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. 1545-0047
2021
Open to Public Inspection
For calendar year 2021, or tax year beginning 01-01-2021 , and ending 12-31-2021
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)119 W MAIN ST
  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$111,739,027J 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)  
2 Check bullet.............
3 Interest on savings and temporary cash investments      
4 Dividends and interest from securities... 1,727,453 2,920,807  
5a Gross rents............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10 3,184,836
b Gross sales price for all assets on line 6a 31,419,570
7 Capital gain net income (from Part IV, line 2)... 8,437,418
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 2,104,843 838,367  
12 Total. Add lines 1 through 11........ 7,017,132 12,196,592  
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 672,137 111,512   570,753
14 Other employee salaries and wages...... 344,305 13,326   336,696
15 Pension plans, employee benefits....... 235,831 13,867   189,226
16a Legal fees (attach schedule)......... Click to see attachment 17,071 3,641   16,045
b Accounting fees (attach schedule)....... Click to see attachment 115,353 49,202   57,702
c Other professional fees (attach schedule).... Click to see attachment 507,557 667,889   156,245
17 Interest............... 14,579 14,579   0
18 Taxes (attach schedule) (see instructions)... Click to see attachment 323,785 148,574   0
19 Depreciation (attach schedule) and depletion... Click to see attachment 31,779 0  
20 Occupancy.............. 89,646 0   97,523
21 Travel, conferences, and meetings....... 119,024 0   119,024
22 Printing and publications.......... 61 0   61
23 Other expenses (attach schedule)....... Click to see attachment 220,613 0   203,321
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 2,691,741 1,022,590   1,746,596
25 Contributions, gifts, grants paid....... 9,508,500 9,508,500
26 Total expenses and disbursements. Add lines 24 and 25 12,200,241 1,022,590   11,255,096
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements -5,183,109
b Net investment income (if negative, enter -0-) 11,174,002
c Adjusted net income (if negative, enter -0-)...  
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 11289X Form 990-PF (2021)
Form 990-PF (2021)
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............. 4,787,407 446,270 446,270
2 Savings and temporary cash investments.........      
3 Accounts receivable bullet52,731
Less: allowance for doubtful accounts bullet     52,731 52,731
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) 1,747,098 Click to see attachment1,055,660 1,055,660
b Investments—corporate stock (attach schedule)....... 8,654,372 Click to see attachment33,616,123 33,616,123
c Investments—corporate bonds (attach schedule)....... 7,327,308 Click to see attachment7,650,602 7,650,602
11 Investments—land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
12 Investments—mortgage loans.............      
13 Investments—other (attach schedule).......... 82,423,176 Click to see attachment66,443,956 66,443,956
14 Land, buildings, and equipment: basis bullet2,553,351
Less: accumulated depreciation (attach schedule) bullet79,666 1,209,580 Click to see attachment2,473,685 2,473,685
15 Other assets (describe bullet)      
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 106,148,941 111,739,027 111,739,027
Liabilities 17 Accounts payable and accrued expenses.......... 12,805 14,455
18 Grants payable.................    
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 attachment263,955 Click to see attachment1,624,543
23 Total liabilities (add lines 17 through 22)......... 276,760 1,638,998
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........... 105,872,181 110,100,029
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)..... 105,872,181 110,100,029
30 Total liabilities and net assets/fund balances (see instructions). 106,148,941 111,739,027
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
105,872,181
2
Enter amount from Part I, line 27a .....................
2
-5,183,109
3
Other increases not included in line 2 (itemize) bulletClick to see attachment
3
9,410,957
4
Add lines 1, 2, and 3 ..........................
4
110,100,029
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
110,100,029
Form 990-PF (2021)
Form 990-PF (2021)
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 23,996,918   22,982,152 1,014,766
b 5,910,222     5,910,222
c 1,512,430     1,512,430
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       1,014,766
b       5,910,222
c       1,512,430
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 8,437,418
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  
Form 990-PF (2021)
Form 990-PF (2021)
Page 4
Part V
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 All other domestic foundations enter 1.39% (0.0139) of line 27b. Exempt foreign organizations enter 4% (0.04) 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........................... 3 155,319
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- ..... 5 155,319
6 Credits/Payments:
a 2021 estimated tax payments and 2020 overpayment credited to 2021 6a 76,968
b Exempt foreign organizations—tax withheld at source...... 6b 0
c Tax paid with application for extension of time to file (Form 8868)... 6c 80,000
d Backup withholding erroneously withheld ........... 6d 0
7 Total credits and payments. Add lines 6a through 6d.............. 7 156,968
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 1,649
11 Enter the amount of line 10 to be: Credited to 2022 estimated taxBullet1,649 RefundedBullet 11 0
Part VI-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 XIV..................................
    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 2021 or the taxable year beginning in 2021? See the instructions for Part XIII.
    If "Yes," complete Part XIII .............................
    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 (2021)
    Form 990-PF (2021)
    Page 5
    Part VI-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 atbullet119 W MAIN 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 2021, 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 VI-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? ...........
    1a(1)
     
