Form990


Department of the TreasuryInternal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except private foundations)
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OMB No. 1545-0047
2021
Open to Public Inspection
A For the 2021 calendar year, or tax year beginning 07-01-2021 , and ending 06-30-2022
BCheck if applicable:
CName of organization
SHANDS JACKSONVILLE MEDICAL CENTER INC
 
 
Doing business as
UF HEALTH JACKSONVILLE
 
Number and street (or P.O. box if mail is not delivered to street address)
655 West 8th Street
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
Jacksonville, FL32209
D Employer identification number

59-2142859
E Telephone number

G Gross receipts $ 939,441,708
F Name and address of principal officer:
Russell Armistead
655 West 8th Street
Jacksonville,FL32209
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
UFHEALTHJAX.ORG
H(a)
Is this a group return for
subordinates?
H(b)
Are all subordinates
included?
If "No," attach a list. See instructions.
H(c)
Group exemption number MediumBullet  
K Form of organization:  
L Year of formation: 1981
M State of legal domicile: FL
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: The mission at Shands Jacksonville Medical Center, Inc. ("SJMC") is to heal, comfort, educate and discover. We dedicate our work to improving the lives of our patients, and the community, through innovations in healthcare.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 13
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 6
5 Total number of individuals employed in calendar year 2021 (Part V, line 2a) ...... 5 6,135
6 Total number of volunteers (estimate if necessary) ............. 6 302
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 51,712
b Net unrelated business taxable income from Form 990-T, Part I, line 11 ......... 7b 0
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 76,124,567 29,436,973
9 Program service revenue (Part VIII, line 2g) ......... 807,692,433 887,656,963
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 1,670,863 1,175,361
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 8,878,612 11,675,523
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12) 894,366,475 929,944,820
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 40,241,052 42,827,776
14 Benefits paid to or for members (Part IX, column (A), line 4).....   0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 374,115,448 430,223,447
16a Professional fundraising fees (Part IX, column (A), line 11e) .....   0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 409,958,167 453,654,243
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 824,314,667 926,705,466
19 Revenue less expenses. Subtract line 18 from line 12....... 70,051,808 3,239,354
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 750,537,278 1,030,307,966
21 Total liabilities (Part X, line 26)............. 475,423,266 752,641,075
22 Net assets or fund balances. Subtract line 21 from line 20..... 275,114,012 277,666,891
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
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Signature of officer Date
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Type or print name and title
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Print/Type preparer's name
Preparer's signature
Date
PTIN
Firm's name MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ..........
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y Form 990 (2021)
Form 990 (2021)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response or note to any line in this Part III..............
1
Briefly describe the organization’s mission: The mission at Shands Jacksonville Medical Center, Inc. is to heal, to comfort, to educate and to discover. We dedicate our work to improving life through innovations in healthcare. Our commitment is to provide constant attention to the needs of our patients, community and each other.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? .....................
If "Yes," describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program
services? ...........................
If "Yes," describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 738,383,274 including grants of $ 42,827,776 ) (Revenue $ 896,113,813 )
SHANDS JACKSONVILLE MEDICAL CENTER, INC. PROVIDES QUALITY HEALTHCARE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE OR ABILITY TO PAY. ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION AND STABILITY OF THE MEDICAL CENTER, IT IS RECOGNIZED THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE THESE ESSENTIAL MEDICAL SERVICES. OUR MISSION IS TO SERVE THE COMMUNITY WITH RESPECT BY PROVIDING HEALTHCARE SERVICES AND HEALTH EDUCATION. THE FOLLOWING SERVICES AND ACTIVITIES ARE PROVIDED WHERE THE NEED AND AN INDIVIDUAL'S INABILITY TO PAY COEXIST: FREE CARE AND/OR SUBSIDIZED CARE, CARE PROVIDED TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS AT OR BELOW COST AND HEALTH ACTIVITIES AND PROGRAMS TO SUPPORT THE COMMUNITY. (CONTINUED IN SCHEDULE O)
4b (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet738,383,274
Form 990 (2021)
Form 990 (2021)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors? See instructions. Click to see attachment...
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If "Yes," complete Schedule C, Part I.............
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part IIClick to see attachment.........
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Rev. Proc. 98-19? If "Yes," complete Schedule C, Part III..
5
 
 
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes," complete Schedule D, Part I.........................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part IIClick to see attachment....
7
Yes
 
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes,"
complete Schedule D, Part IIIClick to see attachment..............
8
Yes
 
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes," complete Schedule D, Part IV..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi endowments? If "Yes," complete Schedule D, Part V......
10
 
No
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X, as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10? If "Yes," complete
Schedule D, Part VI. Click to see attachment...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VII.......
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIII.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part IXClick to see attachment............
11d
Yes
 
e
Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part XClick to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part XClick to see attachment
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year? If "Yes," complete
Schedule D, Parts XI and XII......................
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States? .....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If “Yes,” complete Schedule F, Parts II and IV.....
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If “Yes,” complete Schedule F, Parts III and IV...
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If "Yes," complete Schedule G, Part I. See instructions. ....
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If "Yes," complete Schedule G, Part II............
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If "Yes," complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H....Click to see attachment
20a
Yes
 
b
If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return? Click to see attachment
20b
Yes
 
21
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or domestic government on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.....Click to see attachment
21
Yes
 
Form 990 (2021)
Form 990 (2021)
Page 4
Part IV
Checklist of Required Schedules (continued)
Yes
No
22
Did the organization report more than $5,000 of grants or other assistance to or for domestic individuals on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........
22
 
No
23
Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes," complete Schedule J....................... Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25a...............Click to see attachment
24a
Yes
 
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
No
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds? ...............
24c
 
No
d
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?...
24d
 
No
25a
Section 501(c)(3), 501(c)(4), and 501(c)(29) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes," complete Schedule L, Part I ....
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part I.......................
25b
 
No
26
Did the organization report any amount on Part X, line 5 or 22 for receivables from or payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons? If "Yes," complete Schedule L, Part II...........
26
 
No
27
Did the organization provide a grant or other assistance to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or employee thereof, a grant selection committee member, or to a 35% controlled entity (including an employee thereof) or family member of any of these persons?
If "Yes," complete
Schedule L, Part III.........................
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see the Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, key employee, creator or founder, or substantial contributor? If "Yes," complete Schedule L, Part IV......................
28a
 
No
b
A family member of any individual described in line 28a? If "Yes," complete Schedule L, Part IV.....
28b
 
No
c
A 35% controlled entity of one or more individuals and/or organizations described in line 28a or 28b? If "Yes," complete Schedule L, Part IV.....................
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes," complete Schedule M .................
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N, Part I
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete Schedule N, Part II........................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If "Yes," complete Schedule R, Part I............Click to see attachment
33
Yes
 
34
Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Part II, III, or IV, and Part V, line 1.........................Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part V, line 2 ...
35b
 
No
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If "Yes," complete Schedule R, Part V, line 2.............
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R, Part VI
37
 
No
38
Did the organization complete Schedule O and provide explanations on Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V...........
Yes
No
1a
Enter the number reported in box 3 of Form 1096. Enter -0- if not applicable ..
1a
68
b
Enter the number of Forms W-2G included on line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
Form 990 (2021)
Form 990 (2021)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance (continued)
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
6,135
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file. See instructions.
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No” to line 3b, provide an explanation in Schedule O...
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)? ..
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR).
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year? ..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If "Yes," to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions? ...
6a
 
No
b
If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible? ......................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor? ....................
7a
 
No
b
If "Yes," did the organization notify the donor of the value of the goods or services provided? .....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282? .........................
7c
 
No
d
If "Yes," indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required? ......................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C? ..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds. Did a donor advised fund maintained by the sponsoring organization have excess business holdings at any time during the year? ........
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the sponsoring organization make any taxable distributions under section 4966?........
9a
 
 
b
Did the sponsoring organization make a distribution to a donor, donor advisor, or related person?...
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources. (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If "Yes," enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state? .........
Note. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O..
14b
 
 
15
Is the organization subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or excess parachute payment(s) during the year? ....................
If "Yes," see the instructions and file Form 4720, Schedule N.
15
 
No
16
Is the organization an educational institution subject to the section 4968 excise tax on net investment income? ..
If "Yes," complete Form 4720, Schedule O.
16
 
No
17
Section 501(c)(21) organizations. Did the trust, any disqualified person, or mine operator engage in any activities that would result in the imposition of an excise tax under section 4951, 4952, or 4953? ..
If "Yes," complete Form 6069.
17
 
 
Form 990 (2021)
Form 990 (2021)
Page 6
Part VI
Governance, Management, and Disclosure. For each "Yes" response to lines 2 through 7b below, and for a "No" response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response or note to any line in this Part VI..............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year
1a
13
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent
1b
6
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
Yes
 
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? .
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .......................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If "Yes," provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe on Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If "No," go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe on Schedule O how this was done...................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line 15a or 15b, describe the process on Schedule O. See instructions.
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
 
No
b
If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
 
Section C. Disclosure
17
List the states with which a copy of this Form 990 is required to be filedMediumBullet
FL
18
Section 6104 requires an organization to make its Form 1023 (1024 or 1024-A, if applicable), 990, and 990-T (section 501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how) the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, address, and telephone number of the person who possesses the organization's books and records:
MediumBulletPatricia Rausch655 WEST 8TH STREET   JACKSONVILLE,FL32209 (904) 244-0411
Form 990 (2021)
Form 990 (2021)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response or note to any line in this Part VII..............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See the instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (box 5 of Form W-2, Form 1099-MISC, and/or box 1 of Form 1099-NEC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

See the instructions for the order in which to list the persons above.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(A)
Name and title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W-2/1099-MISC/1099-NEC) 		(E)
Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(1) David R Nelson
 
Chairman / SVP for Health Affairs at Univ of FL
 2.0
.................
48.0 		X   X       0 1,420,423 48,651
(2) Leon L Haley Jr MD
 
CEO / Dean of Univ of FL College of Medicine (thru July 2021)
 20.0
.................
30.0 		X   X       0 705,672 26,332
(3) Russell E Armistead Jr MBA
 
CEO (beginning Aug 2021)
 47.5
.................
2.5 		X   X       328,882 0 17,814
(4) Audrey Moran Esq
 
Director
 2.0
.................
2.0 		X           0 0 0
(5) Chandana Lall MD
 
Director / Professor of Radiology at Univ of FL
 2.0
.................
48.0 		X           0 704,945 24,726
(6) David Mann
 
Director
 0.5
.................
0.5 		X           0 0 0
(7) Elizabeth DeVos MD
 
Director
 0.5
.................
49.5 		X           0 293,393 44,508
(8) Kelly Gray-Eurom MD
 
Director / Chief Quality Officer
 2.0
.................
48.0 		X           0 397,212 36,314
(9) Kendall Spencer
 
Director
 0.5
.................
0.5 		X           0 0 0
(10) LaRae C Brown MD
 
Director
 2.0
.................
48.0 		X           0 417,198 36,700
(11) Leonard Brown Jr
 
Director
 0.5
.................
0.5 		X           0 0 0
(12) Linda R Edwards MD
 
Director
 0.5
.................
49.5 		X           0 397,817 44,569
(13) Marsha Powers
 
Director
 0.5
.................
0.5 		X           0 0 0
(14) Michelle M Boynton
 
Director (Partial Year)
 0.5
.................
0.5 		X           0 0 0
(15) Nathaniel P Ford Sr
 
Director
 0.5
.................
0.5 		X           0 0 0
(16) Dean Cocchi MBA
 
Treasurer / CFO
 47.5
.................
2.5 		    X       482,170 0 33,880
(17) John Clontz Esq
 
Asst. Secretary (beginning July 2021)
 49.5
.................
0.5 		    X       76,116 0 7,588
Form 990 (2021)
Form 990 (2021)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W-2/1099-MISC/1099-NEC) 		(E)
Reportable compensation from related organizations (W-2/1099-MISC/1099-NEC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(18) Jon DeBardeleben JD
 
Secretary (beg Jan 2022) / VP Senior Counsel
 47.5
.......................2.5 		    X       257,257 0 23,788
(19) Patricia Rausch
 
Assistant Treasurer / Controller
 49.5
.......................0.5 		    X       193,662 0 18,565
(20) Randall C Jenkins
 
Secretary (thru Jan 2022) / SVP of General Council of Univ of FL
 5.0
.......................45.0 		    X       0 656,084 50,216
(21) Robert Templin
 
Asst. Secretary
 49.5
.......................0.5 		    X       181,523 0 27,235
(22) Ann-Marie Knight
 
VP Comm Engage (Chief Diversity Officer)
 50.0
.......................0 		      X     232,920 0 27,843
(23) David Vukich MD
 
CMO / Dean for Hospital Affairs of Univ of FL
 2.0
.......................48.0 		      X     0 504,282 60,723
(24) Gregory Miller MBA
 
EVP COO
 40.0
.......................8.0 		      X     576,151 0 28,418
(25) Lesli A Ward
 
VP Chief HRO
 48.0
.......................2.0 		      X     334,647 0 34,890
(26) Patrice Jones
 
VP Chief Nursing Officer
 48.0
.......................0 		      X     376,067 0 26,832
(27) Rita James
 
VP of Ambulatory Services
 2.0
.......................48.0 		      X     0 224,289 12,763
(28) Thanh Hogan
 
VP Clinical Operations
 48.0
.......................0 		      X     315,356 0 22,835
(29) Wayne A Marshall
 
VP UFH North
 48.0
.......................0 		      X     329,350 0 33,743
(30) Jellie Acedo
 
Registered Nurse
 40.0
.......................0 		        X   306,502 0 27,925
(31) Jun Santos
 
Registered Nurse
 40.0
.......................0 		        X   319,511 0 33,447
(32) Michael Gill
 
Registered Nurse
 40.0
.......................0 		        X   268,027 0 32,251
(33) Michele L Worley
 
Coord Perioperative Serv Line
 40.0
.......................0 		        X   267,212 0 28,720
(34) Rhodora R Digo
 
Registered Nurse
 40.0
.......................0 		        X   268,798 0 32,528
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)...........MediumBullet 5,114,150 5,721,316 843,804
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organization MediumBullet667
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If "Yes," complete Schedule J for such individual ..............
3
 
No
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If "Yes," complete Schedule J for such
individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If "Yes," complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
UF PR HOUSESTAFF

653-1 West 8th Street
JACKSONVILLE,FL32209 		MEDICAL STAFFING SERVICES 24,878,970
MORRISONS MANAGEMENT SPECIALISTS

PO BOX 102289
ATLANTA,GA303682289 		FOOD SERVICES 13,048,797
CROTHALL HEALTHCARE FKA PROFESSIONAL SERVICES

13028 COLLECTION CENTER DRIVE
CHICAGO,IL60693 		HOUSEKEEPING AND OTHER MANAGEMENT SERVICES 11,563,254
GENESISCARE USA OF FLORIDA LLC

