Form990-PF

Department of the Treasury
Internal Revenue Service

Return of Private Foundation
or Section 4947(a)(1) Trust Treated as Private Foundation
bulletDo not enter social security numbers on this form as it may be made public.
bulletGo to www.irs.gov/Form990PF for instructions and the latest information.
OMB No. 1545-0052
2020
Open to Public Inspection
For calendar year 2020, or tax year beginning 01-01-2020 , and ending 12-31-2020
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, MT59802
A Employer identification number

81-1099715
B Telephone number (see instructions)

(406) 926-6526
C bullet
G Check all that apply:

D 1. Foreign organizations, check here............. bullet
2. Foreign organizations meeting the 85%
test, check here and attach computation ... bullet
E bullet
H Check type of organization:
F bullet
I Fair market value of all assets at end
of year (from Part II, col. (c),
line 16)bullet$106,148,941J Accounting method:
 
(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)
Revenue 1 Contributions, gifts, grants, etc., received (attach schedule) 523,100
2 Check bullet.............
3 Interest on savings and temporary cash investments 76 76  
4 Dividends and interest from securities... 998,570 2,243,106  
5a Gross rents............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10 163,764
b Gross sales price for all assets on line 6a 23,410,895
7 Capital gain net income (from Part IV, line 2)... 941,737
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)....... Click to see attachment 3,884,693 3,856,883  
12 Total. Add lines 1 through 11........ 5,570,203 7,041,802  
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 645,422 101,094   548,068
14 Other employee salaries and wages...... 266,452 5,581   296,761
15 Pension plans, employee benefits....... 291,891 21,889   264,445
16a Legal fees (attach schedule)......... Click to see attachment 28,580 0   28,766
b Accounting fees (attach schedule)....... Click to see attachment 106,325 25,103   71,904
c Other professional fees (attach schedule).... Click to see attachment 585,509 1,210,843   250,914
17 Interest............... 196,364 196,364   0
18 Taxes (attach schedule) (see instructions)... Click to see attachment 130,029 115,612   0
19 Depreciation (attach schedule) and depletion... Click to see attachment 27,377 0  
20 Occupancy.............. 108,647 0   108,532
21 Travel, conferences, and meetings....... 48,454 0   48,416
22 Printing and publications.......... 38 0   38
23 Other expenses (attach schedule)....... Click to see attachment 120,085 0   123,626
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 2,555,173 1,676,486   1,741,470
25 Contributions, gifts, grants paid....... 3,603,752 3,603,752
26 Total expenses and disbursements. Add lines 24 and 25 6,158,925 1,676,486   5,345,222
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements -588,722
b Net investment income (if negative, enter -0-) 5,365,316
c Adjusted net income (if negative, enter -0-)...  
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 11289X Form 990-PF (2020)
Form 990-PF (2020)
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
Assets 1 Cash—non-interest-bearing............. 379,219 4,787,407 4,787,407
2 Savings and temporary cash investments.........      
3 Accounts receivable bullet  
Less: allowance for doubtful accounts bullet   67,104    
4 Pledges receivable bullet  
Less: allowance for doubtful accounts bullet        
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) bullet  
Less: allowance for doubtful accounts bullet        
8 Inventories for sale or use..............      
9 Prepaid expenses and deferred charges..........      
10a Investments—U.S. and state government obligations (attach schedule) 3,398,471 Click to see attachment1,747,098 1,747,098
b Investments—corporate stock (attach schedule)....... 11,708,144 Click to see attachment8,654,372 8,654,372
c Investments—corporate bonds (attach schedule)....... 8,791,857 Click to see attachment7,327,308 7,327,308
11 Investments—land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
12 Investments—mortgage loans.............      
13 Investments—other (attach schedule).......... 79,722,072 Click to see attachment82,423,176 82,423,176
14 Land, buildings, and equipment: basis bullet1,257,467
Less: accumulated depreciation (attach schedule) bullet47,887 92,824 Click to see attachment1,209,580 1,209,580
15 Other assets (describe bullet)      
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 104,159,691 106,148,941 106,148,941
Liabilities 17 Accounts payable and accrued expenses.......... 39,433 12,805
18 Grants payable................. 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 bullet) Click to see attachment224,206 Click to see attachment263,955
23 Total liabilities (add lines 17 through 22)......... 263,689 276,760
Net Assets or Fund Balances Foundations that follow FASB ASC 958, check here bullet
and complete lines 24, 25, 29 and 30.
24 Net assets without donor restrictions........... 103,896,002 105,872,181
25 Net assets with donor restrictions............    
Foundations that do not follow FASB ASC 958, check here bullet
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)..... 103,896,002 105,872,181
30 Total liabilities and net assets/fund balances (see instructions). 104,159,691 106,148,941
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
103,896,002
2
Enter amount from Part I, line 27a .....................
2
-588,722
3
Other increases not included in line 2 (itemize) bulletClick to see attachment
3
2,564,901
4
Add lines 1, 2, and 3 ..........................
4
105,872,181
5
Decreases not included in line 2 (itemize) bullet
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
105,872,181
Form 990-PF (2020)
Form 990-PF (2020)
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 CAPITAL GAINS DIVIDENDS P    
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 22,149,332   22,469,158 -319,826
b 1,233,279     1,233,279
c 28,284     28,284
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       -319,826
b       1,233,279
c       28,284
d
e
2 Capital gain net income or (net capital loss) Bracket If gain, also enter in Part I, line 7
If (loss), enter -0- in Part I, line 7		 Bracket 2 941,737
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 ................... 		Bracket 3  
Part V
Qualification Under Section 4940(e) for Reduced Tax on Net Investment Income
SECTION 4940(e) REPEALED ON DECEMBER 20, 2019 - DO NOT COMPLETE
1 Reserved
(a)
Reserved 		(b)
Reserved 		(c)
Reserved 		(d)
Reserved
2
Reserved...........................
2
3
Reserved...........................
3
4
Reserved...........................
4
5
Reserved...........................
5
6
Reserved...........................
6
7
Reserved...........................
7
8
Reserved,..........................
8
Form 990-PF (2020)
Form 990-PF (2020)
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 Bullet and enter “N/A" on line 1. Bracket for line 1a
Date of ruling or determination letter:   (attach copy of letter if necessary–see instructions)
b Reserved................................ 1 74,578
c All other domestic foundations enter 1.39% 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 74,578
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 74,578
6 Credits/Payments:
a 2020 estimated tax payments and 2019 overpayment credited to 2020 6a 41,546
b Exempt foreign organizations—tax withheld at source...... 6b 0
c Tax paid with application for extension of time to file (Form 8868)... 6c 60,000
d Backup withholding erroneously withheld ........... 6d 0
7 Total credits and payments. Add lines 6a through 6d.............. 7 101,546
8 Enter any penalty for underpayment of estimated tax. Check here if Form 2220 is attached. Click to see attachment 8 0
9 Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed.......Bullet 9  
10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid...Bullet 10 26,968
11 Enter the amount of line 10 to be: Credited to 2021 estimated taxBullet26,968 RefundedBullet 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 the instructions
for the 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. bullet$ 0(2) On foundation managers.bullet$ 0
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.bullet$ 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)
    bulletMT
    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 2020 or the taxable year beginning in 2020? 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 (2020)
    Form 990-PF (2020)
    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 addressbulletWWW.HEADWATERSMT.ORG
    14
    The books are in care ofbulletMYNOR VELIZ Telephone no.bullet (406) 926-6526