    No
    (2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
    a disqualified person? ..............................
    1a(2)
     
    No
    (3) Furnish goods, services, or facilities to (or accept them from) a disqualified person? ...........
    1a(3)
     
    No
    (4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person? ............
    1a(4)
    Yes
     
    (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)? ......................
    1a(5)
     
    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.) ...............
    1a(6)
     
    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
    c
    ........bullet
    d
    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 2021? .............
    1d
     
    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 2021, did the foundation have any undistributed income (lines 6d
    and 6e, Part XII) for tax year(s) beginning before 2021?....................
    2a
     
    No
    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? ..............................
    3a
     
    No
    b
    If "Yes," did it have excess business holdings in 2021 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 2021.) .....................
    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 2021? ..
    4b
     
    No
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 6
    Part VI-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))? ..........
    5a(1)
     
    No
    (2) Influence the outcome of any specific public election (see section 4955); or to carry
    on, directly or indirectly, any voter registration drive? ....................
    5a(2)
     
    No
    (3) Provide a grant to an individual for travel, study, or other similar purposes? .............
    5a(3)
     
    No
    (4) Provide a grant to an organization other than a charitable, etc., organization described
    in section 4945(d)(4)(A)? See instructions ........................
    5a(4)
    Yes
     
    (5) Provide for any purpose other than religious, charitable, scientific, literary, or
    educational purposes, or for the prevention of cruelty to children or animals? .............
    5a(5)
     
    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
     
    No
    c
    .........bullet
    d
    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? .................
    5d
    Yes
     
    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? .............................
    6a
     
    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?
    7a
     
    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? .........................
    8
     
    No
    Part VII
    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
    MICHAEL A STEWART CHAIR
    1.32     		0 0 0
    119 W MAIN ST
    MISSOULA,MT59802
    CARISSA KUHL VICE CHAIR
    1.32     		0 0 0
    119 W MAIN ST
    MISSOULA,MT59802
    RICHARD OPPER TREASURER
    1.32     		0 0 0
    119 W MAIN ST
    MISSOULA,MT59802
    CHRISTINA J TWOHIG TRUSTEE
    1.32     		0 0 0
    119 W MAIN ST
    MISSOULA,MT59802
    JAY LOWDER TRUSTEE
    1.32     		0 0 0
    119 W MAIN ST
    MISSOULA,MT59802
    KELLEY RISCHKE TRUSTEE
    1.32     		0 0 0
    119 W MAIN ST
    MISSOULA,MT59802
    M JORDAN THOMPSON TRUSTEE
    1.32     		0 0 0
    119 W MAIN ST
    MISSOULA,MT59802
    RACHEL HUFF-DORIA TRUSTEE
    1.32     		0 0 0
    119 W MAIN ST
    MISSOULA,MT59802
    ROBERT J PHILLIPS TRUSTEE
    1.32     		0 0 0
    119 W MAIN ST
    MISSOULA,MT59802
    MARILYN ZIMMERMAN TRUSTEE
    1.30     		0 0 0
    119 W MAIN ST
    MISSOULA,MT59802
    JASON SMITH TRUSTEE
    1.30     		0 0 0
    119 W MAIN ST
    MISSOULA,MT59802
    JENNIFER MEANS TRUSTEE
    1.30     		0 0 0
    119 W MAIN ST
    MISSOULA,MT59802
    BRENDA L SOLORZANO-CLAUDLE CHIEF EXECUTIVE OFFICER
    40.00     		297,193 26,466 0
    119 W MAIN ST
    MISSOULA,MT59802
    MYNOR VELIZ CHIEF FINANCIAL OFFICER
    40.00     		239,410 21,212 0
    119 W MAIN ST
    MISSOULA,MT59802
    ERIN SWITALSKI PROGRAM DIRECTOR
    40.00     		121,038 14,357 0
    119 W MAIN ST
    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
    MARGUERITE SELDIN JIMENEZ EVALUATION AND OPERA
    40.00     		103,341 12,091 0
    119 W MAIN ST
    MISSOULA,MT59802
    ASHLEY N SHAW GRANTS MANAGER
    40.00     		84,099 5,862 0
    119 W MAIN ST
    MISSOULA,MT59802
    STEPHANIE SCHILLING PROGRAM ASSOCIATE
    40.00     		77,695 6,928 0
    119 W MAIN ST
    MISSOULA,MT59802
    Total number of other employees paid over $50,000...................bullet 0
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 7
    Part VII
    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 128,933
    1411 4TH AVE 12TH FLOOR
    SEATTLE,WA98101
    MCEWEN BIG SKY LLC CONSULTING 76,421
    2024 218TH PLACE NE
    SAMMAMISH,WA98074
    MOSS ADAMS LLP AUDIT AND TAX 65,870
    805 SW BROADWAY ST SUITE 1200
    PORTLAND,OR97205
    RESOURCE MEDIA CONSULTING 56,000
    9450 SW GEMINI DR
    BEAVERTON,OR97008
    WIPFLI LLP BOOKKEEPING 52,695
    101 E FRONT ST
    MISSOULA,MT59802
    Total number of others receiving over $50,000 for professional services.............bullet0
    Part VIII-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 VIII-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 (2021)
    Form 990-PF (2021)
    Page 8
    Part IX
    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
    22,492,200
    b
    Average of monthly cash balances.......................
    1b
    2,538,828
    c
    Fair market value of all other assets (see instructions)................
    1c
    66,443,956
    d
    Total (add lines 1a, b, and c).........................
    1d
    91,474,984
    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
    91,474,984
    4
    Cash deemed held for charitable activities. Enter 1.5% (0.015) of line 3 (for greater amount, see
    instructions) .............................
    4
    1,372,125
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. .......
    5
    90,102,859
    6
    Minimum investment return. Enter 5% (0.05) of line 5................
    6
    4,505,143
    Part X
    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 IX, line 6..................
    1
    4,505,143
    2a
    Tax on investment income for 2021 from Part V, line 5.......
    2a
    155,319
    b
    Income tax for 2021. (This does not include the tax from Part V.) ...
    2b
    1,252
    c
    Add lines 2a and 2b............................
    2c
    156,571
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
    4,348,572
    4
    Recoveries of amounts treated as qualifying distributions................
    4
    2,886,868
    5
    Add lines 3 and 4............................
    5
    7,235,440
    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 XII, line 1 ...
    7
    7,235,440
    Part XI
    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
     
