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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.
Graphic Arrow Attach to Form 990.
Graphic Arrow Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2021
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) RUTLAND MENTAL HEALTH SERVICES INC
78 S MAIN ST PO BOX 22
RUTLAND,VT05701 		03-0210725 501(C)(3) 27,797       COMMUNITY HEALTH IMPROVEMENT
(2) RUTLAND COMMUNITY PROGRAMS INC
78 MEADOWS STREET
RUTLAND,VT05701 		03-0307812 501(C)(3) 18,060       COMMUNITY HEALTH IMPROVEMENT
(3) GREEN MOUNTAIN RECOVERY FOUNDATION INC
141 STATE STREET
RUTLAND,VT05701 		51-0425091 501(C)(3) 32,830       COMMUNITY HEALTH IMPROVEMENT
(4) THE MENTOR CONNECTOR
110 MERCHANTS ROW
RUTLAND,VT05701 		65-1290104 501(C)(3) 25,000       COMMUNITY HEALTH IMPROVEMENT
(5) RUTLAND COUNTY HOUSING COALITION
56 HOWE ST BLDG A BX 7
RUTLAND,VT05701 		55-0822651 501(C)(3) 37,104       COMMUNITY HEALTH IMPROVEMENT
(6) VERMONT ADULT LEARNING
16 EVELYN STREET
RUTLAND,VT05701 		03-0276755 501(C)(3) 50,000       COMMUNITY HEALTH IMPROVEMENT
(7) COME ALIVE OUTSIDE INC
PO BOX 267
RUTLAND,VT05701 		47-2357025 501(C)(3) 105,666       COMMUNITY HEALTH IMPROVEMENT
(8) VERMONT FARMERS MARKET EDUCATION CENTER
PO BOX 833
RUTLAND,VT057020833 		45-5293058 501(C)(3) 24,000       COMMUNITY HEALTH IMPROVEMENT
(9) COMMUNITY HEALTH CENTERS OF RUTLAND REGION
375 ROUTE 30
NORTH BOMOSEEN,VT05732 		22-1179701 501(C)(3) 235,114       COMMUNITY HEALTH IMPROVEMENT
(10) PARAMOUNT CENTER INC
30 CENTER STREET
RUTLAND,VT05701 		22-2528303 501(C)(3) 10,000       COMMUNITY HEALTH IMPROVEMENT
(11) RUTLAND FREE CLINIC DBA PARK STREET HEALTH
145 STATE STREET
RUTLAND,VT05701 		83-0427544 501(C)(3) 10,000       COMMUNITY HEALTH IMPROVEMENT
(12) RUTLAND ECONOMIC DEVELOPMENT CORPORATION
67 MERCHANTS ROW
RUTLAND,VT05701 		03-0264949 501(C)(3) 21,755       COMMUNITY HEALTH IMPROVEMENT
(13) UNIVERSITY OF VERMONT & STATE AGRICULTURAL COLLEGE
1 SOUTH PROSPECT ST
BURLINGTON,VT05401 		03-0179440 501(C)(3) 55,625       COMMUNITY HEALTH IMPROVEMENT
(14) UNITED WAY OF RUTLAND COUNTY
6 CHURCH ST STE 1
RUTLAND,VT05701 		03-6000224 501(C)(3) 12,500       COMMUNITY HEALTH IMPROVEMENT
(15) AMERICAN CANCER SOCIETY
55 DAY LANE
WILLISTON,VT05495 		13-1788491 501(C)(3) 5,500       COMMUNITY HEALTH IMPROVEMENT
(16) HOUSING TRUST OF RUTLAND COUNTY INC
27 WALES STREET SUITE 201
RUTLAND,VT05701 		03-0280726 501(C)(3) 25,500       COMMUNITY HEALTH IMPROVEMENT
(17) VERMONT SYMPHONY ORCHESTRA ASSOCIATION
2 CHURCH STREET 3B
BURLINGTON,VT05401 		03-0222134 501(C)(3) 50,000       COMMUNITY HEALTH IMPROVEMENT
(18) WONDERFEET KID'S MUSEUM
PO BOX 6243 11 CENTER STREET
RUTLAND,VT05702 		45-4692194 501(C)(3) 27,500       COMMUNITY HEALTH IMPROVEMENT
(19) HOUSING INITIATIVES INC
5 TREMONT STREET
RUTLAND,VT05701 		20-1914244 501(C)(3) 25,375       COMMUNITY HEALTH IMPROVEMENT
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Graphic Arrow
19
3
Enter total number of other organizations listed in the line 1 table ........................ . Graphic Arrow
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2021
Page 2

Schedule I (Form 990) 2021
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: THE PURPOSE OF THIS POLICY IS TO ESTABLISH A FORMALIZED PROCESS FOR GRANT MANAGEMENT INCLUDING THE: (1) DEVELOPMENT AND REVIEW OF PROPOSALS FOR GRANT FUNDING; (2) REVIEW AND APPROVAL OF GRANT AGREEMENTS AND CONTRACTS ASSOCIATED WITH GRANT PROGRAMS; (3) MANAGEMENT OF GRANT AWARDS; AND, (4) OVERSIGHT OF COMPLIANCE WITH GRANT REPORTING AND CLOSE OUT REQUIREMENTS. THE POLICY IS INTENDED TO CREATE A SINGLE UNIFORM PROCESS FOR ALL GRANT FUNDING TO ENSURE THAT THE ORGANIZATION COMPLIES WITH GRANT AGREEMENT OBLIGATIONS, AND STATE AND FEDERAL LAWS THAT GOVERN GRANTS.
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., RUTLAND MENTAL HEALTH SERVICES, INC., RUTLAND 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) 2021



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