-
TIN:
Form
990-PF
Department of the Treasury
Internal Revenue Service
Return of Private Foundation
or Section 4947(a)(1) Trust Treated as Private Foundation
Do not enter social security numbers on this form as it may be made public.
Go to
www.irs.gov/Form990PF
for instructions and the latest information.
OMB No. 1545-0052
20
19
Open to Public Inspection
For calendar year 2019, or tax year beginning
01-01-2019
, and ending
12-31-2019
Name of foundation
HEADWATERS HEALTH FOUNDATION
OF WESTERN MONTANA
Number and street (or P.O. box number if mail is not delivered to street address)
283 W FRONT STREET NO 301
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
MISSOULA
,
MT
59802
A Employer identification number
81-1099715
B
Telephone number (see instructions)
(406) 926-6526
C
If exemption application is pending, check here
G
Check all that apply:
Initial return
Initial return of a former public charity
Final return
Amended return
Address change
Name change
D 1.
Foreign organizations, check here.............
2
. Foreign organizations meeting the 85%
test, check here and attach computation ...
E
If private foundation status was terminated
under section 507(b)(1)(A), check here .......
H
Check type of organization:
Section 501(c)(3) exempt private foundation
Section 4947(a)(1) nonexempt charitable trust
Other taxable private foundation
F
If the foundation is in a 60-month termination
under section 507(b)(1)(B), check here .......
I
Fair market value of all assets at end
of year (from Part II, col. (c),
line 16)
$
104,159,687
J
Accounting method:
Cash
Accrual
Other (specify)
(Part I, column (d) must be on cash basis.)
Part I
Analysis of Revenue and Expenses
(The total of amounts in columns (b), (c), and (d) may not necessarily equal the amounts in column (a) (see instructions).)
(a)
Revenue and
expenses per
books
(b)
Net investment
income
(c)
Adjusted net
income
(d)
Disbursements
for charitable
purposes
(cash basis only)
1
Contributions, gifts, grants, etc., received (attach schedule)
0
2
Check
.............
3
Interest on savings and temporary cash investments
3,459
3,459
4
Dividends and interest from securities
...
784,122
2,729,563
5a
Gross rents
............
b
Net rental income or (loss)
6a
Net gain or (loss) from sale of assets not on line 10
171,992
b
Gross sales price for all assets on line 6a
21,546,182
7
Capital gain net income (from Part IV, line 2)
...
0
8
Net short-term capital gain
.........
9
Income modifications
...........
10a
Gross sales less returns and allowances
b
Less: Cost of goods sold
....
c
Gross profit or (loss) (attach schedule)
.....
11
Other income (attach schedule)
.......
2,122,741
2,908,860
12
Total.
Add lines 1 through 11
........
3,082,314
5,641,882
13
Compensation of officers, directors, trustees, etc.
585,382
96,001
464,270
14
Other employee salaries and wages
......
295,613
11,545
265,723
15
Pension plans, employee benefits
.......
221,591
23,200
195,684
16a
Legal fees (attach schedule)
.........
21,720
0
22,560
b
Accounting fees (attach schedule)
.......
112,069
24,566
84,085
c
Other professional fees (attach schedule)
....
679,769
1,232,835
278,321
17
Interest
...............
124,176
124,176
124,176
18
Taxes (attach schedule) (see instructions)
...
40,648
134,920
0
19
Depreciation (attach schedule) and depletion
...
12,667
0
20
Occupancy
..............
98,879
0
91,116
21
Travel, conferences, and meetings
.......
190,272
0
191,941
22
Printing and publications
..........
868
0
868
23
Other expenses (attach schedule)
.......
132,977
11
109,998
24
Total operating and administrative expenses.
Add lines 13 through 23
..........
2,516,631
1,647,254
1,828,742
25
Contributions, gifts, grants paid
.......
3,462,358
3,462,358
26
Total expenses and disbursements.
Add lines 24 and 25
5,978,989
1,647,254
5,291,100
27
Subtract line 26 from line 12:
a
Excess of revenue over expenses and disbursements
-2,896,675
b
Net investment income
(if negative, enter -0-)
3,994,628
c
Adjusted net income
(if negative, enter -0-)
...
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 11289X
Form
990-PF
(2019)
Form 990-PF (2019)
Page
2
Part II
Balance Sheets
Attached schedules and amounts in the description column
should be for end-of-year amounts only. (See instructions.)
Beginning of year
End of year
(a)
Book Value
(b)
Book Value
(c)
Fair Market Value
1
Cash—non-interest-bearing
.............
975,329
379,219
379,215
2
Savings and temporary cash investments
.........
888,000
3
Accounts receivable
67,104
Less: allowance for doubtful accounts
67,104
67,104
4
Pledges receivable
Less: allowance for doubtful accounts
5
Grants receivable
.................
6
Receivables due from officers, directors, trustees, and other
disqualified persons (attach schedule) (see instructions)
.....
7
Other notes and loans receivable (attach schedule)
Less: allowance for doubtful accounts
8
Inventories for sale or use
..............
9
Prepaid expenses and deferred charges
..........
8,927
10a
Investments—U.S. and state government obligations (attach schedule)
3,751,248
3,398,471
3,398,471
b
Investments—corporate stock (attach schedule)
.......
10,745,333
11,708,144
11,708,144
c
Investments—corporate bonds (attach schedule)
.......
10,170,506
8,791,857
8,791,857
11
Investments—land, buildings, and equipment: basis
Less: accumulated depreciation (attach schedule)
12
Investments—mortgage loans
.............
13
Investments—other (attach schedule)
..........
68,777,405
79,722,072
79,722,072
14
Land, buildings, and equipment: basis
113,334
Less: accumulated depreciation (attach schedule)
20,510
55,491
92,824
92,824
15
Other assets (describe
)
16
Total assets
(to be completed by all filers—see the
instructions. Also, see page 1, item I)
95,372,239
104,159,691
104,159,687
17
Accounts payable and accrued expenses
..........
13,244
39,433
18
Grants payable
.................
341,200
50
19
Deferred revenue
.................
20
Loans from officers, directors, trustees, and other disqualified persons
21
Mortgages and other notes payable (attach schedule)
......
22
Other liabilities (describe
)
210,323
224,206
23
Total liabilities
(add lines 17 through 22)
.........
564,767
263,689
Foundations that follow FASB ASC 958, check here
and complete lines 24, 25, 29 and 30.
24
Net assets without donor restrictions
...........
94,807,472
103,896,002
25
Net assets with donor restrictions
............
Foundations that do not follow FASB ASC 958, check here
and complete lines 26 through 30.
26
Capital stock, trust principal, or current funds
........
27
Paid-in or capital surplus, or land, bldg., and equipment fund
28
Retained earnings, accumulated income, endowment, or other funds
29
Total net assets or fund balances
(see instructions)
.....
94,807,472
103,896,002
30
Total liabilities and net assets/fund balances
(see instructions)
.
95,372,239
104,159,691
Part III
Analysis of Changes in Net Assets or Fund Balances
1
Total net assets or fund balances at beginning of year—Part II, column (a), line 29 (must agree with end-of-year figure reported on prior year’s return)
...............
1
94,807,472
2
Enter amount from Part I, line 27a
.....................
2
-2,896,675
3
Other increases not included in line 2 (itemize)
3
11,985,205
4
Add lines 1, 2, and 3
..........................
4
103,896,002
5
Decreases not included in line 2 (itemize)
5
0
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29
.
