The purpose of the Conflict of Interest Policy is to protect the interests of Hospice House, Inc. doing business as Hospice House of Williamsburg (the “Corporation”), when it is contemplating entering into a transaction or arrangement that might benefit the private interest of an officer or director of the Corporation or might result in a possible excess benefit transaction.

In accordance with the purpose and the intent of the Corporation’s Conflict of Interest Policy, I hereby affirm that:

• I have received a copy of the Conflict of Interest Policy.

• I have read and understand the Conflict of Interest Policy.

• I have agreed to comply with the Conflict of Interest Policy.

• I understand the Corporation is charitable.

In order to maintain its federal tax exemption, it must engage primarily in activities which accomplish one or more of its tax-exempted purposes.