    Located atbullet283 W FRONT STREETMISSOULAMT ZIP+4bullet59802
    15
    Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of Form 1041 —check here .........bullet
    and enter the amount of tax-exempt interest received or accrued during the year ........bullet
    15
     
    16 At any time during calendar year 2020, did the foundation have an interest in or a signature or other authority over YesNo
    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 bullet
    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?
    (2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
    a disqualified person?......................
    (3) Furnish goods, services, or facilities to (or accept them from) a disqualified person?
    (4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person?
    (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)?...............
    (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.).......
    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
    ........bullet
    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 2020?.............
    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 2020, did the foundation have any undistributed income (lines 6d
    and 6e, Part XIII) for tax year(s) beginning before 2020?.............
    If "Yes," list the years bullet20, 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.
    bullet20, 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?......................
    b
    If "Yes," did it have excess business holdings in 2020 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 2020.)..................
    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 2020?
    4b
     
    No
    Form 990-PF (2020)
    Form 990-PF (2020)
    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))?
    (2) Influence the outcome of any specific public election (see section 4955); or to carry
    on, directly or indirectly, any voter registration drive?.............
    (3) Provide a grant to an individual for travel, study, or other similar purposes?
    (4) Provide a grant to an organization other than a charitable, etc., organization described
    in section 4945(d)(4)(A)? See instructions................
    (5) Provide for any purpose other than religious, charitable, scientific, literary, or
    educational purposes, or for the prevention of cruelty to children or animals?.....
    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
    Yes
     
    .........bullet
    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?..........
    If "Yes," attach the statement required by Regulations section 53.4945–5(d). Click to see attachment
    6a
    Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums on
    a personal benefit contract?.....................
    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?
    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? .................
    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,MT59802
    JAY LOWDER CHAIR
    1.30     		0 0 0
    283 W FRONT STREET
    MISSOULA,MT59802
    CHRISTINA TWOHIG VICE CHAIR
    1.30     		0 0 0
    283 W FRONT STREET
    MISSOULA,MT59802
    RICHARD OPPER TREASURER
    1.30     		0 0 0
    283 W FRONT STREET
    MISSOULA,MT59802
    CARISSA KUHL TRUSTEE
    1.30     		0 0 0
    283 W FRONT STREET
    MISSOULA,MT59802
    KELLEY RISCHKE TRUSTEE
    1.30     		0 0 0
    283 W FRONT STREET
    MISSOULA,MT59802
    MIKE STEWART TRUSTEE
    1.30     		0 0 0
    283 W FRONT STREET
    MISSOULA,MT59802
    JORDAN THOMPSON TRUSTEE
    1.30     		0 0 0
    283 W FRONT STREET
    MISSOULA,MT59802
    RACHEL HUFF-DORIA TRUSTEE
    1.30     		0 0 0
    283 W FRONT STREET
    MISSOULA,MT59802
    HEATHER CAHOON TRUSTEE
    1.30     		0 0 0
    283 W FRONT STREET
    MISSOULA,MT59802
    STEVE MCNEECE TRUSTEE
    1.30     		0 0 0
    283 W FRONT STREET
    MISSOULA,MT59802
    BRENDA SOLORZANO-CLAUDLE CHIEF EXECUTIVE OFFICER
    40.00     		271,433 0 5,993
    283 W FRONT STREET
    MISSOULA,MT59802
    MYNOR VELIZ CHIEF FINANCIAL OFFICER
    40.00     		212,218 12,534 10,950
    283 W FRONT STREET
    MISSOULA,MT59802
    ERIN SWITALSKI PROGRAM DIRECTOR
    40.00     		115,863 6,612 9,819
    283 W FRONT STREET
    MISSOULA,MT59802
    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
    ALYSSA C SHOCK ASSOCIATE
    40.00     		82,759 10,608 0
    283 WEST FRONT ST SUITE 301
    MISSOULA,MT59802
    JENNIFER L SAVAGE COMMUNICATIONS OFFIC
    40.00     		72,916 4,375 0
    283 WEST FRONT ST SUITE 301
    MISSOULA,MT59802
    ZIA MAUMENEE GRANTS MANAGER
    40.00     		67,849 7,195 0
    283 WEST FRONT ST SUITE 301
    MISSOULA,MT59802
    ASHLEY N SHAW PROGRAM ASSOCIATE
    40.00     		69,246 1,408 0
    283 WEST FRONT ST SUITE 301
    MISSOULA,MT59802
    STEPHANIE SCHILLING EVALUATION AND OPERA
    40.00     		58,520 5,513 0
    283 WEST FRONT ST SUITE 301
    MISSOULA,MT59802
    Total number of other employees paid over $50,000...................bullet 0
    Form 990-PF (2020)
    Form 990-PF (2020)
    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 INVESTMENT MANAGEMENT 183,366
    1411 4TH AVE 12TH FLOOR
    SEATTLE,WA98101
    MMW ARCHITECTS PC ARCHITECTURAL 85,081
    125 WEST ALDER ST
    MISSOULA,MT59802
    MCEWEN BIG SKY LLC CONSULTING 82,360
    2024 218TH PLACE NE
    SAMMAMISH,WA98074
    PRINCIPAL GROUP INSURANCE 74,126
    711 HIGH ST
    DES MOINES,IA50392
    MOSS ADAMS LLP AUDIT AND TAX 64,440
    805 SW BROADWAY ST SUITE 1200
    PORTLAND,OR97205
    Total number of others receiving over $50,000 for professional services.............bullet1
    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.........................bullet0
    Form 990-PF (2020)
    Form 990-PF (2020)
    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
    17,913,865
    b
    Average of monthly cash balances.......................
    1b
    1,413,816
    c
    Fair market value of all other assets (see instructions)................
    1c
    82,423,174
    d
    Total (add lines 1a, b, and c).........................
    1d
    101,750,855
    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
    101,750,855
    4
    Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
    instructions) .............................
    4
    1,526,263
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. Enter here and on Part V, line 4
    5
    100,224,592
    6
    Minimum investment return. Enter 5% of line 5..................
    6
    5,011,230
    Part XI
    Distributable Amount (see instructions) (Section 4942(j)(3) and (j)(5) private operating foundations and certain foreign organizations check here right arrow and do not complete this part.)
    1
    Minimum investment return from Part X, line 6....................
    1
    5,011,230
    2a
    Tax on investment income for 2020 from Part VI, line 5......
    2a
    74,578
    b
    Income tax for 2020. (This does not include the tax from Part VI.)...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
    74,578
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
    4,936,652
    4
    Recoveries of amounts treated as qualifying distributions................
    4
    0
    5
    Add lines 3 and 4............................
    5
    4,936,652
    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
    4,936,652
    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
    5,345,222
    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
    1,144,133
    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) Click to see attachment.................
    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
    7,489,355
    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
    7,489,355
    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 (2020)
    Form 990-PF (2020)
    Page 9
    Part XIII
    Undistributed Income (see instructions)
    (a)
    Corpus     		(b)
    Years prior to 2019     		(c)
    2019     		(d)
    2020
    1 Distributable amount for 2020 from Part XI, line 7 4,936,652
    2 Undistributed income, if any, as of the end of 2020:
    a Enter amount for 2019 only....... 444,594
    b Total for prior years:20, 20, 20 0
    3 Excess distributions carryover, if any, to 2020:
    a From 2015......  
    b From 2016......  
    c From 2017......  
    d From 2018......  
    e From 2019......  
    fTotal of lines 3a through e........ 0
    4Qualifying distributions for 2020 from Part
    XII, line 4: bullet$ 7,489,355
    a Applied to 2019, but not more than line 2a 444,594
    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 2020 distributable amount..... 4,936,652
    e Remaining amount distributed out of corpus 2,108,109
    5 Excess distributions carryover applied to 2020. 0 0
    (If an amount appears in column (d), the
    same amount must be shown in column (a).)
    6Enter the net total of each column as
    indicated below:
    a Corpus. Add lines 3f, 4c, and 4e. Subtract line 5 2,108,109
    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 2019. Subtract line
    4a from line 2a. Taxable amount—see
    instructions .............     		0
    f Undistributed income for 2020. Subtract
    lines 4d and 5 from line 1. This amount must
    be distributed in 2021 ..........     		0
    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 2015 not
    applied on line 5 or line 7 (see instructions) ...     		0
    9Excess distributions carryover to 2021.
    Subtract lines 7 and 8 from line 6a ......     		2,108,109
    10 Analysis of line 9:
    a Excess from 2016....  
    b Excess from 2017....  
    c Excess from 2018....  
    d Excess from 2019....  
    e Excess from 2020.... 2,108,109
    Form 990-PF (2020)
    Form 990-PF (2020)
    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 2020, enter the date of the ruling....... bullet
     
