TY 2010 Form 990

(A) Name and Title	(B) Average hours per week (describe hours for related organizations in Schedule O)	(C) Position (check all that apply)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)
(1) PAUL THULI DIRECTOR	.50	X			0	0
(2) JIM KOOPMAN CHAIRPERSON	1.00	X			0	0
(3) TERRI ABING DIRECTOR	.50	X			0	0
(4) KAREN KNOX VICE-CHAIR	1.00	X			0	0
(5) TOM KENNEY SECRETARY	1.00	X			0	0
(6) ERIC SLANE MD DIRECTOR	.50	X			61,973	0
(7) DAVID WHITTY MD DIRECTOR	.50	X			0	0
(8) STEVE SCHNEIDER DIRECTOR	.50	X			0	0
(9) SUSAN FRITZ DIRECTOR	.50	X			0	0
(10) ERIC STADER MD DIRECTOR	.50	X			64,115	0
(11) DAVID KURIHARA DIRECTOR	.50	X			0	0
(12) NICOLE CLAPP CONTRACTED EE CEO	47.00		X		191,100	0
(13) JENNIFER RUTKOWSKI VP OF PROFESSIONAL SERVICE	50.00		X		102,865	14,276
(14) DEREK JONES CMA CONTRACTED EE CFO	47.00		X		31,500	0
(15) LESLIE NEWHOUSE PHYSICIAN ASSISTANT	48.00			X	112,000	8,266
(16) JOLENE ZEIBART NURSE PRACTITIONER	48.00			X	114,133	7,912
(17) ROBERT SMITH MD PHYSICIAN	48.00			X	322,044	22,040

Do not include amounts reported on lines 6b, 7b, 8b, 9b, and 10b of Part VIII.	(A) Total expenses	(B) Program service expenses	(C) Management and general expenses	(D) Fundraising expenses
1	Grants and other assistance to governments and organizations in the U.S. See Part IV, line 21	1,050	1,050
2	Grants and other assistance to individuals in the U.S. See Part IV, line 22
3	Grants and other assistance to governments, organizations, and individuals outside the U.S. See Part IV, lines 15 and 16
4	Benefits paid to or for members
5	Compensation of current officers, directors, trustees, and key employees ....	439,912		439,912
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....
7	Other salaries and wages	7,084,699	5,546,577	1,538,122
8	Pension plan contributions (include section 401(k) and section 403(b) employer contributions) ....	284,041	228,539	55,502
9	Other employee benefits .......	1,010,719	813,223	197,496
10	Payroll taxes ...........	504,066	394,313	109,753
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	83,436		83,436
c	Accounting ...........	60,100		60,100
d	Lobbying ...........
e	Professional fundraising. See Part IV, line 17..
f	Investment management fees ......	2,500		2,500
g	Other ..........	1,914,505	1,663,417	251,088
12	Advertising and promotion ....	87,337		87,337
13	Office expenses .......	849,230	570,093	279,137
14	Information technology ......	294,308	294,308
15	Royalties ..
16	Occupancy ...........	616,027	616,027
17	Travel ............	69,358	36,191	33,167
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......
19	Conferences, conventions, and meetings ....
20	Interest ...........
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization .....	974,315	974,315
23	Insurance ..............	62,916		62,916
24	Other expenses. Itemize expenses not covered above. (Expenses grouped together and labeled miscellaneous may not exceed 5% of total expenses shown on line 25 below.)
a	MEDICAL SUPPLIES	1,332,355	1,332,355
b	PROVISION FOR BAD DEBTS	510,039	510,039
c	REPAIRS & MAINTENANCE	291,405	291,311	94
d	OTHER DIRECT EXPENSES	155,484	141,951	13,533
e	STATE HOSPITAL ASSESSME	61,726	61,726
f	All other expenses
25	Total functional expenses. Add lines 1 through 24f	16,689,528	13,475,435	3,214,093	0
26	Joint costs. Check here if following SOP 98-2 (ASC 958-720). Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation

Part X Balance Sheet
	1	Cashnon-interest-bearing ..........	591,908	1	119,326
2	Savings and temporary cash investments .......	679,447	2	400,259
3	Pledges and grants receivable, net .........		3
4	Accounts receivable, net .........	1,943,897	4	2,164,617
5	Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
	Schedule L ..........		5
6	Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
	Schedule L ..........		6
7	Notes and loans receivable, net .............		7
8	Inventories for sale or use ..............	583,296	8	626,205
9	Prepaid expenses and deferred charges ............	359,745	9	279,855
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	20,114,243
b	Less: accumulated depreciation. .....	10b	9,683,341	10,690,570	10c	10,430,902
11	Investments—publicly traded securities ..........		11
12	Investments—other securities. See Part IV, line 11 ......	8,489,727	12	10,635,386
13	Investments—program-related. See Part IV, line 11 ..		13
14	Intangible assets .........		14
15	Other assets. See Part IV, line 11 ...........	1,022,351	15	1,022,608
16	Total assets. Add lines 1 through 15 (must equal line 34)...	24,360,941	16	25,679,158
	17	Accounts payable and accrued expenses .	1,312,579	17	1,007,981
18	Grants payable ..........		18
19	Deferred revenue ..........		19
20	Tax-exempt bond liabilities ..........	7,989,897	20	7,714,962
21	Escrow or custodial account liability. Complete Part IV of Schedule D..		21
22	Payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........		22
23	Secured mortgages and notes payable to unrelated third parties ..	711,399	23	693,393
24	Unsecured notes and loans payable to unrelated third parties ....		24
25	Other liabilities. Complete Part X of Schedule D.....	100,000	25	80,000
26	Total liabilities. Add lines 17 through 25.....	10,113,875	26	9,496,336
		Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....	14,247,066	27	16,182,822
28	Temporarily restricted net assets .....		28
29	Permanently restricted net assets .....		29
	Organizations that do not follow SFAS 117, check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....		30
31	Paid-in or capital surplus, or land, building or equipment fund .....		31
32	Retained earnings, endowment, accumulated income, or other funds		32
33	Total net assets or fund balances .....	14,247,066	33	16,182,822
34	Total liabilities and net assets/fund balances .....	24,360,941	34	25,679,158

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.

Attach to Form 990 or Form 990-EZ. right arrow

See separate instructions.

OMB No. 1545-0047

2010

Open to Public
Inspection

Name of the organization

GRANT REGIONAL HEALTH CENTER INC

Employer identification number

39-1834962

Part I

Reason for Public Charity Status (All organizations must complete this part.) See instructions

The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)

A church, convention of churches, or association of churches. section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E.)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in

section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in

section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross

receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of

its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses

acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)

An organization organized and operated exclusively to test for public safety. Seesection 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box that describes the type of supporting organization and complete lines 11e through 11h.

Type I

Type II

Type III - Functionally integrated

Type III - Other

By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).

If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box ..................................................

Since August 17, 2006, has the organization accepted any gift or contribution from any of the
following persons?

(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)

Yes

and (iii) below, the governing body of the the supported organization? ................

11g(i)

(ii) a family member of a person described in (i) above? ......................

11g(ii)

(iii) a 35% controlled entity of a person described in (i) or (ii) above? ................

11g(iii)

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization in col. (i) listed in your governing document?		(v) Did you notify the organization in col. (i) of your support?		(vi) Is the organization in col. (i) organized in the U.S.?		(vii) Amount of support?
(i) Name of supported organization	(ii) EIN	Yes	No	Yes	No	Yes	No	(vii) Amount of support?


Total

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2010

Page 2

Part II

Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year(or fiscal year beginning in)		(a) 2006	(b) 2007	(c) 2008	(d) 2009	(e) 2010	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3	The value of services or facilities furnished by a governmental unit to the organization without charge..
4	Total. Add lines 1 through 3..
5	The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6	Public Support. Subtract line 5 from line 4.

Section B. Total Support

Calendar year(or fiscal year beginning in)		(a) 2006	(b) 2007	(c) 2008	(d) 2009	(e) 2010	(f) Total
7	Amounts from line 4..
8	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
9	Net income from unrelated business activities, whether or not the business is regularly carried on..
10	Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..
11	Total support (Add lines 7 through 10).

Gross receipts from related activities, etc. (See instructions.) ..................

First Five Years If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.......................................... right arrow

Section C. Computation of Public Support Percentage

Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f)) .........

Public Support Percentage for 2009 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2010. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ...................... right arrow

33 1/3% support test—2009. If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2010. If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization .................................................. right arrow

10%-facts-and-circumstances test—2009. If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly
supported organization .............................................. right arrow

Private Foundation If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions ................................................... right arrow

Schedule A (Form 990 or 990-EZ) 2010

Page 3

Part III

Support Schedule for Organizations Described in IRC 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)

Section A. Public Support

Calendar year(or fiscal year beginning in)		(a) 2006	(b) 2007	(c) 2008	(d) 2009	(e) 2010	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2	Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
3	Gross receipts from activities that are not an unrelated trade or business under section 513..
4	Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
5	The value of services or facilities furnished by a governmental unit to the organization without charge..
6	Total. Add lines 1 through 5.
7a	Amounts included on lines 1, 2, and 3 received from disqualified persons...
b	Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
c	Add lines 7a and 7b..
8	Public Support (Subtract line 7c from line 6.)

Section B. Total Support

Calendar year (or fiscal year beginning in)		(a) 2006	(b) 2007	(c) 2008	(d) 2009	(e) 2010	(f) Total
9	Amounts from line 6...
10a	Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
b	Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
c	Add lines 10a and 10b.
11	Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
12	Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
13	Total support (Add lines 9, 10c, 11 and 12.).

Section C. Computation of Public Support Percentage

Public Support Percentage for 2010 (line 8 column (f) divided by line 13 column (f)) .........

Public support percentage from 2009 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f)) ......

Investment income percentage from 2009 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2010. If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .......... right arrow

33 1/3% support tests—2009. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private Foundation If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions ..... right arrow

Schedule A (Form 990 or 990-EZ) 2010

Page 4

Part IV

Supplemental Information. Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Explanation

Schedule A (Form 990 or 990-EZ) 2010

Additional Data

Software ID:
Software Version:

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

OMB No. 1545-0047

2010

Name of organization

GRANT REGIONAL HEALTH CENTER INC

Employer identification number

39-1834962

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

Check if your organization is covered by the General Rule or a Special Rule.
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.

General Rule

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, $5,000 or more (in money or
property) from any one contributor. Complete Parts I and II.

Special Rules

For a section 501(c)(3) organization filing Form 990 or 990-EZ, that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), and received from any one contributor, during the year, a contribution of the
greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For a section 501(c)(7), (8), or (10) organization filing Form 990, or 990-EZ, that received from any one contributor,
during the year, aggregate contributions of more than $1,000 for use exclusively for religious, charitable,
scientific, literary, or educational purposes, or the prevention of cruelty to children or animals. Complete Parts I, II, and
III.

For a section 501(c)(7), (8), or (10) organization filing Form 990, or 990-EZ, that received from any one contributor,
during the year, contributions for use exclusively for religious, charitable, etc., purposes, but these contributions did
not aggregate to more than $1,000. If this box is checked, enter here the total contributions that were received during
the year for an exclusively religious, charitable, etc., purpose. Do not complete any of the parts unless the General Rule
applies to this organization because it received nonexclusively religious, charitable, etc., contributions of $5,000 or more
during the year. ......................... Arrow Bullet

Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2 of its Form 990, or check the box in the heading of its
Form 990-EZ, or on line 2 of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).

