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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-455257

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1. GENTIVA HEALTH SERVICES INC PAC GENTIVAPAC

    3350 RIVERWOOD PARKWAY
    SUITE 1400
    ATLANTA, GA 30339

    NOTE: Address is different than previously reported

    Email: eric.slusser@gentiva.com

    NOTE: Email address is different than previously reported

2. Date: 03/11/2010

3. FEC Committee ID #: C00407080 This committee is a separate segregated fund. Its connected organization is a Corporation

Affiliated Committees/Organizations

Committee ID# C00407080
GENTIVA HEALTH SERVICES INC PAC GENTIVAPAC
3350 RIVERWOOD PARKWAY
SUITE 1400
ATLANTA, Georgia 30339
Affiliated Relationship Code: Connected Organization

Custodian of Records:

ERIC SLUSSER
3350 RIVERWOOD PARKWAY
SUITE 1400
ATLANTA, GA 30339
Title: TREASURER
Phone # (770) 951-6450

Treasurer:

ERIC SLUSSER
3350 RIVERWOOD PARKWAY
SUITE 1400
ATLANTA, Georgia 30339
Title: TREASURER
Phone # (770) 951-6450

Designated Agent(s):

ERIC SLUSSER
3350 RIVERWOOD PARKWAY
SUITE 1400
ATLANTA, Georgia 30339
Title: TREASURER
Phone # (770) 951-6450

Banks or Depositories

BANK OF AMERICA
PO BOX 31900
TAMPA, Florida 336313900

Signed: ERIC SLUSSER
Date Signed: 03/11/2010

(End FEC FORM 1)

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