FEC Form 1 for Cotiviti Corporation Political Action Committee (Cotiviti PAC)Form 1 for Cotiviti Corporation Political Action Committee (Cotiviti PAC)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1029764

1. Cotiviti Corporation Political Action Committee (Cotiviti PAC)

NOTE:Commmittee Name is different than previously reported

50 Danbury Road
Wilton, CT 06897
Email: PAC@Cotiviti.com;FECINFO@PASS1.com

NOTE: Email address is different than previously reported

2. Date: 10/15/2015

3. FEC Committee ID #: C00568584 This committee is a separate segregated fund. Its connected organization is a Corporation
In addition, this committee is a Lobbyist/Registrant PAC.

Affiliated Committees/Organizations

Cotiviti Corporation
115 Perimeter Center Place Ste 700
Atlanta, Georgia 30338
Affiliated Relationship Code: Connected Organization

Custodian of Records:

Jonathan Olefson
50 Danbury Road
Wilton, CT 06897
Title: Custodian of Records
Phone # (203) 529-2000

Treasurer:

Steve Senneff
50 Danbury Road
Wilton, Connecticut 06897
Title: Treasurer
Phone # (203) 529-2000

Designated Agent(s):

Adrienne Calderone
50 Danbury Road
Wilton, Connecticut 06897
Title: Assistant Treasurer
Phone # (203) 529-2000

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1029764

1. Cotiviti Corporation Political Action Committee (Cotiviti PAC)

NOTE:Commmittee Name is different than previously reported

NOTE: Email address is different than previously reported

2. Date: 10/15/2015

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Designated Agent(s):

Banks or Depositories

Signed: Steve Senneff
Date Signed: 10/15/2015

FORM TEXT-1

(End FEC FORM 1)

FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-1029764

1. Cotiviti Corporation Political Action Committee (Cotiviti PAC)

NOTE:Commmittee Name is different than previously reported

NOTE: Email address is different than previously reported

2. Date: 10/15/2015

Affiliated Committees/Organizations

Custodian of Records:

Treasurer:

Designated Agent(s):

Banks or Depositories

Signed: Steve Senneff Date Signed: 10/15/2015 function popup1029764F12() { plain_window = window.open('/dcdev/fectxt/1029764F12.txt','plain','scrollbars,resizable,width=500,height=500'); } FORM TEXT-1

(End FEC FORM 1)

Signed: Steve Senneff
Date Signed: 10/15/2015

FORM TEXT-1