For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.

Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2010)

Name of organization GRANT REGIONAL HEALTH CENTER INC
Schedule B (Form 990, 990-EZ, or 990-PF) (2010) Page 1 of 1 of Part I
Part I	Contributors (see Instructions)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
RESTRICTED	RESTRICTED RESTRICTED RESTRICTED RESTRICTED, RESTRICTED RESTRICTED	$RESTRICTED	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Aggregate contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Name of organization GRANT REGIONAL HEALTH CENTER INC
Schedule B (Form 990, 990-EZ, or 990-PF) (2010) Page 1 of 1 of Part II
Part II	Noncash Property (see Instructions)
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
(a) No. from Part I	(b) Description of noncash property given	(c) FMV (or estimate) (see instructions)	(d) Date received
		$
Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Page 1 of 1 of Part III

Name of organization
GRANT REGIONAL HEALTH CENTER INC

Employer identification number

39-1834962

Part III

Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
aggregating more than $1,000 for the year. (Complete columns (a) through (e) and the following line entry.)
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

(a) No.
from
Part I

(b)
Purpose of gift

(d)
Description of how gift is held

(e) Transfer of gift
Transferee's name, address, and ZIP 4	Relationship of transferor to transferee

Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet

Complete if the organization is described below.
SchCMd Bullet

Attach to Form 990 or Form 990-EZ. SchCMd Bullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public
Inspection

If the organization answered “Yes,” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet

Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet

Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet

Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes,” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet

Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)) Complete Part II-A. Do not complete Part II-B.
Round Bullet

Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes,” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, Part V, line 35a (Proxy Tax), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

GRANT REGIONAL HEALTH CENTER INC

Employer identification number

39-1834962

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization's direct and indirect political campaign activities on behalf of or in opposition to candidates for public office in Part IV.

Political expenditures .................................... SchCMd Bullet

Volunteer hours ........................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ......... SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ...... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............

Yes No

Was a correction made? .........................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c) except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt funtion activities .................................... SchCMd Bullet

Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b.. SchCMd Bullet

Did the filing organization file Form 1120-POL for this year? ..........................

Yes No

Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.

(a) Name	(b) Address	(c) EIN	(d) Amount paid from filing organization's funds. If none, enter -0-.	(e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.

For Privacy Act and Paperwork Reduction Act Notice, see the instructions for Form 990.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2010

Page 2

Part II-A

Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).

A Check if the filing organization belongs to an affiliated group.
B Check if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(b) Affiliated Group Totals
1a	Total lobbying expenditures to influence public opinion (grass roots lobbying) ......
b	Total lobbying expenditures to influence a legislative body (direct lobbying) .......
c	Total lobbying expenditures (add lines 1a and 1b) ...................
d	Other exempt purpose expenditures ........................
e	Total exempt purpose expenditures (add lines 1c and 1d) ...............
f	Lobbying nontaxable amount. Enter the amount from the following table in both columns.
	If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:
	Not over $500,00020% of the amount on line 1e.
	Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.
	Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.
	Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.
	Over $17,000,000$1,000,000.

g	Grassroots nontaxable amount (enter 25% of line 1f) .................
h	Subtract line 1g from line 1a. If zero or less, enter -0-. ................
i	Subtract line 1f from line 1c. If zero or less, enter -0-. ................
j	If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting section 4911 tax for this year? ......................................	Yes No

4-Year Averaging Period Under Section 501(h) (Some organizations that made a section 501(h) election do not have to complete all of the five columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2007	(b) 2008	(c) 2009	(d) 2010	(e) Total

2a	Lobbying non-taxable amount

b	Lobbying ceiling amount (150% of line 2a, column(e))

c	Total lobbying expenditures

d	Grassroots non-taxable amount

e	Grassroots ceiling amount (150% of line 2d, column (e))

f	Grassroots lobbying expenditures

Schedule C (Form 990 or 990-EZ) 2010

Page 3

Part II-B

Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).

(a)

Yes

(b)

Amount

During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:

Volunteers? .........................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....

Media advertisements? ....................................

Mailings to members, legislators, or the public? .........................

Publications, or published or broadcast statements? .......................

Grants to other organizations for lobbying purposes? .......................

Direct contact with legislators, their staffs, government officials, or a legislative body? ........

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......

Other activities? If "Yes," describe in Part IV ..........................

Yes

6,793

Total. lines 1c through 1i ...................................

6,793

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 .................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....

If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......

Part III-A

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).

Yes

Were substantially all (90% or more) dues received nondeductible by members? ................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ................

Did the organization agree to carryover lobbying and political expenditures from the prior year? ..........

Part III-B

Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) if BOTH Part III-A, lines 1 and 2 are answered “No” OR if Part III-A, line 3 is answered “Yes”.

Dues, assessments and similar amounts from members .....................

Section 162(e) non-deductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).

Current year .........................................

Carryover from last year ....................................

Total ...........................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................

Taxable amount of lobbying and political expenditures (see instructions) ..............

Part IV

Supplemental Information

Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; and Part ll-B, line 1i.
Also, complete this part for any additional information.

Identifier	Return Reference	Explanation
EXPLANATION OF OTHER LOBBYING ACTIVITIES:	PART II-B, LINE 1I:	GRANT REGIONAL HEALTH CENTER, INC. PAYS ANNUAL ASSOCIATION MEMBERSHIP DUES TO THE AMERICAN HOSPITAL ASSOCIATION (AHA) AND THE WISCONSIN HOSPITAL ASSOCIATION (WHA). THESE DUES ARE PRIMARILY TO ACCESS EDUCATIONAL MATERIALS AND FOR STAFF TRAINING. AHA AND WHA HAS NOTIFIED GRANT REGIONAL THAT APPROXIMATELY $2,611 OF THE ANNUAL DUES PAID WERE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTHCARE ENVIRONMENT. GRANT REGIONAL IS ALSO A MEMBER OF THE RURAL WISCONSIN HEALTH COOPERATIVE (RWHC). EACH YEAR, GRANT REGINOAL PAYS MEMBERSHIP FEES TO THE RWHC AND IN RETURN, THE RWHC PROVIDES VARIOUS SERVICES FOR ITS MEMBER HOSPITALS THROUGHOUT THE STATE OF WISCONSIN. SOME OF THE MANY SERVICES PROVIDED TO MEMBER HOSPITALS INLCUDE: PROVIDING ASSITANCE TO ORGANIZATIONS IN FINDING GRANT FUNDING FOR NEW PROGRAMS, LEGAL SERVICES, REIMBURSEMENT REVIEW SERVICES, ACCOUNTING ASSISTANCE, CONTRACTING FOR THERAPIST AND EMERGENCY ROOM PATIENT CARE COVERAGE, AND ADMINISTRATIVE CONSULTING SERVICES. AS A PART OF THESE SERVICES, THE RWHC ALSO PROVIDES AN ANALYSIS OF CURRENT HEALTHCARE ISSUES IN AN EFFORT TO PROMOTE AND BETTER HEALTHCARE FOR HOSPITALS IN RURAL COMMUNITIES THROUGHOUT WISCONSIN. THESE EFFORTS ALSO INCLUDE LOBBYING ON THE PART OF MEMBER ORGANIZATIONS. RWHC DETERMINED THAT APPROXIMATELY $4,182 OF THE FEES PAID BY GRANT REGIONAL DURING 2010 RELATED TO LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE HEALTHCARE ENVIRONMENT IN THE STATE OF WISCONSIN.

Schedule C (Form 990 or 990EZ) 2010

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11, or 12.
SchDMd Bullet

Attach to Form 990. SchDMd Bullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public Inspection

Name of the organization

GRANT REGIONAL HEALTH CENTER INC

Employer identification number

39-1834962

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .......
2	Aggregate contributions to (during year) ...
3	Aggregate grants from (during year) ...
4	Aggregate value at end of year .......

Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............

Yes No

Did the organization inform all grantees, donors, and donor advisors in writing that grant funds may be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit. ...................................

Yes No

Part II

Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or pleasure) Preservation of an historically importantly land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

Complete lines 2a–2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.


a	Total number of conservation easements .......................	2a
b	Total acreage restricted by conservation easements ..................	2b
c	Number of conservation easements on a certified historic structure included in (a) .....	2c
d	Number of conservation easements included in (c) acquired after 8/17/06 ........	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the taxable year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................

Yes No

Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year SchDMd Bullet

Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................

Yes No

In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.

If the organization elected, as permitted under SFAS 116, not to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,
provide, in Part XIV, the text of the footnote to its financial statements that describes these items.

If the organization elected, as permitted under SFAS 116, to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:

(i)

Revenues included in Form 990, Part VIII, line 1 ........................ SchDMd Bullet

(ii)

Assets included in Form 990, Part X .............................. SchDMd Bullet

If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 relating to these items:

Revenues included in Form 990, Part VIII, line 1 .......................... SchDMd Bullet

Assets included in Form 990, Part X ............................... SchDMd Bullet

For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990

Cat. No. 52283D

Schedule D (Form 990) 2010

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization’s accession and other records, check any of the following that are a significant use of its collection
items (check all that apply):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.

During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No

If "Yes," explain the arrangement in Part XIV and complete the following table:


c	Beginning balance .................................	1c
d	Additions during the year ..............................	1d
e	Distributions during the year .............................	1e
f	Ending balance ...................................	1f

Did the organization include an amount on Form 990, Part X, line 21? .....................

Yes No

If “Yes,” explain the arrangement in Part XIV.

Part V

Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.

		(a)Current Year	(b)Prior Year	(c)Two Years Back	(d)Three Years Back	(e)Four Years Back
1a	Beginning of year balance ....
b	Contributions ........
c	Investment earnings or losses ...
d	Grants or scholarships .....
e	Other expenditures for facilities and programs ........
f	Administrative expenses ....
g	End of year balance ......

Provide the estimated percentage of the year end balance held as:

Board designated or quasi-endowment: SchDMd Bullet

Permanent endowment: SchDMd Bullet

Term endowment: SchDMd Bullet

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) unrelated organizations ........................

3a(i)

(ii) related organizations ........................

3a(ii)

If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIV the intended uses of the organization's endowment funds.

Part VI

InvestmentsLand, Buildings, and Equipment. See Form 990, Part X, line 10.

Description of investment		(b)Cost or other basis (other)	(c) Accumulated depreciation	(d) Book value
1a	Land .................	494,584		494,584
b	Buildings ................	13,433,254	5,454,401	7,978,853
c	Leasehold improvements ............
d	Equipment ................	5,862,537	4,130,983	1,731,554
e	Other .................	323,868	97,957	225,911
Total. Add lines 1a-1e. (Column (d) should equal Form 990, Part X, column (B), line 10(c).)........				10,430,902

Schedule D (Form 990) 2010

Page 3

Part VII

InvestmentsOther Securities. See Form 990, Part X, line 12.

(a) Description of security or category (including name of security)	(b)Book value	(c) Method of valuation: Cost or end-of-year market value
(1)Financial derivatives
(2)Closely-held equity interests
(3)Other (A) CASH & CASH EQUIVALENTS	217,294	C
(B) CORPORATE BONDS	4,553,963	F
(C) MARKETABLE EQUITY SECURITIES	5,660,576	F
(D) CERTIFICATE OF DEPOSIT	203,553	C





Total. (Column (b) should equal Form 990, Part X, col.(B) line 12.)	10,635,386

Part VIII

InvestmentsProgram Related. See Form 990, Part X, line 13.

