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
Blue Cross of Idaho Foundation For
Health Inc
Number and street (or P.O. box number if mail is not delivered to street address)3000 E Pine Ave
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
Meridian, ID83642
A Employer identification number

26-0024334
B Telephone number (see instructions)

(986) 224-3992
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$85,835,793
J 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) 27,232
2 Check bullet.............
3 Interest on savings and temporary cash investments      
4 Dividends and interest from securities... 1,541,128 1,541,128  
5a Gross rents............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10 8,394,962
b Gross sales price for all assets on line 6a 34,175,580
7 Capital gain net income (from Part IV, line 2)... 13,300,850
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).......      
12 Total. Add lines 1 through 11........ 9,963,322 14,841,978  
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 183,115 0   183,115
14 Other employee salaries and wages...... 530,110 0   518,790
15 Pension plans, employee benefits.......        
16a Legal fees (attach schedule).........       625
b Accounting fees (attach schedule)....... 4,400 440   3,960
c Other professional fees (attach schedule).... 368,154 40,315   314,349
17 Interest...............        
18 Taxes (attach schedule) (see instructions)... 202,963 0   0
19 Depreciation (attach schedule) and depletion... 24,517 0  
20 Occupancy.............. 39,422 0   39,082
21 Travel, conferences, and meetings....... 15,638 0   16,185
22 Printing and publications..........        
23 Other expenses (attach schedule)....... 36,492 0   36,663
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 1,404,811 40,755   1,112,769
25 Contributions, gifts, grants paid....... 2,789,811 2,698,953
26 Total expenses and disbursements. Add lines 24 and 25 4,194,622 40,755   3,811,722
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements 5,768,700
b Net investment income (if negative, enter -0-) 14,801,223
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............. 70,739 72,886 72,886
2 Savings and temporary cash investments......... 13,627,962 4,803,486 4,803,485
3 Accounts receivable bullet  
Less: allowance for doubtful accounts bullet   2,846    
4 Pledges receivable bullet9,936
Less: allowance for doubtful accounts bullet   13,020,927 9,936 9,936
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.......... 3,131 3,040 3,040
10a Investments—U.S. and state government obligations (attach schedule)      
b Investments—corporate stock (attach schedule).......      
c Investments—corporate bonds (attach schedule).......      
11 Investments—land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
12 Investments—mortgage loans.............      
13 Investments—other (attach schedule).......... 53,679,045 Click to see attachment78,154,128 78,154,128
14 Land, buildings, and equipment: basis bullet151,228
Less: accumulated depreciation (attach schedule) bullet85,091 90,654 Click to see attachment66,137 66,137
15 Other assets (describe bullet) Click to see attachment0 Click to see attachment2,726,181 Click to see attachment2,726,181
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 80,495,304 85,835,794 85,835,793
Liabilities 17 Accounts payable and accrued expenses.......... 85,004 225,700
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)    
23 Total liabilities (add lines 17 through 22)......... 85,004 225,700
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........... 80,388,809 85,610,094
25 Net assets with donor restrictions............ 21,491 0
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)..... 80,410,300 85,610,094
30 Total liabilities and net assets/fund balances (see instructions). 80,495,304 85,835,794
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
80,410,300
2
Enter amount from Part I, line 27a .....................
2
5,768,700
3
Other increases not included in line 2 (itemize) bullet
3
0
4
Add lines 1, 2, and 3 ..........................
4
86,179,000
5
Decreases not included in line 2 (itemize) bulletClick to see attachment
5
568,906
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29 .
