0001179022-12-000079.txt : 20121203
0001179022-12-000079.hdr.sgml : 20121203
20121203151745
ACCESSION NUMBER: 0001179022-12-000079
CONFORMED SUBMISSION TYPE: 4
PUBLIC DOCUMENT COUNT: 1
CONFORMED PERIOD OF REPORT: 20121201
FILED AS OF DATE: 20121203
DATE AS OF CHANGE: 20121203
REPORTING-OWNER:
OWNER DATA:
COMPANY CONFORMED NAME: Forman Robert S Jr
CENTRAL INDEX KEY: 0001470912
FILING VALUES:
FORM TYPE: 4
SEC ACT: 1934 Act
SEC FILE NUMBER: 001-15669
FILM NUMBER: 121237350
MAIL ADDRESS:
STREET 1: 3350 RIVERWOOD PARKWAY SUITE 1400
CITY: ATLANTA
STATE: GA
ZIP: 30339
ISSUER:
COMPANY DATA:
COMPANY CONFORMED NAME: GENTIVA HEALTH SERVICES INC
CENTRAL INDEX KEY: 0001096142
STANDARD INDUSTRIAL CLASSIFICATION: SERVICES-HOME HEALTH CARE SERVICES [8082]
IRS NUMBER: 364335801
STATE OF INCORPORATION: DE
FISCAL YEAR END: 1231
BUSINESS ADDRESS:
STREET 1: 3350 RIVERWOOD PARKWAY
STREET 2: SUITE 1400
CITY: ATLANTA
STATE: GA
ZIP: 30339
BUSINESS PHONE: 7709516450
MAIL ADDRESS:
STREET 1: 3350 RIVERWOOD PARKWAY
STREET 2: SUITE 1400
CITY: ATLANTA
STATE: GA
ZIP: 30339
FORMER COMPANY:
FORMER CONFORMED NAME: OLSTEN HEALTH SERVICES HOLDING CORP
DATE OF NAME CHANGE: 19991001
4
1
edgar.xml
PRIMARY DOCUMENT
X0306
4
2012-12-01
0001096142
GENTIVA HEALTH SERVICES INC
GTIV
0001470912
Forman Robert S Jr
3350 RIVERWOOD PKWY, SUITE 1400
ATLANTA
GA
30339
1
0
0
0
Common stock units
0
2012-12-01
4
A
0
3014
0
A
Common stock
3014
26629
D
The common stock units of Gentiva Health Services, Inc. are convertible to shares of common stock of Gentiva at a conversion ratio of one unit for one share of common stock.
The common stock units are convertible upon the date of termination of service to the Issuer.
David Brown, by power of attorney
2012-12-03