    b
    Program-related investments—total from Part VIII-B..................
    1b
     
    2
    Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,
    purposes...............................
    2
     
    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
     
    4
    Qualifying distributions. Add lines 1a through 3b. Enter here and on Part XII, line 4.
    4
     
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 9
    Part XII
    Undistributed Income (see instructions)
    (a)
    Corpus     		(b)
    Years prior to 2020     		(c)
    2020     		(d)
    2021
    1 Distributable amount for 2021 from Part X, line 7 7,235,440
    2 Undistributed income, if any, as of the end of 2021:
    a Enter amount for 2020 only....... 0
    b Total for prior years:20, 20, 20 0
    3 Excess distributions carryover, if any, to 2021:
    a From 2016......  
    b From 2017......  
    c From 2018......  
    d From 2019......  
    e From 2020......  
    f Total of lines 3a through e ........ 0
    4Qualifying distributions for 2021 from Part
    XI, line 4: bullet$ 12,550,979
    a Applied to 2020, but not more than line 2a 0
    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 2021 distributable amount..... 7,235,440
    e Remaining amount distributed out of corpus 5,315,539
    5 Excess distributions carryover applied to 2021. 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 5,315,539
    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 2021. Subtract
    lines 4d and 5 from line 1. This amount must
    be distributed in 2022 ..........     		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 2016 not
    applied on line 5 or line 7 (see instructions) ...     		0
    9 Excess distributions carryover to 2022.
    Subtract lines 7 and 8 from line 6a ......     		5,315,539
    10 Analysis of line 9:
    a Excess from 2017....  
    b Excess from 2018....  
    c Excess from 2019....  
    d Excess from 2020....  
    e Excess from 2021.... 5,315,539
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 10
    Part XIII
    Private Operating Foundations (see instructions and Part VI-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 2021, 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) 2021 (b) 2020 (c) 2019 (d) 2018
             
