Southside Community Hospital Inc.

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

“Minutes are taken at each meeting.”

“Form 990, part iii, line 4a: community benefit highlights - " during fy 2014, $8,269,111 in charges at an estimated cost of $3,133,919 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 $9,777,953 at an estimated cost of $3,705,756 were contributed as bad debt to patients who did not have the ability to pay. " loss from medicaid based on cost to charge ratio totaled $2,478,283. " community education includes community/patient health education programs, health screenings, counseling, and support groups. " cash donations made by centra southside community hospital to the community totaled $36,440 southside community hospital is eager to meet the healthcare needs of the community, which consists of its eight surrounding counties of amelia, buckingham, charlotte, 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. Some examples are listed below. Community education and health screenings - longwood wellness health fair rock the block at longwood health fair small business community showcase health fair first fridays health fair (5) cumberland day/patriot day (bp screenings) heart of virginia (bp screenings) chronic kidney disease screening shriners health screening for children blood drives (6) 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 multiple sclerosis support group sleep disorders support group domestic violence prevention support group look good...feel better(acs) cancer support group bereavement support group special projects/ health ministry - community coat and blanket drive- over 600 coats and blankets distributed annual pink ribbon tea party (breast cancer awareness) advanced directives day go red for women (aha) electrophysiology seminar march for babies youth triathlon (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 in scholarships were given in 2014). 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 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 free health education materials to the general public, and assisting in health screenings. Nurses from our pediatric unit teach child car seat classes. Centra southside community hospital employees are encouraged to share their professional health knowledge to the community by speaking to civic organizations or the general public when solicited. The hospital in conjunction with the shriners, conducted free health screenings at the hospital on all participating children from the farmville community. Centra southside community ho”

“Form 990, part vi, section a, line 2: director lewis addison serves as board member of piedmont community health plan. Director e.w. Tibbs serves as officer and director of piedmont community health plan, a 50% joint venture of centra health, inc. Director lewis addison serves as board member of central virginia imaging, a 50% joint venture of centra health, inc. Director 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 as board members of the woodlands, inc., a nursing home.”

“Form 990, part vi, section a, line 7a & b: 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.”

“Form 990, part vi, section b, line 11b: the return was prepared by an independent accountant with assistance and oversight by management. Centra southside will provide all voting members of the board of directors with a copy of the form 990 prior to its filing. Additionally, centra southside will review the form 990 with the finance committee, who will then present it to the board of directors.”

“Form 990, part vi, section b, line 12c: 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, section b, line 15a & b: 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.”

“Form 990, part vi, section c, line 18: 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 .”

“FORM 990, PART VI, SECTION C, LINE 19: 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 4,630,769 - MEDICAL PURCHASE SERVICES 440,668 - CAPITATED MEDICAL CLAIMS 1,501,074 - OTHER PURCHASED SERVICES 1,216,572 354,862 TEMPORARY CONTRACT LABOR 454,918 1,355,888 RECRUITMENT 637 - OFFICE SUPPORT BILLING FEES - 416,721 CLEANING SERVICES 32,233 - MISCELLANEOUS - 465 -------- ------- 8,276,871 2,127,936 ========== ==========”

“Form 990, part xi, line 9: contributed capital from centra health $210,886 change in fair value of interest rate swap agreement $ (9,184) -------- total to form 990, part xi, line 9 $201,702”

“Form 990, part xii, line 2c: 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.”

“Form 990, part xi, line 8 medicaid disallowed a portion of the discharges that were filed during the attestation. The prior period adjustment in the amount of $-86,726 is to correct the recognized revenue from the prior year.”

“Description:physician remuneration total fees:4630769”

“Description:medical purchased services total fees:440668”

“Description:capitated medical claims total fees:1501074”

“Description:other purchased services total fees:1571434”

“Description:contract labor total fees:1810806”

“Description:recruitment total fees:637”

“Description:billing fees total fees:416721”

“Description:cleaning services total fees:32233”

“Description:miscellaneous total fees:465”