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FEC FORM 1

STATEMENT OF ORGANIZATION

FILING FEC-280456

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1. GENTIVA HEALTH SERVICES INC PAC GENTIVAPAC

    3 HUNTINGTON QUADRANGLE
    SUITE 200S
    MELVILLE, NY 117474627
    Email: pac@gentiva.com

2. Date: 03/09/2007

3. FEC Committee ID #: C00407080 This committee is a Separate Segregated Fund

Affiliated Committees/Organizations

GENTIVA HEALTH SERVICES INC.
3 HUNTINGTON QUADRANGLE
SUITE 200S
MELVILLE, New York 117474627
Relationship: Connected
Organization Type: Corporation

Custodian of Records:

John Potapchuk
3 Huntington Quadrangle
Suite 200S
Melville, NY 117474627
Title: Treasurer
Phone # (631) 501-7035

Treasurer:

John Potapchuk
3 Huntington Quadrangle
Suite 200S
Melville, New York 117474627
Title: Treasurer
Phone # (631) 501-7035

Designated Agent(s):

Banks or Depositories

Bank of America
P O Box 798
Wichita, Kansas 67201

Signed: John Potapchuk
Date Signed: 03/09/2007

(End FEC FORM 1)

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