    b 85% (0.85) of line 2a .........          
    c Qualifying distributions from Part XI,
    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 IX, 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 XIV
    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 (2021)
    Form 990-PF (2021)
    Page 11
    Part XIV
    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 7,500
    ACTION INC
    25 W SILVER ST
    BUTTE,MT59701     		  PC GENERAL OPERATING 7,500
    ANACONDA JR HIGH SCHOOL
    1410 W PARK AVE
    ANACONDA,MT59711     		  GOV GENERAL OPERATING 7,500
    ANACONDA PCA FAMILY RESORCE CENTER
    307 E PARK ST
    ANACONDA,MT59711     		  PC ANACONDA JR HIGH SCHOOL 7,500
    ARLEE REHABILITATION CENTER
    700 WOODWORTH AVE
    MISSOULA,MT59801     		  PC GENERAL OPERATING 7,500
    AWARE INC
    205 E PARK AVE
    ANACONDA,MT59711     		  PC GENERAL OPERATING 7,500
    BE THE CHANGE 406 COALITION
    PO BOX 733
    DILLON,MT59725     		  PC GENERAL OPERATING 30,500
    BEAVERHEAD COUNTY MENTAL HEALTH LOCAL ADVISORY COUNCIL
    2 S PACIFIC ST
    DILLON,MT59725     		  GOV GENERAL OPERATING 7,500
    BIGFORK ACES INC
    439 GRAND DR
    BIGFORK,MT59911     		  PC GENERAL OPERATING 7,500
    BITTER ROOT RESOURCE CONSERVATION AND DEVELOPMENT AREA INCORPORATED
    PO BOX 870
    HAMILTON,MT59840     		  PC GENERAL OPERATING 7,500
    BOYS & GIRLS CLUB OF GLACIER COUNTRY
    PO BOX 961
    COLUMBIA FLS,MT59912     		  PC GENERAL OPERATING 7,500
    BOYS & GIRLS CLUB OF MISSOULA COUNTY
    1515 FAIRVIEW AVE SUITE 243
    MISSOULA,MT59801     		  PC GENERAL OPERATING 7,500
    BREAD BASKET INC
    PO BOX 346
    RONAN,MT59864     		  PC GENERAL OPERATING 7,500
    BUTTE 4 C'S
    101 N MAIN ST
    BUTTE,MT59701     		  PC GENERAL OPERATING 650,000
    CANVAS EARLY LEARNING CENTER
    512 1/2 N WASHINGTON ST
    DILLON,MT59725     		  PC GENERAL OPERATING 177,000
    CENTER FOR RESTORATIVE YOUTH JUSTICE
    110 E IDAHO ST
    KALISPELL,MT59901     		  PC GENERAL OPERATING 5,000
    CHARLO COMMUNITY OUTDOOR COMPLEX INC
    39752 MORRIS RD
    CHARLO,MT59824     		  PC GENERAL OPERATING 7,500
    CHURCH ON THE MOVE
    PO BOX 767
    PLAINS,MT59859     		  PC GENERAL OPERATING 7,500
    COMMON GOOD MISSOULA
    2205 34TH
    MISSOULA,MT59803     		  PC GENERAL OPERATING 175,000
    COMMUNITY FOOD AND AGRICULTURE COALITION
    PO BOX 7025
    MISSOULA,MT59807     		  PC GENERAL OPERATING 7,500
    COMMUNITY HARVEST INC
    PO BOX 314
    THOMPSON FALLS,MT59873     		  PC GENERAL OPERATING 5,000
    CONFEDERATED SALISH AND KOOTENAI TRIBES
    PO BOX 278
    PABLO,MT59855     		  GOV GENERAL OPERATING 500,000
    DAYTON ELEMENTARY PARENT TEACHER ORGANIZATION
    PO BOX 195
    DAYTON,MT59914     		  PC GENERAL OPERATING 7,500
    DESMET SCHOOL
    6355 PADRE LN
    MISSOULA,MT59808     		  GOV GENERAL OPERATING 5,000
    DIXON SCHOOL DISTRICT #9
    411 B ST
    DIXON,MT59831     		  GOV GENERAL OPERATING 7,500
    DRUMMOND ELEMENTARY SCHOOL
    PO BOX 349
    DRUMMOND,MT59832     		  GOV GENERAL OPERATING 7,500
    DRUMMOND HIGH SCHOOL
    PO BOX 349
    DRUMMOND,MT59832     		  GOV GENERAL OPERATING 7,500
    DRUMMOND SCHOOL & COMMUNITY LIBRARY
    PO BOX 266
    DRUMMOND,MT59832     		  GOV GENERAL OPERATING 3,000
    DRUMMOND SCHOOL DISTRICT 11
    PO BOX 349
    DRUMMOND,MT59832     		  GOV GENERAL OPERATING 7,500
    DRUMMOND SCHOOL DISTRICT 2
    PO BOX 349
    DRUMMOND,MT59832     		  GOV GENERAL OPERATING 7,500
    EARLY CHILDHOOD COALITION OF THE GREATER HELENA AREA
    901 N BENTON AVE
    HELENA,MT59601     		  PC HOME VISITING TASK FORCE 2,000
    EMPOWER MT
    2300 REGENT ST SUITE 101
    MISSOULA,MT59801     		  PC GENERAL OPERATING 7,500
    FAMILIES IN PARTNERSHIP INC
    PO BOX 762
    LIBBY,MT59923     		  PC GENERAL OPERATING 7,500
    FARM HANDS-NOURISH THE FLATHEAD
    PO BOX 4404
    WHITEFISH,MT59937     		  PC GENERAL OPERATING 7,500
    FLATHEAD COUNTY LIBRARY FOUNDATION INC
    44 2ND AVE W SUITE 104
    KALISPELL,MT59901     		  PC GENERAL OPERATING 7,500
    FLATHEAD FOOD BANK INC
    1203 US HIGHWAY 2 W SUITE 2
    KALISPELL,MT59901     		  PC GENERAL OPERATING 7,500
    FLINT CREEK CHILDCARE CO
    PO BOX 1205
    PHILIPSBURG,MT59858     		  PC GENERAL OPERATING 7,500
    FLORENCE COMMUNITY CENTER
    PO BOX 98
    FLORENCE,MT59833     		  PC GENERAL OPERATING 7,500
    FLORENCE-CARLTON SCHOOL PARENT ASSOCIATION
    PO BOX 433
    FLORENCE,MT59833     		  PC GENERAL OPERATING 7,500
    FRIENDS FOREVER MENTORING
