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Descries the 8900 m2 (95,896 ft2) specialized nursing facility in the USA, with 60 skilled nursing units, 52 apartment units and a range of ancillary areas. Deals with the mechanical system serving this unit, a 240 ton (844 kW) geothermal water source heat pump system with a hot water boiler to provide additional perimeter finned-tube heating. Presents a schematic diagram of the major elements of the mechanical system and describes the factors leading to its selection. Deals with system performance and its operation and maintenance. Notes that the project demonstrates that the higher initial construction cost of a geothermal system can be offset by the correct design approach and the owner will benefit from life cycle cost savings.