Southside Community Hospital Inc.

“Officer lewis addison serves as officer of piedmont community health plan. Officer e.w. Tibbs and board member rodger fauber serve as board members of piedmont community health plan, a 50% joint venture of centra health, inc. Officers lewis addison and e.w. Tibbs serve on the board of directors for the surgery center of lynchburg, a 50% joint venture of centra health, inc. Officer lewis addison serves as board member of central virginia imaging and officer e.w. Tibbs serves as officer of central virginia imaging, a 50% joint venture of centra health, inc. Board member william mcguire and officer leroy pfeiffer, jr. Serve on the board of directors for the woodlands, inc., a nursing home.”

“Through an affiliation agreement, southside hospital's sole corporate member is centra health, inc.”

“Centra health, inc. Is the sole member corporation of southside community hospital (sch) and has the power to elect/approve the board of directors of sch's governing body and approve decisions made by sch's board.”

“See response to part vi, line 7a.”

“The return was prepared by an independent accountant with assistance and oversight by management. Copies of the form 990 were provided to all voting members of the board of directors and any questions raised by the board of directors have been addressed. Management reviewed the form 990 with the finance committee of the board of directors, and then presented it to the board of directors for their approval.”

“All centra southside officers, directors, and key employees, must complete a conflict of interest questionnaire on an annual basis, certifying that neither they nor any of their immediate family members have engaged in any activities that could lead to a potential conflict of interest. Additionally, all officers, directors, and key employees must agree to promptly report any potential conflicts of interest that arise during the year to the president or chairman of centra southside's board of directors.”

“Form 990, part vi, lines 15a & 15b were answered as "no", however, under a management agreement with centra health, inc., a related party, the organization's chief executive officer's compensation is established in accordance with centra health's executive compensation practices which include the use of a compensation committee, independent compensation consultant(s), and compensation study or survey.”

“Photocopies of the organization's form 1023 and recent filings of the form 990 are available upon request at the organization's administrative office. Additionally, filings of the form 990 are available online at www.guidestar.org.”

“THE ORGANIZATION PROVIDES PHOTOCOPIES OF ITS FINANCIAL STATEMENTS, GOVERNING DOCUMENTS, AND CONFLICT OF INTEREST POLICY UPON REQUEST AT ITS ADMINISTRATIVE OFFICE. FUNCTIONAL EXPENSES FORM 990, PART IX, LINE 11G: LINE 11G IS MADE UP OF THE FOLLOWING EXPENSES - Column (B) Column (C) Program Services Mgmt & General HOSPITALIST - PHYSICIAN RENUMERATION 4,254,549 - MEDICAL PURCHASE SERVICES 815,802 - CAPITATED MEDICAL CLAIMS 383,675 - OTHER PURCHASED SERVICES 1,346,410 331,257 TEMPORARY CONTRACT LABOR 2,446,027 154 OTHER PURCHASED SERVICES-MIS 980 1,394 RECRUITMENT 33,414 10,290 OFFICE SUPPORT BILLING FEES 440,619 - CLEANING SERVICES 67,336 - -------- ------- 9,788,812 343,095 ========== =======”

“Community benefit highlights - " during fy 2013, $8,121,263 in charges at an estimated cost of $3,110,217 was contributed as traditional charity care to patients who did not have the ability to pay. Eligibility for charity care is based on poverty income levels set by the state. " charges of $10,979,717 at an estimated cost of $4,204,925 were contributed as bad debt to patients who did not have the ability to pay. " cash donations made by centra southside community hospital to the community totaled $17,800 " community education includes community/patient health education programs, health screenings, counseling, and support groups. " southside community hospital's auxiliary and volunteers donated over 5,471 hours of service during 2013 southside community hospital is eager to meet the healthcare needs of the community, which consists of its eight surrounding counties of amelia, buckingham, charlotte county, cumberland, lunenburg, nottoway, appomattox, and prince edward counties. Employees continually offer professional health education programs, classes, lectures, health fairs, health screenings, support groups, etc., throughout southside virginia. Southside community hospital is dedicated to improving the healthcare of its community. Community education and health screenings - health screenings: southside electric health fair rock the block at longwood health fair heart of virginia festival first fridays health fair (5) buckingham day (bp screenings) patriot day in cumberland (bp screenings) cumberland relay for life (bp screenings) feet 4 fire (bp screenings) steps christmas show (bp screenings) blood drives (5) pace cancer survivor conference prostate cancer awareness day community heart profile (heart health fair) family education and community classes - breastfeeding classes car seat classes sibling classes cpr classes childbirth and family education birthing center tours lamaze classes southside virginia defensive driving class diabetic education class amelia high school career day homeschool/preschool tours support groups - alcoholics anonymous brain injury support group chronic pain/fibromyalgia support group diabetic support group look good...feel better (acs) multiple sclerosis support group sleep disorders support group domestic violence prevention support group cancer support group bereavement support group special projects - caws program-christmas for the elderly community coat and blanket drive-over 600 coats & blankets distributed (2) annual pink ribbon tea party (breast cancer awareness) be a hero donor day advanced directives day go red for women (aha) emotional wellness seminars (3) march for babies walk/sponsor healthy kids day (in conjunction with ymca) medical career camp for middle schoolers volunteer services women's auxiliary of southside community hospital: fundraising for hospital - provides scholarships for nursing students ($6,000 was given in scholarships in 2013). Csch volunteers: front desk, registration, and transport, tele-med-surg, ob, same day surgery, etc. Hospice volunteers: care for end-of-life patients cardio-rehab volunteers: assistants in the gym for cardio patients pace (program for all inclusive care for the elderly) volunteers: assists with activities for the elderly longwood university/hampden-sydney college volunteers: students needing service hours for internships and projects summer youth volunteer program stories of assistance to the community as of 2013, centra southside community hospital's ob, marketing, and material management departments have partnered in creating baby care gift bags and tool kits to give away to the mothers of newborns in the hospital's ob ward. Centra southside community hospital is proud to serve its community and the surrounding counties. Our nurses are eager to assist in community events by conducting blood pressure checks, providing health education materials to the general public, and assisting in health screenings. Another example of providing commun”

“Contributed capital from centra health $235,628 change in fair value of interest rate swap agreement $293,190 -------- total to form 990, part xi, line 9 $528,818”

“Committee responsible for audit process oversight - the audit process of the organization including the oversight of the financial statements and selection of the independent auditor is overseen by the audit & compliance committee of centra health, inc., sole member and related organization.”