2270 COLONIAL BOULEVARD
FORT MYERS,FL33907 		Medical Staffing Services 10,944,192
SODEXO INC & AFFILIATES

PO BOX 360170
PITTSBURGH,PA152516170 		FOOD SERVICES 10,647,276
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet90
Form 990 (2021)
Form 990 (2021)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII.............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512 - 514
Contributions, Gifts, Grants, and OtherAmt Similar Amounts 1a Federated campaigns..1a 1,725
b Membership dues..1b  
c Fundraising events..1c  
d Related organizations1d 288,130
e Government grants (contributions)1e 23,284,619
f All other contributions, gifts, grants, and similar amounts not included above1f 5,862,499
g Noncash contributions included in lines 1a - 1f:$ 1g  
h Total. Add lines 1a-1f.......MediumBullet 29,436,973
Program Service RevenueAmt Business Code
2a PATIENT SERVICE REVENUE 622110 887,062,060 887,062,060    
b Ancillary and Contract Services 622110 594,903 594,903    
c
d
e
f All other program service revenue. 0 0 0 0
g Total. Add lines 2a–2f .....MediumBullet 887,656,963
OtherAmtRevenueAmt 3 Investment income (including dividends, interest, and othersimilar amounts) ......MediumBullet 1,013,081     1,013,081
4 Income from investment of tax-exempt bond proceedsMediumBullet        
5 Royalties...........MediumBullet        
(ii) Personal (i) Real
6a Gross rents   2,469,930 6a
b Less: rental expenses   0 6b
c Rental income or (loss) 0 2,469,930 6c
d Net rental income or (loss).......MediumBullet 2,469,930     2,469,930
(ii) Other (i) Securities
7a Gross amount from sales of assets other than inventory 9,237,860   7a
b Less: cost or other basis and sales expenses 9,075,580   7b
c Gain or (loss) 162,280 0 7c
d Net gain or (loss).........MediumBullet 162,280     162,280
8a Gross income from fundraising events (not including $   of contributions reported on line 1c). See Part IV, line 18 ....
8a  
b Less: direct expenses ... 8b  
c Net income or (loss) from fundraising events..MediumBullet      
9a Gross income from gaming activities.
See Part IV, line 19 ...
9a  
b Less: direct expenses ... 9b  
c Net income or (loss) from gaming activities..MediumBullet        
10a Gross sales of inventory, less
returns and allowances ..
10a 596,273
b Less: cost of goods sold .. 10b 421,308
c Net income or (loss) from sales of inventory..MediumBullet 174,965     174,965
Business Code Miscellaneous Revenue
11a LABORATORY REVENUE 621500 51,712   51,712  
b Affiliate IT Services 900099 112,273 112,273    
c PARKING REVENUE 812930 522,066     522,066
d All other revenue .... 8,344,577 8,344,577 0 0
e Total. Add lines 11a–11d ...... MediumBullet 9,030,628
12 Total revenue. See instructions.....MediumBullet 929,944,820 896,113,813 51,712 4,342,322
Form 990 (2021)
Form 990 (2021)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response or note to any line in this Part IX..............
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising
expenses
1 Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 .... 42,827,776 42,827,776
2 Grants and other assistance to domestic individuals. See Part IV, line 22 ...........    
3 Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............    
4 Benefits paid to or for members .......    
5 Compensation of current officers, directors, trustees, and key employees ........... 4,737,176   4,737,176  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........        
7 Other salaries and wages........ 348,164,970 286,165,057 61,999,913  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 10,697,081 10,654,914 42,167  
9 Other employee benefits ....... 41,624,738 41,429,518 195,220  
10 Payroll taxes ........... 24,999,482 20,292,875 4,706,607  
11 Fees for services (non-employees):        
a Management ......        
b Legal ......... 376,259 3,357 372,902  
c Accounting ........... 202,500   202,500  
d Lobbying ........... 84,684   84,684  
e Professional fundraising services. See Part IV, line 17    
f Investment management fees ......        
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) 135,030,700 54,912,009 80,118,691 0
12 Advertising and promotion .... 3,065,891 3,007,043 58,848  
13 Office expenses ....... 5,357,592 3,152,749 2,204,843  
14 Information technology ...... 11,206,410 7,620,359 3,586,051  
15 Royalties ..        
16 Occupancy ........... 37,629,013 25,587,729 12,041,284  
17 Travel ............ 500,905 328,869 172,036  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials .        
19 Conferences, conventions, and meetings .... 324,232 189,375 134,857  
20 Interest ........... 11,516,075 7,830,931 3,685,144  
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization .. 39,691,454 26,990,189 12,701,265  
23 Insurance ... 3,920,268 3,735,351 184,917  
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a AHCA ASSESSMENT 6,857,517 6,857,517    
b MEDICAL SUPPLIES 188,981,729 188,494,732 486,997  
c Postage and Courier 278,046 46,682 231,364  
d RECRUITING EXPENSE 4,441,106 4,416,539 24,567  
e All other expenses 4,189,862 3,839,703 350,159 0
25 Total functional expenses. Add lines 1 through 24e 926,705,466 738,383,274 188,322,192 0
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2021)
Form 990 (2021)
Page 11
Part X
Balance Sheet
Check if Schedule O contains a response or note to any line in this Part IX..............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash–non-interest-bearing ........ 150,525,812 1 347,874,019
2 Savings and temporary cash investments ......... 80,677,077 2 24,473,743
3 Pledges and grants receivable, net ...... 9,456,598 3 28,867,242
4 Accounts receivable, net ............. 125,685,896 4 151,438,368
5 Loans and other receivables from any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
0 5 0
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
0 6 0
7 Notes and loans receivable, net ...........   7  
8 Inventories for sale or use ............ 18,233,027 8 19,911,342
9 Prepaid expenses and deferred charges ...... 2,876,872 9 5,822,425
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 793,986,888
b Less: accumulated depreciation 10b 487,855,562 234,273,588 10c 306,131,326
11 Investments—publicly traded securities .   11  
12 Investments—other securities. See Part IV, line 11 ..... 0 12  
13 Investments—program-related. See Part IV, line 11 .. 0 13  
14 Intangible assets ...............   14  
15 Other assets. See Part IV, line 11 ........... 128,808,408 15 145,789,501
16 Total assets. Add lines 1 through 15 (must equal line 33)... 750,537,278 16 1,030,307,966
Liabilities 17 Accounts payable and accrued expenses ..... 170,923,764 17 186,049,351
18 Grants payable ...   18  
19 Deferred revenue ......... 5,541,115 19 2,860,249
20 Tax-exempt bond liabilities ......... 204,540,011 20 437,592,655
21 Escrow or custodial account liability. Complete Part IV of Schedule D   21  
22 Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
0 22 0
23 Secured mortgages and notes payable to unrelated third parties .. 13,588,482 23 13,469,054
24 Unsecured notes and loans payable to unrelated third parties ..   24  
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17 - 24). Complete Part X of Schedule D 80,829,894 25 112,669,766
26 Total liabilities. Add lines 17 through 25.. 475,423,266 26 752,641,075
Net Assets or Fund Balance Organizations that follow FASB ASC 958, check here MediumBullet and complete lines 27, 28, 32, and 33.
27 Net assets without donor restrictions .......... 271,544,660 27 274,097,539
28 Net assets with donor restrictions ........... 3,569,352 28 3,569,352
Organizations that do not follow FASB ASC 958, check here MediumBullet and complete lines 29 through 33.
29 Capital stock or trust principal, or current funds .....   29  
30 Paid-in or capital surplus, or land, building or equipment fund ...   30  
31 Retained earnings, endowment, accumulated income, or other funds   31  
32 Total net assets or fund balances ........... 275,114,012 32 277,666,891
33 Total liabilities and net assets/fund balances ........ 750,537,278 33 1,030,307,966
Form 990 (2021)
Form 990 (2021)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response or note to any line in this Part XI..............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
929,944,820
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
926,705,466
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
3,239,354
4
Net assets or fund balances at beginning of year (must equal Part X, line 32, column (A)) ..
4
275,114,012
5
Net unrealized gains (losses) on investments ...............
5
-686,475
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
0
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 32, column (B))
10
277,666,891
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response or note to any line in this Part XII.............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain on
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If "Yes," to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?
3a
Yes
 
b
If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits.
3b
Yes
 
Form 990 (2021)
Form 990 (2021)
Additional Data


Software ID: 21014044
Software Version: 2021v4.2
Form 990, Special Condition Description:
Special Condition Description
SCHEDULE A
(Form 990)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ.
right arrow Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2021
Open to Public
Inspection
Name of the organization
SHANDS JACKSONVILLE MEDICAL CENTER INC
 
Employer identification number

59-2142859
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 12, check only one box.)
1
2
3
4
5
6
7
8
9
10
11
12
a
b
c
d
e
f
Enter the number of supported organizations ...............................  
g
Provide the following information about the supported organization(s).
(i) Name of supported organization (ii) EIN (iii) Type of organization (described on lines 1- 10 above (see instructions)) (iv) Is the organization listed in your governing document? (v) Amount of monetary support (see instructions) (vi) Amount of other support (see instructions)
Yes No
Total
 
   
For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.
Cat. No. 11285F
Schedule A (Form 990) 2021

Schedule A (Form 990) 2021
Page 2
Part II
Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization failed to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2017 (b) 2018 (c) 2019 (d) 2020 (e) 2021 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..            
2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf....            
3 The value of services or facilities furnished by a governmental unit to the organization without charge..            
4 Total. Add lines 1 through 3            
5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f) ..  
6 Public support. Subtract line 5 from line 4.  
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2017 (b) 2018 (c) 2019 (d) 2020 (e) 2021 (f) Total
7 Amounts from line 4..            
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...            
9 Net income from unrelated business activities, whether or not the business is regularly carried on..            
10 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.)..            
11 Total support. Add lines 7 through 10  
12
12
 
13
First 5 years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here ........................................right arrow
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow
Schedule A (Form 990) 2021

Schedule A (Form 990) 2021
Page 3
Part III
Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2017 (b) 2018 (c) 2019 (d) 2020 (e) 2021 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .            
2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose            
3 Gross receipts from activities that are not an unrelated trade or business under section 513 .....            
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...            
5 The value of services or facilities furnished by a governmental unit to the organization without charge            
6 Total. Add lines 1 through 5            
7a Amounts included on lines 1, 2, and 3 received from disqualified persons            
b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.            
c Add lines 7a and 7b..            
8 Public support. (Subtract line 7c from line 6.)  
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2017 (b) 2018 (c) 2019 (d) 2020 (e) 2021 (f) Total
9 Amounts from line 6...            
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b.            
11 Net income from unrelated business activities not included on line 10b, whether or not the business is regularly carried on.            
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part VI.) ..            
13 Total support. (Add lines 9, 10c, 11, and 12.)..            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990) 2021

Schedule A (Form 990) 2021
Page 4
Part IV
Supporting Organizations
(Complete only if you checked a box on line 12 of Part I. If you checked box 12a, of Part I, complete Sections A and B. If you checked box 12b, of Part I, complete Sections A and C. If you checked box 12c, of Part I, complete Sections A, D, and E. If you checked box12d, of Part I, complete Sections A and D, and complete Part V.)
Section A. All Supporting Organizations
Yes
No
1
Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.
1
 
 
2
Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).
2
 
 
3a
Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer lines 3b and 3c below.
3a
 
 
b
Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.
3b
 
 
c
Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.
3c
 
 
4a
Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked box 12a or 12b in Part I, answer lines 4b and 4c below.
4a
 
 
b
Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.
4b
 
 
c
Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.
4c
 
 
5a
Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer lines 5b and 5c below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).
5a
 
 
b
Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?
5b
 
 
c
Substitutions only. Was the substitution the result of an event beyond the organization's control?
5c
 
 
6
Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.
6
 
 
7
Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990) .
7
 
 
8
Did the organization make a loan to a disqualified person (as defined in section 4958) not described on line 7? If “Yes,” complete Part I of Schedule L (Form 990).
8
 
 
9a
Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons, as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.
9a
 
 
b
Did one or more disqualified persons (as defined on line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.
9b
 
 
c
Did a disqualified person (as defined on line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.
9c
 
 
10a
Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.
10a
 
 
b
Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).
10b
 
 
Schedule A (Form 990) 2021

Schedule A (Form 990) 2021
Page 5
Part IV
Supporting Organizations (continued)
Yes
No
11
Has the organization accepted a gift or contribution from any of the following persons?
a
A person who directly or indirectly controls, either alone or together with persons described on lines 11b and 11c below, the governing body of a supported organization?
11a
 
 
b
A family member of a person described on 11a above?
11b
 
 
c
A 35% controlled entity of a person described on line 11a or 11b above? If “Yes” to 11a, 11b, or 11c, provide detail in Part VI.
11c
 
 
Section B. Type I Supporting Organizations
Yes
No
1
Did the officers, directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.
1
 
 
2
Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.
2
 
 
Section C. Type II Supporting Organizations
Yes
No
1
Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).
1
 
 
Section D. All Type III Supporting Organizations
Yes
No
1
Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?
1
 
 
2
Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).
2
 
 
3
By reason of the relationship described in line 2 above, did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.
3
 
 
Section E. Type III Functionally-Integrated Supporting Organizations
1
Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):
a
b
c
2
Activities Test. Answer lines 2a and 2b below.
Yes
No
a
Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.
2a
 
 
b
Did the activities described on line 2a, above constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.
2b
 
 
3
Parent of Supported Organizations. Answer lines 3a and 3b below.
a
Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations?If "Yes" or "No", provide details in Part VI.
3a
 
 
b
Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.
3b
 
 
Schedule A (Form 990) 2021

Schedule A (Form 990) 2021
Page 6
Part V
Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations
1
Section A - Adjusted Net Income (A) Prior Year (B) Current Year
(optional)
1 Net short-term capital gain 1    
2 Recoveries of prior-year distributions 2    
3 Other gross income (see instructions) 3    
4 Add lines 1 through 3 4    
5 Depreciation and depletion 5    
6 Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions) 6    
7 Other expenses (see instructions) 7    
8 Adjusted Net Income (subtract lines 5, 6 and 7 from line 4) 8    
Section B - Minimum Asset Amount (A) Prior Year (B) Current Year
(optional)
1 Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year): 1
a Average monthly value of securities 1a    
b Average monthly cash balances 1b    
c Fair market value of other non-exempt-use assets 1c    
d Total (add lines 1a, 1b, and 1c) 1d    
e Discount claimed for blockage or other factors
(explain in detail in Part VI):  
2 Acquisition indebtedness applicable to non-exempt use assets 2    
3 Subtract line 2 from line 1d 3    
4 Cash deemed held for exempt use. Enter 0.015 of line 3 (for greater amount, see instructions). 4    
5 Net value of non-exempt-use assets (subtract line 4 from line 3) 5    
6 Multiply line 5 by 0.035 6    
7 Recoveries of prior-year distributions 7    
8 Minimum Asset Amount (add line 7 to line 6) 8    
Section C - Distributable Amount Current Year
1 Adjusted net income for prior year (from Section A, line 8, Column A) 1  
2 Enter 85% of line 1 2  
3 Minimum asset amount for prior year (from Section B, line 8, Column A) 3  
4 Enter greater of line 2 or line 3 4  
5 Income tax imposed in prior year 5  
6 Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions) 6  
7
Schedule A (Form 990) 2021