6
103,896,002
Form
990-PF
(2019)
Form 990-PF (2019)
Page
3
Part IV
Capital Gains and Losses for Tax on Investment Income
(a)
List and describe the kind(s) of property sold (e.g., real estate,
2-story brick warehouse; or common stock, 200 shs. MLC Co.)
(b)
How acquired
P—Purchase
D—Donation
(c)
Date acquired
(mo., day, yr.)
(d)
Date sold
(mo., day, yr.)
1 a
PUBLICLY TRADED SECURITIES
b
ALTERNATIVE INVESTMENTS
P
c
d
e
(e)
Gross sales price
(f)
Depreciation allowed
(or allowable)
(g)
Cost or other basis
plus expense of sale
(h)
Gain or (loss)
(e) plus (f) minus (g)
a
21,450,285
21,374,190
76,095
b
95,897
587,332
-491,435
c
d
e
Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69
(l)
Gains (Col. (h) gain minus
col. (k), but not less than -0-)
or
Losses (from col.(h))
(i)
F.M.V. as of 12/31/69
(j)
Adjusted basis
as of 12/31/69
(k)
Excess of col. (i)
over col. (j), if any
a
76,095
b
-491,435
c
d
e
2
Capital gain net income or (net capital loss)
If gain, also enter in Part I, line 7
If (loss), enter -0- in Part I, line 7
2
-415,340
3
Net short-term capital gain or (loss) as defined in sections 1222(5) and (6):
If gain, also enter in Part I, line 8, column (c) (see instructions). If (loss), enter -0-
in Part I, line 8
...................
3
Part V
Qualification Under Section 4940(e) for Reduced Tax on Net Investment Income
(For optional use by domestic private foundations subject to the section 4940(a) tax on net investment income.)
If section 4940(d)(2) applies, leave this part blank.
Was the foundation liable for the section 4942 tax on the distributable amount of any year in the base period?
Yes
No
If "Yes," the foundation does not qualify under section 4940(e). Do not complete this part.
1
Enter the appropriate amount in each column for each year; see instructions before making any entries.
(a)
Base period years Calendar
year (or tax year beginning in)
(b)
Adjusted qualifying distributions
(c)
Net value of noncharitable-use assets
(d)
Distribution ratio
(col. (b) divided by col. (c))
2018
6,555,195
110,983,314
0.059065
2017
990,647
77,661,511
0.012756
2016
48,448
17,220
2.813473
2015
2014
2
Total
of line 1, column (d)
.....................
2
2.885294
3
Average distribution ratio for the 5-year base period—divide the total on line 2 by 5.0, or by the number of years the foundation has been in existence if less than 5 years
......
3
0.961765
4
Enter the net value of noncharitable-use assets for 2019 from Part X, line 5
......
4
103,056,436
5
Multiply line 4 by line 3
......................
5
99,116,073
6
Enter 1% of net investment income (1% of Part I, line 27b)
...........
6
39,946
7
Add lines 5 and 6
........................
7
99,156,019
8
Enter qualifying distributions from Part XII, line 4
,.............
8
6,341,100
If line 8 is equal to or greater than line 7, check the box in Part VI, line 1b, and complete that part using a 1% tax rate. See the Part VI instructions.
Form
990-PF
(2019)
Form 990-PF (2019)
Page
4
Part VI
Excise Tax Based on Investment Income (Section 4940(a), 4940(b), 4940(e), or 4948—see instructions)
1a
Exempt operating foundations described in section 4940(d)(2), check here
and enter “N/A" on line 1.
Date of ruling or determination letter:
(attach copy of letter if necessary–see instructions)
b
Domestic foundations that meet the section 4940(e) requirements in Part V, check
1
79,893
here
and enter 1% of Part I, line 27b
...................
c
All other domestic foundations enter 2% of line 27b. Exempt foreign organizations enter 4% of Part I, line 12, col. (b)
2
Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-)
2
0
3
Add lines 1 and 2
...........................
3
79,893
4
Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-)
4
0
5
Tax based on investment income.
Subtract line 4 from line 3. If zero or less, enter -0-
.....
5
79,893
6
Credits/Payments:
a
2019 estimated tax payments and 2018 overpayment credited to 2019
6a
121,439
b
Exempt foreign organizations—tax withheld at source
......
6b
c
Tax paid with application for extension of time to file (Form 8868)
...
6c
0
d
Backup withholding erroneously withheld
...........
6d
0
7
Total credits and payments. Add lines 6a through 6d
..............
7
121,439
8
Enter any
penalty
for underpayment of estimated tax.
Check here
if Form 2220 is attached.
8
0
9
Tax due.
If the total of lines 5 and 8 is more than line 7, enter
amount owed
.......
9
10
Overpayment.
If line 7 is more than the total of lines 5 and 8, enter the
amount overpaid
...
10
41,546
11
Enter the amount of line 10 to be:
Credited to 2020 estimated tax
41,546
Refunded
11
0
Part VII-A
Statements Regarding Activities
1a
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did
Yes
No
it participate or intervene in any political campaign?
....................
1a
No
b
Did it spend more than $100 during the year (either directly or indirectly) for political purposes? (see Instructions
for definition)
.................................
1b
No
If the answer is "Yes" to
1a
or
1b,
attach a detailed description of the activities and copies of any materials
published or distributed by the foundation in connection with the activities.
c
Did the foundation file
Form 1120-POL
for this year?
.....................
1c
No
d
Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
(1)
On the foundation.
$
0
(2)
On foundation managers.
$
0
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.
$
0
2
Has the foundation engaged in any activities that have not previously been reported to the IRS?
.......
2
No
If "Yes," attach a detailed description of the activities.
3
Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles
of incorporation, or bylaws, or other similar instruments?
If "Yes," attach a conformed copy of the changes
....
3
No
4a
Did the foundation have unrelated business gross income of $1,000 or more during the year?
........
4a
Yes
b
If "Yes," has it filed a tax return on
Form 990-T
for this year?
...................
4b
Yes
5
Was there a liquidation, termination, dissolution, or substantial contraction during the year?
.........
5
No
If "Yes," attach the statement required by General Instruction T.
6
Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:
By language in the governing instrument, or
By state legislation that effectively amends the governing instrument so that no mandatory directions
that conflict with the state law remain in the governing instrument?
................
6
Yes
7
Did the foundation have at least $5,000 in assets at any time during the year?
If "Yes," complete Part II, col. (c),
and Part XV.
.................................
7
Yes
8a
Enter the states to which the foundation reports or with which it is registered (see instructions)
MT
b
If the answer is "Yes" to line 7, has the foundation furnished a copy of Form 990-PF to the Attorney
General (or designate) of each state as required by General Instruction G?
If "No," attach explanation
.
8b
Yes
9
Is the foundation claiming status as a private operating foundation within the meaning of section 4942(j)(3)
or 4942(j)(5) for calendar year 2019 or the taxable year beginning in 2019? See the instructions for Part XIV.
If "Yes," complete Part XIV
.............................
9
No
10
Did any persons become substantial contributors during the tax year?
If "Yes," attach a schedule listing their names
and addresses.
...............................
10
No
Form
990-PF
(2019)
Form 990-PF (2019)
Page
5
Part VII-A
Statements Regarding Activities
(continued)
11
At any time during the year, did the foundation, directly or indirectly, own a controlled entity within the
meaning of section 512(b)(13)? If "Yes," attach schedule. See instructions
.............
