general partner of AI GPE VI-C, AI GPE VI-D and AI GPE VI-E (collectively, the "GPE VI (DE) GP Funds" and together with the GPE VI GP Funds and the AP Funds, the "Advent Funds").
Each of AIC, AILLC, GPE VI GP, GPE VI (DE) GP, ACA LP, ACA II LP, AC GP and the Advent Funds are referred to herein as the "Reporting Persons". Each Reporting Person disclaims Section 16 beneficial ownership of the shares reported herein except to the extent of its respective pecuniary interest therein, if any, and the inclusion of these shares in their report shall not be deemed an admission of beneficial ownership of all of the reported shares for purposes of Section 16 or any other purpose.
This Form 3 is the third of three Form 3's being filed relating to the same event. The Form 3 has been split into three filings because there are more than 10 Reporting Persons in total, and the SEC's EDGAR filing system limits a single Form 3 to a maximum of 10 Reporting Persons. Each Form 3 will be filed by Designated Filer Advent International Corporation.
Richard Terranova, Attorney-in-Fact for Advent International Corp/MA
2016-05-25
Richard Terranova, Attorney-in-Fact for Advent-Cotiviti Acquisition Limited Partnership
2016-05-25
Richard Terranova, Attorney-in-Fact for Advent-Cotiviti Acquisition II Limited Partnership
2016-05-25
Richard Terranova, Attorney-in-Fact for Advent-Cotiviti GP Corporation
2016-05-25
EX-24.3_657495
2
poa.txt
POA DOCUMENT
POWER OF ATTORNEY
KNOW ALL PEOPLE BY THESE PRESENTS that Advent International Corporation, a
Delaware corporation with its principal place of business at 75 State Street,
Boston, Massachusetts ("Advent"), hereby constitutes and appoints Richard
Terranova (the "Attorney") as Advent's true and lawful attorney in its name and
stead to execute and file on behalf of the Corporation in its corporate capacity
and on behalf of the Corporation in its capacity as manager
or general partner of any limited partnership or other entity managed directly
or indirectly by the Corporation any (i) voting proxies and similar documents
and (ii) federal, state, local and foreign filings required to be made to any
governmental, regulatory or similar authority in connection with legal or
regulatory matters, including but not limited to filings with the United States
Securities and Exchange Commission and any "blue sky" or similar state
regulatory filings, in each case provided such action or document has been
approved by a member of the Corporation's legal or compliance department.
This Power of Attorney and the power and authority granted to the Attorney
hereunder shall automatically terminate, without any further action on the part
of Advent or the Attorney, on December 31, 2016, unless otherwise terminated
earlier by Advent at any time in its sole discretion.
IN WITNESS WHEREOF, Advent has set its hand and seal this 20th day of May 2016.
ADVENT INTERNATIONAL CORPORATION
By: /s/ Andrew D. Dodge
Andrew D. Dodge
Title: Vice President