(a) Description of investment type		(b) Book value	(c) Method of valuation: Cost or end-of-year market value









Total. (Column (b) should equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets. See Form 990, Part X, line 15.

(a) Description				(b) Book value









Total. (Column (b) should equal Form 990, Part X, col.(B) line 15.)...........

Part X

Other Liabilities. See Form 990, Part X, line 25.

1.(a) Description of Liability		(b) Amount
Federal Income Taxes
ESTIMATED AMOUNTS PAYABLE TO THIRD PARTY REIMBURSEMENT PROGRAMS		80,000








Total. (Column (b) should equal Form 990, Part X, col.(B) line 25.)		80,000
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).

Schedule D (Form 990) 2010

Page 4

Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1	Total revenue (Form 990, Part VIII, column (A), line 12) ....................	1	17,700,772
2	Total expenses (Form 990, Part IX, column (A), line 25) .....................	2	16,689,528
3	Excess or (deficit) for the year. Subtract line 2 from line 1 .............	3	1,011,244
4	Net unrealized gains (losses) on investments ..........................	4	893,274
5	Donated services and use of facilities .............................	5
6	Investment expenses ...................................	6
7	Prior period adjustments ..................................	7
8	Other (Describe in Part XIV) .................................	8	31,238
9	Total adjustments (net). Add lines 4 - 8 .............................	9	924,512
10	Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 .........	10	1,935,756

Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1	Total revenue, gains, and other support per audited financial statements .......			1	18,695,937
2	Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a	Net unrealized gains on investments ..........	2a	893,274
b	Donated services and use of facilities .........	2b
c	Recoveries of prior year grants ...........	2c
d	Other (Describe in Part XIV): ............	2d	101,891
e	Add lines 2a through 2d .....................			2e	995,165
3	Subtract line 2e from line 1.....................			3	17,700,772
4	Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b .	4a
b	Other (Describe in Part XIV): ...........	4b
c	Add lines 4a and 4b.......................			4c	0
5	Total Revenue. Add lines 3 and 4c. (This should equal Form 990, Part I, line 12.) ......			5	17,700,772

Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1	Total expenses and losses per audited financial statements .............			1	16,791,419
2	Amounts included on line 1 but not on Form 990, Part IX, line 25:
a	Donated services and use of facilities ..........	2a
b	Prior year adjustments ..............	2b
c	Other losses ................	2c
d	Other (Describe in Part XIV): ............	2d	101,891
e	Add lines 2a through 2d......................			2e	101,891
3	Subtract line 2e from line 1.....................			3	16,689,528
4	Amounts included on Form 990, Part IX, line 25, but not on line 1:
a	Investment expenses not included on Form 990, Part VIII, line 7b ..	4a
b	Other (Describe in Part XIV): ............	4b
c	Add lines 4a and 4b.......................			4c	0
5	Total expenses. Add lines 3 and 4c. (This should equal Form 990, Part I, line 18.) ......			5	16,689,528

Part XIV

Supplemental Information

Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.

Identifier	Return Reference	Explanation
DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48:	PART X:	THE ORGANIZATION IS A TAX-EXEMPT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE "CODE") AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE ORGANIZATION IS ALSO EXEMPT FROM STATE INCOME TAXES ON RELATED INCOME PURSUANT TO SIMILAR STATE OF WISCONSIN TAX LAWS. IN ORDER TO ACCOUNT FOR ANY UNCERTAIN TAX POSITIONS, THE ORGANIZATION DETERMINES WHETHER IT IS MORE LIKELY THAN NOT THAT A TAX POSITION WILL BE SUSTAINED UPON EXAMINATION OF THE TECHNICAL MERITS OR THE POSITION, ASSUMING THE TAXING AUTHORITY HAS FULL KNOWLEDGE OF ALL INFORMATION. IF THE TAX POSITION DOES NOT MEET THE MORE LIKELY THAN NOT RECOGNITION THRESHOLD, THE BENEFIT OF THE TAX POSITION IS NOT RECOGNIZED IN THE FINANCIAL STATEMENTS. THE ORGANIZATION IS ALSO ENGAGED, TO A LIMITED EXTENT, IN ACTIVITIES WHICH THE INTERNAL REVENUE SERVICE CONSIDERS UNRELATED TO THE ORGANIZATION'S EXEMPT PURPOSE AND, THEREFORE, TAXABLE. THESE ACTIVITIES, HOWEVER, ANNUALLY RESULT IN NET OPERATING LOSSES FOR INCOME TAX PURPOSES. THE ORGANIZATION DOES NOT PRESENTLY ANTICIPATE THAT A TAX BENEFIT FROM THESE NET OPERATING LOSSES WILL BE REALIZED IN THE FUTURE. ACCORDINGLY, ANY POTENTIAL DEFERRED TAX ASSET RESULTING FROM THE AVAILABILITY OF NET OPERATING LOSS CARRYFORWARDS IS OFFSET BY A VALUATION ALLOWANCE OF EQUAL AMOUNT. NO DEFERRED TAX ASSETS AND LIABILITIES HAVE BEEN RECOGNIZED SINCE NO OTHER DIFFERENCES EXIST BETWEEN THE FINANCIAL AND TAX BASES OF REPORTING THE ORGANIZATION'S ASSETS AND LIABILITIES. THE ORGANIZATION'S POLICY IS TO RECOGNIZE INTEREST AND ANY PENALTIES RELATED TO INCOME TAX MATTERS IN INCOME TAX EXPENSE WHEN INCURRED. AS OF AND FOR THE YEARS ENDING DECEMBER 31, 2010 AND 2009, THERE WAS NO INCOME TAX EXPENSE, TAX PENALTIES, OR INTEREST RELATED TO TAX PENALTIES RECORDED BY THE ORGANIZATION IN THE FINANCIAL STATEMENTS. THE ORGANIZATION RECORDED NO ASSETS OR LIABILITIES FOR UNCERTAIN TAX POSITIONS IN 2010 AND 2009. FEDERAL TAX RETURNS FOR TAX YEARS 2007 AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE.
PART XI, LINE 8 - OTHER ADJUSTMENTS:		CHANGE IN INTEREST IN NET ASSETS OF GRHC FOUNDATION 31,238.
PART XII, LINE 2D - OTHER ADJUSTMENTS:		RENTAL EXPENSES NET AGAINST RENTAL INCOME 101,891.
PART XIII, LINE 2D - OTHER ADJUSTMENTS:		RENTAL EXPENSES NET AGAINST RENTAL INCOME 101,891.

Schedule D (Form 990) 2010

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public Inspection

Name of the organization

GRANT REGIONAL HEALTH CENTER INC

Employer identification number

39-1834962

Part I

Charity Care and Certain Other Community Benefits at Cost

Yes

Does the organization have a charity care policy? If "No," skip to question 6a...........

Yes

If "Yes," is it a written policy? .......................

Yes

If the organization has multiple hospitals, indicate which of the following best describes application of the charity care policy to the various hospitals.

Applied uniformly to all hospitals Applied uniformly to most hospitals Generally tailored to individual hospitals

Answer the following based on the charity care eligibility criteria that applies to the largest number of the organization's patients.

Does the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care to low

income individuals? If "Yes," indicate which of the following is the FPG family income limit for eligibility for free care:

Yes

100% 150% 200% Other 30000.0000000000 %

Does the organization use FPG to determine eligibility for providing discounted care to low income individuals? If

"Yes," indicate which of the following is the family income limit for eligibility for discounted care: .....

Yes

200% 250% 300% 350% 400% Other

If the organization does not use FPG to determine eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization uses an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care.

Does the organization's policy provide free or discounted care to the "medically indigent"? ......

Yes

Does the organization budget amounts for free or discounted care provided under its charity care policy? ...

Yes

If "Yes," did the organization's charity care expenses exceed the budgeted amount?.........

If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discounted
care to a patient who was eligibile for free or discounted care?...............

Does the organization prepare an annual community benefit report?.............

Yes

If "Yes," does the organization make it available to the public? ..............

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

Charity Care and Certain Other Community Benefits at Cost

	(c) Total community benefit expense	(d) Direct offsetting revenue	(e) Net community benefit expense	(f) Percent of total expense
a Charity care at cost (from Worksheets 1 and 2) ..	180,949		180,949	1.080 %
b Unreimbursed Medicaid (from Worksheet 3, column a) .	1,777,516	1,700,358	77,158	0.460 %
c Unreimbursed costs—other means-tested government programs (from Worksheet 3, column b) ....
dTotal Charity Care and Means-Tested Government Programs .....	1,958,465	1,700,358	258,107	1.540 %
Other Benefits e Community health improvement services and community benefit operations (from (Worksheet 4) ....	53,645		53,645	0.320 %
f Health professions education (from Worksheet 5) ..	69,625		69,625	0.420 %
g Subsidized health services (from Worksheet 6) ..	1,427,967	1,215,917	212,050	1.270 %
h Research (from Worksheet 7)
i Cash and in-kind contributions to community groups (from Worksheet 8) ..	7,392		7,392	0.040 %
jTotal Other Benefits ...	1,558,629	1,215,917	342,712	2.050 %
kTotal. Add lines 7d and 7j. ..	3,517,094	2,916,275	600,819	3.590 %

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2010

Schedule H (Form 990) 2010

Page 2

Part II

Community Building Activities Complete this table if the organization conducted any community building activities.

		(c) Total community building expense	(d) Direct offsetting revenue	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development	5,550		5,550	0.030 %
3	Community support	54,072	34,187	19,885	0.120 %
4	Environmental improvements
5	Leadership development and training for community members	30,000		30,000	0.180 %
6	Coalition building	2,850		2,850	0.020 %
7	Community health improvement advocacy	43,649		43,649	0.260 %
8	Workforce development	35,000		35,000	0.210 %
9	Other	142,240	101,433	40,807	0.240 %
10	Total	313,361	135,620	177,741	1.060 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Does the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................

Enter the amount of the organization's bad debt expense (at cost).....

295,804

Enter the estimated amount of the organization's bad debt expense (at cost) attributable to patients eligible under the organization's charity care policy ..

147,902

Provide in Part VI the text of the footnote to the organization's financial statements that describes bad debt expense. In addition, describe the costing methodology used in determining the amounts reported on lines 2 and 3, and rationale for including a portion of bad debt amounts as community benefit.

Section B. Medicare

Enter total revenue received from Medicare (including DSH and IME).....

5,989,638

Enter Medicare allowable costs of care relating to payments on line 5.....

5,930,335

Subtract line 6 from line 5. This is the surplus or (shortfall)........

59,303

Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.
Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.
Check the box that describes the method used:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Does the organization have a written debt collection policy? ...............

Yes

If "Yes," does the organization's collection policy contain provisions on the collection practices to be followed for patients who are known to qualify for charity care or financial assistance? Describe in Part VI......