6
85,610,094
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 P    
b Capital Gains Dividends P    
c
d
e
(e)
Gross sales price
(f)
Depreciation allowed
(or allowable)
(g)
Cost or other basis
plus expense of sale
(h)
Gain or (loss)
(e) plus (f) minus (g)
a 34,000,000   20,874,730 13,125,270
b 175,580     175,580
c
d
e
Complete only for assets showing gain in column (h) and owned by the foundation on 12/31/69 (l)
Gains (Col. (h) gain minus
col. (k), but not less than -0-) or
Losses (from col.(h))
(i)
F.M.V. as of 12/31/69
(j)
Adjusted basis
as of 12/31/69
(k)
Excess of col. (i)
over col. (j), if any
a       13,125,270
b       175,580
c
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 13,300,850
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........................... 3 205,737
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- ..... 5 205,737
6 Credits/Payments:
a 2021 estimated tax payments and 2020 overpayment credited to 2021 6a 203,384
b Exempt foreign organizations—tax withheld at source...... 6b 0
c Tax paid with application for extension of time to file (Form 8868)... 6c 0
d Backup withholding erroneously withheld ........... 6d 0
7 Total credits and payments. Add lines 6a through 6d.............. 7 203,384
8 Enter any penalty for underpayment of estimated tax. Check here if Form 2220 is attached. 8 0
9 Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed.......Bullet 9 2,353
10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid...Bullet 10  
11 Enter the amount of line 10 to be: Credited to 2022 estimated taxBullet   RefundedBullet 11  
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
 
No
b
If "Yes," has it filed a tax return on Form 990-T for this year?...................
4b
 
 
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)
    bulletID
    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.bcidahofoundation.org
    14
    The books are in care ofbulletBlue Cross of Idaho Health Service Telephone no.bullet (986) 224-3991

    Located atbullet3000 E Pine AveMeridianID ZIP+4bullet83642
    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
    Kendra E Witt-Doyle Executive Director
    40.00
    152,043 31,072 0
    3000 E Pine Ave
    Meridian,ID83642
    Mike Reynoldson President - Chair
    1.00
    0 0 0
    3000 E Pine Ave
    Meridian,ID83642
    Steven Driggers Secretary
    1.00
    0 0 0
    3000 E Pine Ave
    Meridian,ID83642
    David Ward Treasurer
    1.00
    0 0 0
    3000 E Pine Ave
    Meridian,ID83642
    Jenny Robertson Director - Vice Chair
    1.00
    0 0 0
    3000 E Pine Ave
    Meridian,ID83642
    Elva Allan Director
    1.00
    0 0 0
    3000 E Pine Ave
    Meridian,ID83642
    Pam McNamara Director
    1.00
    0 0 0
    3000 E Pine Ave
    Meridian,ID83642
    Luke Malek Director
    1.00
    0 0 0
    3000 E Pine Ave
    Meridian,ID83642
    Marybeth Flachbart Director
    1.00
    0 0 0
    3000 E Pine Ave
    meridian,ID83642
    Stephanie Wright Director
    1.00
    0 0 0
    3000 E Pine Ave
    meridian,ID83642
    Ralph Woodard President - Chair
    1.00
    0 0 0
    3000 E Pine Ave
    Meridian,ID83642
    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
    NONE
    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
    Crave Delivery Inc Catering/Blue Cross Appreciation Event 90,592
    2900 W Excursion
    Meridian,ID83642
    Reynolds Meyers LLC Consulting Services 83,218
    PO Box 383
    Boise,ID83701
    FSG Inc Consulting Services 50,000
    500 Boylston St Ste 600
    Boston,MA02116
    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 N/A 0
    2   0
    3   0
    4   0
    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
    77,091,134
    b
    Average of monthly cash balances.......................
    1b
    2,991,467
    c
    Fair market value of all other assets (see instructions)................
    1c
    79,113
    d
    Total (add lines 1a, b, and c).........................
    1d
    80,161,714
    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
    80,161,714
    4
    Cash deemed held for charitable activities. Enter 1.5% (0.015) of line 3 (for greater amount, see
    instructions) .............................
    4
    1,202,426
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. .......
    5
    78,959,288
    6
    Minimum investment return. Enter 5% (0.05) of line 5................
    6
    3,947,964
    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
    3,947,964
    2a
    Tax on investment income for 2021 from Part V, line 5.......
    2a
    205,737
    b
    Income tax for 2021. (This does not include the tax from Part V.) ...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
    205,737
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
    3,742,227
    4
    Recoveries of amounts treated as qualifying distributions................
    4
    0
    5
    Add lines 3 and 4............................
