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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
2020
Open to Public
Inspection
Name of the organization
RUTLAND HOSPITAL INC
 
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" 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) COME ALIVE OUTSIDE INC
PO BOX 267
RUTLAND,VT05701 		47-2357025 501(C)(3) 54,166       COMMUNITY HEALTH IMPROVEMENT
(2) THE MENTOR CONNECTOR
110 MERCHANTS ROW
RUTLAND,VT05701 		65-1290104 501(C)(3) 46,638       COMMUNITY HEALTH IMPROVEMENT
(3) GREEN MOUNTAIN RECOVERY FOUNDATION INC
141 STATE STREET
RUTLAND,VT05701 		51-0425091 501(C)(3) 44,430       COMMUNITY HEALTH IMPROVEMENT
(4) MILL RIVER UNIFIED UNION SCHOOL DISTRICT
2321 MIDDLE ROAD
N CLARENDON,VT05759 		23-7349055 STATE OF VT 19,740       COMMUNITY HEALTH IMPROVEMENT
(5) CENTER FOR HEALTH AND LEARNING
28 VERNON ST STE 319
BRATTLEBORO,VT05301 		03-0351024 501(C)(3) 17,057       COMMUNITY HEALTH IMPROVEMENT
(6) RUTLAND AREA FARM AND FOOD LINK INC
PO BOX 1008
RUTLAND,VT05702 		45-5293058 501(C)(3) 23,000       COMMUNITY HEALTH IMPROVEMENT
(7) COMMUNITY HEALTH CENTERS OF RUTLAND REGION
375 ROUTE 30
NORTH BOMOSEEN,VT05732 		22-1179701 501(C)(3) 256,176       COMMUNITY HEALTH IMPROVEMENT
(8) VERMONT CHAMBER FOUNDATION
PO BOX 37
MONTPELIER,VT05601 		03-0335635 501(C)(3) 10,000       COMMUNITY HEALTH IMPROVEMENT
(9) PARAMOUNT CENTER INC
30 CENTER STREET
RUTLAND,VT05701 		22-2528303 501(C)(3) 340,000       COMMUNITY HEALTH IMPROVEMENT
(10) UNITED WAY OF RUTLAND COUNTY
6 CHURCH ST STE 1
RUTLAND,VT05701 		03-6000224 501(C)(3) 13,000       COMMUNITY HEALTH IMPROVEMENT
(11) UNIVERSITY OF VERMONT
85 S PROSPECT STREET
BURLINGTON,VT05405 		03-0179440 501(C)(3) 54,000       COMMUNITY HEALTH IMPROVEMENT
(12) RUTLAND MENTAL HEALTH SERVICES INC
78 S MAIN ST PO BOX 22
RUTLAND,VT05701 		03-0210725 501(C)(3) 39,080       COMMUNITY HEALTH IMPROVEMENT
(13) RUTLAND COMMUNITY PROGRAMS INC
78 MEADOW STREET
RUTLAND,VT05701 		03-0307812 501(C)(3) 23,596       COMMUNITY HEALTH IMPROVEMENT
(14) RUTLAND COUNTY HOUSING COALITION
56 HOWE ST BLDG A BX 7
RUTLAND,VT05701 		55-0822651 501(C)(3) 12,000       COMMUNITY HEALTH IMPROVEMENT
(15) RUTLAND FREE CLINIC DBA PARK STREET HEALTH
145 STATE STREET
RUTLAND,VT05701 		83-0427544 501(C)(3) 10,000       COMMUNITY HEALTH IMPROVEMENT
(16) RUTLAND REGIONAL PLANNING COMMISION
PO BOX 430
RUTLAND,VT05702 		03-0220669 501(C)(3) 25,000       COMMUNITY HEALTH IMPROVEMENT
(17) RUTLAND ECONOMIC DEVELOPMENT CORPORATION
67 MERCHANTS ROW
RUTLAND,VT05701 		03-0264949 501(C)(6) 15,005       COMMUNITY HEALTH IMPROVEMENT
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
16
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
1
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2020
Page 2

Schedule I (Form 990) 2020
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 GRANTS MONITORING: EFFECTIVE DECEMBER 1, 2013, RRHS ENTERED INTO AN AGREEMENT TO PROVIDE CHCRR A COMMUNITY BENEFIT GRANT OVER A PERIOD OF FIFTY-EIGHT MONTHS FROM DECEMBER 1, 2013, TO SEPTEMBER 30, 2018. THE AGREEMENT WAS RENEWED DURING THE YEAR ENDED SEPTEMBER 30, 2019, FOR A PERIOD OF THIRTY-SIX MONTHS FROM OCTOBER 1, 2018, TO SEPTEMBER 20, 2021. THESE PAYMENTS ARE BEING MADE MONTHLY AND RANGE FROM $20,123 TO $21,348, FOR A TOTAL GRANT OF $734,415. 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 COME ALIVE OUTSIDE, INC., THE MENTOR CONNECTOR, GREEN MOUNTAIN RECOVERY FOUNDATION, INC., MILL RIVER UNIFIED UNION SCHOOL DISTRICT, CENTER FOR HEALTH AND LEARNING, RUTLAND MENTAL HEALTH SERVICES, INC., RUTALND COMMUNITY PROGRAMS, INC. AND RUTLAND COUNTY HOUSING COALITION WAS PROVIDED BY THE JAMES T BOWSE HEALTH TRUST, A DEPARTMENT OF RUTLAND REGIONAL MEDICAL CENTER. SEE SCHEDULE H, PART VI, LINE 5 FOR MORE INFORMATION REGARDING PROGRAMS FUNDED BY THE JAMES T BOWSE HEALTH TRUST.
Schedule I (Form 990) 2020



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