-----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, J05q132k28ZqC0TBpNhlnY9/3fSdl1Sk+/li+uubYFqc/x8LwmLCHyruNncyfr5/ 7XASw9Q5K2DMoDbbX6Ky8A== 0001179022-03-000027.txt : 20030123 0001179022-03-000027.hdr.sgml : 20030123 20030123152913 ACCESSION NUMBER: 0001179022-03-000027 CONFORMED SUBMISSION TYPE: 4 PUBLIC DOCUMENT COUNT: 1 CONFORMED PERIOD OF REPORT: 20030121 FILED AS OF DATE: 20030123 REPORTING-OWNER: COMPANY DATA: COMPANY CONFORMED NAME: HERMAN KIMBERLY CENTRAL INDEX KEY: 0001187068 RELATIONSHIP: OFFICER FILING VALUES: FORM TYPE: 4 BUSINESS ADDRESS: STREET 1: 3 HUNTINGTON QUADRANGLE STREET 2: STE 25 CITY: MELVILLE STATE: NY ZIP: 11747 BUSINESS PHONE: 6315017080 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: 03522353 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 herman012103form4.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*
       Herman   Kimberly S.

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

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

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

___Sr. Vice President & Chief Marketing Officer______

(Last)     (First)     (Middle)

14 Wayside Lane

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

4.  Statement for Month/Day/Year
January 21, 2003

(Street)
Lloyd Harbor, New York   11743

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

Common stock 1/21/03   M

  

25,268

A

1.7438

25,554 D

  

  

  

 

  

  

  

  

  

  

  

  

  

  

 

  

  

  

  

  

   

  

  

  

  

 

  

  

  

  

  

   

  

  

  

  

 

  

  

  

  

  

   

  

  

  

  

 

  

  

  

  

  

    

  

  

  

  

 

  

  

  

  

  

  

  

  

  

  

 

  

  

  

  

  

   

  

  

  

  

 

  

  

  

  

  

   

  

  

  

  

 

  

  

  

  

  

   

  

  

  
  
  

 

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
(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
    Following
    Reported
   Transaction(s)
     (Instr. 4)

10.Ownership
     Form of
    
Derivative
     Security:
     (D) Direct or
     (I) Indirect
       (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 Options 1.7438 1/21/03

M

   

  25,268 6/14/02 3/16/10 Common stock 25,268

  

0  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

  

 


 
 
 

 

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

              January  23, 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

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