    5
    3,742,227
    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
    3,742,227
    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 3,742,227
    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...... 78,164
    b From 2017...... 64,615
    c From 2018...... 518,011
    d From 2019...... 734,334
    e From 2020......  
    f Total of lines 3a through e ........ 1,395,124
    4Qualifying distributions for 2021 from Part
    XI, line 4: bullet$ 3,811,722
    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..... 3,742,227
    e Remaining amount distributed out of corpus 69,495
    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 1,464,619
    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) ...
    78,164
    9 Excess distributions carryover to 2022.
    Subtract lines 7 and 8 from line 6a ......
    1,386,455
    10 Analysis of line 9:
    a Excess from 2017.... 64,615
    b Excess from 2018.... 518,011
    c Excess from 2019.... 734,334
    d Excess from 2020....  
    e Excess from 2021.... 69,495
    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 email address of the person to whom applications should be addressed:
    bThe form in which applications should be submitted and information and materials they should include:
    cAny submission deadlines:
    dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
    factors:
    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
    Adams Elementary School
    110 N 2nd E
    Rexburg,ID83440
      GOV Physical activity equipment or programs at school 1,000
    Alturas Elementary School
    1111 Alturas Elementary Lane
    Hailey,ID83333
      GOV Physical activity equipment or programs at school 1,000
    American Planning Association
    PO Box 9691
    Boise,ID83707
      PC Support education of city planners statewide regarding SDOH 5,000
    Bear Lake School District
    39 FIELDING ST PO BOX 300
    PARIS,ID83261
      GOV Physical activity equipment or programs at school 1,000
    Blackfoot High School
    870 S Fisher St
    Blackfoot,ID83221
      GOV Physical activity equipment or programs at school 1,000
    Bonneville Joint School District 93
    3497 N Ammon Road
    Idaho Falls,ID83401
      GOV Physical activity equipment or programs at school 500
    Boys & Girls Club of Ada County
    610 East 42nd Street
    Garden City,ID83714
      PC Mental health counseling for the Boy & Girls Clubs in Ada County 35,000
    Boys & Girls Club of Ada County
    610 East 42nd Street
    Garden City,ID83714
      PC Support Triple Play program 12,010
    Boys & Girls Club of Ada County
    610 East 42nd Street
    Garden City,ID83714
      PC Support of Triple Play program 21,490
    Butte High School
    120 South Water Street PO Box 655
    Arco,ID83213
      GOV Physical activity equipment or programs at school 1,000
    Cascade Medical Center Foundation Inc
    PO Box 964
    Cascade,ID83611
      PC Pilot Project targeting rural seniors be connected to SDOH services 89,200
    Cecil D Andrus Elementary
    6100 North Park Meadow Way
    Boise,ID83713
      GOV Physical activity equipment or programs at school 500
    Centennial High School
    12400 West McMillan Road
    Boise,ID83713
      GOV Physical activity equipment or programs at school 1,000
    Central District Health Department
    PO Box 23492
    Belfast,ME04915
      GOV WICHC regional collaborative Health Needs Assessment 10,000
    Central Elementary School
    102 N Park Ave
    Sugar City,ID83448
      GOV Physical activity equipment or programs at school 1,000
    City Of Albion
    225 S Main St
    Albion,ID83311
      GOV Youth physical activity equipment or programs 1,000
    City Of American Falls
    550 North Oregon Trail
    American Falls,ID83211
      GOV Youth physical activity equipment or programs 1,000
    City Of Ammon
    2135 S Ammon Rd
    Ammon,ID83406
      GOV Youth physical activity equipment or programs 1,000
    City Of Arimo
