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  5. HALIFAX ANESTHESIOLOGY ASSOCIATES, P.A.

HALIFAX ANESTHESIOLOGY ASSOCIATES, P.A.

Company Details

Entity Name: HALIFAX ANESTHESIOLOGY ASSOCIATES, P.A.
Jurisdiction: FLORIDA
Filing Type: Domestic Profit
Status: Inactive
Date Filed: 30 Jun 2006 (19 years ago)
Date of dissolution: 07 Apr 2019 (6 years ago)
Last Event: VOLUNTARY DISSOLUTION
Event Date Filed: 07 Apr 2019 (6 years ago)
Document Number: P06000088544
FEI/EIN Number 205141183
Address: 6117 Oxbow Bend Ln, Port Orange, FL, 32128, US
Mail Address: PO Box 9652, DAYTONA BEACH, FL, 32120, US
ZIP code: 32128
County: Volusia
Place of Formation: FLORIDA

form 5500

Plan Name Plan Year EIN/PN Received Sponsor Total number of participants
HALIFAX ANESTHESIOLOGY ASSOCIATES 401(K) 2015 205141183 2016-10-04 HALIFAX ANESTHESIOLOGY ASSOCIATES, P.A. 1
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-07-01
Business code 621111
Sponsor’s telephone number 3862581375
Plan sponsor’s address 311 NORTH CLYDE MORRIS BLVD., SUITE, DAYTONA BEACH, FL, 32114

Plan administrator’s name and address
Administrator’s EIN 205141183
Plan administrator’s name HALIFAX ANESTHESIOLOGY ASSOCIATES, P.A.
Plan administrator’s address 311 NORTH CLYDE MORRIS BLVD., SUITE, DAYTONA BEACH, FL, 32114
Administrator’s telephone number 3862581375
HALIFAX ANESTHESIOLOGY ASSOCIATES 401(K) 2015 205141183 2016-10-04 HALIFAX ANESTHESIOLOGY ASSOCIATES, P.A. 36
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-07-01
Business code 621111
Sponsor’s telephone number 3862581375
Plan sponsor’s address 311 NORTH CLYDE MORRIS BLVD., SUITE, DAYTONA BEACH, FL, 32114

Plan administrator’s name and address
Administrator’s EIN 205141183
Plan administrator’s name HALIFAX ANESTHESIOLOGY ASSOCIATES, P.A.
Plan administrator’s address 311 NORTH CLYDE MORRIS BLVD., SUITE, DAYTONA BEACH, FL, 32114
Administrator’s telephone number 3862581375
HALIFAX ANESTHESIOLOGY ASSOCIATES 401(K) 2014 205141183 2015-10-14 HALIFAX ANESTHESIOLOGY ASSOCIATES, P.A. 38
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-07-01
Business code 621111
Sponsor’s telephone number 3862581375
Plan sponsor’s address 311 NORTH CLYDE MORRIS BLVD., SUITE, DAYTONA BEACH, FL, 32114

Plan administrator’s name and address
Administrator’s EIN 205141183
Plan administrator’s name HALIFAX ANESTHESIOLOGY ASSOCIATES, P.A.
Plan administrator’s address 311 NORTH CLYDE MORRIS BLVD., SUITE, DAYTONA BEACH, FL, 32114
Administrator’s telephone number 3862581375

Signature of
Role Plan administrator
Date 2015-10-14
Name of individual signing DERRICK PAYNE
Valid signature Filed with authorized/valid electronic signature
HALIFAX ANESTHESIOLOGY ASSOCIATES 401(K) 2013 205141183 2014-10-14 HALIFAX ANESTHESIOLOGY ASSOCIATES, P.A. 40
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-07-01
Business code 621111
Sponsor’s telephone number 3862581375
Plan sponsor’s address 311 NORTH CLYDE MORRIS BLVD., SUITE, DAYTONA BEACH, FL, 32114

Plan administrator’s name and address
Administrator’s EIN 205141183
Plan administrator’s name HALIFAX ANESTHESIOLOGY ASSOCIATES, P.A.
Plan administrator’s address 311 NORTH CLYDE MORRIS BLVD., SUITE, DAYTONA BEACH, FL, 32114
Administrator’s telephone number 3862581375

Signature of
Role Plan administrator
Date 2014-10-14
Name of individual signing DERRICK PAYNE
Valid signature Filed with authorized/valid electronic signature
HALIFAX ANESTHESIOLOGY ASSOCIATES 401(K) 2012 205141183 2013-08-05 HALIFAX ANESTHESIOLOGY ASSOCIATES, P.A. 38
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-07-01
Business code 621111
Sponsor’s telephone number 3862581375
Plan sponsor’s address 311 NORTH CLYDE MORRIS BLVD., SUITE, DAYTONA BEACH, FL, 32114

Plan administrator’s name and address
Administrator’s EIN 205141183
Plan administrator’s name HALIFAX ANESTHESIOLOGY ASSOCIATES, P.A.
Plan administrator’s address 311 NORTH CLYDE MORRIS BLVD., SUITE, DAYTONA BEACH, FL, 32114
Administrator’s telephone number 3862581375