    210 MAIN ST SW
    RONAN,MT59864     		  PC GENERAL OPERATING 7,500
    FRIENDS OF THE PHILIPSBURG LIBRARY
    PO BOX 797
    PHILIPSBURG,MT59858     		  PC GENERAL OPERATING 7,000
    HABITAT FOR HUMANITY MISSOULA
    PO BOX 7181
    MISSOULA,MT59807     		  PC GENERAL OPERATING 7,500
    HEALTHY MOTHERS HEALTHY BABIES THE MONTANA COALITION INC
    318-20 N LAST CHANCE GULCH SUITE 2C
    HELENA,MT59601     		  PC GENERAL OPERATING 7,500
    HEARTISM COMMUNITY CENTER
    PO BOX 14
    CORVALLIS,MT59828     		  PC GENERAL OPERATING 7,500
    HELENA AREA HABITAT FOR HUMANITY
    PO BOX 459
    HELENA,MT59624     		  PC GENERAL OPERATING 7,500
    HELPING HANDS
    PO BOX 1094
    POLSON,MT59860     		  PC GENERAL OPERATING 55,000
    IDENTITY INC
    PO BOX 1653
    EAST HELENA,MT59635     		  PC GENERAL OPERATING 7,500
    INNER ROADS INC
    734 S 1ST ST W
    MISSOULA,MT59801     		  PC GENERAL OPERATING 7,500
    INTERMOUNTAIN DEACONESS CHILDRENS SERVICES
    500 S LAMBORN ST
    HELENA,MT59601     		  GOV GENERAL OPERATING 7,500
    JEFFERSON LOCAL DEVELOPMENT COR
    PO BOX 1079
    WHITEHALL,MT59759     		  NC TO DEVELOP AND ENSURE SUSTAINABLE CHILDCARE 50,000
    KIDS CO-OP
    34224 S FINLEY POINT RD
    POLSON,MT59860     		  PC GENERAL OPERATING 7,500
    KIWANIS FOUNDATION OF MONTANA
    418 MINERAL AVE
    LIBBY,MT59923     		  PC GENERAL OPERATING 7,500
    LAKE COUNTY COMMUNITY HOUSING
    PO BOX 146
    RONAN,MT59864     		  PC GENERAL OPERATING 7,500
    LIBBY CREEK COMMUNITY INC
    34561 US HIGHWAY 2
    LIBBY,MT59923     		  PC GENERAL OPERATING 7,500
    LINCOLN COUNTY HEALTH DEPARTMENT
    418 MINERAL AVE
    LIBBY,MT59923     		  GOV GENERAL OPERATING 600,000
    LINCOLN COUNTY HIGH SCHOOL
    PO BOX 2000
    EUREKA,MT59917     		  GOV GENERAL OPERATING 5,000
    LINCOLN COUNTY PUBLIC LIBRARIES FOUNDATION
    220 W 6TH ST
    LIBBY,MT59923     		  PC GENERAL OPERATING 7,500
    LITERACY VOLUNTEERS OF AMERICA - BITTERROOT INC
    303 N THIRD ST
    HAMILTON,MT59840     		  PC GENERAL OPERATING 7,500
    LOADS OF DIGNITY FORMALLY LAUNDRY LOVE HAMILTON
    177 ALICE AVE
    HAMILTON,MT59840     		  PC GENERAL OPERATING 5,000
    LOWELL ELEMENTARY SCHOOL
    1215 PHILLIPS ST
    MISSOULA,MT59802     		  GOV GENERAL OPERATING 150,000
    MAPS MEDIA INSTITUTE INC
    515 MADISON
    HAMILTON,MT59840     		  PC GENERAL OPERATING 22,500
    MINERAL COUNTY HEALTH DEPARTMENT
    P O BOX 488
    SUPERIOR,MT59872     		  GOV GENERAL OPERATING 600,000
    MINERAL COUNTY HELP INC
    PO BOX 142
    SUPERIOR,MT59872     		  PC GENERAL OPERATING 7,500
    MISSOULA CITY-COUNTY HEALTH DEPARTMENT
    301 W ALDER ST
    MISSOULA,MT59802     		  GOV GENERAL OPERATING 50,000
    MONTANA ASSOCIATION FOR THE EDUCATION OF YOUNG CHILDREN
    PO BOX 11568
    BOZEMAN,MT59719     		  PC GENERAL OPERATING 7,500
    MONTANA BUDGET AND POLICY CENTER
    15 W 6TH AVE
    HELENA,MT59601     		  PC GENERAL OPERATING 675,000
    MONTANA CHILD CARE RESOURCE & REFERRAL NETWORK INC DBA RAISE MONTANA
    PO BOX 808
    LOLO,MT59847     		  PC GENERAL OPERATING 150,000
    MONTANA DEPARTMENT OF PUBLIC HEALTH AND HUMAN SERVICES
    1625 11TH AVE
    HELENA,MT59601     		  GOV NO KID HUNGRY MONTANA 50,000
    MONTANA FOOD BANK NETWORK INC
    5625 EXPRESSWAY
    MISSOULA,MT59808     		  PC GENERAL OPERATING 375,000
    MONTANA NONPROFIT ASSOCIATION INC
    PO BOX 1744
    HELENA,MT59624     		  PC GENERAL OPERATING 195,000
    MONTANA SKATEPARK ASSOCIATION
    618 S HIGGINS AVE
    MISSOULA,MT59801     		  PC GENERAL OPERATING 7,500
    MONTANA WOMEN VOTE
    725 W ALDER ST SUITE 21
    MISSOULA,MT59802     		  PC GENERAL OPERATING 750,000
    MTAEYC - FLATHEAD CHAPTER
    110 NORTHERN LIGHTS BLVD
    KALISPELL,MT59901     		  PC GENERAL OPERATING 7,500
    NATIVE AMERICAN DEVELOPMENT CORP
    17 N 26TH ST
    BILLINGS,MT59101     		  PC GENERAL OPERATING 750,000
    NEVER ALONE RECOVERY SUPPORT SERVICES
    PO BOX 406
    RONAN,MT59864     		  PC GENERAL OPERATING 105,000
    NORTHWOOD COMMUNITY INC
    41652 HWY 93 FRONTAGE RD
    RONAN,MT59864     		  PC GENERAL OPERATING 7,500
    NURSE FAMILY PARTNERSHIP
    1900 N GRANT ST SUITE 400
    DENVER,CO80203     		  PC GENERAL OPERATING 100,000
    PLAINS ELEMENTARY SCHOOL
    412 RITTENOUR ST
    PLAINS,MT59859     		  GOV GENERAL OPERATING 7,500
    POLSON SCHOOL DISTRICT 23
    111 4TH AVE EAST
    POLSON,MT59860     		  GOV CHERRY VALLEY ELEMENTARY 7,500
    POSTPARTUM RESOURCE GROUP
    PO BOX 10394