Yes

Part IV

Management Companies and Joint Ventures

(a) Name of entity	(b) Description of primary activity of entity	(c) Organization's profit % or stock ownership %	(d) Officers, directors, trustees, or key employees' profit % or stock ownership%	(e) Physicians' profit % or stock ownership %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2010

Page 3

Part VFacility Information

Section A. Hospital Facilities (list in order of size, measured by total revenue per facility, from largest to smallest) How many hospital facilities did the organization operate during the tax year?1 Name and address		Other (Describe)
1	GRANT REGIONAL HEALTH CENTER INC 507 SOUTH MONROE STREET LANCASTER,WI53813	X	X	X	X

Schedule H (Form 990) 2010

Page 4

Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)

Name of Hospital Facility:NOT REQUIRED

Line Number of Hospital Facility (from Schedule H, Part V, Section A):1

				Yes	No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2010)
1	During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. .....................		1
	If “Yes,” indicate what the Needs Assessment describes (check all that apply):
	a	A definition of the community served by the hospital facility
	b	Demographics of the community
	c	Existing health care facilities and resources within the community that are available to respond to the health needs of the community
	d	How data was obtained
	e	The health needs of the community
	f	Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
	g	The process for identifying and prioritizing community health needs and services to meet those needs
	h	The process for consulting with persons representing the community’s interests
	i	Information gaps that limit the hospital facility’s ability to assess all of the community’s health needs
	j	Other (describe in Part VI)
2	Indicate the tax year the hospital facility last conducted a Needs Assessment: 20
3	In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted.		3
4	Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................		4
5	Did the hospital facility make its Needs Assessment widely available to the public? ...........		5
	If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
	a	Hospital facility’s website
	b	Available upon request from the hospital facility
	c	Other (describe in Part VI)
6	If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
	a	Adoption of an implementation strategy to address the health needs of the hospital facility’s community
	b	Execution of the implementation strategy
	c	Development of a community benefit plan for the facility
	d	Participation in community-wide community benefit plan
	e	Inclusion of a community benefit section in operational plans
	f	Adoption of a budget for provision of services that address the needs identified in the CHNA
	g	Prioritization of health needs in the community
	h	Prioritization of services that the hospital facility will undertake to meet health needs in its community
	i	Other (describe in Part VI)
7	Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed together with the reasons why it has not addressed such needs.		7
Financial Assistance Policy
	Did the hospital facility have in place during the tax year a written financial assistance policy that:
8	Explains eligibility criteria for financial assistance, and whether such assistance includes free or discounted care?		8		No
9	Used federal poverty guidelines (FPG) to determine eligibility for providing free care to low incomeindividuals?..		9		No
	If “Yes,” indicate the FPG family income limit for eligibility for free care: %

Schedule H (Form 990) 2010

Page 5

Part VFacility Information (continued)

				Yes	No
10	Used FPG to determine eligibility for providing discounted care to low income individuals?.........		10		No
	If “Yes,” indicate the FPG family income limit for eligibility for discounted care: %
11	Explained the basis for calculating amounts charged to patients?.................		11		No
	If “Yes,” indicate the factors used in determining such amounts (check all that apply):
	a	Income level
	b	Asset level
	c	Medical indigency
	d	Insurance status
	e	Uninsured discount
	f	Medicaid/Medicare
	g	State regulation
	h	Other (describe in Part VI)
12	Explained the method for applying for financial assistance?...................		12		No
13	Included measures to publicize the policy within the community served by the hospital facility?.......		13		No
	If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
	a	The policy was posted at all times on the hospital facility’s web site
	b	The policy was attached to all billing invoices
	c	The policy was posted in the hospital facility’s emergency rooms or waiting rooms
	d	The policy was posted in the hospital facility’s admissions offices
	e	The policy was provided, in writing, to patients upon admission to the hospital facility
	f	The policy was available upon request
	g	Other (describe in Part VI)
Billing and Collections
14	Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy that explained actions the hospital facility may take upon non-payment?........		14		No
15	Check all of the following collection actions against a patient that were permitted under the hospital facility's policies at any time during the tax year:
	a	Reporting to credit agency
	b	Lawsuits
	c	Liens on residences
	d	Body attachments or arrests
	e	Other (describe in Part VI)
16	Did the hospital facility engage in or authorize a third party to engage in any of the following collection actions during the tax year?...................................		16		No
	If “Yes,” check all collection actions in which the hospital facility or a third party engaged (check all that apply):
	a	Reporting to credit agency
	b	Lawsuits
	c	Liens on residences
	d	Body attachments
	e	Other (describe in Part VI)
17	Indicate which actions the hospital facility took before initiating any of the collection actions checked in question 16 (check all that apply):
	a	Notified patients of the financial assistance policy upon admission
	b	Notified patients of the financial assistance policy prior to discharge
	c	Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
	d	Documented its determination of whether a patient who applied for financial assistance under the financial assistance policy qualified for financial assistance
	e	Other (describe in Part VI)

Schedule H (Form 990) 2010

Page 6

Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
				Yes	No
18	Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?..........		18		No
	If “No,” indicate the reasons why (check all that apply):
	a	The hospital facility did not provide care for any emergency medical conditions
	b	The hospital facility did not have a policy relating to emergency medical care
	c	The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
	d	Other (describe in Part VI)
Charges for Medical Care
19	Indicate how the hospital facility determined the amounts generally billed to individuals who had insurance covering emergency or other medically necessary care (check all that apply):
	a	The hospital facility used the lowest negotiated commercial insurance rate for those services at the hospital facility
	b	The hospital facility used the average of the three lowest negotiated commercial insurance rates for those services at the hospital facility
	c	The hospital facility used the Medicare rate for those services
	d	Other (describe in Part VI)
20	Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?.........		20		No
	If “Yes,” explain in Part VI.
21	Did the hospital facility charge any of its patients an amount equal to the gross charge for services provided to that patient?...................................		21		No
	If “Yes,” explain in Part VI.

Schedule H (Form 990) 2010

Page 7

Part VFacility Information (continued)

Section C. Other Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility (list in order of size, measured by total revenue per facility, from largest to smallest) How many non-hospital facilities did the organization operate during the tax year?
Name and address		Type of Facility (Describe)
1
2
3
4
5
6
7
8
9
10

Schedule H (Form 990) 2010

Page 8

Part VI

Supplemental Information

Complete this part to provide the following information.

1	Required descriptions. Provide the description required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 2, 4c, 6i, 7, 11i, 13i, 17l, 18l, 19e, 21d, 25, and 26.
2	Community health needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any community health needs assessments reported in Part V, Section B.
3	Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4	Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5	Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6	Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7	State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.

