-----BEGIN PRIVACY-ENHANCED MESSAGE----- Proc-Type: 2001,MIC-CLEAR Originator-Name: webmaster@www.sec.gov Originator-Key-Asymmetric: MFgwCgYEVQgBAQICAf8DSgAwRwJAW2sNKK9AVtBzYZmr6aGjlWyK3XmZv3dTINen TWSM7vrzLADbmYQaionwg5sDW3P6oaM5D3tdezXMm7z1T+B+twIDAQAB MIC-Info: RSA-MD5,RSA, GOL/i7YbniuntwKKmV8nnKG+L8Ni5qlF08k54iN2v5MZYc1DR0ESXnP7NchxeoMm fRMCMrfSzcXrHO8p3P4smw== 0001179022-03-000023.txt : 20030122 0001179022-03-000023.hdr.sgml : 20030122 20030122161235 ACCESSION NUMBER: 0001179022-03-000023 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 2 CONFORMED PERIOD OF REPORT: 20030102 FILED AS OF DATE: 20030122 REPORTING-OWNER: COMPANY DATA: COMPANY CONFORMED NAME: TROUBH RAYMOND CENTRAL INDEX KEY: 0001186633 RELATIONSHIP: DIRECTOR FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: C/O GENTIVA HEALTH SERVICES INC STREET 2: 3 HUNTINGTON QUADRANGLE CITY: MELVILLE STATE: NY ZIP: 11733 BUSINESS PHONE: 4045274000 SUBJECT COMPANY: COMPANY DATA: COMPANY CONFORMED NAME: GENTIVA HEALTH SERVICES INC CENTRAL INDEX KEY: 0001096142 STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-HEALTH SERVICES [8000] IRS NUMBER: 364335801 STATE OF INCORPORATION: DE FISCAL YEAR END: 1231 FILING VALUES: FORM TYPE: 4 SEC ACT: 1934 Act SEC FILE NUMBER: 001-15669 FILM NUMBER: 03521015 BUSINESS ADDRESS: STREET 1: 3 HUNTINGTON QUADRANGLE 2S CITY: MELVILLE STATE: NY ZIP: 11747-8943 BUSINESS PHONE: 6315017000 MAIL ADDRESS: STREET 1: 3 HUNTINGTON QUADRANGLE 2S CITY: MELVILLE STATE: NY ZIP: 11747-8943 FORMER COMPANY: FORMER CONFORMED NAME: OLSTEN HEALTH SERVICES HOLDING CORP DATE OF NAME CHANGE: 19991001 4 1 troubh010203form4.htm FORM 4 Form 4

 

FORM 4

 

__ Check this box if no longer 
     subject to Section 16. Form 4
     or Form 5 obligations may 
     continue. See Instruction 1(b).

     (Print or Type Responses)

 

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(f) of the Investment Company Act of 1940

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1.  Name and Address of Reporting Person*
       Troubh      Raymond

2.  Issuer Name and Ticker or Trading Symbol
Gentiva Health Services, Inc.   (GTIV)

6.  Relationship of Reporting Person(s) to Issuer
                     (Check all applicable)

_X__   Director                              ___ 10% Owner
_   __  Officer (give title below)     ___Other (specify below)

_                                                                           __

(Last)     (First)     (Middle)

110 Rockefeller Plaza   Rm 712

3. I.R.S. Identification
    Number of Reporting
    Person, if an entity
    (voluntary)

4.  Statement for Month/Day/Year
January 2, 2003

(Street)
New York, New York   10020

5.  If Amendment, Date of
 Original (Month/Year)

7.  Individual or Joint/Group Filing (Check Applicable Line)

_X__ Form filed by One Reporting Person
___
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
(Month/
Day/Year)

2A. Deemed Execution Date, if any
(Month/
Day/Year)

3. Transaction Code
   (Instr. 8)

4. Securities  Acquired  (A)
    or Disposed of (D)
    (Instr. 3, 4 and 5)

5.  Amount of Securities
    Beneficially Owned
    at End of Month
    (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

       

  

  

  

 

  

  

  

  

  

 

  

  

  

  

  

  

  

  

  

  

 

  

  

  

  

  

   

  

  

  

  

 

  

  

  

  

  

   

  

  

  

  

 

  

  

  

  

  

   

  

  

  

  

 

  

  

  

  

  

    

  

  

  

  

 

  

  

