FEC FORM 1
STATEMENT OF ORGANIZATION
FILING FEC-455257
1. GENTIVA HEALTH SERVICES INC PAC GENTIVAPAC
3350 RIVERWOOD PARKWAYSUITE 1400
ATLANTA, GA 30339
NOTE: Address is different than previously reported
Email: eric.slusser@gentiva.comNOTE: 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 CorporationAffiliated Committees/Organizations
Committee ID# C00407080GENTIVA HEALTH SERVICES INC PAC GENTIVAPAC
3350 RIVERWOOD PARKWAY
SUITE 1400
ATLANTA, Georgia 30339
Affiliated Relationship Code: Connected Organization
Custodian of Records:
ERIC SLUSSER3350 RIVERWOOD PARKWAY
SUITE 1400
ATLANTA, GA 30339
Title: TREASURER
Phone # (770) 951-6450
Treasurer:
ERIC SLUSSER3350 RIVERWOOD PARKWAY
SUITE 1400
ATLANTA, Georgia 30339
Title: TREASURER
Phone # (770) 951-6450
Designated Agent(s):
ERIC SLUSSER3350 RIVERWOOD PARKWAY
SUITE 1400
ATLANTA, Georgia 30339
Title: TREASURER
Phone # (770) 951-6450
Banks or Depositories
BANK OF AMERICAPO BOX 31900
TAMPA, Florida 336313900