Identifier	ReturnReference	Explanation
		PART I, LINE 7G: SUBSIDIZED HEALTH SERVICES AT GRANT REGIONAL HEALTH CENTER INCLUDE THE OPERATION OF THE EMERGENCY ROOM DEPARTMENT. THESE SERVICES ARE UNAVAILABLE TO MEMBERS OF THE COMMUNITY OTHER THAN THROUGH GRANT REGIONAL HEALTH CENTER'S EMERGENCY DEPARTMENT. THE DEPARTMENT OPERATES 24 HOURS PER DAY SEVEN DAYS PER WEEK AND IS STAFFED BY A COMBINATION OF PHYSICIANS AND MID-LEVEL PRACTITIONERS. IT IS THE GOAL OF GRANT REGIONAL HEALTH CENTER TO PROVIDE THESE SERVICES TO THE COMMUNITY REGARDLESS OF A PATIENT'S ABILITY TO PAY.
		PART II: GRANT REGIONAL HEALTH CENTER ALSO ENGAGES IN A VARIETY OF COMMUNITY BUILDING ACTIVITIES THAT WOULD OTHERWISE NOT BE MET OR PROVIDED TO MEMBERS OF THE COMMUNITY WITHOUT THE EFFORTS AND SPECIALIZED KNOWLEDGE OF THE LOCAL COMMUNITY HOSPITAL TO THE RESIDENTS OF LANCASTER, WISCONSIN AND THE SURROUNDING AREAS. SOME OF THE COMMUNITY BUILDING ACTIVITIES THAT GRANT REGIONAL PARITICPATES IN ARE LOCAL HEALTH AND WELLNESS FAIRS, SUPPORT GROUPS, PROVIDING EDUCATIONAL MATERIALS TO COMMUNITY MEMBERS, AND LOCAL BLOOD PRESSURE SCREENINGS TO NAME A FEW OF THESE ACTIVITIES. THESE ACTIVITIES WERE DETERMINED BY MEMBERS OF THE COMMUNITY OR ASKED BY COMMUNITY REPRESENTATIVES OF GRANT REGIONAL TO PROVIDE THESE SERVICES SINCE THE HOSPITAL HAS THE EXPERTISE IN THESE AREAS. THE HOSPITAL ALSO PARTICIPATES IN HEALTH EDUCATION AWARENESS AND CAREER BUILDING ACTIVITIES SUCH AS CLINICAL TRAINING EXPERIENCE, FACILITY TOURS TO STUDENTS, SPEAKERS AT LOCAL SCHOOLS, AND CAREER FAIRS. THE HOSPITAL RECOGNIZES THAT IT IS IMPORTANT TO EDUCATE LOCAL COMMUNITY MEMBERS ON THESE CAREERS AS A CAREER BUILDING INITIATIVE SO THAT LOCAL PRIMARY CARE AND ACCESS TO CARE WILL BE CONTINUED IN THE FUTURE WITH WELL-TRAINED AND EDUCATED COMMUNITY MEMBERS IN HEALTH CARE RELATED FIELDS.
		PART III, LINE 4: MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY REPONSIBLE FOR, THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO A VALUATION ALLOWANCE BASED ON ITS ASSESSMENT OF HISTORICAL COLLECTION LIKELIHOOD AND THE CURRENT STATUS OF INDIVIDUAL ACCOUNTS. BALANCES THAT ARE STILL OUTSTANDING AFTER MANAGEMENT HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE VALUATION ALLOWANCE AND A CREDIT TO ACCOUNTS RECEIVABLE. MANY TIMES PATIENTS ARE UNABLE TO COMPLETE THE REQUIRED CHARITY CARE APPLICATION AND ARE TRANSFERRED TO COLLECTION SERVICES EVEN THOUGH THE ORGANIZATION PROVIDES THIS INFORMATION TO ALL PATIENTS AND ASSISTANCE WITH THE APPLICATIONS. DUE TO NO RESPONSES FROM SOME PATIENTS A SIGNIFICANT AMOUNT OF BAD DEBTS COULD BE CONSIDERED AS CHARITY CARE.THE COSTING METHODOLOGY USED ON FORM 990 IS BASED ON A COST TO CHARGE RATIO WHICH IS DEVELOPED BASED ON THE HOSPITALS TOTAL PATIENT SERVICES REVENUES DIVIDED BY OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBTS. THIS COST TO CHARGE RATIO IS APPLIED AGAINST THE TOTAL CHARGES THAT WRITTEN OFF DURING THE FISCAL YEAR TO ESTIMATE THE COST OF THE CARE OF PATIENTS THAT HAVE ACCOUNTS THAT ARE DEEMED TO BE BAD DEBTS TO THE HOSPITAL.
		PART III, LINE 8: GRANT REGIONAL HEALTH CENTER IS DESIGNATED A CRITICAL ACCESS HOSPITAL AND AS SUCH A PORTION OF ITS REVENUES ARE PAID UNDER A COST REIMBURSEMENT SYSTEM. THE TOTAL MEDICARE REVENUE SHOWN BASED ON THE IRS 990 INSTRUCTIONS INCLUDES GROSS MEDICARE REVENUE BUT DOES NOT CONSIDER CONTRACTUAL ADJUSTMENTS FOR THE REIMBURSEMENT THAT IS ACTUALLY RECEIVED FROM THE MEDICARE PROGRAM. THE AMOUNTS LISTED FOR MEDICARE ALSO DO NOT INCLUDE PHYSICIAN SERVICES FOR THE COVERAGE OF THE EMERGENCY DEPARTMENT AT GRANT REGIONAL HEALTH CENTER. PHYSICIAN COVERAGE IS REIMBURSED PRIMARILY ON A FEE SCHEDULE REIMBURSEMENT AT RATES THAT ARE OFTEN BELOW THE COSTS OF CARING FOR PATIENTS. EMERGENCY SERVICES PROVIDED TO MEDICARE PATIENTS ARE VITAL TO THE WELL-BEING OF THE COMMUNITY AND AS SUCH THESE COSTS AND SHORTFALLS SHOULD ALSO BE CONSIDERED AS AN ADDITIONAL BENEFIT THAT GRANT REGIONAL HEALTH CENTER PROVIDES TO THE COMMUNITY AND SURROUNDING AREA OF GRANT COUNTY, WISCONSIN. THE COSTING METHOD USED ABOVE FOR IRS 990 COMPLIANCE REPORTING IS ALSO BASED ON AN OVERALL AVERAGE COST TO CHARGE RATIO AND DOES NOT CONSIDER MEDICARE NON-ALLOWABLE EXPENSES AS IT IS BASED ON TOTAL HOSPITAL PATIENT SERVICE REVENUES (IGNORING CONTRACTUAL ADJUSTMENTS ON FEE SCHEDULE REIMBURSED ITEMS AND NON-ALLOWABLE MEDICARE EXPENSES AS NOTED ABOVE) DIVIDED BY TOTAL OPERATING EXPENSES LESS THE PROVISION FOR BAD DEBT EXPENSE. THIS RATIO IS THEN MULTIPLIED BY THE TOTAL MEDICARE SERVICES WHICH ARE REIMBURSED ON A COST METHODOLOGY EXCLUDING THE FEE SCHEDULE ITEMS LIKE PHYSICIAN SERVICES WHICH THE HOSPITAL WOULD SHOW A LARGE LOSS ON THESE SERVICES.WHETHER THERE IS A SHORTFALL OR SURPLUS ON SERVICES PROVIDED TO MEDICARE BENEFICIARIES, THESE PEOPLE, WHICH ARE TYPICALLY ELDERLY MEMBERS OF THE COMMMUNITY, ARE AN UNDERSERVED POPULATION WHO EXPERIENCE ISSUES WITH ACCESS TO HEALTHCARE SERVICES. WITHOUT TAX-EXEMPT HOSPITALS PROVIDING MEDICARE PATIENT SERVICES, THE CENTERS FOR MEDICARE AND MEDICAID (CMS) WOULD BEAR THE BURDEN OF DIRECTLY PROVIDING SERVICES TO THE ELDERLY AND DISABLED MEMBERS OF THE COMMUNITY.
		PART III, LINE 9B: A PATIENT THAT IS FINANCIALLY RESPONSIBLE FOR THEIR MEDICAL BILLS AND IS NOT COVERED BY AN INSURANCE PLAN MAY TAKE A 25% PROMPT PAYMENT DISCOUNT IF THEY PAY THEIR BALANCE DUE IN FULL WITHIN 25 DAYS OF THE INITIAL SETTLEMENT DATE. GRANT REGIONAL HEALTH CENTER WILL HONOR SUCH PAYMENT AS PAYMENT IN FULL FOR SERVICES BILLED. WHEN A PATIENT'S INCOME IS LESS THAN 200 TO 300% OF THE FEDERAL POVERTY LEVEL FOR THEIR FAMILY SIZE, THE PATIENT MAY ACCESS THE 25% DISCOUNT WITH A WRITTEN PAYMENT ARRANGEMENT TO BE PAID WITHIN A TWELVE MONTH PERIOD UPON APPROVAL OF THE BUSINESS OFFICE MANAGER. THE PATIENT WILL FIRST BE REFERRED TO THE PATIENT FINANCIAL COUNSELOR. THE PATIENT WILL THEN COMPLETE A FINANCIAL APPLICATION AND SUPPLY SUPPORTING DOCUMENTATION. ONCE THE APPLICATION IS COMPLETED THE BUSINESS OFFICE MANAGER WILL REVIEW AND APPROVE. THE PAYMENT AGREED UPON WILL BE IN ACCORDANCE WITH THE BUSINESS OFFICE'S PAYMENT PLAN POLICY. A LETTER WILL BE SENT TO THE PATIENT ACCEPTING THE FINANCIAL APPLICATION AND PAYMENT AGREEMENT TERMS.
		SCHEDULE H ADDITIONAL SUPPLEMENTAL NARRATIVE: WHILE THERE IS GROWING AGREEMENT IN THE UNITED STATES ABOUT WHAT CONSITUTES A NON-PROFIT HOSPITAL'S "COMMUNITY BENEFIT," THIS IS A WORK IN PROGRESS. GRANT REGIONAL HEALTH CENTER PROVIDES SIGNIFICANT CHARITY CARE AND OTHER COMMUNITY BENEFITS AS DEFINED BY THE IRS. BUT IN ADDITION, GRANT REGIONAL BELIEVES THAT IT PROVIDES A CRITICALLY IMPORTANT COMMUNITY BENEFIT WHICH IS NOT EASILY ABLE TO BE QUANTIFIED. THROUGH ITS HOSPITAL SERVICES, LIKE MOST RURAL HOSPITALS, GRANT REGIONAL HEALTH CENTER WAS CREATED AND IS MAINTAINED IN ORDER TO PROVIDE CARE LOCALLY AND WITHOUT THIS HOSPITAL, THIS CARE WOULD NOT BE AVAILABLE LOCALLY.BEYOND PROVIDING HOSPITALIZATIONS, GRANT REGIONAL HEALTH CENTER PROVIDES LOCAL ACCESS TO MANY OTHER HEALTH SERVICES INCLUDING: OBSTETRICS AND BIRTHING CENTER, DIAGNOSTICS, EMERGENCY SERVICES, INFUSION SERVICES, INPATIENT CARE, LABORATORY SERVICES, OCCUPATIONAL HEALTH, REHABILITATION SERVICES, SPECIALTY MEDICINE, SURGICAL SERVICES, AND MANY OTHER SERVICES. ADDITIONAL INFORMATION ON SERVICES PROVIDED CAN BE FOUND IN NARRATIVE FORM INCLUDING SOME STATISTICS ON NUMBER OF PATIENTS WHO BENEFITED DURING 2010 FROM THESE SERVICES IN PART III SECTION 4A OF THE 2010.
		PART VI, LINE 2: GRANT REGIONAL HEALTH CENTER, INC. ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITY IT SERVES BY LOOKING AT LOCAL AND SURROUNDING COMMUNITY DEMOGRAPHICS TO DETERMINE THE SERVICES THAT ARE MOST NECESSARY IN ORDER TO FULFILL ITS MISSION. THE FACILITY ALSO REVIEWS HOSPITAL STATISTICS OF PATIENT VISITS TO DETERMINE WHAT TYPES OF SERVICES OFFERED BY THE FACILITY ARE BEING UTILIZED. AS AN EXAMPLE, DURING 2010, THE ORGANIZATION RECOGNIZED THAT THERE NEEDED TO BE A CONTINUED PRESENCE FOR SPECIALIZED UROLOGY SERVICES IN THE LANCASTER, WISCONSIN COMMUNITY, SO THE ORGANIZATION CONTRACTED WITH A UROLOGIST (PHYSICIAN) AND BEGAN OPERATING A PROVIDER BASED CLINIC FOR THESE SERVICES OUT OF THE HOSPITAL'S OUTPATIENT SPECIALITY CLINIC AREA. THIS WAS DONE AS A LOW COST SOLUTION TO PROVIDING THIS SERVICE AS NO ADDITIONAL SPACE OR RENNOVATIONS WERE REQUIRED TO ADD THIS SERVICE TO MEET THE NEEDS OF PATIENTS IN THE COMMUNITY.
		PART VI, LINE 3: CONSISTENT WITH THE MISSION OF GRANT REGIONAL HEALTH CENTER, INC., HEALTH-RELATED SERVICES ARE PROVIDED TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY, INCLUDING PROVIDING SERVICES TO THOSE PERSONS WHO CANNOT AFFORD HEALTH INSURANCE BECAUSE OF INADEQUATE RESOURCES OR THOSE WHO ARE UNDERINSURED. WHEN A PATIENT'S INCOME IS LESS THAN 200 TO 300% OF THE FEDERAL POVERTY LEVEL, THEY ARE PROVIDED CARE WITHOUT CHARGE OR AT A REDUCED RATE. THIS IS DETERMINED UPON APPROVAL BY THE BUSINESS OFFICE MANAGER AT THE FACILITY AFTER THE PATIENT HAS MET WITH A PATIENT FINANCIAL COUNSELOR AT THE FACILITY AND HAS COMPLETED A FINANCIAL APPLICATION, AND SUPPLIED THE NECESSARY DOCUMENTATION TO SUPPORT A FINANCIAL NEED FOR CARE UNDER GRANT REGIONAL'S COMMUNITY CARE POLICY.INFORMATION ON THE HOSPITAL'S CHARITY CARE POLICIES IS POSTED AT THE HOSPITAL PATIENT REGISTRATION DESK AND REGISTRATION CLERKS AT THE HOSPITAL ARE TRAINED TO INQUIRE WITH SELF PAY PATIENTS UPON REGISTRATION IF THEY WOULD LIKE FURTHER INFORMATION ON THESE POLICIES OR WOULD LIKE TO MEET WITH A MEMBER OF THE BUSINESS OFFICE STAFF. DURING THE COLLECTION PROCESS, GRANT REGIONAL HEALTH CENTER MAKES AN EFFORT TO ALSO PROVIDE INFORMATION AND SEND CHARITY CARE APPLICATION INFORMATION TO THE MAJORITY OF PROVIDE PAY OR SELF-PAY PATIENTS THAT DO NOT RESPOND WITH PAYMENT ON THE FIRST OR SECOND PATIENT STATEMENT THAT IS SENT ITEMIZING THE BALANCE OF THEIR HOSPITAL BILL. SOCIAL SERVICES AND BUSINESS OFFICE STAFF AT THE HOSPITAL IS ALSO AVAILABLE TO PROVIDE INFORMATION TO PATIENTS ON OTHER GOVERNMENT PROGRAMS SUCH AS THE MEDICAL ASSISTANCE PROGRAM TO PATIENTS OR TO REFER PATIENTS TO PERSONNEL AT GRANT COUNTY OR OTHER STATE OF WISCONSIN OR COUNTY AGENCIES THAT MAY PROVIDE ACCESS TO CARE FOR ELIGIBLE PATIENTS OR PROVIDE OTHER INFORMATION TO PATIENTS.
		PART VI, LINE 4: GRANT REGIONAL HEALTH CENTER, INC. IS LOCATED IN LANCASTER, WISCONSIN, WHICH IS A COMMUNITY OF ABOUT 4,000 PEOPLE. LANCASTER IS LOCATED 30 MINUTES FROM DUBUQUE, IOWA AND 1 HOUR 30 MINUTES FROM MADISON, WISCONSIN. THE FACILITY OPERATES A 25-BED, ACUTE CARE CRITICAL ACCESS HOSPITAL. GRANT REGIONAL HEALTH CENTER OFFERS A WIDE VARIETY OF SERVICES IN ORDER TO FULFILL MANY OF THE NEES OF THE INDIVIDUALS IN THE LOCAL COMMUNITY. AMONG SERVICES PROVIDED ARE: DIAGNOSTIC CARE, 24-HOUR EMERGENCY ROOM, OBSTETRICS, REHABILITATION, SURGICAL CARE, AND DIABETES SELF-CARE PROGRAMS, ALONG WITH OTHER SPECIALITY SERVICES, WHICH INCLUDES, AUDIOLOGY, CARDIOLOGY, ORTHOPEDICS, AND UROLOGY, AMONG OTHERS. CARE IS OFFERED TO PATIENTS REGARDLESS OF PAY SOURCE AND REGARDLESS OF A PATIENT'S ABILITY TO PAY. DURING 2010, MEDICARE AND MEDICARE ADVANTAGE PLAN BENEFICIARIES ACCOUNTED FOR APPROXIMATELY 45 PERCENT OF ALL GROSS PATIENT SERVICE REVENUE AT GRANT REGIONAL HEALTH CENTER AND MEDICAID BENEFICIARIES ACCOUNTED FOR APPROXIMATELY 11 PERCENT OF ALL GROSS PATIENT SERVICE REVENUE. MEDICARE AND MEDICAID BENEFICIARIES MAKE UP THE LARGEST PORTION OF PATIENTS THAT ARE SERVED BY GRANT REGIONAL HEALTH CENTER OVER THE PREVIOUS FEW YEARS.
		PART VI, LINE 6: GRANT REGIONAL HEALTH CENTER, INC. IS ACCREDITED THROUGH THE JOINT COMMISSION ON ACCREDITATION OF HEALTHCARE ORGANIZATIONS. THE JOINT COMMISSION IS AN ORGANIZATION THAT EVALUATES HOSPITAL PERFORMANCE STANDARDS, FOCUSING ON THE QUALITY OF HEALTH CARE. ACCREDITATION THROUGH THE JOINT COMMISSION IS RECOGNIZED NATIONWIDE AS A SYMBOL OF QUALITY, AS IT REQUIRES RIGOROUS PERFORMANCE STANDARDS. TO EARN AND MAINTAIN ACCREDITATION, GRANT REGIONAL IS EVALUATED THROUGH AN UNANNOUNCED SURVEY PROCESS COVERING NEARLY 600 STANDARDS RELATED TO QUALITY PATIENT CARE, SAFETY, INFECTION CONTROL, AND ONGOING PERFORMANCE-IMPROVEMENT ACTIVITIES, AMONG OTHERS. ALL HOSPITALS SURVEYED BY THE JOINT COMMISSION ARE EVALUATED AGAINST THE SAME CRITERIA, REGARDLESS OF SIZE OR LOCATION.THE ACTIVITIES OF GRANT REGIONAL HEALTH CENTER ARE SUPPORTED LOCALLY BY A VOLUNTEER BOARD OF DIRECTORS WHICH OVERSEE THE OPERATIONS OF THE HOSPITAL. THE BOARD OF DIRECTORS IS MADE UP OF COMMUNITY MEMBERS WHICH RESIDE IN LANCASTER, WI AND THE SURROUNDING AREA WHICH IS GRANT REGIONAL'S PRIMARY PATIENT SERVICE AREA. THE HOSPITAL ALSO EXTENDS MEDICAL STAFF PRIVILEDGES TO A MAJORITY OF ALL QUALIFIED PHYSICIANS IN THE COMMUNITY AND SURROUNDING AREAS WHICH WISH TO BETTER SERVE THEIR PATIENTS BY PROVIDING CARE AT GRANT REGIONAL HEALTH CENTER.ANY SURPLUSES IN OPERATIONS THAT ARE ACHIEVED BY THE ORGANIZATION OPERATING IN AN EFFECTIVE MANNER AND CONTROLLING THE COST OF HEALTHCARE ARE PRIMARILY RESERVED FOR FUTURE BUILDING AND CAPITAL PURCHASE NEEDS. GRANT REGIONAL HEALTH CENTER RECOGNIZES THAT IT IS IMPORTANT TO SAVE THESE RESERVES DURING YEARS OF SURPLUS SO THAT IN ANY TIMES OF ECONOMIC DOWNTURN IF A LARGE CAPITAL ADDITION IS NEEDED THE ORGANIZATION WILL NOT HAVE TO PASS HIGHER COSTS ON TO MEMBERS OF THE COMMUNITY. THESE FUNDS ARE TRANSFERRED TO A FUNDED DEPRECIATION INVESTMENT ACCOUNT REGULARLY THROUGHOUT EACH FISCAL YEAR WHERE SURPLUSES IN OPERATIONS ARE ACHIEVED.THE HOSPITAL FURTHER ACHIEVES ITS GOAL OF PROVIDING TRUE COMMUNITY SUPPORT BY PROVIDING CHARITY CARE AS DESCRIBED THROUGHOUT SCHEDULE H AND PROVIDING SERVICES TO MEMBERS OF OTHER PROGRAMS WHICH OFTEN REIMBURSE THE HOSPITAL BELOW THE COST OF PROVIDING THIS CARE SUCH AS CHAMPUS, TRICARE, AND THE WISCONSIN HEALTH INSURANCE RISK SHARING PROGRAM OR "HIRSP" (THE HIRSP PROGRAM REIMBURSES THE HOSPITAL AT RATES SIMILAR TO THE MEDICAID PROGRAM AND IS FOR PATIENTS THAT HAVE PRE-EXISTING ILLNESSES WHICH MAKE IT DIFFICULT TO OBTAIN INSURANCE FROM COMMERCIAL INSURANCE CARRIERS IN THE MARKETPLACE).
REPORTS FILED WITH STATES	PART VI, LINE 7	WI