Schedule A (Form 990) 2021
Page 7
Part V
Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations(continued)
Section D - Distributions Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes 1  
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in
excess of income from activity 		2  
3 Administrative expenses paid to accomplish exempt purposes of supported organizations 3  
4 Amounts paid to acquire exempt-use assets 4  
5 Qualified set-aside amounts (prior IRS approval required - provide details in Part VI) 5  
6 Other distributions (describe in Part VI). See instructions 6  
7Total annual distributions. Add lines 1 through 6. 7  
8 Distributions to attentive supported organizations to which the organization is responsive (provide
details in Part VI). See instructions 		8  
9 Distributable amount for 2021 from Section C, line 6 9  
10 Line 8 amount divided by Line 9 amount 10  
Section E - Distribution Allocations (see instructions) (i)
Excess Distributions 		(ii)
Underdistributions
Pre-2021 		(iii)
Distributable
Amount for 2021
1 Distributable amount for 2021 from Section C, line 6  
2 Underdistributions, if any, for years prior to 2021 (reasonable cause required-- explain in Part VI).
See instructions.		  
3 Excess distributions carryover, if any, to 2021:
a From 2016.......  
b From 2017.......  
c From 2018.......  
d From 2019.......  
e From 2020.......  
fTotal of lines 3a through e  
g Applied to underdistributions of prior years  
h Applied to 2021 distributable amount  
i Carryover from 2016 not applied (see
instructions) 		 
j Remainder. Subtract lines 3g, 3h, and 3i from line 3f.  
4Distributions for 2021 from Section D, line 7:
$  
a Applied to underdistributions of prior years  
b Applied to 2021 distributable amount  
c Remainder. Subtract lines 4a and 4b from line 4.  
5 Remaining underdistributions for years prior to
2021, if any. Subtract lines 3g and 4a from line 2.
If the amount is greater than zero, explain in Part VI.
See instructions. 		 
6 Remaining underdistributions for 2021. Subtract
lines 3h and 4b from line 1. If the amount is greater
than zero, explain in Part VI. See instructions. 		 
7 Excess distributions carryover to 2022. Add lines
3j and 4c. 		 
8 Breakdown of line 7:
a Excess from 2017.....  
b Excess from 2018.....  
c Excess from 2019.....  
d Excess from 2020.....  
e Excess from 2021.....  
Schedule A (Form 990) (2021)

Schedule A (Form 990) 2021
Page 8
Part VI
Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Return Reference Explanation
Schedule A (Form 990) 2021


Additional Data


Software ID: 21014044
Software Version: 2021v4.2
Schedule B
(Form 990)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors

Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
Arrow Bullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2021
Name of the organization
SHANDS JACKSONVILLE MEDICAL CENTER INC
 
Employer identification number

59-2142859
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ






Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note: Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......... Arrow Bullet $  
Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ
or on its Form 990PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990) (2021)
Schedule B (Form 990) (2021) Page 2
Name of organization
SHANDS JACKSONVILLE MEDICAL CENTER INC
  		Employer identification number
59-2142859
Part I
Contributors
Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
RESTRICTED
 
 
 
 
  ,    

$ RESTRICTED


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
Schedule B (Form 990) (2021)
Schedule B (Form 990) (2021)
Page 3
Name of organization
SHANDS JACKSONVILLE MEDICAL CENTER INC
  		Employer identification number

59-2142859
Part II
Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a)
No. from Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(See instructions) 		(d)
Date received
 
$    
(a)
No. from Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(See instructions) 		(d)
Date received
 
$    
(a)
No. from Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(See instructions) 		(d)
Date received
 
$    
(a)
No. from Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(See instructions) 		(d)
Date received
 
$    
(a)
No. from Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(See instructions) 		(d)
Date received
 
$    
(a)
No. from Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(See instructions) 		(d)
Date received
 
$    
Schedule B (Form 990) (2021)
Schedule B (Form 990) (2021)
Page 4
Name of organization
SHANDS JACKSONVILLE MEDICAL CENTER INC
  		Employer identification number

59-2142859
Part III
Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
Use duplicate copies of Part III if additional space is needed.
(a)
No. from Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a)
No. from Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a)
No. from Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a)
No. from Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
Schedule B (Form 990) (2021)
Additional Data


Software ID: 21014044
Software Version: 2021v4.2
SCHEDULE C
(Form 990)

Department of the Treasury
Internal Revenue Service
Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527

SchCMd Bullet Complete if the organization is described below. SchCMd Bullet Attach to Form 990 or Form 990-EZ.
SchCMd BulletGo to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2021
Open to Public
Inspection
If the organization answered "Yes" on Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered "Yes" on Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered "Yes" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
SHANDS JACKSONVILLE MEDICAL CENTER INC
 
Employer identification number

59-2142859
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV. See instructions for definition of “political campaign activities."

2
Political campaign activity expenditures. See instructions ....................................................................SchCMd Bullet
$  
3
Volunteer hours for political campaign activities. See instructions ..................................................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 ................................SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 .......................SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................
4a
Was a correction made? ......................................................................................................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c), except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b...........SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ...................................................................
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name (b) Address (c) EIN (d) Amount paid from filing organization's funds. If none, enter -0-. (e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.
1
2
3
4
5
6
For Paperwork Reduction Act Notice, see the instructions for Form 990.
Cat. No. 50084S
Schedule C (Form 990) 2021

Schedule C (Form 990) 2021
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check SchCMd Bulletexpenses, and share of excess lobbying expenditures).Click to see attachment
B Check SchCMd Bullet
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
organization's
totals 		(b) Affiliated group totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ...................... 0 0
b Total lobbying expenditures to influence a legislative body (direct lobbying) ........................ 84,684 708,495
c Total lobbying expenditures (add lines 1a and 1b) ............................................................ 84,684 708,495
d Other exempt purpose expenditures ............................................................................... 738,383,274 2,877,850,012
e Total exempt purpose expenditures (add lines 1c and 1d) .................................................. 738,467,958 2,878,558,507
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.		 1,000,000 1,000,000
If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
Not over $500,00020% of the amount on line 1e.
Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
Over $17,000,000$1,000,000.
g Grassroots nontaxable amount (enter 25% of line 1f) ................................................. 250,000 250,000
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................................................ 0 0
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................................................ 0 0
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ...................................................................................................................

4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
Calendar year (or fiscal year
beginning in) 		(a) 2018 (b) 2019 (c) 2020 (d) 2021 (e) Total
2a Lobbying nontaxable amount 1,000,000 1,000,000 1,000,000 1,000,000 4,000,000
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		6,000,000
c Total lobbying expenditures 92,319 107,823 93,220 708,495 1,001,857
d Grassroots nontaxable amount 250,000 250,000 250,000 250,000 1,000,000
e Grassroots ceiling amount
(150% of line 2d, column (e))		 1,500,000
f Grassroots lobbying expenditures 0 0 0 0 0
Schedule C (Form 990) 2021


Schedule C (Form 990) 2021
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
For each "Yes" response on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.
(a)
Yes|No
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? ...........................................................................................................
 
 
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........
 
 
c
Media advertisements? ...................................................................................................
 
 
 
d
Mailings to members, legislators, or the public? .............................................................................
 
 
 
e
Publications, or published or broadcast statements? ...........................................................
 
 
 
f
Grants to other organizations for lobbying purposes? ..........................................................
 
 
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? .......................
 
 
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................
 
 
 
i
Other activities? ...................................................................................................................
 
 
 
j
Total. Add lines 1c through 1i ....................................................................................................
 
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
 
b
If "Yes," enter the amount of any tax incurred under section 4912 ...........................................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? ........................
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ...............................................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered "No" OR (b) Part III-A, line 3, is answered “Yes."
1
Dues, assessments and similar amounts from members ......................................................................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).
a
Current year .............................................................................................................................
2a
 
b
Carryover from last year ............................................................................................................
2b
 
c
Total ...........................................................................................................................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ......................................................................................................................
4
 
5
Taxable amount of lobbying and political expenditures. See Instructions .........................................
5
 
Part IV
Supplemental Information
Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.
Return Reference Explanation
Schedule C (Form 990) 2021


Additional Data


Software ID: 21014044
Software Version: 2021v4.2

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," on Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b.
SchDMd Bullet Attach to Form 990.
SchDMd Bullet Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2021
Open to Public Inspection
Name of the organization
SHANDS JACKSONVILLE MEDICAL CENTER INC
 
Employer identification number

59-2142859
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .........    
2 Aggregate value of contributions to (during year)    
3 Aggregate value of grants from (during year)    
4 Aggregate value at end of year ........    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization’s property, subject to the organization’s exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ...................... 2a 1
b Total acreage restricted by conservation easements .................... 2b 5.56
c Number of conservation easements on a certified historic structure included in (a) ..... 2c 0
d Number of conservation easements included in (c) acquired after 7/25/06, and not on a historic structure listed in the National Register ... 2d 1
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet0
4
Number of states where property subject to conservation easement is located SchDMd Bullet1
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............
6
Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet0.0
7
Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet $ 0
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .............................
9
In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" on Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under FASB ASC 958, not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under FASB ASC 958, to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:
(i)
Revenue included on Form 990, Part VIII, line 1 .........................SchDMd Bullet $ 0
(ii)
Assets included in Form 990, Part X ...............................SchDMd Bullet $ 54,300
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under FASB ASC 958 relating to these items:
a
Revenue included on Form 990, Part VIII, line 1 ..........................SchDMd Bullet $ 0
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $ 0
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2021

Schedule D (Form 990) 2021
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?...
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b If "Yes," explain the arrangement in Part XIII and complete the following table: Amount
c Beginning balance ............................. 1c  
d Additions during the year ............................ 1d  
e Distributions during the year .......................... 1e  
f Ending balance ................................ 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...
b
If "Yes," explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ....
Part V
Endowment Funds.
Complete if the organization answered "Yes" on Form 990, Part IV, line 10.
(a) Current year (b) Prior year (c) Two years back (d) Three years back (e) Four years back
1a Beginning of year balance ....          
b Contributions ...          
c Net investment earnings, gains, and losses          
d Grants or scholarships ...          
e Other expenditures for facilities
and programs ... 		         
f Administrative expenses ....          
g End of year balance ......          
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet  
c
Term endowment SchDMd Bullet  
The percentages on lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) Unrelated organizations .................
3a(i)
 
 
(ii) Related organizations .................
3a(ii)
 
 
b
If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIII the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis
(investment) 		(b) Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .....   4,541,933 4,541,933
b Buildings ....   457,457,810 241,253,871 216,203,939
c Leasehold improvements   1,579,589 1,415,399 164,190
d Equipment ....   298,634,407 245,186,292 53,448,115
e Other .....   31,773,149   31,773,149
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..SchDMdBullet 306,131,326
Schedule D (Form 990) 2021

Schedule D (Form 990) 2021
Page 3
Part VII
Investments - Other Securities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b) Book value (c) Method of valuation:
Cost or end-of-year market value
(1) Financial derivatives.........    
(2) Closely-held equity interests........    
(3)Other
(A)
(B)
(C)
(D)
(E)
(F)
(G)
(H)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet  
Part VIII
Investments - Program Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.
(a) Description of investment (b) Book value (c) Method of valuation:
Cost or end-of-year market value
(1)
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1)DEPOSITS AND OTHER 29,643,966
(2)DUE FROM AFFILIATES 116,145,535
(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 145,789,501
Part X
Other Liabilities.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
(1) Federal income taxes  
(7)
(8)
(9)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 112,669,766
2. Liability for uncertain tax positions. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII
Schedule D (Form 990) 2021

Schedule D (Form 990) 2021
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1 Total revenue, gains, and other support per audited financial statements ....... 1  
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains (losses) on investments .... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d ..................... 2e  
3 Subtract line 2e from line 1.................. 3  
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIII.) ........... 4b  
c Add lines 4a and 4b.................... 4c  
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5  
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
1 Total expenses and losses per audited financial statements ........... 1  
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities ......... 2a  
b Prior year adjustments ............ 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d.................... 2e  
3 Subtract line 2e from line 1................... 3  
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIII.) ............ 4b  
c Add lines 4a and 4b..................... 4c  
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5  
Part XIII
Supplemental Information
Provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
Return Reference Explanation
Schedule D, Part II, Line 9 Conservation easements financial reporting The easement is not recorded as part of the organization's financial statements.
Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote The Company and its subsidiaries are exempt from federal income taxes pursuant to Section 501(a) as organizations described in Section 501(c)(3) of the Internal Revenue Code and from state income taxes pursuant to Chapter 220 of the Florida Statutes.
Schedule D (Form 990) 2021


Additional Data


Software ID: 21014044
Software Version: 2021v4.2




SCHEDULE H
(Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet Attach to Form 990.
MediumBullet Go to www.irs.gov/Form990EZ for instructions and the latest information.
OMB No. 1545-0047
2021
Open to Public Inspection
Name of the organization
SHANDS JACKSONVILLE MEDICAL CENTER INC
 
Employer identification number

59-2142859
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .
1a
Yes
 
b
If "Yes," was it a written policy? ......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
%
b
Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care: . . . . . . . .
3b
Yes
 
%
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? . . . . . . . . . . . . .

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during
the tax year? . . . . . . . . . . . . . . . . . . . . . . .

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .
5b
 
No
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? . . . . . . . . . . . . .
5c
 
 
6a
Did the organization prepare a community benefit report during the tax year? . . . . . . . . .
6a
Yes
 
b
If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) . . . 		    56,373,786 35,000,000 21,373,786 2.31 %
b Medicaid (from Worksheet 3, column a) . . . . .     190,877,987 125,712,176 65,165,811 7.03 %
c Costs of other means-tested government programs (from Worksheet 3, column b) . .     0 0 0 0 %
d Total Financial Assistance and Means-Tested Government Programs . . . . . 0 0 247,251,773 160,712,176 86,539,597 9.34 %
Other Benefits
e Community health improvement services and community benefit operations (from Worksheet 4).     396,186 0 396,186 0.04 %
f Health professions education (from Worksheet 5) . . .     50,836,612 32,127,721 18,708,891 2.02 %
g Subsidized health services (from Worksheet 6) . . . .     0 0 0 0 %
h Research (from Worksheet 7) .     0 0 0 0 %
i Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .     0 0 0 0 %
j Total. Other Benefits . . 0 0 51,232,798 32,127,721 19,105,077 2.06 %
k Total. Add lines 7d and 7j . 0 0 298,484,571 192,839,897 105,644,674 11.40 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2021
Schedule H (Form 990) 2021
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing         0 0 %
2 Economic development         0 0 %
3 Community support     300,083 271,333 28,750 0 %
4 Environmental improvements         0 0 %
5 Leadership development and
training for community members		         0 0 %
6 Coalition building         0 0 %
7 Community health improvement advocacy     20,000   20,000 0 %
8 Workforce development     800   800 0 %
9 Other         0 0 %
10 Total 0 0 320,883 271,333 49,550 0.01 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Healthcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
0
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
0
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
136,139,074
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
135,567,575
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
571,499
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year
contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI .........................