11
No
12
Did the foundation make a distribution to a donor advised fund over which the foundation or a disqualified person had
advisory privileges? If "Yes," attach statement. See instructions
.................
12
No
13
Did the foundation comply with the public inspection requirements for its annual returns and exemption application?
13
Yes
Website address
WWW.HEADWATERSMT.ORG
14
The books are in care of
MYNOR VELIZ
Telephone no.
(406) 926-6526
Located at
283 W FRONT STREET
MISSOULA
MT
ZIP+4
59802
15
Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of
Form 1041
—check here
.........
and enter the amount of tax-exempt interest received or accrued during the year
........
15
16
At any time during calendar year 2019, did the foundation have an interest in or a signature or other authority over
Yes
No
a bank, securities, or other financial account in a foreign country?
.................
16
No
See the instructions for exceptions and filing requirements for FinCEN Form 114. If "Yes", enter the name of the foreign
country
Part VII-B
Statements Regarding Activities for Which Form 4720 May Be Required
File Form 4720 if any item is checked in the "Yes" column, unless an exception applies.
Yes
No
1a
During the year did the foundation (either directly or indirectly):
(1)
Engage in the sale or exchange, or leasing of property with a disqualified person?
Yes
No
(2)
Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
a disqualified person?
......................
Yes
No
(3)
Furnish goods, services, or facilities to (or accept them from) a disqualified person?
Yes
No
(4)
Pay compensation to, or pay or reimburse the expenses of, a disqualified person?
Yes
No
(5)
Transfer any income or assets to a disqualified person (or make any of either available
for the benefit or use of a disqualified person)?
...............
Yes
No
(6)
Agree to pay money or property to a government official? (
Exception.
Check "No"
if the foundation agreed to make a grant to or to employ the official for a period
after termination of government service, if terminating within 90 days.)
.......
Yes
No
b
If any answer is "Yes" to 1a(1)–(6), did
any
of the acts fail to qualify under the exceptions described in Regulations
section 53.4941(d)-3 or in a current notice regarding disaster assistance? See instructions
........
1b
No
Organizations relying on a current notice regarding disaster assistance check here
........
c
Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts,
that were not corrected before the first day of the tax year beginning in 2019?
.............
1c
No
2
Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private
operating foundation defined in section 4942(j)(3) or 4942(j)(5)):
a
At the end of tax year 2019, did the foundation have any undistributed income (lines 6d
and 6e, Part XIII) for tax year(s) beginning before 2019?
.............
Yes
No
If "Yes," list the years
20
,
20
,
20
,
20
b
Are there any years listed in 2a for which the foundation is
not
applying the provisions of section 4942(a)(2)
(relating to incorrect valuation of assets) to the year’s undistributed income? (If applying section 4942(a)(2)
to
all
years listed, answer "No" and attach statement—see instructions.)
..............
2b
c
If the provisions of section 4942(a)(2) are being applied to
any
of the years listed in 2a, list the years here.
20
,
20
,
20
,
20
3a
Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at
any time during the year?
......................
Yes
No
b
If "Yes," did it have excess business holdings in 2019 as a result of
(1)
any purchase by the foundation
or disqualified persons after May 26, 1969;
(2)
the lapse of the 5-year period (or longer period approved
by the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest; or
(3)
the lapse of the 10-, 15-, or 20-year first phase holding period?
(Use Schedule C, Form 4720, to determine
if the foundation had excess business holdings in 2019.)
..................
3b
4a
Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes?
4a
No
b
Did the foundation make any investment in a prior year (but after December 31, 1969) that could jeopardize its
charitable purpose that had not been removed from jeopardy before the first day of the tax year beginning in 2019?
4b
No
Form
990-PF
(2019)
Form 990-PF (2019)
Page
6
Part VII-B
Statements Regarding Activities for Which Form 4720 May Be Required
(continued)
5a
During the year did the foundation pay or incur any amount to:
Yes
No
(1)
Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))?
Yes
No
(2)
Influence the outcome of any specific public election (see section 4955); or to carry
on, directly or indirectly, any voter registration drive?
.............
Yes
No
(3)
Provide a grant to an individual for travel, study, or other similar purposes?
Yes
No
(4)
Provide a grant to an organization other than a charitable, etc., organization described
in section 4945(d)(4)(A)? See instructions
................
Yes
No
(5)
Provide for any purpose other than religious, charitable, scientific, literary, or
educational purposes, or for the prevention of cruelty to children or animals?
.....
Yes
No
b
If any answer is "Yes" to 5a(1)–(5), did
any
of the transactions fail to qualify under the exceptions described in
Regulations section 53.4945 or in a current notice regarding disaster assistance? See instructions
......
5b
Organizations relying on a current notice regarding disaster assistance check here
.........
c
If the answer is "Yes" to question 5a(4), does the foundation claim exemption from the
tax because it maintained expenditure responsibility for the grant?
..........
Yes
No
If "Yes," attach the statement required by Regulations section 53.4945–5(d).
6a
Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums on
a personal benefit contract?
.....................
Yes
No
b
Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract?
....
6b
No
If "Yes" to 6b, file Form 8870.
7a
At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction?
Yes
No
b
If "Yes", did the foundation receive any proceeds or have any net income attributable to the transaction?
....
7b
8
Is the foundation subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or
excess parachute payment during the year?
.................
Yes
No
Part VIII
Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
and Contractors
1
List all officers, directors, trustees, foundation managers and their compensation. See instructions
(a)
Name and address
(b)
Title, and average
hours per week
devoted to position
(c)
Compensation
(If not paid, enter
-0-)
(d)
Contributions to employee benefit plans and deferred compensation
(e)
Expense account,
other allowances
ROBERT PHILLIPS
CHAIR
1.30
0
0
0
283 W FRONT STREET
MISSOULA
,
MT
59802
JAY LOWDER
CHAIR
1.30
0
0
0
283 W FRONT STREET
MISSOULA
,
MT
59802
CHRISTINA TWOHIG
VICE CHAIR
1.30
0
0
0
283 W FRONT STREET
MISSOULA
,
MT
59802
HEATHER CAHOON
TRUSTEE
1.30
0
0
0
283 W FRONT STREET
MISSOULA
,
MT
59802
CARISSA KUHL
TRUSTEE
1.30
0
0
0
283 W FRONT STREET
MISSOULA
,
MT
59802
STEVE MCNEECE
TRUSTEE
1.30
0
0
0
283 W FRONT STREET
MISSOULA
,
MT
59802
RICHARD OPPER
TRUSTEE
1.30
0
0
0
283 W FRONT STREET
MISSOULA
,
MT
59802
KELLEY RISCHKE
TRUSTEE
1.30
0
0
0
283 W FRONT STREET
MISSOULA
,
MT
59802
MIKE STEWART
TRUSTEE
1.30
0
0
0
283 W FRONT STREET
MISSOULA
,
MT
59802
JORDAN THOMPSON
TRUSTEE
1.30
0
0
0
283 W FRONT STREET
MISSOULA
,
MT
59802
BRENDA SOLORZANO-CLAUDLE
CHIEF EXECUTIVE OFFICER
40.00
277,108
24,191
0
283 W FRONT STREET
MISSOULA
,
MT
59802
MYNOR VELIZ
CHIEF FINANCIAL OFFICER
40.00
196,682
25,705
0
283 W FRONT STREET
MISSOULA
,
MT
59802
ERIN SWITALSKI
PROGRAM DIRECTOR
40.00
97,909
22,433
0
283 W FRONT STREET
MISSOULA
,
MT
59802
2
Compensation of five highest-paid employees (other than those included on line 1—see instructions). If none, enter “NONE."