Schedule H (Form 990) 2010

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet

Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet

Attach to Form 990. SchJMediumBullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public Inspection

Name of the organization

GRANT REGIONAL HEALTH CENTER INC

Employer identification number

39-1834962

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement orprovision of all the expenses described above? If "No," complete Part III to explain....

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? ....

Indicate which, if any, of the following the organization uses to establish the compensation of the
organization's CEO/Executive Director. Check all that apply.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? ...............

Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........

Participate in, or receive payment from, an equity-based compensation arrangement? ........

If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.

Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.

For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 5a or 5b, describe in Part III.

For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ...........................

Any related organization? .........................

If "Yes," to line 6a or 6b, describe in Part III.

For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regs. section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................

If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990

Cat. No. 50053T

Schedule J (Form 990) 2010

Page 2

Part II

Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use Schedule J-1 if additional space needed.

For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.

Note. The sum of columns (B)(i)-(iii) must equal the applicable column (D) or column (E) amounts on Form 990, Part VII, line 1a.

(A) Name		(B) Breakdown of W-2 and/or 1099-MISC compensation			(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)	(F) Compensation reported in prior Form 990 or Form 990-EZ
(A) Name		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
(1) NICOLE CLAPP CONTRACTED EE	(i) (ii)	191,100 0	0 0	0 0	0 0	0 0	191,100 0	0 0
(2) ROBERT SMITH MD	(i) (ii)	322,044 0	0 0	0 0	13,475 0	8,565 0	344,084 0	0 0

Schedule J (Form 990) 2010

Page 3

Part III

Supplemental Information

Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.

Identifier	Return Reference	Explanation
SUPPLEMENTAL INFORMATION	PART III	HEALTHTECH MANAGEMENT SERVICES, INC. IS AN UNRELATED ORGANIZATION WHICH COMPENSATES THE CEO, NICOLE CLAPP, ON BEHALF OF GRANT REGIONAL HEALTH CENTER, INC. SEE INFORMATION ON SCHEDULE O FOR ADDITIONAL INFORMATION RELATED TO THE MANAGEMENT SERVICES AGREEMENT WITH HEALTHTECH MANAGEMENT SERVICES BY GRANT REGIONAL HEALTH CENTER.

Schedule J (Form 990) 2010

Additional Data

Software ID:
Software Version:

- TIN:

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Schedule O (Form 990).
SchKMediumBullet

Attach to Form 990. SchKMediumBullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public
Inspection

Name of the organization
GRANT REGIONAL HEALTH CENTER INC

Employer identification number
39-1834962

Part I

Bond Issues

(a) Issuer Name		(b) Issuer EIN	(c) CUSIP #	(d) Date Issued	(e) Issue Price	(f) Description of Purpose	(g) Defeased		(h) On Behalf of Issuer		(i) Pool financing
(a) Issuer Name		(b) Issuer EIN	(c) CUSIP #	(d) Date Issued	(e) Issue Price	(f) Description of Purpose	Yes	No	Yes	No	Yes	No
A	CITY OF LANCASTER WISCONSIN	39-6005501	NONEAVAIL	12-20-2007	8,000,000	HOSPITAL RENNOVATION AND EXPANSION PROJECTS FOR OBSTETRICS AND REHAB		X		X		X

Part II

Proceeds

	A		B		C		D
	1 Amount of bonds retired. . . . .	488,105
2 Amount of bonds defeased . . . .
3 Total proceeds of issue . . . .	8,000,000
4 Gross proceeds in reserve funds . .
5 Capitalized interest from proceeds.
6 Proceeds in refunding escrow. . . . .
7 Issuance costs from proceeds . . .	160,000
8 Credit enhancement from proceeds.
9 Working capital expenditures from proceeds . .
10 Capital expenditures from proceeds . .	2,509,459
11 Other spent proceeds . .	5,330,541
12 Other unspent proceeds. . .
13 Year of substantial completion . . .	2008
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue?	X
15 Were the bonds issued as part of an advance refunding issue?		X
16 Has the final allocation of proceeds been made? . .	X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? .	X

Part III

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . .		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . .		X

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50193E

Schedule K (Form 990) 2010

Page 2

Part III

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use?		X
b Are there any research agreements that may result in private business use of bond-financed property? . .		X
c Does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts or research agreements relating to the financed property? .	X
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . . . . . . . . . . . .
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government .
6 Total of lines 4 and 5 . . .. . . . . .
7 Has the organization adopted management practices and procedures to ensure the post-issuance compliance of its tax-exempt bond liabilities?	X

Part IV

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has a Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate, been filed with respect to the bond issue? . . .		X
2 Is the bond issue a variable rate issue?		X
3a Has the organization or the governmental issuer entered into a hedge with respect to the bond issue?		X
b Name of provider .
c Term of hedge . .
d Was the hedge superintegrated? .
e Was a hedge terminated? .
4a Were gross proceeds invested in a GIC? .		X
b Name of provider .
c Term of GIC . .
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? .
5 Were any gross proceeds invested beyond an available temporary period? .		X
6 Did the bond issue qualify for an exception to rebate? . . .		X

Schedule K (Form 990) 2010

Page 3

Part V

Supplemental Information

Complete this part to provide additional information for responses to questions on Schedule K (see instructions).

Identifier	Return Reference	Explanation

Schedule K (Form 990) 2010

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.

