SEC Form 4
FORM 4 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
or Section 30(h) of the Investment Company Act of 1940
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Check this box if no longer subject to Section 16. Form 4 or Form 5 obligations may continue. See Instruction 1(b).
1. Name and Address of Reporting Person*
HICKS R STEVEN

(Last) (First) (Middle)
3350 RIVERWOOD PKWY, SUITE 1400

(Street)
ATLANTA GA 30339

(City) (State) (Zip)
2. Issuer Name and Ticker or Trading Symbol
GENTIVA HEALTH SERVICES INC [ GTIV ]
5. Relationship of Reporting Person(s) to Issuer
(Check all applicable)
X Director 10% Owner
Officer (give title below) Other (specify below)
3. Date of Earliest Transaction (Month/Day/Year)
10/18/2013
4. If Amendment, Date of Original Filed (Month/Day/Year)
6. Individual or Joint/Group Filing (Check Applicable Line)
X Form filed by One Reporting Person
Form filed by More than One Reporting Person
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 Following Reported Transaction(s) (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 10/18/2013 A 481,288 A (1) 481,288 D
Common stock 10/18/2013 A 1,906,150(2) A (1) 1,906,150 I By Hicks Healthcare, LP
Common stock 10/18/2013 A 49,755(3) A (1) 49,755 I By Harden Healthcare Texas, LLC
Common stock 10/18/2013 A 96,943 A (1) 96,943 I By Kristen Hicks Hanson 2006 Trust, R. Steven Hicks, Trustee
Common stock 10/18/2013 A 96,943 A (1) 96,943 I By Robert Steven Hicks 2006 Trust, R. Steven Hicks, Trustee
Common stock 10/18/2013 A 96,943 A (1) 96,943 I By Brandon V. Hicks 2006 Trust, R. Steven Hicks, Trustee
Common stock 10/18/2013 A 96,943 A (1) 96,943 I By Shelly Mabry Ellard 2006 Trust, R. Steven Hicks, Trustee
Common stock 10/18/2013 A 96,943 A (1) 96,943 I By Jason Mabry 2006 Trust, R. Steven Hicks, Trustee
Common stock 10,000 I By spouse
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) 3A. Deemed Execution Date, if any (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 Exercisable and Expiration Date (Month/Day/Year) 7. Title and Amount of Securities Underlying Derivative Security (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: Direct (D) or Indirect (I) (Instr. 4) 11. Nature of Indirect Beneficial Ownership (Instr. 4)
Code V (A) (D) Date Exercisable Expiration Date Title Amount or Number of Shares
Common stock units $0(4) 10/18/2013 A 1,225 (5) (5) Common stock 1,225 $0 1,225 D
Explanation of Responses:
1. Received in exchange for shares of Harden Healthcare Holdings, Inc. common stock in connection with the merger of Harden Healthcare Holdings, Inc. into a wholly owned subsidiary of the Issuer (the "Merger"). On the effective date of the Merger, the closing price of the Issuer's common stock was $11.91 per share.
2. These shares are held indirectly through Hicks Healthcare, LP, of which Mr. Hicks is manager of its general partner. Mr. Hicks disclaims beneficial ownership of these shares except to the extent of his pecuniary interest therein.
3. These shares are held indirectly through Harden Healthcare Texas, LLC, of which Mr. Hicks is an owner. Mr. Hicks disclaims beneficial ownership of these shares except to the extent of his pecuniary interest therein.
4. 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.
5. The common stock units are convertible upon the date of termination of service to the Issuer.
Remarks:
David Brown, by power of attorney 10/22/2013
** Signature of Reporting Person 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.
Persons who respond to the collection of information contained in this form are not required to respond unless the form displays a currently valid OMB Number.