    KALISPELL,MT59904     		  PC GENERAL OPERATING 7,500
    PROMISE686
    19 HOLCOMB BRIDGE RD
    ATLANTA,GA30071     		  PC MONTANA INITIATIVE 7,500
    PROMOTING EXCELLNCE IN ALBERTON - AREA KIDS FOUNDATION
    PO BOX 36
    ALBERTON,MT59820     		  PC GENERAL OPERATING 5,000
    RESOURCE ASSISTANCE CENTER - BEAVERHEAD DEPT
    205 E CENTER
    DILLON,MT59725     		  PC GENERAL OPERATING 7,500
    RONAN HIGH SCHOOL
    46525 STAGECOACH TR
    RONAN,MT59864     		  GOV GENERAL OPERATING 7,500
    RONAN SCHOOL DISTRICT 30
    421 ANDREW ST NW
    RONAN,MT59864     		  GOV RONAN HIGH SCHOOL 7,500
    SALISH & KOOTENAI HOUSING AUTHORITY
    PO BOX 38
    PABLO,MT59855     		  GOV GENERAL OPERATING 7,500
    SALISH INSTITUTE
    PO BOX 914
    ST IGNATIUS,MT59865     		  PC GENERAL OPERATING 7,500
    SALISH KOOTENAI COLLEGE FOUNDATION
    PO BOX 70
    PABLO,MT59855     		  PC GENERAL OPERATING 100,000
    SALISH KOOTENAI COLLEGE INC
    58138 US HWY 93
    PABLO,MT59855     		  PC CENTER FOR PREVENTION AND WELLNESS 750,000
    SANDERS COUNTY COMMUNITY HOUSING ORGANIZATION
    303 MAIN ST
    THOMPSON FALLS,MT59873     		  PC GENERAL OPERATING 7,500
    SEELEY LAKE COMMUNITY FOUNDATION
    PO BOX 25
    SEELEY LAKE,MT59868     		  PC GENERAL OPERATING 7,500
    SEELEY LAKE ELEMENTARY
    PO BOX 840
    SEELEY LAKE,MT59868     		  PC GENERAL OPERATING 5,000
    SNQWEYLMISTN
    63893 HWY 93
    RONAN,MT59864     		  PC GENERAL OPERATING 7,500
    SPARROWS VINE
    PO BOX 864
    SEELEY LAKE,MT59868     		  PC GENERAL OPERATING 7,500
    ST PETER'S HEALTH FOUNDATION
    2475 BROADWAY
    HELENA,MT59601     		  PC GENERAL OPERATING 50,000
    ST REGIS ELEMENTARY SCHOOL
    90 TIGER ST
    ST REGIS,MT59866     		  GOV GENERAL OPERATING 4,000
    ST REGIS FRIENDS AND NEIGHBORS CLUB
    6 TIGER ST
    ST REGIS,MT59866     		  PC GENERAL OPERATING 5,000
    ST REGIS SCHOOL DISTRICT 1
    90 TIGER ST
    ST REGIS,MT59866     		  GOV ST REGIS ELEMENTARY 7,500
    SWAN VALLEY SCHOOL
    6423 HIGHWAY 83
    CONDON,MT59826     		  GOV GENERAL OPERATING 7,500
    THE HENRY J KAISER FAMILY FOUNDATION
    185 BERRY ST SUITE 2000
    SAN FRANCISCO,CA94107     		  PC GENERAL OPERATING 50,000
    TROY FARMERS MARKET
    PO BOX 51
    TROY,MT59935     		  PC GENERAL OPERATING 7,500
    UNITED WAY OF MISSOULA COUNTY
    412 W ALDER ST
    MISSOULA,MT59802     		  PC GENERAL OPERATING 600,000
    UNIVERSITY OF MONTANA
    203 B PFNAC
    MISSOULA,MT59812     		  GOV AMERICAN INDIAN GOVERNANCE AND POLICY INSTITUTE 100,000
    UNIVERSITY OF MONTANA
    32 CAMPUS DR ORSP UH116
    MISSOULA,MT59812     		  GOV CENTER FOR CHILDREN, FAMILIES AND WORKFORCE DEVELOPMENT 375,000
    VALLEY OAK EDUCATION RESOURCE CENTER
    PO BOX 870
    HAMILTON,MT59840     		  PC GENERAL OPERATING 7,500
    W F MORRISON SCHOOL
    BOX 867
    TROY,MT59935     		  GOV GENERAL OPERATING 7,500
    WESTERN MONTANA PROFESSIONAL LEARNING COLLABORATIVE
    PO BOX 1516
    TROUT CREEK,MT59874     		  PC GENERAL OPERATING 7,500
    WESTERN NATIVE VOICE
    PO BOX 1018
    BILLINGS,MT59103     		  PC GENERAL OPERATING 100,000
    WHITEHALL PUBLIC SCHOOLS
    PO BOX 1109
    WHITEHALL,MT59759     		  GOV GENERAL OPERATING 7,500
    YES YOUTH EMPOWERMENT SERVICES
    PO BOX 686
    ANACONDA,MT59711     		  PC GENERAL OPERATING 7,500
    ZERO TO FIVE MONTANA STATEWIDE OFFICE
    3240 DREDGE DR
    HELENA,MT59602     		  PC GENERAL OPERATING 600,000
    Total .................................bullet 3a 9,508,500
    bApproved for future payment
    Total .................................bullet 3b 0
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 12
    Part XV-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 ...........     		         
    4 Dividends and interest from securities ....          
    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 25,316 18 3,159,520  
    9 Net income or (loss) from special events:          
    10 Gross profit or (loss) from sales of inventory          
    11 Other revenue: a
    b
    c
    d
    e
    12 Subtotal. Add columns (b), (d), and (e) .. 58,080 6,959,052 0
    13Total. Add line 12, columns (b), (d), and (e)..................
    13
    7,017,132
    (See worksheet in line 13 instructions to verify calculations.)
    Part XV-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 XV-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 (2021)
    Form 990-PF (2021)
    Page 13
    Part XVI
    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 (2021)
    Additional Data