OMB No. 1545-0047

2010

Open to Public
Inspection

Name of the organization

GRANT REGIONAL HEALTH CENTER INC

Employer identification number

39-1834962

Identifier	Return Reference	Explanation
FORM 990, PART VI, SECTION A, LINE 7A		THE CITY OF LANCASTER DELEGATES ONE BOARD MEMBER TO SERVE ON THE GRANT REGIONAL HEALTH CENTER BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION A, LINE 7B		ANY FACILITY RENNOVATIONS OR ISSUANCE OF NEW DEBT IN EXCESS OF $250,000 IS SUBJECT TO APPROVAL BY THE CITY OF LANCASTER.
FORM 990, PART VI, SECTION B, LINE 11		THE BOARD OF DIRECTORS RECEIVED A COPY OF THE FORM 990 PRIOR TO THE FILING OF THE RETURN WITH THE IRS. THE FORM 990 IS ALSO REVIEWED BY MANAGEMENT OF THE ORGANIZATION PRIOR TO SUBMISSION TO THE IRS.
	FORM 990, PART VI, SECTION B, LINE 12C	CONFLICTS OF INTEREST ARE CONSIDERED TO EXIST IN SITUATIONS WHERE EMPLOYEES' ACTIONS OR ACTIVITIES INVOLVE: - THE OBTAINING OF AN IMPROPER PERSONAL GAIN OR ADVANTAGE BY REASON OF AN EMPLOYEE'S POSITION WITH THE HOSPITAL, - AN ADVERSE EFFECT UPON THE INTERESTS OF GRANT REGIONAL HEALTH CENTER, - THE OBTAINING BY A THIRD PARTY OF AN IMPROPER GAIN, OR OF AN ADVANTAGE TO THE DETRIMENT OF THE HOSPITAL; OR - THE APPEARANCE OF ANY OF THE ABOVE. ANY RELATED ISSUES TO A CONFLICT OF INTEREST SHALL BE DISCLOSED TO THE APPROPRIATE SUPERVISOR, COMPLIANCE OFFICER, OR HOTLINE. COMPLIANCE WITH THE POLICY IS MONITORED BY HAVING BOARD MEMBERS, OFFICERS, AND EMPLOYEES DISCLOSE ANNUALLY IN A WRITTEN STATEMENT ANY ISSUES THAT MAY GIVE RISE TO A CONFLICT OF INTEREST. IF ANY CONFLICTS ARE KNOWN BY BOARD MEMBERS THEN THESE BOARD MEMBERS ARE ASKED TO ABSTAIN FROM VOTING ON ANY CONFLICTED MATTERS.
	FORM 990, PART VI, SECTION B, LINE 15	GRANT REGIONAL HEALTH CENTER USES THE RURAL WISCONSIN HEALTH COOPERATIVE SCALE AND HR SCHEDULES TO DETERMINE PROPER COMPENSATION FOR ITS TOP MANAGEMENT PERSONNEL AND TO REVIEW FOR COMPARIBILITY FACTORS. THE RURAL WISCONSIN HEALTH COOPERATIVE SCALES ARE A COMPILATION OF AVERAGE SALARIES AND COMPENSATION AMOUNTS FOR VARIOUS POSITIONS AT ITS MEMBER HOSPITALS WHICH INCLUDE A LARGE NUMBER OF RURAL AND COMMUNITY HOSPITALS LOCATED THROUGHOUT WISCONSIN. GRANT REGIONAL HEALTH CENTER ALSO PARTICIPANTS IN THE ANNUAL WISCONSIN HOSPITAL ASSOCIATION COMPENSATION SURVEY TO ALLOW ACCESS TO SALARY AND BENEFIT COMPARIBILITY DATA EACH YEAR. WHEN THE FACILITY'S BUDGET PROCESS IS BEING REVIEWED EACH YEAR AN AVERAGE WAGE INCREASE IS COMPARED WITH THIS DATA AND PRESENTED TO THE BOARD OF DIRECTORS TO REVIEW BEFORE SETTING TARGET OR BUDGETED PERFORMANCE OR MARKET VALUE ADJUSTED TO COMPENSATION EACH YEAR. THE HOSPITAL ALSO REVIEWS THIS DATA WHEN IT DETERMINES THAT NEW POSITIONS SHOULD BE ADDED TO BETTER MEET PATIENT SERVICE NEEDS IN THE COMMUNITY.
	FORM 990, PART VI, SECTION C, LINE 19	GRANT REGIONAL HEALTH CENTER WILL MAKE A COPY OF ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. SUMMARIZED FINANCIAL STATEMENTS ARE AVAILABLE TO THE GENERAL PUBLIC AT ANY TIME FOLLOWING THE SUBMISSION OF THE WISCONSIN HOSPITAL SURVEY TO THE WISCONSIN HOSPITAL ASSOCIATION.
CHANGES IN NET ASSETS OR FUND BALANCES:	FORM 990, PART XI, LINE 5:	NET UNREALIZED GAINS ON INVESTMENTS: 893,274. CHANGE IN INTEREST IN NET ASSETS OF GRHC FOUNDATION 31,238. TOTAL TO FORM 990, PART XI, LINE 5: 924,512.
SELECTION OF INDEPENDENT ACCOUNTANT	PART X11, LINE 2C	THE ORGANIZATION HAS A COMMITTEE THAT ASSUMES RESPONSIBILITY FOR THE AUDIT OF ITS FINANCIAL STATEMENTS AND THE BOARD OF DIRECTORS TAKES TIME TO MEET WITH THE INDEPENDENT ACCOUNTANTS FOLLOWING THE AUDIT EACH YEAR TO REVIEW THE FINANCIAL STATEMENTS AND ITEMS NOTED DURING THE AUDIT WITHOUT MANAGEMENT PRESENT TO ALLOW EVEN MORE OVERSIGHT BY THE BOARD INTO THE ANNUAL AUDIT PROCESS. MEMBERS OF THE BOARD OF DIRECTORS ALSO HAVE THE CONTACT INFORMATION OF THE INDEPENDENT ACCOUNTANT AND ARE ENCOURAGED TO CONTACT THE ACCOUNTANTS DURING THE YEAR WHEN QUESTIONS ARISE. THERE HAS BEEN NO CHANGE TO THESE PROCEDURES DURING THE PAST YEAR.
DELEGATION OF CONTROL/MANAGEMENT COMPANY EXPLANATION	PART VI, SECTION 1, LINE 3	GRANT REGIONAL HEALTH CENTER'S BOARD OF DIRECTORS MAINTAINS THE CONTROL OVER KEY DECISIONS OF THE ORGANIZATION INCLUDING REVIEW AND APPROVAL OF THE MONTHLY FINANCIAL STATEMENTS, STRATEGIC PLAN, BUDGETS, AND OTHER KEY OPERATING MEASURES AND GOALS. THE BOARD OF DIRECTORS HAS ENTERED INTO A MANAGEMENT SERVICES AGREEMENT WITH HEALTHTECH MANAGEMENT SERVICES, INC. (HEALTHTECH), A HOSPITAL MANAGEMENT COMPANY WHICH CONTRACTS WITH HOSPITALS THROUGHOUT THE UNITED STATES TO PROVIDE MANAGEMENT SERVICES ON EITHER A LONG-TERM OR SHORT-TERM BASIS. UNDER THIS AGREEMENT, HEALTHTECH PROVIDES GENERAL ADMINISTRATIVE, CONSULTING, AND GROUP PURCHASING SERVICES TO GRHC. UNDER THE MANAGEMENT AGREEMENT, HEALTHTECH IS ALSO RESPONSIBLE FOR THE SELECTION AND REVIEW OF THE ADMINISTRATOR OF GRANT REGIONAL HEALTH CENTER.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2010

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBullet

Attach to Form 990. MediumBullet

See separate instructions.

OMB No. 1545-0047

2010

Open to Public Inspection

Name of the organization

GRANT REGIONAL HEALTH CENTER INC

Employer identification number

39-1834962

Part I

Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)

(a) Name, address, and EIN of disregarded entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Total income	(e) End-of-year assets	(f) Direct controlling entity

Part II

Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	(g) Section 512(b)(13) controlled organization
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Exempt Code section	(e) Public charity status (if section 501(c)(3))	(f) Direct controlling entity	Yes	No
(1) GRANT REGIONAL HEALTH CENTER FOUNDATION INC 507 SOUTH MONROE STREET LANCASTER,WI53813 39-1834961	FUND RAISING	WI	501 (C) 3	509 (A) (3)	N/A	Yes
(2) GRANT REGIONAL AUXILLARY 507 SOUTH MONROE STREET LANCASTER,WI53813 75-3031038	VOLUNTEERS	WI	501 (C) 3	509 (A) (1)	N/A		No

For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2010

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(e) Type of entity (C corp, S corp, or trust)	(f) Share of total income	(g) Share of end-of-year assets	(h) Percentage ownership

Schedule R (Form 990) 2010

Page 3

Part V

Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)

Note. Complete line 1 if any entity is listed in Parts II, III or IV.

Yes

1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?

a Receipt of (i) interest (ii) annuities (iii) royalties (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .

b Gift, grant, or capital contribution to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

c Gift, grant, or capital contribution from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

d Loans or loan guarantees to or for other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

e Loans or loan guarantees by other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

f Sale of assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

g Purchase of assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

h Exchange of assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

i Lease of facilities, equipment, or other assets to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .

j Lease of facilities, equipment, or other assets from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .

k Performance of services or membership or fundraising solicitations for other organization(s) . . . . . . . . . . . . . . . . . . . . . .

l Performance of services or membership or fundraising solicitations by other organization(s) . . . . . . . . . . . . . . . . . . . . . .

m Sharing of facilities, equipment, mailing lists, or other assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

n Sharing of paid employees . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

o Reimbursement paid to other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

p Reimbursement paid by other organization for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Yes

q Other transfer of cash or property to other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

r Other transfer of cash or property from other organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.

(a) Name of other organization	(b) Transaction type(a-r)	(c) Amount involved	(d) Method of determining amount involved
(1) GRANT REGIONAL HEALTH CENTER FOUNDATION INC	C	22,180	CASH RECEIPT / COST
(1)
(2)
(3)
(4)
(5)
(6)

Schedule R (Form 990) 2010

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)

Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.

(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Are all partners section 501(c)(3) organizations?		(e) Share of end-of-year assets	(f) Disproprtionate allocations?		(g) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	(h) General or managing partner?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(e) Share of end-of-year assets	Yes	No	(g) Code VUBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2010

Page 5

Part VII

Supplemental Information

Complete this part to provide additional information for responses to questions on Schedule R (see instructions).

Identifier	Return Reference	Explanation

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: TO PROVIDE COMPREHENSIVE HOSPITAL AND CLINICAL SERVICES TO RESIDENTS OF SOUTHWEST WISCONSIN REGARDLESS OF A PATIENT'S ABILITY TO PAY.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ....	3	11
4	Number of independent voting members of the governing body (Part VI, line 1b) ....	4	9
5	Total number of individuals employed in calendar year 2010 (Part V, line 2a) ...	5	186
6	Total number of volunteers (estimate if necessary) ....	6	25
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ..	7a	196,510
b	Net unrelated business taxable income from Form 990-T, line 34 ..	7b	-17,264

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	150,274	17,313
9	Program service revenue (Part VIII, line 2g) .........	16,231,412	17,148,907
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	-93,607	275,037
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	244,609	259,515
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	16,532,688	17,700,772
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	1,950	1,050
14	Benefits paid to or for members (Part IX, column (A), line 4) ....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	8,316,675	9,323,437
16a	Professional fundraising fees (Part IX, column (A), line 11e)....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f)....	7,743,364	7,365,041
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	16,061,989	16,689,528
19	Revenue less expenses. Subtract line 18 from line 12......	470,699	1,011,244
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16)............	24,360,941	25,679,158
21	Total liabilities (Part X, line 26)............	10,113,875	9,496,336
22	Net assets or fund balances. Subtract line 21 from line 20 .....	14,247,066	16,182,822

Sign Here

	Signature of officer	Date

	Type or print name and title.