    b Check box to indicate whether the organization is a private operating foundation described in section or
    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) 2020 (b) 2019 (c) 2018 (d) 2017
             
    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.)
    1Information Regarding Foundation Managers:
    aList 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).)
    bList 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.
    2Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
    Check here bullet
    aThe name, address, and telephone number or e-mail address of the person to whom applications should be addressed:
    VISIT WEBSITE FOR MOST CURRENT INFO
    283 W FRONT ST
    MISSOULA,MT59802
    (406) 926-6526
    bThe form in which applications should be submitted and information and materials they should include:
    VISIT WEBSITE FOR MOST CURRENT INFO WWW.HEADWATERSMT.ORG
    cAny submission deadlines:
    VISIT WEBSITE FOR MOST CURRENT INFO WWW.HEADWATERSMT.ORG
    dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
    factors:
    VISIT WEBSITE FOR MOST CURRENT INFO WWW.HEADWATERSMT.ORG
    Form 990-PF (2020)
    Form 990-PF (2020)
    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)
    aPaid during the year
    A VOICE
    PO BOX 832
    PABLO,MT59855     		  PC GENERAL OPERATING 5,000
    ALBERTON COMMUNITY FOOD BANK
    PO BOX 8
    ALBERTON,MT59820     		  PC GENERAL OPERATING 2,500
    ALL NATIONS HEALTH CENTER
    830 W CENTRAL
    MISSOULA,MT59801     		  PC GENERAL OPERATING 195,000
    ANACONDA JR HIGH SCHOOL
    1410 WEST PARK AVE
    ANACONDA,MT59711     		  GOV GENERAL OPERATING 5,000
    ANACONDA MINISTERIAL PROJECT CARE
    PO BOX 1280
    ANACONDA,MT59711     		  PC GENERAL OPERATING 1,750
    ANACONDA PCA FAMILY RESORCE CENTER
    307 E PARK ST
    ANACONDA,MT59711     		  PC GENERAL OPERATING 5,000
    ARLEE COMMUNITY DEVELOPMENT CORPORATION
    PO BOX 452
    ARLEE,MT59821     		  PC GENERAL OPERATING 8,000
    AWARE INC
    205 E PARK AVE
    ANACONDA,MT59711     		  PC GENERAL OPERATING 5,000
    BE THE CHANGE 406 COALITION
    PO BOX 733
    DILLON,MT59725     		  PC GENERAL OPERATING 50,000
    BEAVERHEAD COMMUNITY FOOD PANTRY
    PO BOX 1356
    DILLON,MT59725     		  PC GENERAL OPERATING 2,000
    BEAVERHEAD COUNTY MENTAL HEALTH LOCAL ADVISORY COUNCIL
    2 SOUTH PACIFIC ST
    DILLON,MT59725     		  PC GENERAL OPERATING 5,000
    BIGFORK ACES INC
    439 GRAND DR
    BIGFORK,MT59911     		  PC GENERAL OPERATING 5,000
    BIGFORK FOOD BANK INC
    PO BOX 850
    BIGFORK,MT59911     		  PC GENERAL OPERATING 1,500
    BITTERROOT BUCS AMERICAN LEGION BASEBALL TEAM
    PO BOX 1111
    FLORENCE,MT59833     		  PC HEARTISM COMMUNITY CENTER 5,000
    BITTERROOT CASA INC
    217 NORTH 3RD ST SUITE H-1
    HAMILTON,MT59840     		  PC GENERAL OPERATING 2,752
    BITTERROOT ECOLOGICAL AWARENESS RESOURCES INC
    1105 W MAIN ST
    HAMILTON,MT59840     		  PC GENERAL OPERATING 7,500
    BOYS & GIRLS CLUB OF MISSOULA COUNTY
    1515 FAIRVIEW AVE SUITE 243
    MISSOULA,MT59801     		  PC OUT OF SCHOOL TIME CLUB 5,000
    BOYS & GIRLS CLUB OF THE FLATHEAD RESERVATION
    PO BOX 334
    RONAN,MT59864     		  PC GENERAL OPERATING 80,000
    BREAD BASKET INCORPORATED
    PO BOX 346
    RONAN,MT59864     		  PC GENERAL OPERATING 8,000
    BUTTE EMERGENCY FOOD BANK
    1019 E SECOND ST
    BUTTE,MT59701     		  PC GENERAL OPERATING 9,450
    CASA OF LAKE COUNTY
    PO BOX 511
    POLSON,MT59860     		  PC GENERAL OPERATING 5,000
    CHILD AND FAMILY RESOURCE COUNCIL INC DBA THE PARENTING PLACE
    1644 S 8TH ST W
    MISSOULA,MT59801     		  PC FRANKLIN TO FORT STUDY TECH HUB 5,000
    CHILD BRIDGE INC
    PO BOX 310
    BIGFORK,MT59911     		  PC GENERAL OPERATING 5,000
    CHILD DEVELOPMENT CENTER INC
    3335 LT MOSS RD
    MISSOULA,MT59804     		  PC GENERAL OPERATING 5,000
    CHILDWISE INSTITUTE
    500 S LAMBORN ST
    HELENA,MT59601     		  PC GENERAL OPERATING 3,500
    COLUMBIA FALLS FOOD BANK
    PO BOX 1081
    COLUMBIA FALLS,MT59912     		  PC GENERAL OPERATING 2,000
    COMMUNITY FOOD AND AGRICULTURE COALITION
    PO BOX 7025
    MISSOULA,MT59807     		  PC GENERAL OPERATING 75,000
    COMMUNITY FOOD BANK OF MINERAL COUNTY
    308 PINE ST
    SUPERIOR,MT59872     		  PC GENERAL OPERATING 4,000
    COMMUNITY HARVEST INC
    PO BOX 314
    THOMPSON FALLS,MT59873     		  PC GENERAL OPERATING 3,000
    COMMUNITY SERVICES FELLOWSHIP
    PO BOX 161
    NOXON,MT59853     		  PC GENERAL OPERATING 2,000
    COMMUNITY SUPPORT CENTER
    236 E REEDER ST
    DILLON,MT59725     		  PC GENERAL OPERATING 10,000
    CONFEDERATED SALISH AND KOOTENAI TRIBES
    35401 MISSION DR
    ST IGNATIUS,MT59808     		  GOV TRIBAL HEALTH DEPARTMENT 50,000
    CONFEDERATED SALISH AND KOOTENAI TRIBES
    PO BOX 278
    PABLO,MT59855     		  GOV GENERAL OPERATING 48,500
    CONFEDERATED SALISH AND KOOTENAI TRIBES
    PO BOX 278
    PABLO,MT59855     		  GOV DEPARTMENT OF EDUCATION 5,000
    CONFEDERATED SALISH AND KOOTENAI TRIBES
    PO BOX 278
    PABLO,MT59855     		  GOV DEPARTMENT OF EDUCATION 2,500
    CONFEDERATED SALISH AND KOOTENAI TRIBES
    PO BOX 278