9b

Yes

 
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership % 		(e) Physicians'
profit % or stock
ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2021
Schedule H (Form 990) 2021
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest—see instructions)How many hospital facilities did the organization operate during the tax year?1Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility) 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (describe) Facility reporting group
1 SHANDS JACKSONVILLE MEDICAL CENTER INC
655 W 8TH STREET
JACKSONVILLE,FL32209
UFHEALTHJAX.ORG
4063 		X X   X     X      
Schedule H (Form 990) 2021
Schedule H (Form 990) 2021
Page 4
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
SHANDS JACKSONVILLE MEDICAL CENTER INC
Name of hospital facility or letter of facility reporting group  
Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A): 		1
Yes No
Community Health Needs Assessment
1 Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................ 1   No
2 Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C............... 2   No
3 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 12...................... 3 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
4 Indicate the tax year the hospital facility last conducted a CHNA: 20 21
5 In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted ................. 5 Yes  
6 a Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C.................................. 6a Yes  
b Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................ 6b Yes  
7 Did the hospital facility make its CHNA report widely available to the public?.............. 7 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
8 Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. .............. 		8 Yes  
9 Indicate the tax year the hospital facility last adopted an implementation strategy: 20 21
10 Is the hospital facility's most recently adopted implementation strategy posted on a website?......... 10 Yes  
a If "Yes" (list url): https://ufhealthjax.org/community/community-health-needs-assessment.aspx
b If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ...... 10b    
11 Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.
12a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)?............................... 12a   No
b If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........ 12b    
c If "Yes" on line 12b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2021
Schedule H (Form 990) 2021
Page 5
Part VFacility Information (continued)

Financial Assistance Policy (FAP)
SHANDS JACKSONVILLE MEDICAL CENTER INC
Name of hospital facility or letter of facility reporting group  
Yes No
Did the hospital facility have in place during the tax year a written financial assistance policy that:
13 Explained eligibility criteria for financial assistance, and whether such assistance included free or discounted care? 13 Yes  
If “Yes,” indicate the eligibility criteria explained in the FAP:
a
b
c
d
e
f
g
h
14 Explained the basis for calculating amounts charged to patients?................. 14 Yes  
15 Explained the method for applying for financial assistance?................... 15 Yes  
If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):
a
b
c
d
e
16 Was widely publicized within the community served by the hospital facility?........ 16 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
HTTP://UFHEALTHJAX.ORG/PATIENT-CARE/FINANCIAL-ASSISTANCE.ASPX
b
HTTP://UFHEALTHJAX.ORG/PATIENT-CARE/FINANCIAL-ASSISTANCE.ASPX
c
d
e
f
g
h
i
j
Schedule H (Form 990) 2021
Schedule H (Form 990) 2021
Page 6
Part VFacility Information (continued)

Billing and Collections
SHANDS JACKSONVILLE MEDICAL CENTER INC
Name of hospital facility or letter of facility reporting group  
Yes No
17 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained all of the actions the hospital facility or other authorized party may take upon nonpayment?.................................. 17 Yes  
18 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a
b
c
d
e
f
19 Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............ 19   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
20 Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):
a
b
c
d
e
f
Policy Relating to Emergency Medical Care
21 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.................. 21 Yes  
If "No," indicate why:
a
b
c
d
Schedule H (Form 990) 2021
Schedule H (Form 990) 2021
Page 7
Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)
SHANDS JACKSONVILLE MEDICAL CENTER INC
Name of hospital facility or letter of facility reporting group  
Yes No
22 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
23 During the tax year, did the hospital facility charge any FAP-eligible individual to whom the hospital facility provided emergency or other medically necessary services more than the amounts generally billed to individuals who had insurance covering such care? ............................... 23   No
If "Yes," explain in Section C.
24 During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ........................... 24   No
If "Yes," explain in Section C.
Schedule H (Form 990) 2021
Schedule H (Form 990) 2021
Page 8
Part V
Facility Information (continued)
Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference Explanation
Schedule H, Part V, Section B, Line 3E ONCE THE SIGNIFICANT HEALTH NEEDS WERE IDENTIFIED, THIS LIST WAS PRIORITIZED FOR IMPLEMENTATION PLANNING AND STRATEGIZING. THE DATA SUPPORTING EACH OF THE NINE KEY AREAS IDENTIFIED FROM PRIMARY AND SECONDARY ANALYSIS WERE PRESENTED AND DISCUSSED DURING A PRIORITIZATION WORKSHOP HOSTED BY THE JACKSONVILLE NONPROFIT HOSPITAL PARTNERSHIP (THE PARTNERSHIP) ON MAY 11, 2021. FORTY-NINE COMMUNITY LEADERS RANKED THE NINE THEMES IN PRIORITY ORDER OF SIGNIFICANCE. THE TOP THEMES THAT EMERGED WERE MENTAL HEALTH, ACCESS, POVERTY AND CHRONIC DISEASE. AS A KEY COMPONENT OF THE COMMUNITY ASSESSMENT, THE PRIORITIZATION PROCESS PROVIDES THE PARTNERSHIP WITH INFORMATION ABOUT WHAT LEADERS BELIEVE SHOULD BE THE FOCUS TO IMPROVE POPULATION HEALTH AND COMMUNITY WELLNESS.
Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - SHANDS JACKSONVILLE MEDICAL CENTER, INC.. THE PRIMARY DATA USED IN THIS ASSESSMENT CONSIST OF (1) KEY STAKEHOLDER INTERVIEWS CONDUCTED VIRTUALLY, (2) FOCUS GROUP DISCUSSIONS FACILITATED BY THE PARTNERSHIP, AND (3) A COMMUNITY SURVEY DISTRIBUTED THROUGH ONLINE AND ON PAPER SUBMISSIONS. STAKEHOLDERS FROM DUVAL COUNTY WERE SELECTED BASED ON THEIR KNOWLEDGE OF THE HEALTH NEEDS OF PARTICULAR COMMUNITIES. SEVEN INTERVIEWS WERE CONDUCTED WITH DUVAL COUNTY ORGANIZATIONS THAT WORK WITH POPULATIONS MOST AT RISK FOR HEALTH DISPARITIES TO GAIN INSIGHTS INTO THEIR SPECIFIC NEEDS. IN ADDITION, EIGHT INTERVIEWS WERE CONDUCTED WITH REGIONAL AGENCIES THAT OFFER SERVICES IN DUVAL COUNTY. THE FULL LIST OF AGENCIES REPRESENTED WAS: STARTING POINT BEHAVIORAL HEALTH, SPBH, NAMI, HOMELESS COALITION, JASMYN, LUTHERAN SERVICES, ABILITY HOUSING, FIRE WATCH, CLAY COUNTY BEHAVIORAL HEALTH, WE CARE, MERCY SERVICES, ST. JOHNS HOUSING PARTNERSHIP, THE WAY CLINIC, FEEDING NORTHEAST FLORIDA, ACLU REGIONAL ORGANIZER, BAKER PREVENTION COALITION, PIE IN THE SKY, NORTHEAST FLORIDA HEALTHY START, WILDFLOWER CLINIC, BARNABAS CENTER, COUNCIL OF AGING, CIL JACKSONVILLE, SAFE KIDS NEFL, STEWART MARCHMAN, YMCA, FDOH-NASSAU, HEALTHY START COALITION OF NE FL, FDOH-DUVAL, FDOH-CLAY, FDOH-ST. JOHNS, SULZBACHER CENTER FOR THE HOMELESS, JEWISH FAMILY AND COMMUNITY SOCIAL SERVICES, AND VOLUNTEERS IN MEDICINE. A TOTAL OF 13 FOCUS GROUPS WERE CONDUCTED WITH 114 PARTICIPANTS BETWEEN MARCH AND APRIL OF 2021 IN DUVAL COUNTY. ALL FOCUS GROUPS WERE CONDUCTED USING A VIRTUAL MEETING PLATFORM. THE FOCUS GROUP PARTICIPANTS INCLUDED REPRESENTATIVES FROM ORANIZATION THAT SERVE MINORITY, LOW-INCOME, VETERANS, AND MEDICALLY UNDERSERVED POPULATIONS MOST AT RISK FOR HEALTH DISPARITIES AND THOSE EXPERIENCING CHALLENGES IN ACCESSING HEALTHCARE. OTHER FOCUS GROUPS WERE CONDUCTED THAT REPRESENTED THE REGIONAL POPULATION WHICH INCLUDED ONE WITH THE LGBTQ+ POPULATION, AND ONE GROUP WITH PEOPLE OF DIFFERING ABILITIES. THROUGH BOTH THE STAKEHOLDER INTERVIEWS AND THE FOCUS GROUPS, SJMC SELECTED PARTICIPANTS BASED ON THEIR KNOWLEDGE OF THE HEALTH NEEDS OF THE MEDICALLY UNDERSERVED, LOW-INCOME, AND MINORITY POPULATIONS. THESE PARTICIPANTS INCLUDE REPRESENTATIVES FROM ORGANIZATIONS SERVING -COMMUNITY MEMBERS EXPERIENCING HOMELESSNESS -VETERANS -SENIORS -INDIVIDUALS EXPERIENCING FOOD INSECURITY -LGBTQ+ INDIVIDUALS A COMMUNITY SURVEY WAS DISSEMINATED BETWEEN MARCH AND APRIL OF 2021 THROUGHOUT THE FIVE-COUNTY AREA OF NORTHEAST FLORIDA. THE SURVEY WAS DISTRIBUTED IN ENGLISH AND IN SPANISH AND PAPER SURVEYS WERE ALSO AVAILABLE. AN ELECTRONIC SURVEY LINK AND QR CODE WERE SHARED WITH MEMBERS OF THE COMMUNITY IN A NUMBER OF WAYS INCLUDING A PRESS RELEASE, A FEATURED SEGMENT ON LOCAL PUBLIC RADIO, VARIOUS SOCIAL MEDIA OUTLETS, TRADITIONAL BROADCASTS, AND OTHER ONLINE MEDIA OUTLETS. FIVE THOUSAND POSTCARDS WITH THE SURVEY LINK AND QR CODE WERE DISTRIBUTED THROUGHOUT THE FIVE-COUNTY AREA IN HOSPITAL WAITING ROOMS, VACCINE SITES AND CLINICS, AND VIA DOOR-TO-DOOR CANVASSERS. SURVEY RESPONDENTS WERE ASKED ABOUT THEIR VIEWS ON THE COMMUNITY'S HEALTH NEEDS, BARRIERS AND MOST IMPACTED POPULATIONS. STANDARDS FOR COLLECTING, REVIEWING, PRESENTING, AND ANALYZING SECONDARY DATA ARE BASED ON INDUSTRY TRENDS THAT ASSESS HEALTH STATUS AND RISK FACTORS FOR POPULATION HEALTH AND COMMUNITY WELLNESS. QUANTITATIVE DATA FOR EACH COUNTY IS OBTAINED FROM THE BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS), COUNTY HEALTH RANKINGS AND ROADMAPS (CHR&R), FLORIDA CHARTS, FLORIDA DEPARTMENT OF HEALTH. LOCAL COMMUNITY HEALTH ASSESSMENTS (CHA), HOSPITAL UTILIZATION REPORTS, U.S. CENSUS, AND THE YOUTH RISK BEHAVIOR SURVEILLANCE SYSTEM (YRBSS). POPULATION HEALTH MEASURES THE PHYSICAL, MENTAL, ENVIRONMENTAL, AND SOCIAL WELL-BEING OF A POPULATION. COLLECTING, ASSEMBLING, AND ANALYZING AVAILABLE DATA THAT INCLUDES STATISTICS ON HEALTH STATUS, EPIDEMIOLOGIC STUDIES OF HEALTH PROBLEMS, HEALTHCARE UTILIZATION, SERVICE AVAILABILITY, AND SELF- REPORTED ANALYTICS HELPS TO IDENTIFY UNMET NEEDS AND EMERGING NEEDS.
Schedule H, Part V, Section B, Line 6a Facility , 1 Facility , 1 - SHANDS JACKSONVILLE MEDICAL CENTER, INC.. THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED WITH ASCENSION HEALTH, BAPTIST HEALTH, BROOKS REHABILITATION, AND MAYO CLINIC FLORIDA WHICH CAME TOGETHER AND FORMED THE JACKSONVILLE NONPROFIT HOSPITAL PARTNERSHIP.
Schedule H, Part V, Section B, Line 6b Facility , 1 Facility , 1 - SHANDS JACKSONVILLE MEDICAL CENTER, INC.. THE COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED WITH THE HEALTH PLANNING COUNCIL OF NORTHEAST FLORIDA.
Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - SHANDS JACKSONVILLE MEDICAL CENTER, INC.. CHRONIC DISEASE FOOD PHARMACY PROGRAM - THIS PROGRAM PROVIDES ACCESS TO FRESH FOOD AND VEGETABLES FOR FOOD INSECURE MEMBERS OF THE COMMUNITY WHO HAVE CHRONIC LEVELS OF DIABETES, HYPERTENSION AND/OR OBESITY. THE PROGRAM IS DESIGNED TO INCREASE ACCESS TO FOOD IN THE MOST FOOD INSECURE NEIGHBORHOODS AS WELL AS PROVIDE NUTRITIONAL EDUCATION TO CONTRIBUTE TO PROVIDE SKILLS TO ASSIST SELF-MANAGEMENT TECHNIQUES TO REDUCE DISEASE. THE PROGRAM IS OPEN TO COMMUNITY MEMBERS WHO VISIT THE TOTAL CARE CLINIC OR WELLNESS CENTERS. THE TOTAL CARE CLINIC AND WELLNESS CENTERS PROVIDE CARE TO UNDERSERVED AND UNINSURED COMMUNITY MEMBERS WHO QUALIFY FOR CITY CONTRACT COVERAGE. MATERNAL AND CHILD HEALTH 1. LITTLE MIRACLES - COMMUNITY PROGRAM THAT PROVIDES PREGNANCY TESTS, PRENATAL AND INFANT CARE ACCESS ASSISTANCE AND MATERNITY AND CHILDBIRTH EDUCATION. NURSES SCHEDULE FIRST PRENATAL AND NEWBORN CARE APPOINTMENT WITHIN THE UF HEALTH NETWORK. 2. HEALTHY START - COMMUNITY BASED, NURSE LED, PRENATAL CASE MANAGEMENT FOR HIGH-RISK WOMEN. INTER-CONCEPTION CASE MANAGEMENT FOR THREE TO SIX MONTHS POST-DELIVERY. PROGRAM PROVIDES CHILDBIRTH CLASSES, BREASTFEEDING CLASSES, PARENTING CLASSES AND ASSISTANCE WITH MEDICAID ENROLLMENT. 3. NURSE FAMILY PARTNERSHIP - EVIDENCE-BASED PROGRAM THAT PROVIDES NURSE-LED, PRENATAL CASE MANAGEMENT, INFANT HEALTH AND DEVELOPMENT HOME VISITATION UNTIL CHILD TURNS TWO. 4. TRAUMA PREVENTION PROGRAM - COMMUNITY PROGRAM THAT EDUCATES CHILDREN AND PARENTS IN THE JACKSONVILLE COMMUNITY ON IMPORTANT SAFETY TOPICS IN AN EFFORT TO REDUCE THE NUMBER AND SEVERITY OF INJURIES. MENTAL HEALTH 1. EDUCATE FAMILIES (PARTICULARLY THOSE WITH CHILDREN HIGH RISK FOR SUICIDE ATTEMPT) ON LETHAL MEANS SAFETY IN THE HOME 2. TRAIN MENTAL HEALTH PROVIDERS ON LETHAL MEANS COUNSELING HOUSING, POVERTY AND TRANSPORTATION BLUE ZONES INITIATIVE - BLUE ZONES USES OVER 20 YEARS OF RESEARCH AND SCIENTIFICALLY PROVEN LESSONS OF LONGEVITY, HEALTH, AND HAPPINESS FROM THE LONGEST-LIVED CULTURES IN THE WORLD TO TRANSFORM COMMUNITY ENVIRONMENTS SO HEALTHY CHOICES ARE THE EASIEST TO MAKE. THERE IS A PROVEN HISTORY OF IMPROVING WELL-BEING FOR ENTIRE POPULATIONS. TO BOOST THE WELL-BEING OF ENTIRE COMMUNITIES, BLUE ZONES TAKE A SYSTEMS APPROACH DEVELOPING A PLAN TO MAKE LASTING CHANGES IN ALL THE PLACES AND SPACES PEOPLE LIVE, WORK, LEARN, AND PLAY. THESE CHANGES TO OUR SURROUNDINGS AND SYSTEMS COLLECTIVELY NUDGE PEOPLE TO MOVE NATURALLY, EAT WISELY, DEVELOP THE RIGHT OUTLOOK, AND CONNECT WITH EACH OTHER. THE GOAL IS TO BUILD A CULTURE OF WELL-BEING NOT ONLY MEANS HEALTHIER AND HAPPIER PEOPLE; IT ALSO MEANS A BETTER AND MORE PRODUCTIVE WORKFORCE AND A MORE VIBRANT ECONOMY. THE PRIMARY FOCUS AREAS ARE: * SUSTAINABLE COMMUNITY VITALITY * IMPROVED WELL-BEING * CIVIC PRIDE AND ECONOMIC DEVELOPMENT * MORE PRODUCTIVE, LESS COSTLY POPULATIONS NEEDS UF HEALTH JACKSONVILLE WILL NOT ADDRESS NO ENTITY CAN ADDRESS ALL OF THE HEALTH NEEDS PRESENT IN ITS COMMUNITY. THE HOSPITAL IS COMMITTED TO SERVING THE COMMUNITY BY ADHERING TO ITS MISSION, USING ITS SKILLS AND CAPABILITIES, AND REMAINING A STRONG ORGANIZATION SO THAT IT CAN CONTINUE TO PROVIDE A WIDE RANGE OF COMMUNITY BENEFITS. THIS IMPLEMENTATION STRATEGY DOES NOT INCLUDE SPECIFIC PLANS TO ADDRESS THE FOLLOWING HEALTH PRIORITIES THAT WERE IDENTIFIED IN THE 2021 COMMUNITY HEALTH NEEDS ASSESSMENT. ACCESS THE HOSPITAL PROVIDES ACCESS TO A WIDE ARRAY OF HEALTH CARE SERVICES FOR UNINSURED, MEDICAID, AND OTHER PATIENTS AND WILL CONTINUE TO PROVIDE SUCH ACCESS AS RESOURCES PERMIT. THE HOSPITAL IS RECOGNIZED AS THE REGION'S SAFETY-NET PROVIDER FOR MEDICAID AND UNINSURED INDIVIDUALS, AND OPERATES THE COMMUNITY CLINICS DEPARTMENT (WHICH PROVIDES A VARIETY OF SERVICES AND PROGRAMS INCLUDING FREE/LOW-COST PRIMARY CARE, MEDICATIONS, SELF-MANAGEMENT SUPPORT AND CARE MANAGEMENT), THE COMMUNITY OBSTETRICS INITIATIVES (WHICH STRIVE TO IMPROVE BIRTH OUTCOMES), THE TELEMEDICINE CLINIC, AND OTHERS PROGRAMS AND SERVICES. WHILE MANY OF THE PROGRAMS AND INITIATIVES DESCRIBED ABOVE IMPROVE THE ACCESS FOR VULNERABLE POPULATIONS, THIS IMPLEMENTATION STRATEGY DOES NOT INCLUDE SPECIFIC ACCESS-RELATED INITIATIVES BECAUSE THE AVAILABILITY OF FUTURE RESOURCES TO SUPPORT THEM IS HIGHLY UNCERTAIN. CANCER PREVENTIVE SCREENINGS SERVE AS ONE OF THE MOST EFFECTIVE WAYS TO MITIGATE THE MOST PREVALENT AND PREVENTABLE CANCERS, SUCH AS BREAST AND PROSTATE CANCER. THE HOSPITAL PROVIDES ACCESS TO AND CLOSELY MONITORS PREVENTION SCREENINGS THROUGH THE TOTAL CARE CLINIC, WHICH IS DEDICATED TO THE MOST VULNERABLE MEMBERS OF THE COMMUNITY, AND IN COLLABORATION WITH UF JACKSONVILLE PHYSICIANS. PREVENTION OUTREACH TACTICS WILL CONTINUE TO EDUCATE AND ENCOURAGE SCREENING ACROSS THE COMMUNITY. THIS IMPLEMENTATION STRATEGY DOES NOT INCLUDE SPECIFIC CANCER-RELATED INITIATIVES DUE TO THE UNCERTAINTY OF FUTURE RESOURCES TO SUPPORT ACTIVITIES.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2021
Schedule H (Form 990) 2021
Page 9
Part VFacility Information (continued)