Paid Preparer's Use Only	Preparer's signature	Date	Check if self- employed	Preparer’s taxpayer identification number (see instructions)
	Firm’s name (or yours if self-employed), address, and ZIP + 4			EIN
				Phone no.


4a	(Code: ) (Expenses $ 13,475,435 including grants of $ 1,050 ) (Revenue $ 16,805,173 )
	GRANT REGIONAL HEALTH CENTER, INC. ("GRANT REGIONAL") PROVIDES HEALTH CARE SERVICES AND OTHER SUPPORT THROUGH VARIOUS PROGRAMS THAT ARE DESIGNED, AMONG OTHER MATTERS, TO ENHANCE THE HEALTH OF THE COMMUNITY, INCLUDING THE HEALTH OF LOW-INCOME PATIENTS. THE ORGANIZATION OPERATES A CRITICAL ACCESS HOSPITAL WHICH PROVIDES INPATIENT ACUTE CARE AND SWING BED SERVICES, ALONG WITH AN EMERGENCY DEPARTMENT, WHICH IS OPEN TWENTY-FOUR HOURS PER DAY, AND OTHER OUTPATIENT SERVICES. AMONG THE SERVICES PROVIDED ARE DIAGNOSTIC CARE INCLUDING LABORATORY AND RADIOLOGY SERVICES, OBSTETRICS, REHABILITATION, SURGICAL SERVICES, AND WALK-IN CARE. GRANT REGIONAL ALSO HAS RELATIONSHIPS WITH REGIONAL CENTERS IN MADISON, WISCONSIN AND DUBUQUE, IOWA WHO COME TO THE FACILITY ON A REGULAR BASIS TO PROVIDE SPECIALTY SERVICES. THE SPECIALTY SERVICES PROVIDED INCLUDE, BUT ARE NOT LIMITED TO: AUDIOLOGY, CARDIOLOGY, DERMATOLOGY, OB/GYN SURGERY, OPHTHALMOLOGY, ORTHOPEDICS, PULMONOLOGY, AND UROLOGY. DURING 2010, GRANT REGIONAL HAD 1,008 ROUTINE MED/SURG PATIENT DAYS, 344 SWING BED DAYS, 297 NURSERY DAYS, 350 OBSTETRIC DAYS, AND 17 DAYS OF ROUTINE HOSPICE CARE FOR INPATIENT CARE AND PROVIDED 5,438 VISITS TO PATIENTS NEEDING EMERGENCY OR URGENT CARE IN THE EMERGENCY DEPARTMENT. CONSISTENT WITH THE MISSION OF GRANT REGIONAL, CARE IS PROVIDED TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY, INCLUDING PROVIDING SERVICES TO THOSE PERSONS WHO ARE EITHER UNDERINSURED OR CANNOT AFFORD HEALTH INSURANCE BECAUSE OF INADEQUATE RESOURCES. HEALTH CARE SERVICES TO PATIENTS UNDER GOVERNMENT PROGRAMS, SUCH AS MEDICAID HOSPITAL SERVICES, ARE ALSO CONSIDERED PART OF GRANT REGIONAL'S BENEFIT PROVIDED TO THE COMMUNITY, SINCE A SUBSTANTIAL PORTION OF SUCH SERVICES ARE REIMBURSED AT AMOUNTS LESS THAN THE COSTS OF PROVIDING CARE.PATIENTS WHO MEET CERTAIN CRITERIA FOR CHARITY CARE, BASED ON FEDERAL POVERTY GUIDELINES, ARE PROVIDED CARE AT A SIGNIFICANTLY REDUCED RATE, DETERMINATED BASED ON QUALIFYING CRITERIA AS DEFINED IN GRANT REGIONAL'S COMMUNITY CARE POLICY, AND FROM APPLICATIONS COMPLETED BY PATIENTS. THE AMOUNT OF CHARGES FOREGONE FOR SERVICES AND SUPPLIES FURNISHED UNDER THIS POLICY FOR 2010 TOTALED APPROXIMATELY $312,000. IN ADDITION, PATIENT CHARGES TO BENEFICIARIES OF THE WISCONSIN MEDICAID PROGRAM WERE REDUCED BY APPROXIMATELY $1,365,000 IN DISCOUNTS IN 2010. (SEE ALSO SCHEDULE H TO THE FORM 990 FOR ADDITIONAL INFORMATION ON THE COST OF PROVIDING THESE MEDICAL SERVICES TO MEMBERS OF THE COMMUNITY.)IN ADDITION TO THE VARIOUS INPATIENT, OUTPATIENT, AND CHARITY CARE SERVICES, GRANT REGIONAL HEALTH CENTER PROVIDED NUMEROUS BENEFITS TO ITS SURROUNDING COMMUNITIES. EDUCATIONAL PROGRAMS, SUCH AS BREASTFEEDING, CANCER, DIABETES, HEART DISEASE, AND WOMEN'S HEALTH EDUCATION WERE PROVIDED TO THE COMMUNITY DURING 2010. HEALTH SCREENINGS INCLUDING BLOOD PRESSURE, CHOLESTEROL, DIABETES, HEARING, MAMMOGRAPHY, AND WOMEN'S HEALTH SCREENINGS WERE ALSO PROVIDED. (SEE ALSO SCHEDULE H TO THE FORM 990 FOR INFORMATION ON THE COST OF PROVIDING THESE SERVICES IN THE COMMUNITY AND SURROUNDING AREAS.)GRANT REGIONAL ALSO PROVIDES ON-THE-JOB EDUCATION TO COLLEGE STUDENTS PURSUING CAREERS IN HEALTH CARE. STUDENTS ARE MENTORED DURING THEIR TIME AT THE FACILITY BY EMPLOYEES OF GRANT REGIONAL AND GRANT REGIONAL PROVIDES PRACTICAL EXPERIENCE THROUGH ITS CARE ENVIRONMENT FOR STUDENTS TO USE THROUGHOUT THEIR FUTURE CAREERS IN THE NURSING SERVICES FIELD.

4b	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4c	(Code: ) (Expenses $ including grants of $ ) (Revenue $ )












4d	Other program services. (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses$ 13,475,435

(A) Name and Title	(B) Average hours per week (describe hours for related organizations in Schedule O)			(D) Reportable compensation from the organization (W- 2/1099-MISC)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and Title
(18) KIMBERLY MOORE RADIOLOGY MANAGER	48.00	X		88,549	0	14,544
(19) SCOTT MITCHELL CFO (FORMER 10/30/2010)	47.00		X	93,949	0	6,222

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	999,730	0	52,494

(A) Name and business address	(B) Description of services	(C) Compensation





2 Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 in compensation from the organization 0

				(A) Total revenue	(B) Related or exempt function revenue	(C) Unrelated business revenue	(D) Revenue excluded from tax under sections 512, 513, or 514
1a	Federated campaigns..1a
b	Membership dues....1b
c	Fundraising events....1c
d	Related organizations...1d
e	Government grants (contributions)1e		17,313

f	All other contributions, gifts, grants, and similar amounts not included above1f
g	Noncash contributions included in lines 1a-1f:$
h	Total. Add lines 1a-1f.......			17,313
			Business Code
2a	NET PATIENT REVENUE		621,400	16,624,863	16,624,863
b	DIETARY		722,210	145,096	145,096
c	CONTRACT SERVICE REVEN		621,400	140,852		140,852
d	THERAPEUTIC SERVICE RE		812,900	55,658		55,658
e	LIFELINE		621,990	35,214	35,214
f	All other program service revenue .			147,224			147,224
g	Total. Add lines 2a–2f........			17,148,907
3	Investment income (including dividends, interest
	and other similar amounts).....			167,243			167,243
4	Income from investment of tax-exempt bond proceeds..
5	Royalties............
		(i) Real	(ii) Personal
6a	Gross Rents	361,406
b	Less: rental expenses	101,891
c	Rental income or (loss)	259,515
d	Net rental income or (loss).......			259,515			259,515
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	1,025,459	450
b	Less: cost or other basis and sales expenses	914,193	3,922
c	Gain or (loss)	111,266	-3,472
d	Net gain or (loss)..........			107,794			107,794
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
	a
b	Less: direct expenses ...b
c	Net income or (loss) from gaming activities...
10a	Gross sales of inventory, less returns and allowances .
	a
b	Less: cost of goods sold ..b
c	Net income or (loss) from sales of inventory..
Miscellaneous Revenue			Business Code
11a
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......
12	Total revenue. See Instructions....			17,700,772	16,805,173	196,510	681,776


				(A) Beginning of year		(B) End of year
1	Cashnon-interest-bearing ..........			591,908	1	119,326
2	Savings and temporary cash investments .......			679,447	2	400,259
3	Pledges and grants receivable, net .........				3
4	Accounts receivable, net .........			1,943,897	4	2,164,617
5	Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
	Schedule L ..........				5
6	Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
	Schedule L ..........				6
7	Notes and loans receivable, net .............				7
8	Inventories for sale or use ..............			583,296	8	626,205
9	Prepaid expenses and deferred charges ............			359,745	9	279,855
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	20,114,243
b	Less: accumulated depreciation. .....	10b	9,683,341	10,690,570	10c	10,430,902
11	Investments—publicly traded securities ..........				11
12	Investments—other securities. See Part IV, line 11 ......			8,489,727	12	10,635,386
13	Investments—program-related. See Part IV, line 11 ..				13
14	Intangible assets .........				14
15	Other assets. See Part IV, line 11 ...........			1,022,351	15	1,022,608
16	Total assets. Add lines 1 through 15 (must equal line 34)...			24,360,941	16	25,679,158
17	Accounts payable and accrued expenses .			1,312,579	17	1,007,981
18	Grants payable ..........				18
19	Deferred revenue ..........				19
20	Tax-exempt bond liabilities ..........			7,989,897	20	7,714,962
21	Escrow or custodial account liability. Complete Part IV of Schedule D..				21
22	Payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
	persons. Complete Part II of Schedule L..........				22
23	Secured mortgages and notes payable to unrelated third parties ..			711,399	23	693,393
24	Unsecured notes and loans payable to unrelated third parties ....				24
25	Other liabilities. Complete Part X of Schedule D.....			100,000	25	80,000
26	Total liabilities. Add lines 17 through 25.....			10,113,875	26	9,496,336
	Organizations that follow SFAS 117, check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets .....			14,247,066	27	16,182,822
28	Temporarily restricted net assets .....				28
29	Permanently restricted net assets .....				29
	Organizations that do not follow SFAS 117, check here and complete lines 30 through 34.
30	Capital stock or trust principal, or current funds .....				30
31	Paid-in or capital surplus, or land, building or equipment fund .....				31
32	Retained earnings, endowment, accumulated income, or other funds				32
33	Total net assets or fund balances .....			14,247,066	33	16,182,822
34	Total liabilities and net assets/fund balances .....			24,360,941	34	25,679,158