HALIFAX STAFFING INC: Form 990, tax year 2009

View the entire original 990 at ProPublica ↗

Organization
HALIFAX STAFFING INC (EIN 59-3222299)
Tax period
2009-10-01 to 2010-09-30
Filed
2011-08-15
IRS object ID
201142279349304429
Schema version
2009v1.7
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2011-08-15T16:47:27-05:00Timestamp
Tax Period End Date2010-09-30TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1OLIVARI & ASSOCIATES CPA'SBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1141 SAGE BRUSH TRAIL SUITE DAddressLine1
CityORMOND BEACHCity
StateFLState
ZIP Code32174ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2009-10-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN593222299EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1HALIFAX STAFFING INCBusinessNameLine1
FieldValueIRS element (for citing)
Name ControlHALINameControl
Phone3862264560Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line1303 NORTH CLYDE MORRIS BLVDAddressLine1
CityDAYTONA BEACHCity
StateFLState
ZIP Code32114ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameKATHLEEN DULKOName
TitleCONTROLLERTitle
Phone3862264560Phone
Date Signed2011-08-15DateSigned

Preparer Preparer

FieldValueIRS element (for citing)
NameMARY GREENLEESName
Phone3866720775Phone
Date Prepared2011-08-15DatePrepared
FieldValueIRS element (for citing)
Tax Year2009TaxYear
Build TS2016-02-24 21:20:13ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonKATHLEEN DULKONameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line1303 NORTH CLYDE MORRIS BLVDAddressLine1
CityDAYTONA BEACHCity
StateFLState
ZIP Code32114ZIPCode
FieldValueIRS element (for citing)
Gross Receipts217487227GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Organization501cXOrganization501c
Web SiteN/AWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1994YearFormation
State Legal DomicileFLStateLegalDomicile
Activity Or Mission DescriptionHALIFAX STAFFING PROVIDES PAYROLL AND PAYROLL RELATED FUNCTIONS ON BEHALF OF ITS SUPPORTED ORGANIZATION, HALIFAX HOSPITAL MEDICAL CENTER D/B/A HALIFAX HEALTH (59-6001217)ActivityOrMissionDescription
Nbr Voting Members Governing Body6NbrVotingMembersGoverningBody
Nbr Independent Voting Members6NbrIndependentVotingMembers
Total Nbr Employees3722TotalNbrEmployees
Total Gross UBI0TotalGrossUBI
Contributions Grants Current Year0ContributionsGrantsCurrentYear
Program Service Revenue Prior Year217801507ProgramServiceRevenuePriorYear
Program Service Revenue CY217487227ProgramServiceRevenueCY
Investment Income Current Year0InvestmentIncomeCurrentYear
Other Revenue Current Year0OtherRevenueCurrentYear
Total Revenue Prior Year217801507TotalRevenuePriorYear
Total Revenue Current Year217487227TotalRevenueCurrentYear
Grants And Similar Amnts CY0GrantsAndSimilarAmntsCY
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year217801507SalariesEtcPriorYear
Salaries Etc Current Year217487227SalariesEtcCurrentYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expenses Current Year0OtherExpensesCurrentYear
Total Expenses Prior Year217801507TotalExpensesPriorYear
Total Expenses Current Year217487227TotalExpensesCurrentYear
Revenues Less Expenses CY0RevenuesLessExpensesCY
Total Assets EOY0TotalAssetsEOY
Total Liabilities EOY0TotalLiabilitiesEOY
Net Assets Or Fund Balances EOY0NetAssetsOrFundBalancesEOY