Section D. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?9
Name and address Type of Facility (describe)
1 UF Health North
15255 Max Leggett Pkwy
Jacksonville,FL32218 		Hospital Campus and Outpatient Clinic
2 Faculty Clinic
653-2 W 8th Street
Jacksonville,FL32209 		Outpatient Clinic
3 UF Health Proton Therapy Institute
2015 N Jefferson Street
Jacksonville,FL32206 		Outpatient Clinic
4 Emerson Clinic
4555 Emerson Expressway
Jacksonville,FL32207 		Outpatient Clinic
5 UF Health Oncology
15255 Max Leggett Pkwy
Jacksonville,FL32218 		Oncology Center
6 UF Health Oncology Baymeadows
7751 Baymeadows Rd Suite 205
Jacksonville,FL32256 		Oncology Center
7 UF Health Oncology LaVilla
425 N Lee St suite 201
Jacksonville,FL32202 		Oncology Center
8 UF Health Oncology Fernandina
1699 S 14th St Unit 2
Fernandina Beach,FL32034 		Oncology Center
9 UF Health Oncology Orange Park
2141 Loch Rane Blvd Suite 16
Orange Park,FL32073 		Oncology Center
10
Schedule H (Form 990) 2021
Schedule H (Form 990) 2021
Page 10
Part VI
Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Form and Line Reference Explanation
Schedule H, Part I, Line 6a Community benefit report prepared by related organization Shands Teaching Hospitals and Clinics
Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance The organization used the cost to charge ratio to compute the cost of financial assistance reported in part I, line 7. A direct cost methodology was used for all other amounts.
Schedule H, Part II Community Building Activities SHANDS JACKSONVILLE MEDICAL CENTER, INC. SUPPORT ACTIVITIES THAT PROMOTE THE HEALTH AND WELL-BEING OF COMMUNITY MEMBERS THROUGH COMMUNITY SUPPORT, COMMUNITY HEALTH IMPROVEMENT ADVOCACY, AND WORKFORCE DEVELOPMENT. THESE ACTIVITIES INCLUDE: -FOOD PHARMACY THAT PROVIDES FRESH FRUITS, VEGETABLES, DAIRY, AND MEATS TO COMMUNITY MEMBERS IDENTIFIED AS BEING FOOD INSECURE. -COVID-19 HEALTH LITERACY INITIATIVES. -FUNDING FOR COMMUNITY ORGANIZATIONS, INCLUDING GIRL SCOUTS, LEADERSHIP JACKSONVILLE, SULZBACHER CENTER FOR THE HOMELESS, JASMYN (Jacksonville Area Sexual Minority Youth Network), AND LOCAL AMERICAN HEART ASSOCIATION EVENTS. -YOUTH EDUCATION TO ADVANCE CAREERS IN HEALTHCARE.
Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount FOR FINANCIAL STATEMENT PURPOSES, THE ORGANIZATION DIRECTLY REDUCES THE AMOUNT OF PATIENT SERVICE REVENUE REPORTED ON THE ORGANIZATION'S AUDITED FINANCIAL STATEMENTS BY THE AMOUNT OF BAD DEBT EXPENSE. THEREFORE, BAD DEBTS ARE INCLUDED IN NET PATIENT REVENUE AND BAD DEBT EXPENSE IS NOT SEPARATELY REPORTED AS AN EXPENSE.
Schedule H, Part III, Line 3 Bad Debt Expense Methodology The organization reports $0 bad debt expense because bad debts are included in net patient revenue. Therefore, the amount of bad debts attributable to patients eligible under the organization's financial assistance policy is also $0.
Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote The provision for bad debts is based on management's assessment of historical and expected net collections, considering business and economic conditions, trends in federal and state governmental health care coverage, and other collection indicators. Throughout the year, management assesses the adequacy of the allowance for uncollectible accounts based upon these trends. The results of these reviews are then used to make any modification to the provision for bad debts to establish an appropriate allowance for uncollectible accounts. Patient accounts receivable are written off after collection efforts have been followed under the Company's policies.
Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs The amounts reported on lines 5 and 6 were derived from the FYE 2022 Medicare Cost Report.
Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance Patients may qualify for different levels of financial assistance. If they qualify for 100% financial assistance there are no collection efforts. For less than 100% financial assistance, collection efforts are consistent with those used for all self-pay account balances, which includes sending invoices for 120 days and then turning account balances over to a collection agency. UF Health Jacksonville will not refer accounts for collection where the patient has initially applied for financial assistance and the patient has not yet been notified of the decision, provided the patient has complied with the information requests delineated during the application process.
Schedule H, Part V, Section B, Line 16a FAP website - SHANDS JACKSONVILLE MEDICAL CENTER, INC.: Line 16a URL: HTTP://UFHEALTHJAX.ORG/PATIENT-CARE/FINANCIAL-ASSISTANCE.ASPX;
Schedule H, Part V, Section B, Line 16b FAP Application website - SHANDS JACKSONVILLE MEDICAL CENTER, INC.: Line 16b URL: HTTP://UFHEALTHJAX.ORG/PATIENT-CARE/FINANCIAL-ASSISTANCE.ASPX;
Schedule H, Part V, Section B, Line 16c FAP plain language summary website - SHANDS JACKSONVILLE MEDICAL CENTER, INC.: Line 16c URL: HTTP://UFHEALTHJAX.ORG/PATIENT-CARE/FINANCIAL-ASSISTANCE.ASPX;
Schedule H, Part VI, Line 2 Needs assessment SJMC's community benefit activities are a planned, managed, organized, and measured approach to meeting identified community health needs. Through collaboration with the community and other partners, SJMC is committed to improving the health and well-being of the communities it serves. SJMC assesses the healthcare needs of the community it serves through a variety of methods, including surveys, focus groups, and community engagement. These assessments are used to identify the healthcare needs of the community, particularly for underserved and low-income groups. Based on the findings of these assessments, SJMC develops and implements community benefit projects and services that aim to improve the health status and quality of life of community residents. These projects and services are aligned with SJMC's strategic and clinical priorities, as well as partner areas of attention. SJMC's community benefit categories include financial assistance, community health services, health professions education, research, and donations. These categories are aligned with national guidelines developed by the Catholic Health Association in collaboration with the Voluntary Hospital Association.
Schedule H, Part VI, Line 3 Patient education of eligibility for assistance The eligibility for Financial Assistance under federal, state or local government programs is determined under the organization's Financial Assistance Program. Ideally, eligibility is obtained upon admission or before discharge. The organization provides notice of the Financial Assistance Program via the patient's billing statements. Information about the organization's Financial Assistance Program is also available on the organization's website. Education is also provided through distribution of the plain language summary, hospital staff, signage throughout the hospital and referrals from community organizations.
Schedule H, Part VI, Line 4 Community information UF Health Jacksonville serves the City of Jacksonville and Duval County. Duval County encompasses 918 square miles in northeastern Florida and is defined by 53 zip codes with a population of 957,755. The Caucasian population makes up 52.0% of the population, with Black/African American population accounting for 28.9%, Hispanic/Latinx 10.5%, Asian 5%, and all others at less than 5%. The median household income for Duval County is $55,807 and 13.5% of the population lives under the federal poverty guidelines. The unemployment rate is 5.8%.
Schedule H, Part VI, Line 5 Promotion of community health We have a community-based Board, operate emergency rooms, have open medical staff and use excess funds to invest in patient care needs. In addition to satisfying regulatory requirements of the federal and state agencies and local funders, the community needs assessment represents an unprecedented effort and key opportunity to bring together hospital data, population health, health- related quality of life indicators and community member input to provide a more detailed and complete profile of community health needs. The long term goal to achieve regional collaboration that will serve as an opportunity for optimal leverage of resources, setting (and managing) regional health priorities, and developing regional collective impact strategies among all health-related stakeholders. SJMC IS PART OF UNIVERSITY OF FLORIDA HEALTH, THE SOUTHEAST'S MOST COMPREHENSIVE ACADEMIC HEALTH CENTER, WITH CAMPUSES IN GAINESVILLE, JACKSONVILLE, LEESBURG, AND THE VILLAGES. SJMC IS BASED IN JACKSONVILLE. IT FEATURES an academic health center WITH 603 HOSPITAL BEDS near Downtown Jacksonville and a 92-bed hospital and outpatient medical campus in North Jacksonville. SJMC works to serve the community in tandem with University of Florida Jacksonville Physicians, Inc. ("UFJPI"), a not-for-profit organization consisting of more than 60 primary and specialty care centers that offer first-rate care from nearly 400 UF faculty physicians. Located on the UF Health Jacksonville downtown campus, the UF Health Proton Therapy Institute is one of few facilities in the U.S. equipped to treat cancer with protons. Proton therapy greatly reduces the damage to surrounding tissue, which is a significant improvement from traditional radiation therapy. The campus also is home to the state's first and region's only Level I adult and pediatric trauma program, TraumaOne. UF Health physicians collectively offer more than 100 advanced specialty and subspecialty services, FROM PRIMARY CARE TO HIGHLY SPECIALIZED AND COMPLEX CARE, INCLUDING CANCER, HEART AND VASCULAR, NEUROMEDICINE, PEDIATRICS, OBSTETRICS AND GYNECOLOGY, AND TRAUMA/CRITICAL CARE.
Schedule H, Part VI, Line 6 Affiliated health care system Shands Jacksonville Medical Center, Inc. ("SJMC") is affiliated with the following organizations: Shands Jacksonville Foundation, Inc., Shands Jacksonville Healthcare, Inc., Shands Jacksonville Community Services, Inc., Shands Jacksonville Affiliates Inc., and Shands Jacksonville Properties Inc. In strategic partnership with these affiliates, Shands Jacksonville Medical Center, Inc. works to heal, comfort, educate and to discover through quality health care, elimination of health disparities, medical education, innovation and research. The organization understands its responsibility to the health of its community and the affiliates provide critical support in delivering constant attention to the needs of patients and the community.
Schedule H (Form 990) 2021
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Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," on Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990.
lBullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2021
Open to Public
Inspection
Name of the organization
SHANDS JACKSONVILLE MEDICAL CENTER INC
 
Employer identification number
59-2142859
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ........................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on Form 990, Part IV, line 21, for any recipient
that received more than $5,000. Part II can be duplicated if additional space is needed.
(a) Name and address of organization
or government		 (b) EIN (c) IRC section
(if applicable)		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
noncash assistance		 (h) Purpose of grant
or assistance
(1) UNIVERISTY OF FLORIDA JACKSONVILLE PHYSICIANS INC
653 WEST 8TH STREET
JACKSONVILLE,FL32209 		59-1867557 501(C)(3) 42,113,827 0 N/A N/A GENERAL SUPPORT
(2) WOLFSON CHILDREN'S HOSPITAL
800 PRUDENTIAL DRIVE
JACKSONVILLE,FL32207 		59-1452787 501(C)(3) 628,949 0 N/A N/A GENERAL SUPPORT
(3) SHANDS JACKSONVILLE FOUNDATION INC
655 WEST 8TH STREET
JACKSONVILLE,FL32209 		59-2622323 501(C)(3) 85,000 0 N/A N/A General Support
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
3
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
0
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2021

