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-1290950

1. Cotiviti Corporation Political Action Committee (Cotiviti PAC)

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

2. Date: 11/08/2018

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

Committee ID# C00568584
Cotiviti Corporation
115 Perimeter Center Place Ste 700
Atlanta, Georgia 30338
Affiliated Relationship Code: Connected Organization

Custodian of Records:

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

Treasurer:

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

Designated Agent(s):

Banks or Depositories

Wells Fargo N.A.
4 Corporate Drive Suite 495
Shelton, Connecticut 06484

Signed: Heather Norko
Date Signed: 11/08/2018

FORM TEXT-1

(End FEC FORM 1)

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