    115 Henderson Ave
    Arimo,ID83214
      GOV Youth physical activity equipment or programs 1,000
    City Of Bancroft
    PO Box 39
    Bancroft,ID83217
      GOV Youth physical activity equipment or programs 1,000
    City Of Blackfoot
    157 N Broadway
    Blackfoot,ID83221
      GOV Youth physical activity equipment or programs 500
    City Of Boise
    PO Box 500
    Boise,ID83701
      GOV Youth physical activity equipment or programs 1,000
    City Of Bonners Ferry
    PO Box 149
    Bonners Ferry,ID83805
      GOV Incorporating health into city Comprehensive Plan 50,000
    City Of Bonners Ferry
    PO Box 149
    Bonners Ferry,ID83805
      GOV Youth physical activity equipment or programs 500
    City Of Bonners Ferry
    PO Box 149
    Bonners Ferry,ID83805
      GOV Support activation of the city Comprehensive Plan supporting Social Determinants of Health 20,000
    City of Caldwell
    PO Box 1179
    Caldwell,ID83606
      GOV Youth physical activity equipment or programs 1,000
    City of Cambridge
    PO Box 80
    Cambridge,ID83610
      GOV Youth physical activity equipment or programs 500
    City of Cascade
    105 S Main Street
    Cascade,ID83611
      GOV Youth physical activity equipment or programs 1,000
    City of Cascade
    105 S Main Street
    Cascade,ID83611
      GOV Incorporation of health in city comp plan to focus on SDOH 30,000
    City Of Chubbuck
    290 East Linden Ave
    Chubbuck,ID83202
      GOV Youth physical activity equipment or programs 1,000
    City of Coeur D'Alene
    710 E Mullian Ave
    Coeur D Alene,ID83814
      GOV Youth physical activity equipment or programs 1,000
    City Of Crouch
    342 Village Circle
    Crouch,ID83622
      GOV Youth physical activity equipment or programs 500
    City of Dalton Gardens
    6360 N 4th St
    Dalton Gardens,ID83815
      GOV Youth physical activity equipment or programs 500
    City Of Dayton
    PO Box 12
    Dayton,ID83232
      GOV Youth physical activity equipment or programs 1,000
    City of Dietrich
    211 N Waucanza Street
    Dietrich,ID83324
      GOV Youth physical activity equipment or programs 1,000
    City Of Dover
    PO Box 115
    Dover,ID83825
      GOV Youth physical activity equipment or programs 1,000
    City Of Downey
    PO Box 204
    Downey,ID83234
      GOV Youth physical activity equipment or programs 1,000
    City Of Driggs
    PO Box 48
    Driggs,ID83422
      GOV Youth physical activity equipment or programs 1,000
    City Of Driggs
    PO Box 48
    Driggs,ID83422
      GOV Activation Grant for recommended projects from the city comprehensive plan. 20,000
    City Of Driggs
    PO Box 48
    Driggs,ID83422
      GOV Community Partnership Projects 20,000
    City Of East Hope
    PO Box 186
    Hope,ID83836
      GOV Youth physical activity equipment or programs 1,000
    City Of Emmett
    501 E Main
    Emmett,ID83617
      GOV Youth physical activity equipment or programs 1,000
    City of Fairfield
    407 Soldier Rd
    Fairfeild,ID83327
      GOV Youth physical activity equipment or programs 1,000
    City Of Ferdinand
    PO Box 101
    Ferdinand,ID83526
      GOV Youth physical activity equipment or programs 1,000
    City Of Fernan Lake
    PO Box 1775
    Coeur D Alene,ID83816
      GOV Youth physical activity equipment or programs 500
    City Of Firth
    106 E Center Street
    Firth,ID83236
      GOV Youth physical activity equipment or programs 1,000
    City of Franklin
    PO BOX 69
    FRANKLIN,ID83237
      GOV Youth physical activity equipment or programs 1,000
    City Of Garden City
    6015 Glennwood St
    Garden City,ID83714
      GOV Youth physical activity equipment or programs 500
    City of Genesee
    PO Box 38
    Genesee,ID83832
      GOV Youth physical activity equipment or programs 500
    City Of Grace
    103 E Center St
    Grace,ID83241
      GOV Youth physical activity equipment or programs 1,000
    City of Hayden Lake
    3013 Lake Forest Drive