Schedule I (Form 990) 2021
Page 2
Part III
Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.
(a) Type of grant or assistance (b) Number of
recipients		 (c) Amount of
cash grant		 (d) Amount of
noncash assistance		 (e) Method of valuation (book,
FMV, appraisal, other)		 (f) Description of noncash assistance
(1)
(2)
(3)
(4)
(5)
(6)
(7)
Part IV
Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.
Return Reference Explanation
Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. Funds included in the grant paid to University of Florida Jacksonville Physicians, Inc. are monitored to ensure funds are spent in accordance with the existing written agreement. The amount is based on negotiations between in-house counsel, VP of Finance and/or CFOs, President, Dean and/or CEO of each organization. If spending patterns change during the fiscal year, amounts can be reviewed and amended. Funds paid to WOLFSON CHILDREN'S HOSPITAL are agreed upon in the written agreement. SJMC monitors the funding and ensures that proper allocation of funds are paid subsequent to each fiscal year based on financial performance. Funds paid to Shands Jacksonville Foundation, a related organization, are monitored throughout the year to ensure the funds are spent in accordance with the written agreement.
Schedule I (Form 990) 2021



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Software ID: 21014044
Software Version: 2021v4.2


Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" on Form 990, Part IV, line 23.
SchJMediumBullet Attach to Form 990.
SchJMediumBullet Go to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2021
Open to Public Inspection
Name of the organization
SHANDS JACKSONVILLE MEDICAL CENTER INC
 
Employer identification number

59-2142859
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes on Line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain .....
1b
 
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked on Line 1a? ....
2
 
 
3
Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? .............
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
 
No
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.
5
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ....................
5a
 
No
b
Any related organization? .......................
5b
 
No
If "Yes," on line 5a or 5b, describe in Part III.
6
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ..................
6a
 
No
b
Any related organization? ......................
6b
 
No
If "Yes," on line 6a or 6b, describe in Part III.
7
For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
Yes
 
8
Were any amounts reported on Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III ..........................
8
 
No
9
If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2021

Schedule J (Form 990) 2021
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported on Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.
(A) Name and Title (B) Breakdown of W-2, 1099-MISC compensation, and/or 1099-NEC (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation in column (B) reported as deferred on prior Form 990
(i) Base
compensation 		(ii) Bonus & incentive
compensation 		(iii) Other reportable compensation
1Russell E Armistead Jr MBA
 
CEO (beginning Aug 2021) 		(i)

(ii)		 304,598
-------------
0 		0
-------------
0 		24,284
-------------
0 		17,400
-------------
0 		414
-------------
0 		346,696
-------------
0 		0
-------------
0
2Leon L Haley Jr MD
 
CEO / Dean of Univ of FL College of Medicine (thru July 2021) 		(i)

(ii)		 0
-------------
522,441 		0
-------------
0 		0
-------------
183,231 		0
-------------
15,160 		0
-------------
11,172 		0
-------------
732,004 		0
-------------
0
3David R Nelson
 
Chairman / SVP for Health Affairs at Univ of FL 		(i)

(ii)		 0
-------------
1,106,611 		0
-------------
309,000 		0
-------------
4,812 		0
-------------
27,086 		0
-------------
21,565 		0
-------------
1,469,074 		0
-------------
0
4Linda R Edwards MD
 
Director 		(i)

(ii)		 0
-------------
388,321 		0
-------------
0 		0
-------------
9,496 		0
-------------
27,641 		0
-------------
16,928 		0
-------------
442,386 		0
-------------
0
5Kelly Gray-Eurom MD
 
Director / Chief Quality Officer 		(i)

(ii)		 0
-------------
384,700 		0
-------------
7,700 		0
-------------
4,812 		0
-------------
15,461 		0
-------------
20,853 		0
-------------
433,526 		0
-------------
0
6Chandana Lall MD
 
Director / Professor of Radiology at Univ of FL 		(i)

(ii)		 0
-------------
700,133 		0
-------------
0 		0
-------------
4,812 		0
-------------
15,394 		0
-------------
9,332 		0
-------------
729,671 		0
-------------
0
7LaRae C Brown MD
 
Director 		(i)

(ii)		 0
-------------
366,173 		0
-------------
48,300 		0
-------------
2,725 		0
-------------
15,357 		0
-------------
21,343 		0
-------------
453,898 		0
-------------
0
8Elizabeth DeVos MD
 
Director 		(i)

(ii)		 0
-------------
288,532 		0
-------------
2,000 		0
-------------
2,861 		0
-------------
26,097 		0
-------------
18,411 		0
-------------
337,901 		0
-------------
0
9Dean Cocchi MBA
 
Treasurer / CFO 		(i)

(ii)		 403,696
-------------
0 		67,550
-------------
0 		10,924
-------------
0 		17,400
-------------
0 		16,480
-------------
0 		516,050
-------------
0 		0
-------------
0
10Jon DeBardeleben JD
 
Secretary (beg Jan 2022) / VP Senior Counsel 		(i)

(ii)		 229,633
-------------
0 		24,885
-------------
0 		2,739
-------------
0 		13,050
-------------
0 		10,738
-------------
0 		281,045
-------------
0 		0
-------------
0
11Randall C Jenkins
 
Secretary (thru Jan 2022) / SVP of General Council of Univ of FL 		(i)

(ii)		 0
-------------
482,027 		0
-------------
170,277 		0
-------------
3,780 		0
-------------
27,200 		0
-------------
23,016 		0
-------------
706,300 		0
-------------
0
12Patricia Rausch
 
Assistant Treasurer / Controller 		(i)

(ii)		 175,767
-------------
0 		12,570
-------------
0 		5,325
-------------
0 		11,770
-------------
0 		6,794
-------------
0 		212,226
-------------
0 		0
-------------
0
13Robert Templin
 
Asst. Secretary 		(i)

(ii)		 180,139
-------------
0 		0
-------------
0 		1,384
-------------
0 		11,031
-------------
0 		16,203
-------------
0 		208,758
-------------
0 		0
-------------
0
14Thanh Hogan
 
VP Clinical Operations 		(i)

(ii)		 272,289
-------------
0 		37,240
-------------
0 		5,827
-------------
0 		15,505
-------------
0 		7,330
-------------
0 		338,191
-------------
0 		0
-------------
0
15Rita James
 
VP of Ambulatory Services 		(i)

(ii)		 0
-------------
224,289 		0
-------------
0 		0
-------------
0 		0
-------------
12,763 		0
-------------
0 		0
-------------
237,052 		0
-------------
0
16Patrice Jones
 
VP Chief Nursing Officer 		(i)

(ii)		 326,076
-------------
0 		46,060
-------------
0 		3,932
-------------
0 		17,400
-------------
0 		9,432
-------------
0 		402,900
-------------
0 		0
-------------
0
17Ann-Marie Knight
 
VP Comm Engage (Chief Diversity Officer) 		(i)

(ii)		 208,885
-------------
0 		21,630
-------------
0 		2,405
-------------
0 		14,050
-------------
0 		13,793
-------------
0 		260,763
-------------
0 		0
-------------
0
18Wayne A Marshall
 
VP UFH North 		(i)

(ii)		 278,246
-------------
0 		38,640
-------------
0 		12,464
-------------
0 		17,400
-------------
0 		16,343
-------------
0 		363,094
-------------
0 		0
-------------
0
19Gregory Miller MBA
 
EVP COO 		(i)

(ii)		 481,784
-------------
0 		84,350
-------------
0 		10,017
-------------
0 		17,400
-------------
0 		11,018
-------------
0 		604,569
-------------
0 		0
-------------
0
20David Vukich MD
 
CMO / Dean for Hospital Affairs of Univ of FL 		(i)

(ii)		 0
-------------
494,505 		0
-------------
0 		0
-------------
9,777 		0
-------------
39,465 		0
-------------
21,258 		0
-------------
565,005 		0
-------------
0
21Lesli A Ward
 
VP Chief HRO 		(i)

(ii)		 301,617
-------------
0 		30,870
-------------
0 		2,160
-------------
0 		23,200
-------------
0 		11,690
-------------
0 		369,537
-------------
0 		0
-------------
0
22Jun Santos
 
Registered Nurse 		(i)

(ii)		 214,417
-------------
0 		103,417
-------------
0 		1,676
-------------
0 		17,400
-------------
0 		16,047
-------------
0 		352,958
-------------
0 		0
-------------
0
23Michele L Worley
 
Coord Perioperative Serv Line 		(i)

(ii)		 216,830
-------------
0 		45,414
-------------
0 		4,968
-------------
0 		16,196
-------------
0 		12,524
-------------
0 		295,932
-------------
0 		0
-------------
0
24Jellie Acedo
 
Registered Nurse 		(i)

(ii)		 200,320
-------------
0 		105,439
-------------
0 		743
-------------
0 		11,845
-------------
0 		16,080
-------------
0 		334,427
-------------
0 		0
-------------
0
25Michael Gill
 
Registered Nurse 		(i)

(ii)		 176,872
-------------
0 		87,516
-------------
0 		3,639
-------------
0 		16,259
-------------
0 		15,992
-------------
0 		300,278
-------------
0 		0
-------------
0
26Rhodora R Digo
 
Registered Nurse 		(i)

(ii)		 177,202
-------------
0 		91,103
-------------
0 		494
-------------
0 		16,498
-------------
0 		16,031
-------------
0 		301,327
-------------
0 		0
-------------
0
Schedule J (Form 990) 2021

Schedule J (Form 990) 2021
Page 3
Part III
Supplemental Information
Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II. Also complete this part for any additional information.
Return Reference Explanation
Schedule J, Part I, Line 7 Non-fixed payments In order to recruit and retain key talent, SJMC offers short and long term incentive plans for certain employees listed in Part VII, section A, line 1A. For calendar year 2021, the incentive plans were targeted in the areas of financial performance, clinical quality, and employee and patient satisfaction.
Schedule J (Form 990) 2021

Additional Data


Software ID: 21014044
Software Version: 2021v4.2

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Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax-Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part Ⅵ, line 24a. Provide descriptions,
explanations, and any additional information in Part Ⅵ.
SchKMediumBullet Attach to Form 990.
SchKMediumBulletGo to www.irs.gov/Form990 for instructions and the latest information.
OMB No. 1545-0047
2021
Open to Public
Inspection
Name of the organization
SHANDS JACKSONVILLE MEDICAL CENTER INC
 
Employer identification number
59-2142859
Part Ⅰ
Bond Issues
(a) Issuer name (b) Issuer EIN (c) CUSIP # (d) Date issued (e) Issue price (f) Description of purpose (g) Defeased (h) On
behalf of
issuer		 (i) Pool
financing
Yes No Yes No Yes No
A Florida Development Finance Corporation
  		59-3270584 34061QAL1 12-10-2015 87,267,800 2015 Capital Financing of North Campus   X   X   X
B Florida Development Finance Corporation
  		59-3270584 34061QBG1 01-25-2022 269,584,010 2022A bond: Refund Series 2013B, 2015 & 2019 Bonds and Capital Financing   X   X   X
Part Ⅱ
Proceeds
A B C D
1 Amount of bonds retired .................. 0 0    
2 Amount of bonds legally defeased .............. 0 0    
3 Total proceeds of issue .................. 87,267,800 269,584,010    
4 Gross proceeds in reserve funds ............. 0 0    
5 Capitalized interest from proceeds ............. 0 0    
6 Proceeds in refunding escrows ............... 0 0    
7 Issuance costs from proceeds ............... 1,358,192 2,589,341    
8 Credit enhancement from proceeds ............. 0 1,225,730    
9 Working capital expenditures from proceeds ............. 0 0    
10 Capital expenditures from proceeds ............. 85,909,608 186,172,960    
11 Other spent proceeds ............. 0 79,595,979    
12 Other unspent proceeds ............. 0 0    
13 Year of substantial completion ............. 2018 2022
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue of tax-exempt
bonds (or, if issued prior to 2020, a current refunding issue)? ........ 		  X X          
15 Were the bonds issued as part of an advance refunding issue of taxable
bonds (or, if issued prior to 2020, an advance refunding issue)? ........ 		  X   X        
16 Has the final allocation of proceeds been made? .......... X   X          
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? .................. X   X          
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2021

Schedule K (Form 990) 2021
Page 2
Part Ⅲ
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? .............   X   X        
2 Are there any lease arrangements that may result in private business use of bond-financed property? ...............   X   X        
3a Are there any management or service contracts that may result in private business use of bond-financed property? .............   X   X        
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?                
c Are there any research agreements that may result in private business use of bond-financed property? .............   X   X        
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?                
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government ....SchKMediumBullet 0 % 0 %    
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government ......... SchKMediumBullet 0 % 0 %    
6 Total of lines 4 and 5 ............. 0 % 0 %    
7 Does the bond issue meet the private security or payment test? ...   X   X        
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?.............   X   X        
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of. ..        
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? .............                
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2? ........ 		  X   X        
Part Ⅳ
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? ...   X   X        
2 If "No" to line 1, did the following apply? ....
a Rebate not due yet? .......   X X          
b Exception to rebate? ........   X   X        
c No rebate due? ......... X     X        
If "Yes" to line 2c, provide in Part Ⅵ the date the rebate
computation was performed ......
3 Is the bond issue a variable rate issue? .....   X   X        
Schedule K (Form 990) 2021

Schedule K (Form 990) 2021
Page 3
Part Ⅳ
Arbitrage (Continued)
A B C D
Yes No Yes No Yes No Yes No
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue? X     X        
b Name of provider .......... Merrill Lynch
  		 
  		 
  		 
 
c Term of hedge ......... 1200 %      
d Was the hedge superintegrated? ......   X            
e Was the hedge terminated? ........   X            
5a Were gross proceeds invested in a guaranteed investment contract (GIC)?   X   X        
b Name of provider ..........  
  		 