Mission DescriptionHALIFAX STAFFING PROVIDES PAYROLL AND PAYROLL RELATED FUNCTIONS ON BEHALF OF ITS SUPPORTED ORGANIZATION, HALIFAX HOSPITAL MEDICAL CENTER D/B/A HALIFAX HEALTH (59-6001217)MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense217487227Expense
DescriptionPROVIDE PAYROLL AND STAFFING FOR SUPPORTED ORGANIZATION, HALIFAX HOSPITAL MEDICAL CENTER.Description
Total Program Service Expense217487227TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredfalseScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiesfalseLobbyingActivities
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentsfalseTermOrPermanentEndowments
Balance Sheet Amounts ReportedfalseBalanceSheetAmountsReported
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmtfalseConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitalfalseHospital
Grants To OrganizationsfalseGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntityfalseRelatedOrgControlledEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredfalseScheduleORequired
Number Forms Transmitted With10960NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees3722NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncomefalseUnrelatedBusinessIncome
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Nbr Voting Governing Body Members6NbrVotingGoverningBodyMembers
Number Independent Voting Members6NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiesfalseDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholdersfalseMembersOrStockholders
Election Of Board MembersfalseElectionOfBoardMembers
Decisions Subject To ApprovalfalseDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodyfalseForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOtrueCompensationProcessCEO
Compensation Process OthertrueCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonKATHLEEN DULKONamePerson
Telephone Number3862264560TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1303 N CLYDE MORRIS BLVDAddressLine1
CityDAYTONA BEACHCity
StateFLState
ZIP Code32114ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (17 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekIndividual Trustee Or DirectorIndividualTrusteeOrDirectorReportable Comp From OrganizationReportableCompFromOrganizationReportable Comp From Related OrgsReportableCompFromRelatedOrgsOther CompensationOtherCompensationOfficerOfficerHighest Compensated EmployeeHighestCompensatedEmployee
GLENN RITCHEY
CHAIRMAN1.00X000
BLAINE LANSBERRY
TREASURER1.00X000
ART GILES
SECRETARY1.00X000
PAM CARBIENER MD
MEMBER1.00X000
JOHN P JOHNSON
MEMBER1.00X000
KAREN JANS
SECRETARY1.00X000
JEFFREY FEASEL
CEO40.00540461033000X
DONALD STONER
CHIEF MEDICA40.00316814022000X
ERIC PEBURN
CHIEF FINANC40.00283925046058X
LORI MYERS
CHIEF NURSIN40.00258042044354X
LORI DELONE
CHIEF INFORM40.00191396020701X
ALBERT ALEXANDER
CHIEF HUMAN40.00155116016972X
FEDERICO VINAS
PHYSICIAN40.001920372019174X
ROHIT KHANNA
PHYSICIAN40.0015058870773X
WILLIAM KUHN
PHYSICIAN40.001110162049413X
ABDUL SORATHIA
PHYSICIAN40.00537883050481X
BRAD FACTOR
40.00494915039474X
FieldValueIRS element (for citing)
Total Reportable Comp From Org7314973TotalReportableCompFromOrg
Total Other Compensation342400TotalOtherCompensation
Number Individuals GT100 K203NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Program Service Revenue ProgramServiceRevenue

