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," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990.
lBullet Information about Schedule I (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2014
Open to Public
Inspection
Name of the organization
 
 
Employer identification number
03-0183483
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" to 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
non-cash assistance		 (h) Purpose of grant
or assistance
(1)  
3447 ROUTE 7
PITTSFORD,VT05763 		03-6000625 PITTSFORD, VT 8,200       COMMUNITY HEALTH IMPROVEMENT
(2)  
64 GRANGE HALL ROAD
N CLARENDON,VT05759 		03-0253069 WALLINGFORD DIS 22,600       COMMUNITY HEALTH IMPROVEMENT
(3)  
PO BOX 10832
BEDFORD,NH03110 		02-0243160 501(C)(3) 10,579       COMMUNITY HEALTH IMPROVEMENT
(4)  
60 S MAIN STREET
WATERBURY,VT05676 		03-0276755 501(C)(3) 26,708       COMMUNITY HEALTH IMPROVEMENT
(5)  
7 ALBERT CREE DRIVE
RUTLAND,VT05701 		03-0185024 501(C)(3) 6,584       COMMUNITY HEALTH IMPROVEMENT
(6)  
PO BOX 829
MONTPELIER,VT05601 		03-0267183 501(C)(3) 29,000       COMMUNITY HEALTH IMPROVEMENT
(7)  
898 DELORM ROAD
LEICESTER,VT05733 		03-0364354 501(C)(3) 35,000       COMMUNITY HEALTH IMPROVEMENT
(8)  
103 PARK AVENEUE
RUTLAND,VT05701 		03-0369442 501(C)(3) 22,175       COMMUNITY HEALTH IMPROVEMENT
(9)  
80 SOUTH MAIN STREET
RUTLAND,VT05701 		03-0210725 501(C)(3) 38,565       COMMUNITY HEALTH IMPROVEMENT
(10)  
375 ROUTE 30
NORTH BOMOSEEN,VT05732 		22-1179701 501(C)(3) 1,773,580       COMMUNITY HEALTH IMPROVEMENT




2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
10
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2014
Page 2

Schedule I (Form 990) 2014
Page 2
Part III
Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" to 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
non-cash assistance		 (e)Method of valuation (book,
FMV, appraisal, other)		 (f)Description of non-cash assistance












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 GRANTS MONITORING: RUTLAND REGIONAL HEALTH SERVICES (RRHS), THROUGH RUTLAND REGIONAL MEDICAL CENTER(RRMC), AWARDED A FIVE-YEAR COMMUNITY BENEFIT GRANT TO COMMUNITY HEALTH CENTERS OF THE RUTLAND REGION, INC. (CHCRR) IN THE AMOUNT OF $4,600,000 THAT IS FUNDED BY RRMC AND WAS EFFECTIVE MAY 1, 2008. FOR THE YEARS ENDED SEPTEMBER 30, 2014 AND 2013, RESPECTIVELY, $1,773,580 AND $833,333 WAS EXPENDED FOR THE GRANT AWARD FROM RRMC AND IS INCLUDED IN RUTLAND REGIONAL MEDICAL CENTER'S GENERAL OPERATING EXPENSES. RRHS CONTINUALLY WORKS WITH CHCRR TO ENSURE THE ORGANIZATION IS USING FUNDS APPROPRIATELY AND FURTHERING THE CHCRR EXEMPT PURPOSE. THE OTHER GRANTS LISTED ON SCHEDULE I, PART II, WERE PROVIDED BY THE JAMES T BOWSE HEALTH TRUST, A DEPARTMENT OF RUTLAND REGIONAL MEDICAL CENTER. THE BOWSE TRUST ONLY CONSIDERS GRANT PROPOSALS THROUGH ITS FORMAL GRANT PROPOSAL PROCESS, WHICH REQUIRES THAT THE REQUESTING ORGANIZATION MEET CERTAIN CRITERIA AND SUBMIT A PLANNING GRANT/LETTER OF INTENT, FULL PROPOSAL, AND PLANNING GRANT BUDGET FORM DESCRIBING HOW THE GRANT WILL BE USED.
SCHEDULE I, PART II, COLUMN H PURPOSE OF GRANT OR ASSISTANCE: ASSISTANCE FOR LOTHROP ELEMENTARY SCHOOL, RUTLAND SOUTH SUPERVISORY UNION, GIRL SCOUTS OF THE GREEN MOUNTAIN, VERMONT ADULT LEARNING, RUTLAND AREA VISITING NURSES, PREVENT CHILD ABUSE, FOXCRAFT FARM HARVEST, RUTLAND DISMAS HOUSE, AND RUTLAND MENTAL HEALTH WAS PROVIDED BY THE JAMES T BOWSE HEALTH TRUST, A DEPARTMENT OF RUTLAND REGIONAL MEDICAL CENTER. SEE SCHEDULE H, PART VI, LINE 6 FOR MORE INFORMATION REGARDING PROGRAMS FUNDED BY THE JAMES T BOWSE HEALTH TRUST.
Schedule I (Form 990) 2014



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