    PABLO,MT59855     		  GOV DEPARTMENT OF HUMAN RESOURCE DEVELOMENT 25,000
    CONFEDERATED SALISH AND KOOTENAI TRIBES
    PO BOX 278
    PABLO,MT59855     		  GOV DEPARTMENT OF HUMAN RESOURCE DEVELOMENT 2,500
    CONFEDERATED SALISH AND KOOTENAI TRIBES
    PO BOX 278
    PABLO,MT59855     		  GOV TRIBAL DEFENDERS OFFICE 25,000
    COURT APPOINTED SPECIAL ADVOCATES OF MISSOULA INC
    PO BOX 7433
    MISSOULA,MT59807     		  PC GENERAL OPERATING 2,500
    DARBY BREAD BOX
    PO BOX 207
    DARBY,MT59829     		  PC GENERAL OPERATING 2,000
    DAYTON ELEMENTARY PARENT TEACHER ORGANIZATION
    PO BOX 195
    DAYTON,MT59914     		  PC SCIENCE / SOCIAL STUDIES CURRICULUM 5,000
    DEER LODGE FOOD PANTRY
    PO BOX 285
    DEER LODGE,MT59722     		  PC GENERAL OPERATING 1,500
    DIXON SENIOR CITIZEN CENTER
    PO BOX 85
    DIXON,MT59831     		  PC GENERAL OPERATING 2,500
    DPHHS NO KID HUNGRY MONTANA
    1625 11TH AVE
    HELENA,MT59601     		  GOV GENERAL OPERATING 84,000
    DREAM ADAPTIVE RECREATION INC
    PO BOX 4084
    WHITEFISH,MT59937     		  PC GENERAL OPERATING 5,000
    DRUMMOND ELEMENTARY SCHOOL
    PO BOX 349
    DRUMMOND,MT59832     		  GOV FOR THE ELEMENTARY SCHOOL 5,000
    DRUMMOND HIGH SCHOOL
    PO BOX 349
    DRUMMOND,MT59832     		  GOV FOR THE HIGH SCHOOL 5,000
    DRUMMOND SCHOOL DISTRICT 11
    PO BOX 349
    DRUMMOND,MT59832     		  GOV FOR THE ELEMENTARY SCHOOL 5,000
    DRUMMOND SCHOOL DISTRICT 2
    PO BOX 349
    DRUMMOND,MT59832     		  GOV FOR THE HIGH SCHOOL 5,000
    EMMAS HOUSE - BITTERROOT VALLEYCHILDRENS ADVOCACY CENTER INC
    PO BOX 2034
    HAMILTON,MT59840     		  PC TRAUMA TREATMENT PROGRAMS 5,000
    EMPOWER MT
    2300 REGENT ST SUITE 101
    MISSOULA,MT59801     		  PC GENERAL OPERATING 5,000
    FAMILIES FIRST LEARNING LAB
    PO BOX 5626
    MISSOULA,MT59806     		  PC GENERAL OPERATING 5,000
    FAMILIES IN PARTNERSHIP INCORPORATED
    PO BOX 762
    LIBBY,MT59923     		  PC GENERAL OPERATING 10,000
    FARM HANDS-NOURISH THE FLATHEAD
    PO BOX 4404
    WHITEFISH,MT59937     		  PC FOOD FOR ALL 10,000
    FIFTH JUDICAL DISTRICT VOICE FOR CHILDREN INC
    PO BOX 1464
    DILLON,MT59725     		  PC GENERAL OPERATING 5,000
    FLATHEAD COUNTY LIBRARY FOUNDATION INC
    44 2ND AVE WEST SUITE 104
    KALISPELL,MT59901     		  PC GENERAL OPERATING 5,000
    FLATHEAD FOOD BANK INC
    1203 US HIGHWAY 2 WEST SUITE 2
    KALISPELL,MT59901     		  PC GENERAL OPERATING 14,350
    FLATHEAD RESERVATION COMMUNITY ACTION
    53116 MARSH CREEK RD
    CHALRO,MT59864     		  PC GENERAL OPERATING 33,000
    FLORENCE COMMUNITY CENTER
    PO BOX 98
    FLORENCE,MT59833     		  PC FLORENCE RECREATION CENTER 5,000
    FLORENCE CRITTENTON HOME & SERVICES
    901 N HARRIS ST
    HELENA,MT59601     		  PC GENERAL OPERATING 10,000
    FLORENCE-CARLTON MIDDLE SCHOOL PARENT ASSOCIATION
    PO BOX 433
    FLORENCE,MT59833     		  PC K-8 HEALTH & WELLNESS 5,000
    FOR THE BENEFIT OF CULTIVATING CONNECTIONS
    175 SKALKAHO HWY
    HAMILTON,MT59840     		  PC GENERAL OPERATING 5,000
    FRED MOODRY INTERMEDIATE SCHOOL
    219 E 3RD ST
    ANACONDA,MT59711     		  GOV GENERAL OPERATING 5,000
    FREEDOM GARDENS
    319 S 5TH ST W
    MISSOULA,MT59801     		  PC GENERAL OPERATING 5,000
    GARDEN CITY HARVEST INC
    PO BOX 205
    MISSOULA,MT59806     		  PC GENERAL OPERATING 2,500
    GLACIER TWINS AMERICAN LEGION BASEBALL INC
    PO BOX 2007
    WHITEFISH,MT59937     		  PC GENERAL OPERATING 5,000
    GRACE LUTHERAN CHURCH
    275 HATTIE LN
    HAMILTON,MT59840     		  PC SANITATION PROJECT 5,000
    GRANITE COUNTY FOOD PANTRY
    12 MAXVILLE RD
    PHILIPSBURG,MT59858     		  PC GENERAL OPERATING 1,500
    GREATER BUTTE COMMUNITY CO-ORDINATED CHILD CHILD CARE SERV
    101 N MAIN ST
    BUTTE,MT59701     		  PC GENERAL OPERATING 207,500
    GREATER MISSOULA FAMILY YOUNG MENS CHRISTIAN ASSOCIATION
    3000 S RUSSELL ST
    MISSOULA,MT59801     		  PC GENERAL OPERATING 27,500
    HAVEN HOUSE INC
    316 N THIRD ST
    HAMILTON,MT59840     		  PC GENERAL OPERATING 3,000
    HEARTISM COMMUNITY CENTER
    PO BOX 14
    CORVALLIS,MT59828     		  PC GENERAL OPERATING 5,000
    HELENA AREA HABITAT FOR HUMANITY
    PO BOX 459
    HELENA,MT59624     		  PC GENERAL OPERATING 5,000
    HELENA FOOD SHARE INC
    PO BOX 943
    HELENA,MT59624     		  PC GENERAL OPERATING 11,950
    HELPING HANDS FUND
    PO BOX 1094
    POLSON,MT59860     		  PC COMMUNITY CRADLES 15,000
    HOT SPRINGS FOOD PANTRY
    100 MAIN ST
    HOT SPRINGS,MT59845     		  PC GENERAL OPERATING 6,000
    INNER ROADS INC
    734 S 1ST ST W
    MISSOULA,MT59801     		  PC GENERAL OPERATING 5,000
    INTERMOUNTAIN DEACONESS CHILDRENS SERVICES
    500 S LAMBORN ST
    HELENA,MT59601     		  PC GENERAL OPERATING 2,500
    KIDS CO-OP
    34224 S FINLEY PT RD
    POLSON,MT59860     		  PC GENERAL OPERATING 5,000
    KIWANIS FOUNDATION OF MONTANA
    PO BOX 1171
    TROY,MT59935     		  PC KOATS FOR KIDS 5,000
    LAKE COUNTY COMMUNITY DEVELOPMENT CORPORATION
    PO BOX 128
    RONAN,MT59864     		  PC FARMERS TO FAMILIES FOOD BOX PROGRAM 25,000
    LAKE COUNTY HEALTH DEPARTMENT
    802 MAIN ST
    POLSON,MT59860     		  GOV MATERNAL CHILD HEALTH OPERATING SUPPORT 10,000