  		 
  		 
 
c Term of GIC .........        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? ........                
6 Were any gross proceeds invested beyond an available temporary period?   X   X        
7 Has the organization established written procedures to monitor the requirements of section 148? ...   X   X        
Part Ⅴ
Procedures To Undertake Corrective Action
--------------------------------------------------------------------------------------------------------------- A B C D
Yes No Yes No Yes No Yes No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?   X   X        
Part Ⅵ
Supplemental Information. Provide additional information for responses to questions on Schedule K. (See instructions).
Return Reference Explanation
Schedule K, Part VI Part III Line 9, Part IV Line 7, and Part V While the organization does not currently have an approved written policy, it does maintain procedures that include annual arbitrage reporting and routine reviews and determinations of private business use.
Schedule K, Part IV, Line 2c COLUMN A Issuer name: Florida Development Finance Corporation The calculation for computing no rebate due was performed on 12/10/2020
Schedule K (Form 990) 2021

Additional Data


Software ID: 21014044
Software Version: 2021v4.2

SCHEDULE O
(Form 990)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
MediumBullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2021
Open to Public
Inspection
Name of the organization
SHANDS JACKSONVILLE MEDICAL CENTER INC
 
Employer identification number

59-2142859
Return Reference Explanation
Form 990, Part III, Line 4a Program Service Accomplishments (CONTINUED FROM PART III) UF HEALTH JACKSONVILLE IS A 695 BED NOT-FOR-PROFIT ACADEMIC MEDICAL CENTER AFFILIATED WITH THE UNIVERSITY OF FLORIDA. THERE ARE MORE THAN 370 NATIONALLY RECOGNIZED FACULTY PHYSICIANS WORKING WITH OVER 300 UNIVERSITY OF FLORIDA FULL-TIME RESIDENTS AT UF HEALTH JACKSONVILLE. FOR FISCAL YEAR ENDED JUNE 30, 2022, THE HOSPITAL SERVED 24,762 INPATIENT ADMISSIONS, EXCLUDING NEWBORNS, AND 112,021 ER VISITS. UF HEALTH JACKSONVILLE HAS A LEVEL 1 TRAUMA CENTER, WHICH HAD 4,308 TRAUMA CENTER VISITS. THE FLORIDA POISON INFORMATION CENTER IS ALSO LOCATED ON CAMPUS, COVERING 42 COUNTIES AND APPROXIMATELY 160 - 200 CALLS EACH DAY. UF HEALTH JACKSONVILLE TOGETHER WITH OUR UNIVERSITY OF FLORIDA COLLEAGUES AND AFFILIATES HAS DEVELOPED SEVERAL CENTERS OF EXCELLENCE. THESE CENTERS BRING TOGETHER INTERDISCIPLINARY TEAMS USING ALL THE RESOURCES OF THE ACADEMIC MEDICAL CENTER. UF HEALTH JACKSONVILLE IS A LEADER IN PROVIDING BOTH UNIQUE AND ESSENTIAL CLINICAL PROGRAMS AND SERVICES, AS WELL AS IN PROMOTING GOOD HEALTH WITH PREVENTATIVE CARE, SCREENINGS AND HEALTH EDUCATION PROGRAMS THAT REACH RESIDENTS WHERE THEY LIVE AND WORK. THE HOSPITAL HOSTS HEALTH FAIRS, SUPPORT GROUPS AND OTHER SPECIAL EVENTS AND PERFORMED BLOOD PRESSURE, HIV, CHOLESTEROL, STROKE ASSESSMENT, PREGNANCY, BLOOD SUGAR AND GLAUCOMA SCREENINGS. UF HEALTH JACKSONVILLE ALSO HAS AN ACTIVE COMMUNITY ENGAGEMENT DEPARTMENT COMMITTED TO IMPROVING COMMUNITY HEALTH, EDUCATING THE NEXT GENERATION OF HEALTHCARE PROFESSIONALS, ADVOCATING FOR HEALTH AND OTHER HEALTH NEEDS AND CONTRIBUTING TO QUALITY OF LIFE PRIORITIES OF OUR COMMUNITY INCLUDING JACKSONVILLE'S URBAN CORE. IN MARCH 2020 THE HOSPITAL BEGAN EFFORTS TO CARE FOR COVID-19 PATIENTS AND PROVIDE UPDATES TO THE COMMUNITY TO COMBAT THE GLOBAL PANDEMIC.
Form 990, Part VI, Line 1a Delegate broad authority to a committee The Executive Committee shall consist of the same individuals serving on the Executive Committee of Shands Jacksonville Healthcare, Inc., the sole member of SJMC. These Executive Committee members consist of the following individuals: 1. THE CHAIR OF THE BOARD. 2. THE VICE PRESIDENT FOR HEALTH AFFAIRS OF THE UNIVERSITY OF FLORIDA. 3. DEAN OF THE COLLEGE OF MEDICINE OF THE JACKSONVILLE REGIONAL CAMPUS, UNIVERSITY OF FLORIDA. 4. THE CHIEF EXECUTIVE OFFICER OF THE CORPORATION. 5. FOUR DIRECTORS WHO ARE NOT EMPLOYEES OF THE CORPORATION OR OF THE UNIVERSITY OF FLORIDA OR ANY OF ITS COLLEGES, ALL OF WHOM SHALL BE APPOINTED BY THE CHAIR OF THE BOARD. 6. ONE CATEGORY TWO DIRECTOR (OR TWO CATEGORY TWO DIRECTORS IF THE SAME PERSON SERVES AS THE CHAIR OF THE CORPORATION AND VICE PRESIDENT FOR HEALTH AFFAIRS OF THE UNIVERSITY). THE EXECUTIVE COMMITTEE SHALL HAVE THE AUTHORITY AND RESPONSIBILITY TO (I) MAKE REFERRALS OF SUBSTANTIVE ISSUES TO THE APPROPRIATE BOARD COMMITTEES AND TO COORDINATE THE PRESENTATION OF COMMITTEE FINDINGS AND RECOMMENDATIONS TO THE BOARD OF DIRECTORS, (II) MAKE RECOMMENDATIONS TO THE BOARD OF DIRECTORS ON MATTERS OF POLICY THAT ARE NOT BEING CONSIDERED BY OTHER COMMITTEES, (III) ADVISE THE BOARD OF DIRECTORS CONCERNING AFFAIRS OF THE CORPORATION, AND (IV) TRANSACT ALL BUSINESS OF THE BOARD OF DIRECTORS DURING THE PERIODS BETWEEN MEETINGS OF THE BOARD OF DIRECTORS, EXCEPT THAT IT MAY NOT: 1.ELECT OR REMOVE OFFICERS OR REMOVE DIRECTORS; 2.CREATE OR ABOLISH ANY COMMITTEES; 3.AMEND THE ARTICLES OF INCORPORATION OF THE CORPORATION OR OF THE BYLAWS; 4.MODIFY IN ANY RESPECT OR CAUSE TO BE VIOLATED POLICIES ADOPTED BY THE BOARD OF DIRECTORS; 5.TAKE ANY ACTION THAT IS REQUIRED BY LAW, OR ARTICLE IV, SECTION 3 OF THE BYLAWS, TO BE TAKEN BY THE MEMBER. The Executive Committee shall keep minutes of its meetings and shall inform the Board of Directors, at the next regularly scheduled Board meeting, of all of its actions.
Form 990, Part VI, Line 2 Family/business relationships amongst interested persons Jon Debardeleben; Greg Miller; Russell E Armistead, Jr; Dean Cocchi - Business relationship, Jon Debardeleben; Greg Miller; Leon L Haley, JR, MD; Dean Cocchi - Business relationship
Form 990, Part VI, Line 6 Classes of members or stockholders The sole member of the Corporation shall be Shands Jacksonville Healthcare, Inc.
Form 990, Part VI, Line 7a Members or stockholders electing members of governing body The sole member of the Corporation shall be Shands Jacksonville Healthcare, Inc. The directors shall be the same individuals from time to time as the Board of Directors of Shands Jacksonville Healthcare, Inc., subject to the right of the mayor of the city of Jacksonville to nominate a director.
Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders The following actions require approval by the Member: a) The adoption of annual operating and capital budgets; b) The merger or dissolution, or the sale, lease, exchange or other disposition of all or substantially all of the assets; c) The acquisition of an interest in real or personal property, outside of approved budgetary authority, at a price or involving an annual economic obligation in excess of Five Hundred Thousand Dollars ($500,000.00); d) The conveyance or disposition of an interest in real or personal property involving fair market value, net book value, or an annual economic benefit exceeding Five Hundred Thousand Dollars ($500,000.00); e) The establishment of a long range or strategic plan; f) The incurrence of long-term indebtedness; g) The election or removal with or without cause of the Chief Executive Officer; h) The amendment of bylaws or articles of incorporation; or i) Such other matters where member or shareholder action is required by law.
Form 990, Part VI, Line 11b Review of form 990 by governing body A complete copy of the Form 990 is provided to the Board of Directors, Chief Executive Officer, Secretary and Treasurer of the corporation before the return is filed.
Form 990, Part VI, Line 12c Conflict of interest policy The Corporate Compliance Department's Conflicts of Interest policy covers any director, officer, member of a board committee or key staff member who has a direct or indirect financial interest as defined by the policy. The individuals covered under the policy are required to disclose a conflict of interest or a potential conflict of interest when it arises. The Deliberative Body, as defined by the policy, reviews and monitors conflicts of interests annually and as they arise. Any individual who has a conflict of interest is prohibited from participating in the Deliberative Body's deliberations and decision in the transaction.
Form 990, Part VI, Line 15a Process to establish compensation of top management official The organization's compensation committee engages Mercer, an independent firm engaged in the development of compensation surveys on executive pay levels across different industries, to provide competitive data and guidance on determining appropriate and reasonable ranges and salaries. Mercer annually reviews all aspects of executive compensation-including all elements of supplemental benefits- to ensure that they are reasonable total remuneration levels. The compensation committee uses the Mercer comparability data to review and approve compensation for the top management official. The review is done annually and was last conducted during the fiscal year ended June 30, 2022. The compensation committee documents the decisions and determinations in committee minutes.
Form 990, Part VI, Line 15b Process to establish compensation of other employees The organization's compensation committee engages Mercer, an independent firm engaged in the development of compensation surveys on executive pay levels across different industries, to provide competitive data and guidance on determining appropriate and reasonable ranges and salaries. Mercer annually reviews all aspects of executive compensation-including all elements of supplemental benefits- to ensure that they are reasonable total remuneration levels. The compensation committee uses the Mercer comparability data to review and approve compensation for many of the organization's officers and key employees. The review is done annually and was last conducted during the fiscal year ended June 30, 2022. The compensation committee documents the decisions and determinations in committee minutes.
Form 990, Part VI, Line 19 Required documents available to the public The conflicts of interest policy, governing documents and financial statements are available upon request.
Form 990, Part VIII, Line 11d Other Miscellaneous Revenue OTHER REVENUE - Total Revenue: 8191434, Related or Exempt Function Revenue: 8191434, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; REIMBURSEMENTS - Total Revenue: 153143, Related or Exempt Function Revenue: 153143, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ;
Form 990, Part IX, Line 11g Other Fees Professional Fees - Total Expense: 48752923, Program Service Expense: 12196337, Management and General Expenses: 36556586, Fundraising Expenses: ; Purchased Services - Total Expense: 86277777, Program Service Expense: 42715672, Management and General Expenses: 43562105, Fundraising Expenses: ;
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990) 2021


Additional Data


Software ID: 21014044
Software Version: 2021v4.2
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBulletAttach to Form 990.
MediumBullet Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047
2021
Open to Public Inspection
Name of the organization
SHANDS JACKSONVILLE MEDICAL CENTER INC
 
Employer identification number

59-2142859
Part I
Identification of Disregarded Entities. Complete if the organization answered "Yes" on Form 990, Part IV, line 33.
(a)
Name, address, and EIN (if applicable) of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income


 		(e)
End-of-year assets


 		(f)
Direct controlling
entity










Part II
Identification of Related Tax-Exempt Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.
(a)
Name, address, and EIN of related organization


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section


 		(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled entity?
Yes No
(1)University of Florida
226 Tigert Hall

Gainesville,FL32611
59-6002052 		Education FL 501(c)(3) 2 NA
 
 
No
(2)Shands Jacksonville HealthcareInc
655 West 8th Street

Jacksonville,FL32209
59-2441966 		SUPPORT SJMC FL 501(c)(3) Type II UF
 
 
No
(3)SHANDS JACKSONVILLE PROPERTIES INC
655 West 8th Street

Jacksonville,FL32209
59-1158241 		SUPPORT SJMC FL 501(c)(3) Type II SJHC
 
 
No
(4)SHANDS JACKSONVILLE COMMUNITY SERVICES INC
655 West 8th Street

Jacksonville,FL32209
51-0173761 		SUPPORT SJMC FL 501(c)(3) Type II SJHC
 
 
No
(5)SHANDS JACKSONVILLE FOUNDATION INC
655 West 8th Street

Jacksonville,FL32209
59-2622323 		SUPPORT SJMC FL 501(c)(3) Type II SJHC
 
 
No
(6)SHANDS JACKSONVILLE AFFILIATES INC
655 West 8th Street

Jacksonville,FL32209
59-1913819 		SUPPORT SJMC FL 501(c)(3) Type I SJMC
 
Yes
 
(7)UNIVERSITY OF FLORIDA JACKSONVILLE PHYSICIANS INC
653 WEST 8TH STREET

Jacksonville,FL32209
59-1867557 		SUPPORT UF COLLEGE OF MEDICINE - JACKSONVILLE FL 501(c)(3) Type I UF
 
 
No
(8)SHANDS TEACHING HOSPITAL AND CLINICS INC
PO Box 100336

Gainesville,FL32610
59-1943502 		MEDICAL SERVICES FL 501(c)(3) 3 UF
 
 
No
(9)Elder Care of Alachua County Inc
PO Box 100336

Gainesville,FL32610
59-3051104 		Services for the Elderly FL 501(c)(3) 7 STHC
 
 
No
(10)Shands Lake Shore Inc
PO Box 100336

Gainesville,FL32610
59-2699965 		Health Care FL 501(c)(3) 3 STHC
 
 
No
(11)Southeastern Healthcare Foundation
PO Box 100336

Gainesville,FL32610
59-2357609 		Hospital Support FL 501(c)(3) Type II STHC
 
 
No
(12)Shands Auxiliary Inc
PO Box 100336

Gainesville,FL32610
59-3551267 		Hospital Support FL 501(c)(3) Type I SEHF
 
 
No
(13)Central Florida Health Inc dba UF Health Central Florida
600 EAST DIXIE AVENUE

Leesburg,FL34748
33-1197054 		SUPPORT STHC, UFHL, AND UFHV FL 501(c)(3) Type II STHC
 
 
No
(14)Leesburg Regional Medical Center Inc dba UF Health Leesburg Hospital
600 EAST DIXIE AVENUE

LEESBURG,FL34748
59-0878982 		MEDICAL SERVICES FL 501(c)(3) 3 UFHCF
 
 
No
(15)The Villages Tri-County Medical Center Inc dba UF Health The Villages Hospi
tal1451 EL CAMINO REAL

THE VILLAGES,FL32159
59-3527036 		MEDICAL SERVICES FL 501(c)(3) 3 UFHCF
 
 
No
(16)Leesburg Regional Medical Center Foundation Inc dba UF Health Leesburg Hosp
ital Foundation600 EAST DIXIE AVENUE

LEESBURG,FL34748
59-1800743 		SUPPORT UFHL FL 501(c)(3) Type I UFHL
 
 
No
(17)The Villages Regional Hospital Auxiliary Foundation Inc dba UF Health The V
illages Hospital Auxiliary Foundation1501 N US Highway 441 Suite 182

THE VILLAGES,FL32159
55-0818419 		SUPPORT UFHV FL 501(c)(3) Type I UFHV
 
 
No
(18)FACULTY CLINIC INC
PO BOX 44008

Jacksonville,FL32231
59-2856153 		SUPPORT UF JAX PHYSICIANS FL 501(c)(3) Type I UF
 
 
No
(19)University of Florida Foundation Inc
PO Box 14425

Gainesville,FL326042425
59-0974739 		Support the University of Florida FL 501(c)(3) 7 UF
 
 
No
(20)University of Florida Investment Corporation (UFICO)
4510 NW 6th Place 2nd Floor

Gainesville,FL32607
20-1226494 		Investment Management FL 501(c)(3) Type I UF
 
 
No
(21)University of Florida Development Corporation
747 SW 2nd Avenue IMB 49

Gainesville,FL32601
35-2427022 		Support the University of Florida and Promote Economic Development FL 501(c)(3) Type I UF
 