(a)
Name and address of each employee paid more than $50,000
(b)
Title, and average
hours per week
devoted to position
(c)
Compensation
(d)
Contributions to
employee benefit
plans and deferred
compensation
(e)
Expense account,
other allowances
JENNIFER L SAVAGE
COMMUNICATIONS OFFIC
40.00
70,318
4,488
0
283 WEST FRONT ST SUITE 301
MISSOULA
,
MT
59802
ASHLEY N SHAW
PROGRAM ASSOCIATE
40.00
64,815
1,356
0
283 WEST FRONT ST SUITE 301
MISSOULA
,
MT
59802
ZIA MAUMENEE
GRANTS MANAGER
40.00
60,920
4,088
0
283 WEST FRONT ST SUITE 301
MISSOULA
,
MT
59802
Total
number of other employees paid over $50,000
...................
0
Form
990-PF
(2019)
Form 990-PF (2019)
Page
7
Part VIII
Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
and Contractors
(continued)
3
Five highest-paid independent contractors for professional services (see instructions). If none, enter "NONE".
(a)
Name and address of each person paid more than $50,000
(b)
Type of service
(c)
Compensation
FSG INC
CONSULTING
83,750
1411 4TH AVE 12TH FLOOR
SEATTLE
,
WA
98101
MCEWEN BIG SKY LLC
CONSULTING
81,042
2024 218TH PLACE NE
SAMMAMISH
,
WA
98074
MOSS ADAMS LLP
AUDIT AND TAX
66,550
805 SW BROADWAY ST SUITE 1200
PORTLAND
,
OR
97205
FUND EVALUATION GROUP LLC
INVESTMENT
61,626
201 EAST FIFTH ST SUITE 1600
CINCINNATI
,
OH
45202
WIPFLI LLP
ACCOUNTING
50,000
11 SCOTT ST
WAUSAU
,
WI
54402
Total
number of others receiving over $50,000 for professional services
.............
0
Part IX-A
Summary of Direct Charitable Activities
List the foundation’s four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc.
Expenses
1
2
3
4
Part IX-B
Summary of Program-Related Investments
(see instructions)
Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2.
Amount
1
2
All other program-related investments. See instructions.
3
Total.
Add lines 1 through 3
.........................
0
Form
990-PF
(2019)
Form 990-PF (2019)
Page
8
Part X
Minimum Investment Return
(All domestic foundations must complete this part. Foreign foundations, see instructions.)
1
Fair market value of assets not used (or held for use) directly in carrying out charitable, etc.,
purposes:
a
Average monthly fair market value of securities
...................
1a
24,217,746
b
Average of monthly cash balances
.......................
1b
686,005
c
Fair market value of all other assets (see instructions)
................
1c
79,722,072
d
Total
(add lines 1a, b, and c)
.........................
1d
104,625,823
e
Reduction claimed for blockage or other factors reported on lines 1a and
1c (attach detailed explanation)
.............
1e
0
2
Acquisition indebtedness applicable to line 1 assets
..................
2
0
3
Subtract line 2 from line 1d
.........................
3
104,625,823
4
Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
instructions)
.............................
4
1,569,387
5
Net value of noncharitable-use assets.
Subtract line 4 from line 3. Enter here and on Part V, line 4
5
103,056,436
6
Minimum investment return.
Enter 5% of line 5
..................
6
5,152,822
Part XI
Distributable Amount
(see instructions) (Section 4942(j)(3) and (j)(5) private operating foundations and certain foreign organizations check here
and do not complete this part.)
1
Minimum investment return from Part X, line 6
....................
1
5,152,822
2a
Tax on investment income for 2019 from Part VI, line 5
......
2a
79,893
b
Income tax for 2019. (This does not include the tax from Part VI.)
...
2b
c
Add lines 2a and 2b
............................
2c
79,893
3
Distributable amount before adjustments. Subtract line 2c from line 1
............
3
5,072,929
4
Recoveries of amounts treated as qualifying distributions
................
4
0
5
Add lines 3 and 4
............................
5
5,072,929
6
Deduction from distributable amount (see instructions)
.................
6
0
7
Distributable amount
as adjusted. Subtract line 6 from line 5. Enter here and on Part XIII, line 1
...
7
5,072,929
Part XII
Qualifying Distributions
(see instructions)
1
Amounts paid (including administrative expenses) to accomplish charitable, etc., purposes:
a
Expenses, contributions, gifts, etc.—total from Part I, column (d), line 26
..........
1a
5,291,100
b
Program-related investments—total from Part IX-B
..................
1b
0
2
Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,
purposes
...............................
2
50,000
3
Amounts set aside for specific charitable projects that satisfy the:
a
Suitability test (prior IRS approval required)
....................
3a
b
Cash distribution test (attach the required schedule)
.................
3b
1,000,000
4
Qualifying distributions.
Add lines 1a through 3b. Enter here and on Part V, line 8, and Part XIII, line 4
4
6,341,100
5
Foundations that qualify under section 4940(e) for the reduced rate of tax on net investment
income. Enter 1% of Part I, line 27b. See instructions
.................
5
0
6
Adjusted qualifying distributions.
Subtract line 5 from line 4
..............
6
6,341,100
Note:
The amount on line 6 will be used in Part V, column (b), in subsequent years when calculating whether the foundation qualifies for
the section 4940(e) reduction of tax in those years.
Form
990-PF
(2019)
Form 990-PF (2019)
Page
9
Part XIII
Undistributed Income
(see instructions)
(a)
Corpus
(b)
Years prior to 2018
(c)
2018
(d)
2019
1
Distributable amount for 2019 from Part XI, line 7
5,072,929
2
Undistributed income, if any, as of the end of 2019:
a
Enter amount for 2018 only
.......
1,712,765
b
Total for prior years:
20
,
20
,
20
0
3
Excess distributions carryover, if any, to 2019:
a
From 2014
......
b
From 2015
......
c
From 2016
......
d
From 2017
......
e
From 2018
......
f
Total
of lines 3a through e
........
0
4
Qualifying distributions for 2019 from Part
XII, line 4:
$
6,341,100
a
Applied to 2018, but not more than line 2a
1,712,765
b
Applied to undistributed income of prior years
(Election required—see instructions)
.....
0
c
Treated as distributions out of corpus (Election
required—see instructions)
........
0
d
Applied to 2019 distributable amount
.....
4,628,335
e
Remaining amount distributed out of corpus
0
5
Excess distributions carryover applied to 2019.
0
0
(If an amount appears in column (d), the
same amount must be shown in column (a).)
6
Enter the net total of each column as
indicated below:
a
Corpus. Add lines 3f, 4c, and 4e. Subtract line 5
0
b
Prior years’ undistributed income. Subtract
line 4b from line 2b
..........
0
c
Enter the amount of prior years’ undistributed
income for which a notice of deficiency has
been issued, or on which the section 4942(a)
tax has been previously assessed
......
0
d
Subtract line 6c from line 6b. Taxable amount
—see instructions
...........
0
e
Undistributed income for 2018. Subtract line
4a from line 2a. Taxable amount—see
instructions
.............
0
f
Undistributed income for 2019. Subtract
lines 4d and 5 from line 1. This amount must
be distributed in 2020
..........
444,594
7
Amounts treated as distributions out of
corpus to satisfy requirements imposed by
section 170(b)(1)(F) or 4942(g)(3) (Election may
be required - see instructions)
.......