    LIBBY AMERICAN LEGION BASEBALL INC
    PO BOX 1528
    LIBBY,MT59923     		  PC GENERAL OPERATING 5,000
    LIBBY COMMUNITY GARDEN INC
    286 EDGEWATER DR
    LIBBY,MT59923     		  PC GENERAL OPERATING 5,000
    LIBBY FOOD PANTRY INC
    PO BOX 311
    LIBBY,MT59923     		  PC GENERAL OPERATING 3,000
    LIBBY HIGH SCHOOL
    724 LOUISIANA AVE
    LIBBY,MT59923     		  PC GENERAL OPERATING 5,000
    LINCOLN COUNTY HEALTH DEPARTMENT
    418 MINERAL AVE
    LIBBY,MT59923     		  GOV GENERAL OPERATING 200,000
    LINCOLN PRIMARY PRESCHOOL
    506 CHESTNUT ST
    ANACONDA,MT59711     		  GOV GENERAL OPERATING 5,000
    LITERACY VOLUNTEERS OF AMERICA - BITTERROOT INC
    303 N THIRD ST SUITE A 156
    HAMILTON,MT59840     		  PC GENERAL OPERATING 5,000
    LITTLE LEAGUE BASEBALL INC- DILLON
    420 SWEETWATER ESTATES DR
    DILLON,MT59725     		  PC GENERAL OPERATING 5,000
    MADISON VALLEY CARING AND SHARING INC
    PO BOX 171
    ENNIS,MT59729     		  PC GENERAL OPERATING 1,500
    MINERAL COUNTY COMMUNITY FOUNDATION
    PO BOX 93
    SUPERIOR,MT59872     		  PC GENERAL OPERATING 5,000
    MINERAL COUNTY HEALTH DEPARTMENT
    PO BOX 488
    SUPERIOR,MT59872     		  GOV GENERAL OPERATING 200,000
    MINERAL COUNTY HELP INC
    PO BOX 142
    SUPERIOR,MT59872     		  PC GENERAL OPERATING 5,000
    MISSION FALLS FARMERS MARKET
    33699 LEMERY RD
    ST IGNATIUS,MT59865     		  NC GENERAL OPERATING 7,500
    MISSION VALLEY FOOD PANTRY INC
    PO BOX 644
    ST IGNATIUS,MT59865     		  PC GENERAL OPERATING 8,000
    MISSION VALLEY SENIOR CITIZENS INC
    528 MAIN ST SW
    RONAN,MT59864     		  PC GENERAL OPERATING 6,000
    MISSOULA FOOD BANK & COMMUNITY CENTER INCORPORATED
    1720 WYOMING ST
    MISSOULA,MT59801     		  PC GENERAL OPERATING 10,000
    MISSOULA INTERFAITH COLLABORATIVE
    202 BROOKS ST
    MISSOULA,MT59801     		  PC GENERAL OPERATING 175,000
    MONTANA ACADEMY OF PEDIATRIC PHYSICIANS INC
    3031 GRAND AVE SUITE 157
    BILLINGS,MT59102     		  PC GENERAL OPERATING 2,500
    MONTANA BUDGET AND POLICY CENTER
    15 W 6TH AVE
    HELENA,MT59601     		  PC GENERAL OPERATING 125,000
    MONTANA CHILD CARE RESOURCE & REFERRAL NETWORK INC
    PO BOX 808
    LOLO,MT59847     		  PC GENERAL OPERATING 50,000
    MONTANA FOOD BANK NETWORK INC
    5625 EXPRESSWAY
    MISSOULA,MT59808     		  PC GENERAL OPERATING 130,000
    MONTANA HUMAN RIGHTS NETWORK INC
    PO BOX 1509
    HELENA,MT59624     		  PC GENERAL OPERATING 50,000
    MONTANA LEGAL SERVICES ASSOCIATION
    616 HELENA AVE SUITE 100
    HELENA,MT59601     		  PC GENERAL OPERATING 50,000
    MONTANA NONPROFIT ASSOCIATION INC
    PO BOX 1744
    HELENA,MT59624     		  PC GENERAL OPERATING 225,000
    MONTANA WOMEN VOTE
    725 W ALDER ST SUITE 21
    MISSOULA,MT59802     		  PC GENERAL OPERATING 75,000
    MOUNTAIN HOME MONTANA INC
    2606 SOUTH AVE W
    MISSOULA,MT59804     		  PC GENERAL OPERATING 2,500
    NEVER ALONE RECOVERY SUPPORT SERVICES
    PO BOX 383
    RONAN,MT59864     		  PC GENERAL OPERATING 25,000
    NORTH VALLEY FOOD BANK INC
    251 FLATHEAD AVE
    WHITEFISH,MT59937     		  PC FUNDS TO SERVE INCREASED CUSTOMERS DURING COVID 8,000
    NURTURING CENTER INC
    146 3RD AVE W
    KALISPELL,MT59901     		  PC GENERAL OPERATING 7,500
    ORPHAN GIRL CHILDRENS THEATRE
    PO BOX 885
    BUTTE,MT59703     		  PC GENERAL OPERATING 2,500
    PANTRY PARTNERS FOOD BANK
    PO BOX 806
    STEVENSVILLE,MT59870     		  PC GENERAL OPERATING 3,000
    PEAK FOUNDATION
    PO BOX 36
    ALBERTON,MT59820     		  PC PROMOTING EXCELLENCE IN ALBERTON-AREA 5,000
    PLAINS COMMUNITY FOOD BANK
    PO BOX 767
    PLAINS,MT59859     		  PC GENERAL OPERATING 1,500
    POLSON LOAVES AND FISH PANTRY INC
    904 1ST ST E
    POLSON,MT59860     		  PC GENERAL OPERATING 10,000
    POLSON SCHOOL DISTRICT 23
    111 4TH AVE E
    POLSON,MT59860     		  GOV CHERRY VALLEY ELEMENTARY 5,000
    RAVALLI HEAD START INC
    81 KURTZ LN
    HAMILTON,MT59840     		  PC GENERAL OPERATING 5,000
    REMNANT CHURCH
    34 RIVERVIEW DR
    TROY,MT59935     		  PC GENERAL OPERATING 2,000
    SAFE HARBOUR INC
    PO BOX 497
    RONAN,MT59864     		  PC GENERAL OPERATING 10,000
    SALISH & KOOTENAI HOUSING AUTHORITY
    PO BOX 38
    PABLO,MT59855     		  GOV GENERAL OPERATING 5,000
    SALISH KOOTENAI COLLEGE FOUNDATION
    PO BOX 70
    PABLO,MT59855     		  PC GENERAL OPERATING 37,500
    SALISH KOOTENAI COLLEGE
    58138 US HWY 93
    PABLO,MT59855     		  GOV GENERAL OPERATING 2,500
    SALISH KOOTENAI COLLEGE
    58138 US HWY 93
    PABLO,MT59855     		  GOV CENTER FOR PREVENTION AND WELLNES 102,500
    SALISH KOOTENAI COLLEGE
    58138 US HWY 93
    PABLO,MT59855     		  GOV SILVER FOX GOLF COURSE 5,000
    SALISH KOOTENAI COLLEGE
    58138 US HWY 93
    PABLO,MT59855     		  GOV DEPARTMENT OF EDUCATION 5,000
    SAMARITAN HOUSE INC
    PO BOX 592
    KALISPELL,MT59903     		  PC GENERAL OPERATING 5,000
    SANDERS COUNTY COMMUNITY HOUSING ORGANIZATION
    303 MAIN ST
    THOMPSON FALLS,MT59873     		  PC GENERAL OPERATING 5,000
    SANDERS COUNTY COUNCIL ON AGING INC
    PO BOX 339
    HOT SPRINGS,MT59845     		  PC GENERAL OPERATING 2,500
    SEELEY SWAN COMMUNITY FOOD BANK
