VistaCare, Inc. Common Stock Certificate

Summary

This document is a stock certificate issued by VistaCare, Inc., a Delaware corporation, representing ownership of fully paid and non-assessable shares of its common stock. The certificate can be transferred on the corporation's books by the holder or an authorized attorney upon proper endorsement and surrender. It is subject to the company's Certificate of Incorporation and Bylaws. The certificate must be countersigned by the transfer agent to be valid. If lost or destroyed, a replacement may require a bond of indemnity.

EX-4.01 5 p66849exv4w01.txt EX-4.01 Exhibit 4.01 [VISTACARE LOGO] VistaCare, Inc. INCORPORATED UNDER THE LAWS OF THE STATE OF DELAWARE Number Shares VC COMMON STOCK CUSIP THIS CERTIFICATE IS TRANSFERABLE SEE REVERSE FOR IN CANTON, MA, JERSEY CITY, NJ CERTAIN DEFINITIONS AND NEW YORK CITY, NY THIS CERTIFIES that is the owner of FULLY PAID AND NON-ASSESSABLE SHARES OF COMMON STOCK OF VistaCare, Inc. transferable on the books of the Corporation by the holder hereof in person or by duly authorized attorney upon surrender of this certificate properly endorsed. This certificate and the shares represented hereby are issued and shall be held subject to all the provisions of the Certificate of Incorporation and Bylaws of the Corporation as from time to time amended to all of which the holder by acceptance hereof assents. This certificate is not valid until countersigned and (B)registered by the Transfer Agent and Registrar. Witness the facsimile seal of the Corporation and the facsimile signatures of its duly authorized officers. [SEAL] Dated: /s/ Stephen Lewis /s/ Richard R. Slager ----------------------------- -------------------------------- Secretary President and Chief Executive Officer COUNTERSIGNED AND REGISTERED: EquiServe Trust Company, N.A. TRANSFER AGENT AND REGISTRAR By AUTHORIZED OFFICER VISTACARE, INC. The Corporation will furnish without charge to each stockholder who so requests the powers, designations, preferences and relative, participating, optional, or other special rights of each class of stock or series thereof of the Corporation, and the qualifications, limitations or restrictions of such preferences and/or rights. Such request may be made to the Corporation or the transfer agent. The following abbreviations, when used in the inscription on the face of this certificate, shall be construed as though they were written out in full according to applicable laws or regulations: TEN COM -as tenants in common UNIF GIFT MIN ACT-_______Custodian_______ TEN ENT -as tenants by the entireties (Cust) (Minor) IT TEN -as joint tenants with right under Uniform Gifts to Minors of survivorship and not as Act _________________________ tenants in common (State) UNIF TRANS MIN ACT-_______Custodian_______ (Cust) (Minor) under Uniform Transfers to Minors Act _________________________ (State) Additional abbreviations may also be used though not in the above list. For value received, _____________________________ hereby sell, assign and transfer unto PLEASE INSERT SOCIAL SECURITY OR OTHER IDENTIFYING NUMBER OF ASSIGNEE ________________________________________________________________________________ ________________________________________________________________________________ Please print or typewrite name and address including postal zip code of assignee ________________________________________________________________________________ ________________________________________________________________________________ _________________________________________________________________________ Shares of the Capital Stock represented by the within Certificate, and do hereby irrevocably constitute and appoint ________________________________________________________________________________ Attorney to transfer the said stock on the books of the within-named Corporation with full power of substitution in the premises. Dated, ____________________ _____________________________________________________ NOTICE: THE SIGNATURE(S) TO THIS ASSIGNMENT MUST CORRESPOND WITH THE NAME(S) AS WRITTEN UPON THE FACE OF THE CERTIFICATE IN EVERY PARTICULAR, WITHOUT ALTERATION OR ENLARGEMENT OR ANY CHANGE WHATEVER. SIGNATURE(S) GUARANTEED: _____________________________________________________ THE SIGNATURE(S) MUST BE GUARANTEED BY AN ELIGIBLE GUARANTOR INSTITUTION (BANKS, STOCKBROKERS, SAVINGS AND LOAN ASSOCIATIONS AND CREDIT UNIONS WITH MEMBERSHIP IN AN APPROVED SIGNATURE GUARANTEE MEDALLION PROGRAM), PURSUANT TO S.E.C. RULE 17 Ad-18. KEEP THIS CERTIFICATE IN A SAFE PLACE. IF IT IS LOST, STOLEN, MUTILATED OR DESTROYED, THE CORPORATION MAY REQUIRE A BOND OF INDEMNITY AS A CONDITION TO THE ISSUANCE OF A REPLACEMENT CERTIFICATE. AMERICAN BANK NOTE COMPANY 55TH STREET AT SANSOM STREET PHILADELPHIA, PA 19139 ###-###-#### SALES: DAN BURNS: 617 ###-###-#### /NET/BANKNOTE/HOME 12/V/VistaCare H 74140 PRODUCTION COORDINATOR: JOCELYN WHITAKER: 215 ###-###-#### PROOF OF AUGUST 6, 2002 VISTACARE, INC. H 74140 BACK OPERATOR: lr NEW