0
8
Excess distributions carryover from 2014 not
applied on line 5 or line 7 (see instructions)
...
0
9
Excess distributions carryover to 2020.
Subtract lines 7 and 8 from line 6a
......
0
10
Analysis of line 9:
a
Excess from 2015
....
b
Excess from 2016
....
c
Excess from 2017
....
d
Excess from 2018
....
e
Excess from 2019
....
Form
990-PF
(2019)
Form 990-PF (2019)
Page
10
Part XIV
Private Operating Foundations
(see instructions and Part VII-A, question 9)
1a
If the foundation has received a ruling or determination letter that it is a private operating
foundation, and the ruling is effective for 2019, enter the date of the ruling
.......
b
Check box to indicate whether the organization is a private operating foundation described in section
4942(j)(3)
or
4942(j)(5)
2a
Enter the lesser of the adjusted net
income from Part I or the minimum
investment return from Part X for each
year listed
..........
Tax year
Prior 3 years
(e) Total
(a)
2019
(b)
2018
(c)
2017
(d)
2016
b
85% of line 2a
.........
c
Qualifying distributions from Part XII,
line 4 for each year listed
.....
d
Amounts included in line 2c not used directly
for active conduct of exempt activities
..........
e
Qualifying distributions made directly
for active conduct of exempt activities.
Subtract line 2d from line 2c
....
3
Complete 3a, b, or c for the
alternative test relied upon:
a
“Assets" alternative test—enter:
(1)
Value of all assets
......
(2)
Value of assets qualifying
under section 4942(j)(3)(B)(i)
b
“Endowment" alternative test— enter 2/3
of minimum investment return shown in
Part X, line 6 for each year listed
...
c
“Support" alternative test—enter:
(1)
Total support other than gross
investment income (interest,
dividends, rents, payments
on securities loans (section
512(a)(5)), or royalties)
....
(2)
Support from general public
and 5 or more exempt
organizations as provided in
section 4942(j)(3)(B)(iii)
....
(3)
Largest amount of support
from an exempt organization
(4)
Gross investment income
Part XV
Supplementary Information (Complete this part only if the foundation had $5,000 or more in
assets at any time during the year—see instructions.)
1
Information Regarding Foundation Managers:
a
List any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation
before the close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2).)
b
List any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the
ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.
2
Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
Check here
if the foundation only makes contributions to preselected charitable organizations and does not accept
unsolicited requests for funds. If the foundation makes gifts, grants, etc. to individuals or organizations under
other conditions, complete items 2a, b, c, and d. See instructions
a
The name, address, and telephone number or email address of the person to whom applications should be addressed:
b
The form in which applications should be submitted and information and materials they should include:
c
Any submission deadlines:
d
Any restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
factors:
Form
990-PF
(2019)
Form 990-PF (2019)
Page
11
Part XV
Supplementary Information
(continued)
3
Grants and Contributions Paid During the Year or Approved for Future Payment
Recipient
If recipient is an individual,
show any relationship to
any foundation manager
or substantial contributor
Foundation
status of
recipient
Purpose of grant or
contribution
Amount
Name and address (home or business)
a
Paid during the year
A CAROUSEL FOR MISSOULA FOUNDATION INC
PO BOX 3345
MISSOULA
,
MT
59806
PC
SPONSORSHIP FOR ACTIVITIES THAT DIRECTLY SERVICE CHILDREN AND FAMILIES
2,500
A VOICE
PO BOX 832
PABLO
,
MT
59855
PC
GENERAL OPERATING
5,000
ANACONDA COMMUNITY INTERVENTION INC
PO BOX 1273
ANACONDA
,
MT
59711
PC
SPONSORSHIP GRANT
2,500
ANACONDA PCA FAMILY RESORCE CENTER
520 OAK STREET
ANACONDA
,
MT
59711
PC
GENERAL OPERATING
2,500
ANACONDA SCHOOL DISTRICT 10
1410 W PARK STREET
ANACONDA
,
MT
59711
GOV
GENERAL OPERATING
15,000
ANACONDA-DEER LODGE COUNTY PUBLIC HEALTH
115 W COMMERCIAL AVENUE
ANACONDA
,
MT
59711
GOV
GENERAL OPERATING
5,000
ANACONDA-DEER LODGE COUNTY PUBLIC HEALTH
115 W COMMERCIAL AVENUE
ANACONDA
,
MT
59711
GOV
SPONSORSHIP GRANT
2,500
ARLEE COMMUNITY DEVELOPMENT CORPORATION
PO BOX 452
ARLEE
,
MT
59821
PC
GENERAL OPERATING
15,000
AWARE INC
205 E PARK AVENUE
ANACONDA
,
MT
59711
PC
GENERAL OPERATING
5,000
BEAVERHEAD COUNTY MENTAL HEALTH LOCAL ADVISORY COUNCIL
2 SOUTH PACIFIC STREET
DILLON
,
MT
50972
GOV
GENERAL OPERATING
5,000
BIG SKY AACAP
2620 COLONIAL DRIVE
HELENA
,
MT
59601
PC
GENERAL OPERATING
2,500
BITTER ROOT RC&D
1709 N 1ST STREET
HAMILTON
,
MT
59840
PC
GENERAL OPERATING
5,000
BITTERROOT CASA INC
PO BOX 661
HAMILTON
,
MT
59828
PC
GENERAL OPERATING
5,000
BITTERROOT VALLEY CHILDRENS ADVOCACY CENTER INC
PO BOX 2034
HAMILTON
,
MT
59840
PC
GENERAL OPERATING
2,500
BOYS & GIRLS CLUB OF GLACIER COUNTRY
PO BOX 961
COLUMBIA FALLS
,
MT
59912
PC
GENERAL OPERATING
5,000
BOYS & GIRLS CLUB OF GLACIER COUNTRY
PO BOX 961
COLUMBIA FALLS
,
MT
59912
PC
EVENT SPONSORSHIP