    PO BOX 1344
    SEELEY LAKE,MT59868     		  PC GENERAL OPERATING 2,500
    SINCERELY PAUL FEEDING HIS SHEEP
    8 LEGION ST
    WHITEHALL,MT59759     		  PC GENERAL OPERATING 1,500
    SMELTER CITY RECREATION COMPLEX
    PO BOX 33
    ANACONDA,MT59711     		  PC GENERAL OPERATING 5,000
    SNQWELMISTN
    533116 MARSH CREEK RD
    CHARLO,MT59824     		  PC GENERAL OPERATING 5,000
    SOFT LANDING MISSOULA
    939 STEPHENS AVE SUITE C
    MISSOULA,MT59801     		  PC GENERAL OPERATING 2,500
    SOMERS LAKESIDE SCHOOL DISTRICT 29
    315 SCHOOL ADDITION RD
    SOMERS,MT59932     		  PC AMERICORPS VISTA SERVICE MEMBER 5,000
    SPARROWS NEST OF NW MT
    PO BOX 8384
    KALISPELL,MT59904     		  PC GENERAL OPERATING 5,000
    SPARROWS VINE
    PO BOX 864
    SEELEY LAKE,MT59868     		  PC GENERAL OPERATING 5,000
    SPECIAL OLYMPICS MONTANA INC
    PO BOX 3507
    GREAT FALLS,MT59403     		  PC GENERAL OPERATING 2,500
    ST IGNATIUS COMMUNITY SENIOR CITIZENS CENTER
    PO BOX 758
    ST IGNATIUS,MT59865     		  PC GENERAL OPERATING 11,000
    ST IGNATIUS HIGH SCHOOL
    PO BOX 1540
    ST IGNATIUS,MT59865     		  PC MISSION SPECIAL OLYMPICS 5,000
    ST REGIS SCHOOL DISTRICT 1
    90 TIGER ST
    ST REGIS,MT59866     		  PC GENERAL OPERATING 5,000
    THE HENRY J KAISER FAMILY FOUNDATION
    185 BERRY ST SUITE 2000
    SAN FRANCISCO,CA94107     		  PC GENERAL OPERATING 50,000
    THE IRWIN AND FLORENCE ROSTEN FOUNDATION INC
    515 MADISON
    HAMILTON,MT59840     		  PC GENERAL OPERATING 5,000
    TOBACCO VALLEY FOOD PANTRY AND THRIFT STORE
    PO BOX 714
    EUREKA,MT59917     		  PC GENERAL OPERATING 1,500
    UNITED WAY OF BUTTE AND ANACONDA
    PO BOX 4447
    BUTTE,MT59702     		  PC HELPING PARTNER AGENCIES 5,000
    UNITED WAY OF MISSOULA COUNTY
    412 W ALDER ST
    MISSOULA,MT59802     		  PC GENERAL OPERATING 250,000
    UNITED WAY OF THE LEWIS AND CLARK AREA
    PO BOX 862
    HELENA,MT59624     		  PC GENERAL OPERATING 25,000
    UNIVERSITY OF MONTANA FOUNDATION
    32 CAMPUS DR
    MISSOULA,MT59812     		  GOV RURAL INSTITUTE FOR INCLUSIVE COMMUNITIES 5,000
    UNIVERSITY OF MONTANA FOUNDATION
    32 CAMPUS DR
    MISSOULA,MT59812     		  GOV SPECTRUM 2,500
    UNIVERSITY OF MONTANA
    203 B PFNAC
    MISSOULA,MT59812     		  GOV NATIVE AMERICAN STUDIES 26,500
    UNIVERSITY OF MONTANA
    32 CAMPUS DR ORSP UH116
    MISSOULA,MT59812     		  GOV CENTER FOR CHILDREN, FAMILIES AND WORKFORCE DEVELOPMENT 260,000
    VALLEY OAK EDUCATION RESOURCE CENTER
    PO BOX 870
    HAMILTON,MT59840     		  PC GENERAL OPERATING 5,000
    VIOLENCE FREE CRISIS LINE DBA ABBIE SHELTER
    PO BOX 1401
    KALISPELL,MT59903     		  PC GENERAL OPERATING 2,500
    WESTSHORE COMMUNITY ASSISTANCE PROGRAM
    PO BOX 630
    LAKESIDE,MT59922     		  PC GENERAL OPERATING 1,500
    YES YOUTH EMPOWERMENT SERVICES
    PO BOX 686
    ANACONDA,MT59711     		  PC GENERAL OPERATING 5,000
    ZION LUTHERAN CHURCH
    PO BOX 942
    ST IGNATIUS,MT59865     		  PC GENERAL OPERATING 5,000
    Total .................................bullet 3a 3,603,752
    bApproved for future payment
    Total .................................bullet 3b 0
    Form 990-PF (2020)
    Form 990-PF (2020)
    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.)
    1Program service revenue: (a)
    Business code     		(b)
    Amount     		(c)
    Exclusion code     		(d)
    Amount
    a
    b
    c
    d
    e
    f
    gFees and contracts from government agencies          
    2 Membership dues and assessments....          
    3 Interest on savings and temporary cash
    investments ...........     		    14 76  
    4 Dividends and interest from securities.... 901101 1,910 14 996,660  
    5 Net rental income or (loss) from real estate:
    aDebt-financed property......          
    bNot debt-financed property.....          
    6 Net rental income or (loss) from personal property          
    7 Other investment income.....          
    8 Gain or (loss) from sales of assets other than
    inventory ............     		901101 2,117 18 161,647  
    9 Net income or (loss) from special events:          
    10 Gross profit or (loss) from sales of inventory          
    11 Other revenue:
    aALTERNATIVE INVESTMENTS     		901101 -30,919 14 3,915,612  
    b
    c
    d
    e
    12 Subtotal. Add columns (b), (d), and (e).. -26,892 5,073,995 0
    13Total. Add line 12, columns (b), (d), and (e)..................
    13
    5,047,103
    (See worksheet in line 13 instructions to verify calculations.)
    Part XVI-B
    Relationship of Activities to the Accomplishment of Exempt Purposes
    Line No.
    DownArrow     		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 (2020)
    Form 990-PF (2020)
    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? ...........
    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.
    Bullet Bullet
    May the IRS discuss this return
    with the preparer shown below?
    See instructions.
    Signature of officer or trustee Date Title
    Paid Preparer Use Only Print/Type preparer's name Preparer's Signature Date PTIN
    Firm's name SmallBullet
    		 Firm's EIN SmallBullet
    Firm's address SmallBullet