  

  

  

  

  

  

  

  

 

  

  

  

  

  

   

  

  

  

  

 

  

  

  

  

  

   

  

  

  

  

 

  

  

  

  

  

   

  

  

  
 

  
  

 

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.
Transac-tion Date
(Month/
Day/Year)

3A.
 Deemed
 Execution
 Date, if
 any
 (Month/
 Day/Year)

4.Transaction Code
   (Instr. 8)

5.Number of Derivative
   Securities Acquired
   (A) or Disposed of (D)
   (Instr. 3, 4 and 5)

6.Date Exerciseable
   and Expiration  Date
  (Month/Day/Year)

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 at
    End of Month
    (Instr. 4)

10.Ownership
     Form of
     Derivative
     Securities
     Beneficially
     Owned at
     End of Month
     (Instr. 4)

11.Nature  of
     Indirect
     Beneficial
     Ownership
     (Instr. 4)

Code

V

(A)

(D)

Date Exercisable

Expiration Date

Title

Amount or Number of Shares

  Stock option

8.74 1/02/03  

A

   

7,500

  

1/02/04

1/02/13

Common stock

7,500

  

34,345 D

  

  

  

  

 

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

 

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

 

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

 

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

 

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

 

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

 

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

 

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

 

  

  

  

  

  

  

  

  

  

  

  

  

 

 
 
 
 

 

  /s/ John T. Price, Attorney-in-fact                 
**Signature of Reporting Person

              January  22, 2003                             
Date

 

Reminder:

Report on a separate line for each class of securities beneficially owned directly or indirectly.

*

If the form is filed by more than one reporting person, see Instruction 4(b)(v).

**

Intentional misstatements or omissions of facts constitute Federal Criminal Violations
See 18 U.S.C. 1001 and 15 U.S.C. 78ff(a).

Note:

File three copies of this Form, one of which must be manually signed. If space is insufficient, see Instruction 6 for procedure

EX-99.16 PWR OF ATTY 3 troubhpowerofattorney.htm POWER OF ATTORNEY POWER OF ATTORNEY

POWER OF ATTORNEY

            KNOW BY ALL THESE PRESENT, that the undersigned hereby constitutes and appoints Phillip A. Bradley and John T. Price his/her true and lawful attorney-in-fact to:

1)   Execute for and on behalf of the undersigned, in the undersigned's capacity as an officer and/or director of Gentiva Health Services, Inc. (the "Company"), Forms 3, 4 and 5 in accordance with Section 16(a) of the Securities Exchange Act of 1934 and the rules thereunder;

2)   Do and perform any and all acts for on behalf of the undersigned which may be necessary or desirable to complete and execute any such Form 3, 4 or 5 and timely file such form with the United States Securities and Exchange Commission and any stock exchange or similar authority; and

3)    Take any other action of any type whatsoever in connection with the foregoing, which in the opinion of such attorney-in-fact may be of benefit to, in the best interest of, or legally required by, the undersigned, it being understood that the documents executed by such attorney-in-fact on behalf of the undersigned pursuant to this Power of Attorney shall be in such form and shall contain such terms and conditions as such attorney-in-fact may approve in his/her discretion.

            The undersigned hereby grants to each such attorney-in-fact full power and authority to do and perform any and every act and thing whatsoever requisite, necessary or proper to be done in the exercise of any of the rights and powers herein granted, as fully to all intents and purposes as the undersigned might or could do if personally present, with full power of substitution or revocation, hereby ratifying and confirming all that such attorney-in-fact, or his/her substitute or substitutes, shall lawfully do or cause to be done by virtue of this Power of Attorney and the rights and powers herein granted.  The undersigned acknowledges that the foregoing attorneys-in-fact, in serving in such capacity at the request of the undersigned, are not assuming, nor is the Company assuming, any of the undersigned's responsibilities to comply with Section 16 of the Securities Exchange Act of 1934.

            This Power of Attorney dated as of today, shall remain in full force and effect until the undersigned is no longer required to file Forms 3, 4 and 5 with respect to the undersigned's holdings of and transactions in securities issues by the Company, unless earlier revoked by the undersigned in a signed writing delivered to the foregoing attorneys-in-fact.

            IN WITNESS WHEREOF, the undersigned has caused this Power of Attorney to be executed.

Date:  December 23, 2002

/s/  Raymond S. Troubh

 

 

 

 

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