2,500
BOYS AND GIRLS CLUB OF MISSOULA COUNTY
1515 FAIRVIEW AVENUE
MISSOULA
,
MT
59801
PC
GENERAL OPERATING
2,500
BOYS AND GIRLS CLUB OF MISSOULA COUNTY
1515 FAIRVIEW AVENUE
MISSOULA
,
MT
59801
PC
OUT OF SCHOOL TIME CLUB
5,000
BOYS AND GIRLS CLUB OF THE FLATHEAD RESERVATION
62579 US-93
RONAN
,
MT
59864
PC
GENERAL OPERATING
2,500
BOYS AND GIRLS CLUB OF THE FLATHEAD RESERVATION
62579 US-93
RONAN
,
MT
59864
PC
EVENT SPONSORSHIP
5,000
BRIGHTWAYS LEARNING
3700 S RUSSELL STREET SUITE 114
MISSOULA
,
MT
59801
PC
GENERAL OPERATING
2,500
BUTTE 4-C'S
101 N MAIN STREET
BUTTE
,
MT
59701
PC
GENERAL OPERATING
7,500
BUTTE RESCUE MISSION
610 E PLATINUM STREET
BUTTE
,
MT
59701
PC
GENERAL OPERATING
5,000
CASA OF LAKE COUNTY
PO BOX 511
POLSON
,
MT
59860
PC
GENERAL OPERATING
5,000
CHARLO COMMUNITY OUTDOOR COMPLEX INC
39752 MORRIS ROAD
CHARLO
,
MT
59824
PC
GENERAL OPERATING
5,000
CHARLO SCHOOL DISTRICT 7J
404 1ST AVENUE W
CHARLO
,
MT
59824
GOV
GENERAL OPERATING
10,000
CHILD BRIDGE INC
836 HOLT DRIVE
BIGFORK
,
MT
59911
PC
GENERAL OPERATING
5,000
CHILD CARE CONNECTIONS
901 N BENTON AVENUE
HELENA
,
MT
59601
PC
EVENT SPONSORSHIP
2,000
COMMUNITY FOOD AND AGRICULTURE COALITION
PO BOX 7025
MISSOULA
,
MT
59807
PC
EVENT SPONSORSHIP
5,000
CONFEDERATED SALISH AND KOOTENAI TRIBES
42487 COMPLEX BOULEVARD
PABLO
,
MT
59855
GOV
EVENT SPONSORSHIP
2,500
CONFEDERATED SALISH AND KOOTENAI TRIBES
42487 COMPLEX BOULEVARD
PABLO
,
MT
59855
GOV
TRIBAL HEALTH DEPARTMENT
9,000
DAYTON ELEMENTARY PARENT TEACHER ORGANIZATION
PO BOX 195
DAYTON
,
MT
59914
PC
GENERAL OPERATING
5,000
DESMET SCHOOL
6355 PADRE LANE
MISSOULA
,
MT
59808
GOV
EVENT SPONSORSHIP
2,500
DIXON SCHOOL DISTRICT 9
411 B STREET
DIXON
,
MT
59831
GOV
AI CULTURAL PRESERVATION
10,000
DRUMMOND SCHOOL DISTRICT 11
108 W EDWARDS STREET
DRUMMOND
,
MT
59832
GOV
GENERAL OPERATING
10,000
DRUMMOND SCHOOL DISTRICT 2
108 W EDWARDS STREET
DRUMMOND
,
MT
59832
GOV
GENERAL OPERATING
10,000
EAT RIGHT MONTANA INC
PO BOX 1631
HELENA
,
MT
59624
PC
GENERAL OPERATING
500
EMPOWERMT
2300 REGENT STREET
MISSOULA
,
MT
59801
PC
GENERAL OPERATING
5,000
EUREKA SCHOOL DISTRICT
340 9TH STREET
EUREKA
,
MT
59917
GOV
GENERAL OPERATING
20,000
FAMILIES IN PARTNERSHIP INC
PO BOX 762
LIBBY
,
MT
59923
PC
GENERAL OPERATING
5,000
FAMILIES IN PARTNERSHIP INC
PO BOX 762
LIBBY
,
MT
59923
PC
SPONSORSHIP GRANT
5,000
FARM HANDS-NOURISH THE FLATHEAD
PO BOX 4404
WHITEFISH
,
MT
59937
PC
GENERAL OPERATING
5,000
FLORENCE CARLTON PARENT ORGANIZATION
PO BOX 433
FLORENCE
,
MT
59833
PC
GENERAL OPERATING
5,000
FLORENCE COMMUNITY CENTER
PO BOX 98
FLORENCE
,
MT
59833
PC
GENERAL OPERATING
5,000
FLORENCE CRITTENTON HOME & SERVICES
901 N HARRIS STREET
HELENA
,
MT
59601
PC
GENERAL OPERATING
5,000
FLORENCE-CARLTON SCHOOL DISTRICT 15-6
5602 OLD HIGHWAY 93
FLORENCE
,
MT
59833
GOV
GENERAL OPERATING
5,000
FORTINE SCHOOL DISTRICT
358 MEADOWCREEK ROAD
FORTINE
,
MT
59918
GOV
GENERAL OPERATING
5,000
FOURTH D INC
1500 W BROADWAY STREET SUITE B
MISSOULA
,
MT
59802
PC
GENERAL OPERATING
2,500
FRIENDS FOREVER MENTORING
49518 US HIGHWAY 93
POLSON
,
MT
59860
PC
GENERAL OPERATING
5,000
FRIENDS OF THE PHILIPSBURG LIBRARY
110 RUMSEY ROAD
PHILIPSBURG
,
MT
59858
PC
GENERAL OPERATING
5,000
GLACIER LAKE SCHOOL
62551 WILD ROSE LANE
ST IGNATIUS
,
MT
59865
GOV
GENERAL OPERATING
2,000
GREAT BEAR FOUNDATION
117 WEST BROADWAY STREET
MISSOULA
,
MT
59807
PC
GENERAL OPERATING
5,000
GREATER MISSOULA FAMILY YMCA
3000 S RUSSELL STREET
MISSOULA
,
MT
59801
PC
SPONSORSHIP GRANT
2,500
HABITAT FOR HUMANITY INTERNATIONAL INC
PO BOX 7181
MISSOULA
,
MT
59807
PC
SPONSORSHIP GRANT
2,500
HEALTHY MOTHERS HEALTHY BABIES THE MONTANA COALITION INC
318-20 N LAST CHANCE GULCH SUITE 2C
HELENA
,
MT
59601
PC
GENERAL OPERATING
5,000
HELPING HANDS FUND
PO BOX 1094
POLSON
,
MT
59860
PC
GENERAL OPERATING
5,000
INTERMOUNTAIN PLANNED PARENTHOOD INC
1500 CANNON STREET
HELENA
,
MT
59601
PC
GENERAL OPERATING
2,500
INTERMOUNTAIN
3240 DREDGE DRIVE
HELENA
,
MT
59602
PC
ZERO TO FIVE PROGRAM
802,500
INTERMOUNTAIN
3240 DREDGE DRIVE
HELENA
,
MT
59602
PC
CHILD CARE SOLUTIONS TO SUPPORT YOUR WORKFORCE
180,000
KIWANIS FOUNDATION OF MONTANA
PO BOX 1171
TROY
,
MT
59935
PC
GENERAL OPERATING
5,000
KIWANIS FOUNDATION OF MONTANA
PO BOX 1171
TROY
,
MT
59935
PC
SPONSORSHIP GRANT
2,500
KOOTENAI VALLEY HEAD START INC
263 INDIAN HEAD ROAD
LIBBY
,
MT
59923
PC
SPONSORSHIP GRANT
5,000
LAKE COUNTY PUBLIC HEALTH
802 MAIN STREET
POLSON
,
MT
59860
GOV
GENERAL OPERATING
5,000
LEARN INC
1345 DAKOTA STREET
MISSOULA
,
MT
59802
PC
SPONSORSHIP GRANT
2,500
LINCOLN COUNTY PUBLIC HEALTH
933 FARM TO MARKET ROAD SUITE D
LIBBY
,
MT
59923
GOV
ZERO TO FIVE COLLABORATIVE
177,200
LITERACY VOLUNTEERS OF AMERICA BITTERROOT INC
121 3RD AVENUE NW
SIDNEY
,
MT
59270
PC
SPONSORSHIP GRANT
5,000
MA HOPE INSTITUTE
PO BOX 3603
MISSOULA
,
MT
59806
PC
SPONSORSHIP GRANT
5,000
MAKE-A-WISH FOUNDATION OF MONTANA INC
1015 MOUNT AVENUE SUITE C
MISSOULA
,
MT
59801
PC
SPONSORSHIP GRANT
2,500
MINERAL COUNTY COMMUNITY FOUNDATION
33 S LAST CHANCE GULCH SUITE 2A
HELENA
,
MT
59601
PC
GENERAL OPERATING
5,000
MINERAL COUNTY HEALTH DEPARTMENT
PO BOX 488
SUPERIOR
,
MT
59872
GOV
STRATEGIC INITIATIVE
150,000