    		 Phone no.
    Form 990-PF (2020)
    Additional Data


    Software ID:  
    Software Version:  


    Form 990PF - Special Condition Description:
    Special Condition Description
    Schedule B
    (Form 990, 990-EZ,
    or 990-PF)
    Department of the Treasury
    Internal Revenue Service
    Schedule of Contributors

    Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
    Arrow Bullet Go to www.irs.gov/Form990 for the latest information.
    OMB No. 1545-0047
    2020
    Name of the organization
    HEADWATERS HEALTH FOUNDATION
    OF WESTERN MONTANA
    Employer identification number

    81-1099715
    Organization type (check one):
    Filers of:
    Section:
    Form 990 or 990-EZ






    Form 990-PF




    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
    Special Rules
    ......... Arrow Bullet $  
    Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't 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 on line H of its Form 990-EZ
    or on its Form 990PF, Part I, line 2, to certify that it doesn't 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) (2020)
    Schedule B (Form 990, 990-EZ, or 990-PF) (2020) Page 2
    Name of organization
    HEADWATERS HEALTH FOUNDATION
    OF WESTERN MONTANA         		Employer identification number
    81-1099715
    Part I
    Contributors
    Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    1
    COMMUNITY MEDICAL CENTER
     
    2827 FORT MISSOULA RD
     
    MISSOULA, MT59804

    		$ 500,000


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    2
    ALPS PROPERTY & CASUALTY INSURANCE COMPANY
     
    111 NORTH HIGGINS AVE
     
    MISSOULA, MT59802

    		$ 23,100


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
     
     
     
     

    		$  


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
     
     
     
     

    		$  


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
     
     
     
     

    		$  


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
     
     
     
     

    		$  


    (Complete Part II for noncash contributions.)
    Schedule B (Form 990, 990-EZ, or 990-PF) (2020)
    Schedule B (Form 990, 990-EZ, or 990-PF) (2020)
    Page 3
    Name of organization
    HEADWATERS HEALTH FOUNDATION
    OF WESTERN MONTANA         		Employer identification number

    81-1099715
    Part II
    Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
    (a)
    No. from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (See instructions)     		(d)
    Date received
    2
    		 COMMUNICATION SYSTEM COMPONENTS $ 23,100 2020-01-27
    (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) (2020)
    Schedule B (Form 990, 990-EZ, or 990-PF) (2020)
    Page 4
    Name of organization
    HEADWATERS HEALTH FOUNDATION
    OF WESTERN MONTANA         		Employer identification number

    81-1099715
    Part III
    Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. 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 $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
    Use duplicate copies of Part III if additional space is needed.
    (a)
    No. from Part I    		 (b) Purpose of gift (c) Use 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 (c) Use 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 (c) Use 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 (c) Use 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) (2020)
    Additional Data


    Software ID:  
    Software Version:  

    TY 2020 AccountingFeesSchedule
    Name:
    HEADWATERS HEALTH FOUNDATION
     
    OF WESTERN MONTANA
    EIN:
    81-1099715
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    ACCOUNTING 106,325 25,103   71,904

    TY 2020 CashDistributionExplnStmt
    Name:
    HEADWATERS HEALTH FOUNDATION
     
    OF WESTERN MONTANA
    EIN:
    81-1099715
    Explanation:
    ORGANIZATION: HEADWATERS HEALTH FOUNDATION OF WESTERN MONTANATIN: 81-1099715TAX YEAR ENDED: DECEMBER 31, 2020FORM 990-PF, PART XII, LINE 3B - REPORTING SET-ASIDES UNDER THE CASH DISTRIBUTION TEST1. FUNDS WERE SET ASIDE FOR GENERATING FUTURE CASH FLOW TO FULFILL MULTI-INSTALLMENT GRANTS THAT WILL COVER MORE THAN ONE TAXABLE YEAR. THE START-UP PERIOD WILL ALSO ALLOW THE FOUNDATION TO MONTIOR THESE GRANTS AND RECEIVE PROGRESS REPORTS BEFORE MAKING FURTHER DISTRIBUTIONS TO THE RECIPIENTS. 2. THE AMOUNTS SET ASIDE FOR THE PROJECT DESCRIBED IN ITEM 1 WILL ACTUALLY BE PAID WITHIN THE 24 MONTH PERIOD THAT ENDS NO MORE THAN 60 MONTHS AFTER THE DATE OF THE SET-ASIDE. 3. THE PROJECT WAS NOT COMPLETED BEFORE THE END OF THE ABOVE-REFERENCED TAX YEAR. 4. BELOW IS A LIST OF THE DISTRIBUTABLE AMOUNTS DETERMINED UNDER IRC SECTION 4942(D) FOR ALL PAST TAX YEARS IN THE TAXPAYER'S START-UP PERIOD:2017 - $765,4312018 - $2,189,5572019 - $3,043,7572020 - $3,949,4395. BELOW IS A LIST OF ACTUAL PAYMENTS MADE IN CASH OR ITS EQUIVALENT FOR EXEMPT PURPOSES DURING EACH TAX YEAR IN THE TAXPAYER'S START-UP PERIOD:2017 - $990,6472018 - $3,555,1952019 - $5,341,1002020 - $6,489,355

    Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

    TY 2020 DepreciationSchedule
    Name:
    HEADWATERS HEALTH FOUNDATION
     
    OF WESTERN MONTANA
    EIN:
    81-1099715
    Description of Property Date Acquired Cost or Other Basis Prior Years' Depreciation Computation Method Rate /
    Life (# of years)    		 Current Year's Depreciation Expense Net Investment Income Adjusted Net Income Cost of Goods Sold Not Included
    INTERACTIVE DISPLAY SYSTEM 2017-02-16 5,661 3,208 NC 5.000000000000 0 0    
    SMARTSIMPLE SOFTWARE LTD 2018-07-05 57,673 17,302 NC 5.000000000000 0 0    
    BUILDING 2019-12-23 688,431   NC 39.000000000000 0 0    
    LAND 2020-01-01 387,243   L   0 0    
    FURNITURE AND EQUIPMENT 2020-01-01 23,100   NC 7.000000000000 0 0    
    CONSTRUCTION IN PROGRESS 2020-01-01 95,359   NC 0 % 0 0    

    Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

    TY 2020 ExpenditureResponsibilityStmt
    Name:
    HEADWATERS HEALTH FOUNDATION
     
    OF WESTERN MONTANA
    EIN:
    81-1099715
    Grantee's Name Grantee's Address Grant Date Grant Amount Grant Purpose Amount Expended By Grantee Any Diversion By Grantee? Dates of Reports By Grantee Date of Verification Results of Verification
    MISSION FALLS FARMERS MARKET
          		PO BOX 7025
    MISSOULA,MT59807     		2020-03-12 2,500 2020 ASPARAGUS FESTIVAL SPONSORSHIP 2,500 NO 2/1/21 2021-02-01  
    MISSION FALLS FARMERS MARKET
          		PO BOX 7025
    MISSOULA,MT59807     		2020-01-28 5,000 MARKET OPERATING EXPENSES 5,000 NO 4/14/20 2021-02-01  