    Hayden Lake,ID83835
      GOV Youth physical activity equipment or programs 1,000
    City of Hazelton
    PO BOX 145
    Hazelton,ID83335
      GOV Youth physical activity equipment or programs 500
    City Of Homedale
    31 W Wyoming Ave
    Homedale,ID83628
      GOV Youth physical activity equipment or programs 1,000
    City of Hope
    PO Box 277
    Hope,ID83846
      GOV Youth physical activity equipment or programs 500
    City Of Idaho Falls
    PO Box 50220
    Idaho Falls,ID83405
      GOV Youth physical activity equipment or programs 500
    City Of Jerome
    152 E Ave A
    Jerome,ID83338
      GOV Youth physical activity equipment or programs 1,000
    City Of Jerome
    152 E Ave A
    Jerome,ID83338
      GOV Incorporation of health into city comp plan and to focus on outcomes related to SDOH 50,000
    City Of Juliaetta
    PO Box 229
    Juliaetta,ID83535
      GOV Youth physical activity equipment or programs 1,000
    City Of Kamiah
    PO Box 338
    Kamiah,ID83536
      GOV Youth physical activity equipment or programs 1,000
    City Of Lapwai
    315 S Main St
    Lapwai,ID83540
      GOV Youth physical activity equipment or programs 1,000
    City Of Lewiston
    PO Box 617
    Lewiston,ID83501
      GOV Youth physical activity equipment or programs 1,000
    City Of Malad
    59 Bannock Street
    Malad,ID83252
      GOV Pathway lighting in Malad 20,000
    City Of Malad
    59 Bannock Street
    Malad,ID83252
      GOV Youth physical activity equipment or programs 1,000
    City of Marsing
    PO Box 125
    Marsing,ID83639
      GOV Youth physical activity equipment or programs 500
    City of McCall
    216 Park St
    McCall,ID83638
      GOV Youth physical activity equipment or programs 1,000
    City Of Meridian
    PO Box 670
    Caldwell,ID83606
      GOV Youth physical activity equipment or programs 500
    City Of Montpelier
    534 Washington St
    Montpelier,ID83254
      GOV Youth physical activity equipment or programs 1,000
    City of Moscow
    206 E 3rd St
    Moscow,ID83843
      GOV Youth physical activity equipment or programs 1,000
    City of Mountain Home
    PO BOX 10
    MOUNTAIN HOME,ID83647
      GOV Youth physical activity equipment or programs 1,000
    City Of Nampa
    311 3rd St S
    Nampa,ID83651
      GOV Youth physical activity equipment or programs 500
    City Of Nampa
    311 3rd St S
    Nampa,ID83651
      GOV Support for Safe Routes to School programming 20,000
    City of Oakley
    105 N Center St
    Oakley,ID83346
      GOV Youth physical activity equipment or programs 500
    City Of Orofino
    217 1St St
    Orofino,ID83544
      GOV Bike repair stations 3,230
    City Of Orofino
    217 1St St
    Orofino,ID83544
      GOV Sand Volleyball Court 1,415
    City Of Orofino
    217 1St St
    Orofino,ID83544
      GOV Sand Volleyball Court 1,074
    City Of Orofino
    217 1St St
    Orofino,ID83544
      GOV Safe Routes to Schools Bike Trailer 8,917
    City Of Orofino
    217 1St St
    Orofino,ID83544
      GOV Sand Volleyball Court 4,101
    City Of Orofino
    217 1St St
    Orofino,ID83544
      GOV Youth physical activity equipment or programs 1,000
    City Of Orofino
    217 1St St
    Orofino,ID83544
      GOV Stove & vent hood for Teen Center 1,295
    City Of Orofino
    217 1St St
    Orofino,ID83544
      GOV Safe Routes to Schools Bike Trailer 2,608
    City Of Orofino
    217 1St St
    Orofino,ID83544
      GOV Safe Routes to Schools Bike Trailer 16,500
    City Of Orofino
    217 1St St
    Orofino,ID83544
      GOV Riverside Play Park improvements 27,001
    City of Parma
    PO Box 608
    Parma,ID83660
      GOV Youth physical activity equipment or programs 1,000
    City of Paul
    PO Box 130
    Paul,ID83347
      GOV Youth physical activity equipment or programs 500
    City Of Peck
    PO Box 105
    Peck,ID83545
      GOV Youth physical activity equipment or programs 1,000
    City Of Pierce
    PO Box 356