    Software ID:  
    Software Version:  


    Form 990PF - Special Condition Description:
    Special Condition Description

    TY 2021 AccountingFeesSchedule
    Name:
    HEADWATERS HEALTH FOUNDATION
     
    OF WESTERN MONTANA
    EIN:
    81-1099715
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    ACCOUNTING 115,353 49,202   57,702

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

    TY 2021 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 2021-01-01 151,674 59,156 NC 7.000000000000 0 0    
    CONSTRUCTION IN PROGRESS 2021-01-01 1,262,669   NC 0 % 0 0    

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

    TY 2021 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
    JEFFERSON LOCAL DEVELOPMENT CORPORATION
          		PO BOX 1079
    WHITEHALL,MT59759     		2021-08-09 50,000 TO DEVELOP AND ENSURE SUSTAINABLE CHILDCARE (PROVIDERS AND FACILITIES) IN BOULDER, MT, AND ITS IMMEDIATE ENVIRONS 50,000 NONE 9/14/21 2021-12-31  

    TY 2021 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
    MEAD JOHNSON NUTRITIONAL 283,815 283,815
    PNC FINANCIAL SERVICES GROUP 422,614 422,614
    ALLY FINL INC 253,596 253,596
    MORGAN STANLEY 439,290 439,290
    L3HARRIS TECHNOLOGIES 259,469 259,469
    GILEAD SCIENCES 460,731 460,731
    FISERV INC 444,349 444,349
    AMERICAN TOWER CORP 457,560 457,560
    PIMCO INCOME INSTL 2,849,838 2,849,838
    WELLS FARGO & CO 154,206 154,206
    MICROCHIP TECHN 234,524 234,524
    IHS MARKIT LTD4 339,219 339,219
    MCCORMICK & CO 365,166 365,166
    MOTOROLA SOLUTIONS 372,766 372,766
    UNITED PARCEL SER 313,459 313,459