MISSION RIDGE CHURCH INC
800 KENSINGTON AVENUE LL2
MISSOULA
,
MT
59801
PC
SPONSORSHIP GRANT
2,500
MISSION VALLEY AQUATICS
309 RIDGEWATER DRIVE
POLSON
,
MT
59860
PC
SPONSORSHIP GRANT
5,000
MISSION VALLEY JUNIOR GOLF INC
111 BAYVIEW DRIVE
POLSON
,
MT
59860
PC
GENERAL OPERATING
5,000
MISSOULA CHILDREN'S THEATRE
200 N ADAMS STREET
MISSOULA
,
MT
59802
PC
SPONSORSHIP GRANT
2,500
MISSOULA CITY-COUNTY HEALTH DEPARTMENT
301 WEST ALDER STREET
MISSOULA
,
MT
59802
GOV
SPONSORSHIP GRANT
2,500
MISSOULA INTERFAITH COLLABORATIVE
202 BROOKS STREET
MISSOULA
,
MT
59801
PC
POLICY GRANT
175,000
MISSOULA URBAN INDIAN HEALTH CENTER INC
2100 STEPHENS AVENUE SUITE 105
MISSOULA
,
MT
59801
PC
STRATEGIC INITIATIVE
90,000
MISSOULA URBAN INDIAN HEALTH CENTER INC
2100 STEPHENS AVENUE SUITE 105
MISSOULA
,
MT
59801
PC
GENERAL OPERATING
2,500
MONTANA ASSOCIATION FOR THE EDUCATION OF YOUNG CHILDREN
PO BOX 11568
BOZEMAN
,
MT
59719
PC
FLATHEAD CHAPTER
5,000
MONTANA BUDGET AND POLICY CENTER
101 N LAST CHANCE GULCH SUITE 220
HELENA
,
MT
59601
PC
POLICY GRANT
125,000
MONTANA CASA GAL ASSOCIATION
2409 ARNOLD LANE
BILLINGS
,
MT
59102
PC
SPONSORSHIP GRANT
2,500
MONTANA FOOD BANK NETWORK INC
5625 EXPRESSWAY
MISSOULA
,
MT
59808
PC
GENERAL OPERATING
5,000
MONTANA FOOD BANK NETWORK INC
5625 EXPRESSWAY
MISSOULA
,
MT
59808
PC
SPONSORSHIP GRANT
2,500
MONTANA HEALTH PLUS
1085 EUCLID AVENUE
HELENA
,
MT
59601
PC
SPONSORSHIP GRANT
2,500
MONTANA HOMEOWNERSHIP NETWORK
509 1ST AVENUE S
GREAT FALLS
,
MT
59401
PC
SPONSORSHIP GRANT
2,500
MONTANA HUMAN RIGHTS NETWORK INC
PO BOX 1509
HELENA
,
MT
59624
PC
POLICY MEETING HONORARIUM
140,000
MONTANA LEGAL SERVICES ASSOCIATION
616 HELENA AVENUE SUITE 100
HELENA
,
MT
59601
PC
GENERAL OPERATING
100,000
MONTANA NONPROFIT ASSOCIATION INC
PO BOX 1744
HELENA
,
MT
59624
PC
STRATEGIC INITIATIVE
205,000
MONTANA PUBLIC HEALTH ASSOCIATION
1400 E BROADWAY STREET
HELENA
,
MT
59601
GOV
GENERAL OPERATING
2,500
MONTANA TWO SPIRIT SOCIETY
PO BOX 7514
MISSOULA
,
MT
59807
PC
GENERAL OPERATING
5,000
NEVER ALONE RECOVERY SUPPORT SERVICES
PO BOX 406
RONAN
,
MT
59864
PC
GENERAL OPERATING
5,000
NKWUSM SALISH LANGUAGE SCHOOL
PO BOX 5
ARLEE
,
MT
59821
PC
STRATEGIC INITIATIVE
5,000
NKWUSM SALISH LANGUAGE SCHOOL
PO BOX 5
ARLEE
,
MT
59821
PC
GENERAL OPERATING
5,000
NORTH LAKE COUNTY PUBLIC LIBRARY
2 1ST AVENUE E
POLSON
,
MT
59860
PC
GENERAL OPERATING
5,000
NORTH VALLEY FOOD BANK INC
251 FLATHEAD AVENUE
FLATHEAD
,
MT
59937
PC
GENERAL OPERATING
5,000
NORTHWEST MONTANA UNITED WAY
1203 US-2
KALISPELL
,
MT
59901
PC
GENERAL OPERATING
5,000
NORTHWOOD COMMUNITY INC
41652 US-93
RONAN
,
MT
59864
PC
GENERAL OPERATING
5,000
PEAK FOUNDATION
PO BOX 36
ALBERTON
,
MT
59820
PC
GENERAL OPERATING
5,000
PEAK FOUNDATION
PO BOX 36
ALBERTON
,
MT
59820
PC
SPONSORSHIP GRANT
2,500
PHILIPSBURG K-12 SCHOOL DISTRICT
407 SCHNEPEL STREET
PHILIPSBURG
,
MT
59858
GOV
GENERAL OPERATING
15,000
POLSON SCHOOL DISTRICT 23
111 4TH AVENUE E
POLSON
,
MT
59860
GOV
GENERAL OPERATING
20,000
RAVALLI HEAD START INC
81 KURTZ LANE
HAMILTON
,
MT
59840
PC
GENERAL OPERATING
5,000
RONAN SCHOOL DISTRICT 30
421 ANDREW STREET NW
RONAN
,
MT
59864
GOV
SCHOOL COMMUNITY POWWOW
2,500
RONAN SCHOOL DISTRICT
421 ANDREW STREET NW
RONAN
,
MT
59864
GOV
K WILLIAM HARVEY
30,000
RURAL DYNAMICS INC
410 CENTRAL AVENUE SUITE 401
GREAT FALLS
,
MT
59401
PC
SPONSORSHIP GRANT
2,500
S A F E HARBOUR INC
63506 US-93
RONAN
,
MT
59864
PC
GENERAL OPERATING
7,500
SALISH & KOOTENAI HOUSING AUTHORITY
56243 US-93
PABLO
,
MT
59855
PC
GENERAL OPERATING
5,000
SALISH KOOTENAI COLLEGE INC
PO BOX 70
PABLO
,
MT
59855
PC
CENTER FOR PREVENTION AND WELLNESS
25,000
SALISH KOOTENAI COLLEGE INC
PO BOX 70
PABLO
,
MT
59855
PC
STATEGIC INITIATIVE
227,000
SALISH KOOTENAI COLLEGE INC
PO BOX 70
PABLO
,
MT
59855
PC
GENERAL OPERATING
5,000
SOMERS LAKESIDE SCHOOL DISTRICT 29
315 SCHOOL ADDITION ROAD
SOMERS
,
MT
59932
PC
GENERAL OPERATING
5,000
SPARROWS NEST OF NORTHWEST MONTANA
PO BOX 8384
KALISPELL
,
MT
59904
PC
GENERAL OPERATING
5,000
SPECIAL OLYMPICS MONTANA INC
PO BOX 3507
GREAT FALLS
,
MT
59403
PC
GENERAL OPERATING
5,000
ST IGNATIUS PUBLIC SCHOOLS
76 3RD AVENUE
ST IGNATIUS
,
MT
59865
GOV
GENERAL OPERATING
20,000
ST LUKE COMMUNITY HEALTHCARE FOUNDATION
107 6TH AVENUE SW
RONAN
,
MT
59864
PC
GENERAL OPERATING
2,500
ST PETERS HEALTH
2475 BROADWAY STREET
HELENA
,
MT
59601
PC
SPONSORSHIP GRANT
2,500
ST REGIS FRIENDS AND NEIGHBORS CLUB
6 TIGER STREET
SAINT REGIS
,
MT
59866
PC
SPONSORSHIP GRANT
2,500
ST REGIS SCHOOL DISTRICT 1
90 TIGER STREET
SAINT REGIS
,
MT
59866
GOV
GENERAL OPERATING
5,000
THE COMMUNITY SUPPORT CENTER
236 E REEDER STREET
DILLON
,
MT
59725
PC
GENERAL OPERATING
5,000
TWO EAGLE RIVER SCHOOL
58020 US-93
PABLO
,
MT
59855
GOV
CULTURAL PRESERVATION
10,000
UNIVERSITY OF MONTANA FOUNDATION
950 ARTHUR AVENUE
MISSOULA
,
MT
59812
GOV
GENERAL OPERATING
5,000
UNIVERSITY OF MONTANA FOUNDATION
950 ARTHUR AVENUE
MISSOULA
,
MT
59812
GOV
SPONSORSHIP GRANT
2,500
UNIVERSITY OF MONTANA
32 CAMPUS DRIVE ORSP UH 116
MISSOULA
,
MT
59812
GOV
BIG SKY POLL
114,658
UNIVERSITY OF MONTANA
32 CAMPUS DRIVE ORSP UH 116
MISSOULA
,
MT
59812
GOV
GENERAL OPERATING
5,000
UNIVERSITY OF MONTANA