 
No
(22)Florida Clinical Practice Association Inc
PO Box 100205

Gainesville,FL326100205
59-1680273 		Enhance medical education and research at the University of Florida FL 501(c)(3) Type I UF
 
 
No
(23)GatorCare Health Management Corporation
1329 SW 16th Street

Gainesville,FL32610
46-1185106 		Self-Insured Health Ins Plan FL 501(c)(3) Type I UF
 
 
No
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2021
Schedule R (Form 990) 2021
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, because it had one or more related organizations treated as a partnership during the tax year.
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V-UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No












Part IV
Identification of Related Organizations Taxable as a Corporation or Trust. Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.
(a)
Name, address, and EIN of
related organization
 		(b)
Primary activity
 		(c)
Legal
domicile
(state or foreign
country)
 		(d)
Direct controlling
entity
 		(e)
Type of entity
(C corp, S corp,
or trust) 		(f)
Share of total income
 		(g)
Share of end-of-year
assets
 		(h)
Percentage
ownership
 		(i)
Section 512(b)(13) controlled entity?
Yes No
(1) SOUTHERN HOSPITAL SYSTEMS INC

PO BOX 100336
GAINESVILLE,FL32610
59-1930524 		SUPPORT FOR SHANDS JACKSONVILLE MEDICAL CENTER, INC. FL NA
  		C Corporation         No












Schedule R (Form 990) 2021
Schedule R (Form 990) 2021
Page 3
Part V
Transactions With Related Organizations. Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest, (ii) annuities, (iii) royalties, or (iv) rent from a controlled entity .....................
1a
 
No
b Gift, grant, or capital contribution to related organization(s) ............................
1b
Yes
 
c Gift, grant, or capital contribution from related organization(s) ............................
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) ............................
1d
 
No
e Loans or loan guarantees by related organization(s) ............................
1e
 
No
f Dividends from related organization(s) ............................
1f
 
No
g Sale of assets to related organization(s) ............................
1g
 
No
h Purchase of assets from related organization(s) ............................
1h
 
No
i Exchange of assets with related organization(s) ............................
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) .......................
1j
 
No
k Lease of facilities, equipment, or other assets from related organization(s) ......................
1k
Yes
 
l Performance of services or membership or fundraising solicitations for related organization(s) .....................
1l
Yes
 
m Performance of services or membership or fundraising solicitations by related organization(s) .................
1m
Yes
 
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................
1n
Yes
 
o Sharing of paid employees with related organization(s) ............................
1o
Yes
 
p Reimbursement paid to related organization(s) for expenses ............................
1p
Yes
 
q Reimbursement paid by related organization(s) for expenses ............................
1q
 
No
r Other transfer of cash or property to related organization(s) ............................
1r
Yes
 
s Other transfer of cash or property from related organization(s) ............................
1s
Yes
 
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of related organization 		(b)
Transaction
type (a-s) 		(c)
Amount involved 		(d)
Method of determining amount involved





Schedule R (Form 990) 2021
Schedule R (Form 990) 2021
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on Form 990, Part IV, line 37.
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Predominant income (related, unrelated, excluded from tax under sections 512-514)

(e)
Are all partners
section
501(c)(3)
organizations? 		(f)
Share of total income




 		(g)
Share of
end-of-year
assets 		(h)
Disproprtionate allocations? 		(i)
Code V-UBI
amount in box 20
of Schedule K-1
(Form 1065) 		(j)
General or
managing
partner? 		(k)
Percentage
ownership
Yes No Yes No Yes No






























Schedule R (Form 990) 2021
Schedule R (Form 990) 2021
Page 5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R. See instructions.
Return Reference Explanation
Schedule R (Form 990) 2021

Additional Data


Software ID: 21014044
Software Version: 2021v4.2






TY 2021 AffiliatedGroupSchedule
Name:
SHANDS JACKSONVILLE MEDICAL CENTER INC
EIN:
59-2142859
Software ID:
21014044
Software Version:
2021v4.2
Affiliated Group Business Name:
SHANDS JACKSONVILLE MEDICAL CENTER INC
Address. Either US or Foreign Type:
655 West 8th Street
Jacksonville, FL32209    
EIN:
59-2142859
Electing Organization Checkbox:
Total Grassroots Lobbying:
0
Total Direct Lobbying:
84,684
Total Lobbying Expenditures:
84,684
Other Exempt Purpose Expenditures:
738,383,274
Total Exempt Purpose Expenditures:
738,467,958
Lobbying Nontaxable Amount:
1,000,000
Grassroots Nontaxable Amount:
250,000
Tot Lobbying Grassroot Minus Non Tx:
0
Tot Lobby Expend Mns Lobbying Non Tx:
0
Share Of Excess Lobbying:
0
Affiliated Group Business Name:
Shands Jacksonville Healthcare Inc
Address. Either US or Foreign Type:
655 West 8th Street
Jacksonville, FL32209    
EIN:
59-2441966
Electing Organization Checkbox:
Total Grassroots Lobbying:
0
Total Direct Lobbying:
0
Total Lobbying Expenditures:
0
Other Exempt Purpose Expenditures:
0
Total Exempt Purpose Expenditures:
0
Lobbying Nontaxable Amount:
0
Grassroots Nontaxable Amount:
0
Tot Lobbying Grassroot Minus Non Tx:
0
Tot Lobby Expend Mns Lobbying Non Tx:
0
Share Of Excess Lobbying:
0
Affiliated Group Business Name:
Shands Jacksonville Foundation
Address. Either US or Foreign Type:
655 West 8th Street
Jacksonville, FL32209    
EIN:
59-2622323
Electing Organization Checkbox:
Total Grassroots Lobbying:
0
Total Direct Lobbying:
0
Total Lobbying Expenditures:
0
Other Exempt Purpose Expenditures:
419,274
Total Exempt Purpose Expenditures:
419,274
Lobbying Nontaxable Amount:
83,855
Grassroots Nontaxable Amount:
20,964
Tot Lobbying Grassroot Minus Non Tx:
0
Tot Lobby Expend Mns Lobbying Non Tx:
0
Share Of Excess Lobbying:
0
Affiliated Group Business Name:
Shands Jacksonville Community Services
Address. Either US or Foreign Type:
655 West 8th Street
Jacksonville, FL32209    
EIN:
51-0173761
Electing Organization Checkbox:
Total Grassroots Lobbying:
0
Total Direct Lobbying:
0
Total Lobbying Expenditures:
0
Other Exempt Purpose Expenditures:
1,160,364
Total Exempt Purpose Expenditures:
1,160,364
Lobbying Nontaxable Amount:
191,036
Grassroots Nontaxable Amount:
47,759
Tot Lobbying Grassroot Minus Non Tx:
0
Tot Lobby Expend Mns Lobbying Non Tx:
0
Share Of Excess Lobbying:
0
Affiliated Group Business Name:
Shands Jacksonville Affiliates Inc
Address. Either US or Foreign Type:
655 West 8th Street
Jacksonville, FL32209    
EIN:
59-1913819
Electing Organization Checkbox:
Total Grassroots Lobbying:
0
Total Direct Lobbying:
0
Total Lobbying Expenditures:
0
Other Exempt Purpose Expenditures:
557,679
Total Exempt Purpose Expenditures:
557,679
Lobbying Nontaxable Amount:
108,652
Grassroots Nontaxable Amount:
27,163
Tot Lobbying Grassroot Minus Non Tx:
0
Tot Lobby Expend Mns Lobbying Non Tx:
0
Share Of Excess Lobbying:
0
Affiliated Group Business Name:
Shands Jacksonville Properties
Address. Either US or Foreign Type:
655 West 8th Street
Jacksonville, FL32209    
EIN:
59-1158241
Electing Organization Checkbox:
Total Grassroots Lobbying:
0
Total Direct Lobbying:
0
Total Lobbying Expenditures:
0
Other Exempt Purpose Expenditures:
1,511,937
Total Exempt Purpose Expenditures:
1,511,937
Lobbying Nontaxable Amount:
225,597
Grassroots Nontaxable Amount:
56,399
Tot Lobbying Grassroot Minus Non Tx:
0
Tot Lobby Expend Mns Lobbying Non Tx:
0
Share Of Excess Lobbying:
0
Affiliated Group Business Name:
ELDER CARE OF ALACHUA COUNTY INC
Address. Either US or Foreign Type:
PO BOX 100336
GAINESVILLE, FL32610    
EIN:
59-3051104
Electing Organization Checkbox:
Total Grassroots Lobbying:
0
Total Direct Lobbying:
0
Total Lobbying Expenditures:
0
Other Exempt Purpose Expenditures:
2,532,777
Total Exempt Purpose Expenditures:
2,532,777
Lobbying Nontaxable Amount:
276,639
Grassroots Nontaxable Amount:
69,160
Tot Lobbying Grassroot Minus Non Tx:
0
Tot Lobby Expend Mns Lobbying Non Tx:
0
Share Of Excess Lobbying:
0
Affiliated Group Business Name:
SHANDS AUXILIARY INC
Address. Either US or Foreign Type:
PO BOX 100336
GAINESVILLE, FL32610    
EIN:
59-3551267
Electing Organization Checkbox:
Total Grassroots Lobbying:
0
Total Direct Lobbying:
0
Total Lobbying Expenditures:
0
Other Exempt Purpose Expenditures:
64,174
Total Exempt Purpose Expenditures:
64,174
Lobbying Nontaxable Amount:
12,835
Grassroots Nontaxable Amount:
3,209
Tot Lobbying Grassroot Minus Non Tx:
0
Tot Lobby Expend Mns Lobbying Non Tx:
0
Share Of Excess Lobbying:
0
Affiliated Group Business Name:
SOUTHEASTERN HEALTHCARE FOUNDATION INC
Address. Either US or Foreign Type:
PO BOX 100336
GAINESVILLE, FL32610    
EIN:
59-2357609
Electing Organization Checkbox:
Total Grassroots Lobbying:
0
Total Direct Lobbying:
0
Total Lobbying Expenditures:
0
Other Exempt Purpose Expenditures:
4,210,420
Total Exempt Purpose Expenditures:
4,210,420
Lobbying Nontaxable Amount:
360,521
Grassroots Nontaxable Amount:
90,130
Tot Lobbying Grassroot Minus Non Tx:
0
Tot Lobby Expend Mns Lobbying Non Tx:
0
Share Of Excess Lobbying:
0
Affiliated Group Business Name:
Shands at lake shore inc
Address. Either US or Foreign Type:
PO BOX 100336
GAINESVILLE, FL32610    
EIN:
59-2699965
Electing Organization Checkbox:
Total Grassroots Lobbying:
0
Total Direct Lobbying:
0
Total Lobbying Expenditures:
0
Other Exempt Purpose Expenditures:
0
Total Exempt Purpose Expenditures:
0
Lobbying Nontaxable Amount:
0
Grassroots Nontaxable Amount:
0
Tot Lobbying Grassroot Minus Non Tx:
0
Tot Lobby Expend Mns Lobbying Non Tx:
0
Share Of Excess Lobbying:
0
Affiliated Group Business Name:
SHANDS TEACHING HOSPITAL AND CLINICS INC
Address. Either US or Foreign Type:
PO BOX 100336
GAINESVILLE, FL32610    
EIN:
59-1943502
Electing Organization Checkbox:
Total Grassroots Lobbying:
0
Total Direct Lobbying:
623,811
Total Lobbying Expenditures:
623,811
Other Exempt Purpose Expenditures:
1,716,904,888
Total Exempt Purpose Expenditures:
1,717,528,699
Lobbying Nontaxable Amount:
1,000,000
Grassroots Nontaxable Amount:
250,000
Tot Lobbying Grassroot Minus Non Tx:
0
Tot Lobby Expend Mns Lobbying Non Tx:
0
Share Of Excess Lobbying:
0
Affiliated Group Business Name:
CENTRAL FLORIDA HEALTH INC
Address. Either US or Foreign Type:
600 E DIXIE AVE
LEESBURG, FL34748    
EIN:
33-1197054
Electing Organization Checkbox:
Total Grassroots Lobbying:
0
Total Direct Lobbying:
0
Total Lobbying Expenditures:
0
Other Exempt Purpose Expenditures:
358,080
Total Exempt Purpose Expenditures:
358,080
Lobbying Nontaxable Amount:
71,616
Grassroots Nontaxable Amount:
17,904
Tot Lobbying Grassroot Minus Non Tx:
0
Tot Lobby Expend Mns Lobbying Non Tx:
0
Share Of Excess Lobbying:
0
Affiliated Group Business Name:
LEESBURG REGIONAL MEDICAL CENTER INC
Address. Either US or Foreign Type:
600 E DIXIE AVE
LEESBURG, FL34748    
EIN:
59-0878982
Electing Organization Checkbox:
Total Grassroots Lobbying:
0
Total Direct Lobbying:
0
Total Lobbying Expenditures:
0
Other Exempt Purpose Expenditures:
224,879,997
Total Exempt Purpose Expenditures:
224,879,997
Lobbying Nontaxable Amount:
1,000,000
Grassroots Nontaxable Amount:
250,000
Tot Lobbying Grassroot Minus Non Tx:
0
Tot Lobby Expend Mns Lobbying Non Tx:
0
Share Of Excess Lobbying:
0
Affiliated Group Business Name:
LEESBURG REGIONAL MEDICAL CENTER FOUNDATION INC
Address. Either US or Foreign Type:
600 E DIXIE AVE
LEESBURG, FL34748    
EIN:
59-1800743
Electing Organization Checkbox:
Total Grassroots Lobbying:
0
Total Direct Lobbying:
0
Total Lobbying Expenditures:
0
Other Exempt Purpose Expenditures:
58,250
Total Exempt Purpose Expenditures:
58,250
Lobbying Nontaxable Amount:
11,650
Grassroots Nontaxable Amount:
2,913
Tot Lobbying Grassroot Minus Non Tx:
0
Tot Lobby Expend Mns Lobbying Non Tx:
0
Share Of Excess Lobbying:
0
Affiliated Group Business Name:
THE VILLAGES TRI-COUNTY MEDICAL CENTER INC
Address. Either US or Foreign Type:
1451 EL CAMINO REAL
THE VILLAGES, FL32159    
EIN:
59-3527036
Electing Organization Checkbox:
Total Grassroots Lobbying:
0
Total Direct Lobbying:
0
Total Lobbying Expenditures:
0
Other Exempt Purpose Expenditures:
186,277,184
Total Exempt Purpose Expenditures:
186,277,184
Lobbying Nontaxable Amount:
1,000,000
Grassroots Nontaxable Amount:
250,000
Tot Lobbying Grassroot Minus Non Tx:
0
Tot Lobby Expend Mns Lobbying Non Tx:
0
Share Of Excess Lobbying:
0
Affiliated Group Business Name:
THE VILLAGES REGIONAL HOSPITAL AUXILIARY INC
Address. Either US or Foreign Type:
1501 N US HIGHWAY 441
THE VILLAGES, FL32159    
EIN:
55-0818419
Electing Organization Checkbox:
Total Grassroots Lobbying:
0
Total Direct Lobbying:
0
Total Lobbying Expenditures:
0
Other Exempt Purpose Expenditures:
531,714
Total Exempt Purpose Expenditures:
531,714
Lobbying Nontaxable Amount:
104,757
Grassroots Nontaxable Amount:
26,189
Tot Lobbying Grassroot Minus Non Tx:
0
Tot Lobby Expend Mns Lobbying Non Tx:
0
Share Of Excess Lobbying:
0