    TY 2021 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 4,487,510 4,487,510
    PIMCO RAE FUNDAMENTAL 4,595,905 4,595,905
    VANGUARD DEVELOPED MARKET 8,516,503 8,516,503
    VANGUARD EMERGING MKTS 4,796,786 4,796,786
    VANGUARD INSTITUTIONAL 10,904,469 10,904,469
    BLACK HILLS CORP 314,950 314,950

    TY 2021 InvestmentsGovtObligationsSch
    Name:
    HEADWATERS HEALTH FOUNDATION
     
    OF WESTERN MONTANA
    EIN:
    81-1099715
    US Government Securities - End of Year Book Value:

    1,055,660
    US Government Securities - End of Year Fair Market Value:

    1,055,660
    State & Local Government Securities - End of Year Book Value:


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


    0


    TY 2021 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 6,892,672 6,892,672
    ACCOLADE PARTNERS VII LP FMV 1,381,228 1,381,228
    ACCRUED INTEREST FMV 54,491 54,491
    AMBERBROOK VIII LP FMV 2,161,216 2,161,216
    AUDAX DIRECT LENDING SOLUTIONS FUND-C LP FMV 1,338,861 1,338,861
    COLLER INTERNATIONAL PARTNERS VII FEEDER FUND LP FMV 1,557,409 1,557,409
    EDGE PRINCIPAL INVESTMENTS IV LP FMV 693,851 693,851
    FALCON PRIVATE CREDIT OPPORTUNITIES VI LP FMV 1,488,717 1,488,717
    FEG SELECT LLC FMV 19,395,741 19,395,741
    HARVEST MLP INCOME FUND II LLC FMV 3,725,993 3,725,993
    IRONWOOD INTERNATIONAL LTD FMV 9,594,605 9,594,605
    MAP RE 2018 LP FMV 2,348 2,348
    RCP ADVISORS FMV 1,175,041 1,175,041
    SEAPORT GLOBAL PROPERTY SECURITIES FUND LLC FMV 2,578,238 2,578,238
    THE HIGHCLERE INTERNATIONAL INVESTORS EMERGING MARKETS SMID FUND FMV 47,849 47,849
    WEATHERLOW OFFSHORE FUND I LTD FMV 10,454,466 10,454,466
    STRATEGIC VALUE FMV 1,793,732 1,793,732
    FIDELITY REAL ESTATE FMV 2,107,498 2,107,498

    TY 2021 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 151,674 59,156 92,518  
    CONSTRUCTION IN PROGRESS 1,262,669 0 1,262,669  


    TY 2021 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 17,071 3,641   16,045


    TY 2021 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 17,494 0   17,494
    COMPUTER AND SOFTWARE 43,780 0   43,015
    ADVERTISING AND PROMOTIONS 2,649 0   2,649
    FEES AND SUBSCRIPTIONS 18,095 0   18,022
    OFFICE EXPENSE 5,889 0   5,889
    REPAIRS AND MAINTENANCE 1,632 0   1,602
    EQUIPMENT RENT 22,568 0   9,251
    SMALL EQUIPMENT 12,186 0   12,186
    MISCELLANEOUS 12,857 0   12,857
    STATE FILING FEES 20 0   20
    GRANTEE VISITS 293 0   293
    NONPROFIT CENTER 18,150 0   15,043
    GRANTEE CONVENINGS 65,000 0   65,000


    TY 2021 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 2,104,843 838,367 2,104,843


    TY 2021 OtherIncreasesSchedule
    Name:
    HEADWATERS HEALTH FOUNDATION
     
    OF WESTERN MONTANA
    EIN:
    81-1099715
    Description Amount
    UNREALIZED GAIN ON INVESTMENTS 9,410,957


    TY 2021 OtherLiabilitiesSchedule
    Name:
    HEADWATERS HEALTH FOUNDATION
     
    OF WESTERN MONTANA
    EIN:
    81-1099715
    Description Beginning of Year - Book Value End of Year - Book Value
    PAYROLL LIABILITIES 99,869 90,874
    DEFERRED EXCISE TAX 138,800 277,498
    TAXES PAYABLE 25,286 69,095
    CLEARWATER CONSTRUCTION LOAN 0 1,187,076


    TY 2021 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 310,827 310,827   0
    CONSULTING 153,734 0   152,668
    RECRUITING 3,577 0   3,577
    ALTERNATIVE INVESTMENTS 39,419 357,062   0


    TY 2021 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 30,486 148,574   0
    EXCISE TAX 293,249 0   0
    STATE INCOME TAX 50 0   0