    TY 2020 InvestmentsCorpBondsSchedule
    Name:
    HEADWATERS HEALTH FOUNDATION
     
    OF WESTERN MONTANA
    EIN:
    81-1099715
    Name of Bond End of Year Book Value End of Year Fair Market Value
    GOLDMAN SACHS 326,670 326,670
    MEAD JOHNSON NUTRITIONAL 299,648 299,648
    PNC FINANCIAL SERVICES GROUP 442,403 442,403
    ARTISAN HIGH INCOME INSTITUTIONAL 1,367,898 1,367,898
    DELTA AIRLINES 226,125 226,125
    ALLY FINL INC 263,125 263,125
    BECTON, DICKINS 352,101 352,101
    CVS HEALTH CORP 365,282 365,282
    DUKE ENERGY CORP 414,320 414,320
    MORGAN STANLEY 457,683 457,683
    MIRCOCHIP TECHNOLOGIES 243,432 243,432
    L3HARRIS TECHNOLOGIES 269,464 269,464
    GILEAD SCIENCES 473,655 473,655
    ROPER TECHNOLOGIES 459,933 459,933
    VERIZON COMMUNICATIONS 422,076 422,076
    FISERV INC 462,962 462,962
    AMERICAN TOWER CORP 480,531 480,531

    TY 2020 InvestmentsCorpStockSchedule
    Name:
    HEADWATERS HEALTH FOUNDATION
     
    OF WESTERN MONTANA
    EIN:
    81-1099715
    Name of Stock End of Year Book Value End of Year Fair Market Value
    DFA EMERGING MKTS VALUE 4,440,945 4,440,945
    PIMCO RAE FUNDAMENTAL 4,213,427 4,213,427

    TY 2020 InvestmentsGovtObligationsSch
    Name:
    HEADWATERS HEALTH FOUNDATION
     
    OF WESTERN MONTANA
    EIN:
    81-1099715
    US Government Securities - End of Year Book Value:

    1,747,098
    US Government Securities - End of Year Fair Market Value:

    1,747,098
    State & Local Government Securities - End of Year Book Value:


    0
    State & Local Government Securities - End of Year Fair Market Value:


    0


    TY 2020 InvestmentsOtherSchedule2
    Name:
    HEADWATERS HEALTH FOUNDATION
     
    OF WESTERN MONTANA
    EIN:
    81-1099715
    Category/ Item Listed at Cost or FMV Book Value End of Year Fair Market Value
    ABS GLOBAL FMV 6,703,273 6,703,273
    ACCOLADE PARTNERS VII LP FMV 418,041 418,041
    ACCRUED INTEREST FMV 58,343 58,343
    AMBERBROOK VIII LP FMV 780,980 780,980
    AUDAX DIRECT LENDING SOLUTIONS FUND-C LP FMV 982,955 982,955
    COLLER INTERNATIONAL PARTNERS VII FEEDER FUND LP FMV 1,661,835 1,661,835
    EDGE PRINCIPAL INVESTMENTS IV LP FMV 415,407 415,407
    FALCON PRIVATE CREDIT OPPORTUNITIES VI LP FMV 900,437 900,437
    FEG SELECT LLC FMV 39,733,496 39,733,496
    HARVEST MLP INCOME FUND II LLC FMV 2,654,637 2,654,637
    IRONWOOD INTERNATIONAL LTD FMV 8,858,048 8,858,048
    MAP RE 2018 LP FMV 1,299,885 1,299,885
    RCP ADVISORS FMV 571,199 571,199
    SEAPORT GLOBAL PROPERTY SECURITIES FUND LLC FMV 2,022,958 2,022,958
    THE HIGHCLERE INTERNATIONAL INVESTORS EMERGING MARKETS SMID FUND FMV 4,672,106 4,672,106
    WCP NEWCOLD LP FMV 39,702 39,702
    WEATHERLOW OFFSHORE FUND I LTD FMV 9,902,723 9,902,723
    STRATEGIC VALUE FMV 747,151 747,151

    TY 2020 LandEtcSchedule2
    Name:
    HEADWATERS HEALTH FOUNDATION
     
    OF WESTERN MONTANA
    EIN:
    81-1099715
    Category / Item Cost / Other Basis Accumulated Depreciation Book Value End of Year Fair Market Value
    INTERACTIVE DISPLAY SYSTEM 5,661 3,208 2,453  
    SMARTSIMPLE SOFTWARE LTD 57,673 17,302 40,371  
    BUILDING 688,431 0 688,431  
    LAND 387,243 0 387,243  
    FURNITURE AND EQUIPMENT 23,100 0 23,100  
    CONSTRUCTION IN PROGRESS 95,359 0 95,359  


    TY 2020 LegalFeesSchedule
    Name:
    HEADWATERS HEALTH FOUNDATION
     
    OF WESTERN MONTANA
    EIN:
    81-1099715
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    LEGAL FEES 28,580 0   28,766


    TY 2020 OtherExpensesSchedule
    Name:
    HEADWATERS HEALTH FOUNDATION
     
    OF WESTERN MONTANA
    EIN:
    81-1099715
    Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    INSURANCE 22,198 0   22,198
    COMPUTER AND SOFTWARE 37,963 0   38,367
    ADVERTISING AND PROMOTIONS 203 0   203
    FEES AND SUBSCRIPTIONS 19,183 0   19,183
    OFFICE EXPENSE 3,657 0   3,657
    REPAIRS AND MAINTENANCE 391 0   421
    EQUIPMENT RENT 2,933 0   2,933
    SMALL EQUIPMENT 7,004 0   7,004
    MISCELLANEOUS 5,447 0   5,447
    STATE FILING FEES 70 0   70
    GRANTEE VISITS 324 0   324
    NONPROFIT CENTER 20,712 0   23,819


    TY 2020 OtherIncomeSchedule2
    Name:
    HEADWATERS HEALTH FOUNDATION
     
    OF WESTERN MONTANA
    EIN:
    81-1099715
    Description Revenue And Expenses Per Books Net Investment Income Adjusted Net Income
    ALTERNATIVE INVESTMENTS 3,884,693 3,856,883 3,884,693


    TY 2020 OtherIncreasesSchedule
    Name:
    HEADWATERS HEALTH FOUNDATION
     
    OF WESTERN MONTANA
    EIN:
    81-1099715
    Description Amount
    UNREALIZED GAIN ON INVESTMENTS 2,564,901


    TY 2020 OtherLiabilitiesSchedule
    Name:
    HEADWATERS HEALTH FOUNDATION
     
    OF WESTERN MONTANA
    EIN:
    81-1099715
    Description Beginning of Year - Book Value End of Year - Book Value
    PAYROLL LIABILITIES 109,354 99,869
    DEFERRED EXCISE TAX 114,852 138,800
    TAXES PAYABLE 0 25,286


    TY 2020 OtherProfessionalFeesSchedule
    Name:
    HEADWATERS HEALTH FOUNDATION
     
    OF WESTERN MONTANA
    EIN:
    81-1099715
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    INVESTMENT MANAGEMENT 275,867 275,867   0
    CONSULTING 251,016 0   249,316
    RECRUITING 1,598 0   1,598
    ALTERNATIVE INVESTMENTS 57,028 934,976   0


    TY 2020 TaxesSchedule
    Name:
    HEADWATERS HEALTH FOUNDATION
     
    OF WESTERN MONTANA
    EIN:
    81-1099715
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    FOREIGN TAX 12,877 115,612   0
    EXCISE TAX 117,102 0   0
    STATE INCOME TAX 50 0   0