32 CAMPUS DRIVE ORSP UH 116
MISSOULA
,
MT
59812
GOV
POLICY GRANT
210,000
UPPER WEST SHORE ELEMENTARY SCHOOL DISTRICT
506 B STREET
DAYTON
,
MT
59914
GOV
DAYTON ELEMENTARY
5,000
VALLEY VIEW ELEMENTARY SCHOOL DISTRICT 35
42448 VALLEY VIEW ROAD
POLSON
,
MT
59860
GOV
AI CULTURAL PRESERVATION
5,000
WESTERN NATIVE VOICE
310 N 27TH STREET
BILLINGS
,
MT
59103
PC
GENERAL OPERATING
125,000
WORD
2405 MCINTOSH LOOP
MISSOULA
,
MT
59801
PC
SPONSORSHIP GRANT
2,500
YES YOUTH EMPOWERMENT SERVICES
PO BOX 686
ANACONDA
,
MT
59711
PC
GENERAL OPERATING
5,000
YOUNG WOMENS CHRISTIAN ASSO OF MISSOULA
1130 W BROADWAY STREET
MISSOULA
,
MT
59802
PC
SPONSORSHIP GRANT
2,500
YOUTH HOMES INC
PO BOX 7616
MISSOULA
,
MT
59807
PC
GENERAL OPERATING
2,500
YWCA HELENA
1200 N LAST CHANCE GULCH
HELENA
,
MT
59601
PC
SPONSORSHIP GRANT
2,500
Total
.................................
3a
3,462,358
b
Approved for future payment
Total
.................................
3b
0
Form
990-PF
(2019)
Form 990-PF (2019)
Page
12
Part XVI-A
Analysis of Income-Producing Activities
Enter gross amounts unless otherwise indicated.
Unrelated business income
Excluded by section 512, 513, or 514
(e)
Related or exempt
function income
(See instructions.)
1
Program service revenue:
(a)
Business code
(b)
Amount
(c)
Exclusion code
(d)
Amount
a
b
c
d
e
f
g
Fees and contracts from government agencies
2
Membership dues and assessments
....
3
Interest on savings and temporary cash
investments
...........
14
3,459
4
Dividends and interest from securities
....
14
784,122
5
Net rental income or (loss) from real estate:
a
Debt-financed property
......
b
Not debt-financed property
.....
6
Net rental income or (loss) from personal property
7
Other investment income
.....
14
1,721,922
8
Gain or (loss) from sales of assets other than
inventory
............
204
18
171,788
9
Net income or (loss) from special events:
10
Gross profit or (loss) from sales of inventory
11
Other revenue:
a
ORDINARY INCOME FROM PASSTHROUGH
-27,236
01
428,055
b
c
d
e
12
Subtotal. Add columns (b), (d), and (e)
..
-27,032
3,109,346
0
13
Total.
Add line 12, columns (b), (d), and (e)
..................
13
3,082,314
(See worksheet in line 13 instructions to verify calculations.)
Part XVI-B
Relationship of Activities to the Accomplishment of Exempt Purposes
Line No.
Explain below how each activity for which income is reported in column (e) of Part XVI-A contributed importantly to
the accomplishment of the foundation’s exempt purposes (other than by providing funds for such purposes). (See
instructions.)
Form
990-PF
(2019)
Form 990-PF (2019)
Page
13
Part XVII
Information Regarding Transfers To and Transactions and Relationships With Noncharitable Exempt Organizations
1
Did the organization directly or indirectly engage in any of the following with any other organization described in section 501(c) (other than section 501(c)(3) organizations) or in section 527, relating to political organizations?
Yes
No
a
Transfers from the reporting foundation to a noncharitable exempt organization of:
(1)
Cash
...................................
1a(1)
No
(2)
Other assets
.................................
1a(2)
No
b
Other transactions:
(1)
Sales of assets to a noncharitable exempt organization
....................
1b(1)
No
(2)
Purchases of assets from a noncharitable exempt organization
..................
1b(2)
No
(3)
Rental of facilities, equipment, or other assets
.......................
1b(3)
No
(4)
Reimbursement arrangements
...........................
1b(4)
No
(5)
Loans or loan guarantees
.............................
1b(5)
No
(6)
Performance of services or membership or fundraising solicitations
................
1b(6)
No
c
Sharing of facilities, equipment, mailing lists, other assets, or paid employees
..............
1c
No
d
If the answer to any of the above is "Yes," complete the following schedule. Column
(b)
should always show the fair market value
of the goods, other assets, or services given by the reporting foundation. If the foundation received less than fair market value
in any transaction or sharing arrangement, show in column
(d)
the value of the goods, other assets, or services received.
(a)
Line No.
(b)
Amount involved
(c)
Name of noncharitable exempt organization
(d)
Description of transfers, transactions, and sharing arrangements
2a
Is the foundation directly or indirectly affiliated with, or related to, one or more tax-exempt organizations
described in section 501(c) (other than section 501(c)(3)) or in section 527?
...........
Yes
No
b
If "Yes," complete the following schedule.
(a)
Name of organization
(b)
Type of organization
(c)
Description of relationship
Sign Here
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
May the IRS discuss this return
with the preparer shown below
(see instr.)
Yes
No
Signature of officer or trustee
Date
Title
Paid Preparer Use Only
Print/Type preparer's name
Preparer's Signature
Date
Check if self-
employed
PTIN
Firm's name
Firm's EIN
Firm's address
Phone no.
Form
990-PF
(2019)
Additional Data
Software ID:
Software Version:
Form 990PF - Special Condition Description:
Special Condition Description