Signature of
Role Plan administrator
Date 2013-08-05
Name of individual signing DERRICK PAYNE
Valid signature Filed with authorized/valid electronic signature
HALIFAX ANESTHESIOLOGY ASSOCIATES 401(K) 2011 205141183 2012-08-03 HALIFAX ANESTHESIOLOGY ASSOCIATES, P.A. 42
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-07-01
Business code 621111
Sponsor’s telephone number 3862581375
Plan sponsor’s address 311 NORTH CLYDE MORRIS BLVD., SUITE, DAYTONA BEACH, FL, 32114

Plan administrator’s name and address
Administrator’s EIN 205141183
Plan administrator’s name HALIFAX ANESTHESIOLOGY ASSOCIATES, P.A.
Plan administrator’s address 311 NORTH CLYDE MORRIS BLVD., SUITE, DAYTONA BEACH, FL, 32114
Administrator’s telephone number 3862581375

Signature of
Role Plan administrator
Date 2012-08-03
Name of individual signing DERRICK PAYNE
Valid signature Filed with authorized/valid electronic signature
HALIFAX ANESTHESIOLOGY ASSOCIATES 401(K) 2010 205141183 2011-10-06 HALIFAX ANESTHESIOLOGY ASSOCIATES, P.A. 52
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-07-01
Business code 621111
Sponsor’s telephone number 3862581375
Plan sponsor’s address 311 NORTH CLYDE MORRIS BLVD., SUITE, DAYTONA BEACH, FL, 32114

Plan administrator’s name and address
Administrator’s EIN 205141183
Plan administrator’s name HALIFAX ANESTHESIOLOGY ASSOCIATES, P.A.
Plan administrator’s address 311 NORTH CLYDE MORRIS BLVD., SUITE, DAYTONA BEACH, FL, 32114
Administrator’s telephone number 3862581375

Signature of
Role Plan administrator
Date 2011-10-05
Name of individual signing DERRICK PAYNE
Valid signature Filed with authorized/valid electronic signature
HALIFAX ANESTHESIOLOGY ASSOCIATES 401(K) 2009 205141183 2010-10-13 HALIFAX ANESTHESIOLOGY ASSOCIATES, P.A. 58
File View Page
Three-digit plan number (PN) 001
Effective date of plan 2006-07-01
Business code 621111
Sponsor’s telephone number 3862581375
Plan sponsor’s address 311 NORTH CLYDE MORRIS BLVD., SUITE, DAYTONA BEACH, FL, 32114

Plan administrator’s name and address
Administrator’s EIN 205141183
Plan administrator’s name HALIFAX ANESTHESIOLOGY ASSOCIATES, P.A.
Plan administrator’s address 311 NORTH CLYDE MORRIS BLVD., SUITE, DAYTONA BEACH, FL, 32114
Administrator’s telephone number 3862581375

Signature of
Role Plan administrator
Date 2010-10-12
Name of individual signing DERRICK PAYNE
Valid signature Filed with authorized/valid electronic signature

Agent

Name Role Address
PAYNE DERRICK Agent 6117 Oxbow Bend Ln, Port Orange, FL, 32128

Vice President

Name Role Address
Silva Ebel Vice President 311 W CLYDE MORRIS BLVD, #524, DAYTONA BEACH, FL, 32114
PAYNE, DERRICK Vice President 311 W CLYDE MORRIS BLVD, #524, DAYTONA BEACH, FL, 32114
FOX, DAVID Vice President 311 W CLYDE MORRIS BLVD, #524, DAYTONA BEACH, FL, 32114
RACHMAN, NATHAN Vice President 311 W CLYDE MORRIS BLVD, #524, DAYTONA BEACH, FL, 32114
HOLLOWAY, DANIELA Vice President 311 W CLYDE MORRIS BLVD, #524, DAYTONA BEACH, FL, 32114

President

Name Role Address
LEV, DAVE, MD President 311 W CLYDE MORRIS BLVD, #524, DAYTONA BEACH, FL, 32114

Events

Event Type Filed Date Value Description
VOLUNTARY DISSOLUTION 2019-04-07 No data No data
CHANGE OF PRINCIPAL ADDRESS 2016-01-29 6117 Oxbow Bend Ln, Port Orange, FL 32128 No data
CHANGE OF MAILING ADDRESS 2016-01-29 6117 Oxbow Bend Ln, Port Orange, FL 32128 No data
REGISTERED AGENT ADDRESS CHANGED 2016-01-29 6117 Oxbow Bend Ln, Port Orange, FL 32128 No data
REGISTERED AGENT NAME CHANGED 2010-01-10 PAYNE, DERRICK No data
AMENDED AND RESTATEDARTICLES 2007-12-05 No data No data
AMENDMENT 2006-10-09 No data No data

Documents

Name Date
VOLUNTARY DISSOLUTION 2019-04-07
ANNUAL REPORT 2018-01-24
ANNUAL REPORT 2017-03-24
ANNUAL REPORT 2016-01-29
ANNUAL REPORT 2015-01-21
ANNUAL REPORT 2014-01-12
ANNUAL REPORT 2013-02-10
ANNUAL REPORT 2012-01-09
ANNUAL REPORT 2011-01-06
ANNUAL REPORT 2010-01-10

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Date of last update: 02 Feb 2025

Sources: Florida Department of State

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