FieldValueIRS element (for citing)
DescriptionEXPENSE REIMBURSEMENTDescription
Total Revenue Column217487227TotalRevenueColumn
Related Or Exempt Function Income217487227RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Program Service Revenue217487227TotalProgramServiceRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column217487227TotalRevenueColumn
Related Or Exempt Function Income217487227RelatedOrExemptFunctionIncome

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total166962329Total
Program Services166962329ProgramServices

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total19377104Total
Program Services19377104ProgramServices

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total20200368Total
Program Services20200368ProgramServices

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total10947426Total
Program Services10947426ProgramServices

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total217487227Total
Program Services217487227ProgramServices
Management And General0ManagementAndGeneral
Fundraising0Fundraising

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY
FieldValueIRS element (for citing)
Method Of Accounting CashXMethodOfAccountingCash
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedfalseFSAudited
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Supporting Organization509a3XSupportingOrganization509a3
Supporting Org509a3 Type1XSupportingOrg509a3Type1
Certification CheckboxXCertificationCheckbox
Contrib By Controlling IndividualfalseContribByControllingIndividual
Contribution By Related PartyfalseContributionByRelatedParty
Contrib By35 Controlled EntityfalseContribBy35ControlledEntity

Supported Org Information SupportedOrgInformation

Name Name

FieldValueIRS element (for citing)
Business Name Line1HALIFAX HOSPITAL MEDICAL CENTER DBA HALIFAX HEALTHBusinessNameLine1
FieldValueIRS element (for citing)
EIN596001217EIN
Type Of Organization6TypeOfOrganization
Listed In Governing DoctrueListedInGoverningDoc
Supported Organization NotifiedtrueSupportedOrganizationNotified
Organized In UStrueOrganizedInUS
Amount$0Amount
FieldValueIRS element (for citing)
Total Number Of Supported Orgs1TotalNumberOfSupportedOrgs

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Board Or Committee ApprovalXBoardOrCommitteeApproval
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlanfalseSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentsfalseAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (11 entries)

Base Compensation Filing OrgBaseCompensationFilingOrgDeferred Comp Filing OrgDeferredCompFilingOrgTotal Compensation Filing OrgTotalCompensationFilingOrgBonus Filing OrgBonusFilingOrgNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg
JEFFREY FEASEL
54046133000573461
DONALD STONER
2492982200033881467516
ERIC PEBURN
2839253300032998313058
LORI MYERS
25804244000302396354
LORI DELONE
191396165002120974201
ALBERT ALEXANDER
15511616500172088472
FEDERICO VINAS
36752713000193954615528456174
ROHIT KHANNA
45492715066601050960773
WILLIAM KUHN
4204874400011595756896755413
ABDUL SORATHIA
84532440005883644533516481
BRAD FACTOR
210542330005343892843736474

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (5 entries)

IdentifierIdentifierReturn ReferenceReturnReferenceExplanationExplanation
ORGANIZATION'S PROCESS USED TO REVIEW FORM 990FORM 990, PAGE 6, PART VI, LINE 11NO REVIEW WAS OR WILL BE CONDUCTED.
ENFORCEMENT OF CONFLICTS POLICYFORM 990, PAGE 6, PART VI, LINE 12CTHE ORGANIZATION FOLLOWS THE POLICIES AND PROCEDURES OF ITS SUPPORTED ORGANIZATION, HALIFAX HEALTH.
COMPENSATION PROCESS FOR TOP OFFICIALFORM 990, PAGE 6, PART VI, LINE 15ATHE ORGANIZATION FOLLOWS THE POLICIES AND PROCEDURES OF ITS SUPPORTED ORGANIZATION, HALIFAX HEALTH.
COMPENSATION PROCESS FOR OFFICERSFORM 990, PAGE 6, PART VI, LINE 15BTHE ORGANIZATION FOLLOWS THE POLICIES AND PROCEDURES OF ITS SUPPORTED ORGANIZATION, HALIFAX HEALTH.
GOVERNING DOCUMENTS DISCLOSURE EXPLANATIONFORM 990, PAGE 6, PART VI, LINE 19UPON REQUEST

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII

Name Of Disregarded Entity NameOfDisregardedEntity

FieldValueIRS element (for citing)
Business Name Line1HALIFAX HOSPITAL MEDICAL CENTERBusinessNameLine1
Business Name Line2D/B/A HALIFAX HEALTHBusinessNameLine2

Address US AddressUS

FieldValueIRS element (for citing)
Address Line1303 N CLYDE MORRIS BLVDAddressLine1
CityDAYTONA BEACHCity
StateFLState
ZIP Code32114ZIPCode
FieldValueIRS element (for citing)
EIN596001217EIN
Primary ActivitiesHOSPITALPrimaryActivities
Legal Domicile StateFLLegalDomicileState
Exempt Code Section170ExemptCodeSection
Public Charity Status6PublicCharityStatus
Direct Controlling Entity NAN/ADirectControllingEntityNA
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgfalseGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgfalseGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgsfalsePerformOfServicesByOtherOrgs
Sharing Of FacilitiesfalseSharingOfFacilities
Sharing Of Paid EmployeestrueSharingOfPaidEmployees
Reimbursement Paid To Other OrgfalseReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable

Name Of Other Organization NameOfOtherOrganization

FieldValueIRS element (for citing)
Business Name Line1HALIFAX HEALTHBusinessNameLine1
FieldValueIRS element (for citing)
Transaction TypeNTransactionType
Amount Involved217487227AmountInvolved

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