    Pierce,ID83546
      GOV Youth physical activity equipment or programs 500
    City of Pocatello
    911 North 7th Ave
    Pocatello,ID83205
      GOV Youth physical activity equipment or programs 1,000
    City Of Ponderay
    PO Box 500
    Ponderay,ID83852
      GOV Youth physical activity equipment or programs 1,000
    City Of Post Falls
    408 N Spokane St
    Post Falls,ID83852
      GOV Youth physical activity equipment or programs 1,000
    City Of Preston
    70 W Oneida
    Preston,ID83263
      GOV Youth physical activity equipment or programs 1,000
    City Of Rexburg
    35 N 1St St
    Rexburg,ID83440
      GOV Equipment for economic dev center targeting women business owners 20,000
    City Of Rexburg
    35 N 1St St
    Rexburg,ID83440
      GOV Youth physical activity equipment or programs 1,000
    City Of Rexburg
    35 N 1St St
    Rexburg,ID83440
      GOV Incorporation of health into city comp plan and focus on outcomes related to SDOH 50,000
    City of Roberts
    PO Box 242
    Roberts,ID83444
      GOV Youth physical activity equipment or programs 1,000
    City Of Sandpoint
    1123 Lake St
    Sandpoint,ID83864
      GOV Facilitation and action plan for housing task force 20,000
    City Of Shelley
    101 South Emmerson
    Shelley,ID83274
      GOV Youth physical activity equipment or programs 1,000
    City Of Shoshone
    207 S Rail St W
    Shoshone,ID83352
      GOV Youth physical activity equipment or programs 1,000
    City Of Smelterville
    PO Box 200
    Smelterville,ID83868
      GOV Youth physical activity equipment or programs 1,000
    City of Spirit Lake
    PO Box 309
    Spirit Lake,ID83869
      GOV Youth physical activity equipment or programs 500
    City Of Stanley
    PO Box 53
    Stanley,ID83278
      GOV Youth physical activity equipment or programs 1,000
    City of Star
    PO Box 130
    Star,ID83669
      GOV Youth physical activity equipment or programs 500
    City of Tensed
    206 3rd Street Box 126
    Tensed,ID83870
      GOV Youth physical activity equipment or programs 500
    City Of Tetonia
    3192 Perry Ave
    Tetonia,ID83452
      GOV Youth physical activity equipment or programs 1,000
    City Of Twin Falls
    321 2Nd Ave E
    Twin Falls,ID83301
      GOV Because Kids Grieve Garden Project 3,522
    City Of Twin Falls
    321 2Nd Ave E
    Twin Falls,ID83301
      GOV Safe cycling routes, 30,000
    City Of Twin Falls
    321 2Nd Ave E
    Twin Falls,ID83301
      GOV Convert existing classroom to dance/workout/fitness studio 22,933
    City Of Twin Falls
    321 2Nd Ave E
    Twin Falls,ID83301
      GOV CTG Adaptive Playground funding 25,000
    City Of Twin Falls
    321 2Nd Ave E
    Twin Falls,ID83301
      GOV Youth physical activity equipment or programs 1,000
    City Of Twin Falls
    321 2Nd Ave E
    Twin Falls,ID83301
      GOV Facilitation regarding Center for Community Health 12,500
    City Of Twin Falls
    321 2Nd Ave E
    Twin Falls,ID83301
      GOV Community garden to be established by Univ of Idaho in the City of Twin Falls 43,999
    City Of Victor
    10 South Main Street Unit 101
    Victor,ID83455
      GOV Youth physical activity equipment or programs 500
    City Of Wallace
    703 Cedar St
    Wallace,ID83873
      GOV Youth physical activity equipment or programs 1,000
    City of Weiser
    55 W Idaho St
    Weiser,ID83672
      GOV Youth physical activity equipment or programs 1,000
    City of Wendell
    375 1st Ave East
    Wendell,ID83355
      GOV Youth physical activity equipment or programs 1,000
    City Of Weston
    Po Box 68
    Weston,ID83286
      GOV Youth physical activity equipment or programs 1,000
    City Of Winchester
    501 Nezperce Ave
    Winchester,ID83555
      GOV Youth physical activity equipment or programs 1,000
    City of Worley
    PO Box 219
    Worley,ID83876
      GOV Youth physical activity equipment or programs 1,000
    Coeur dAlene Charter Academy
    4904 N Duncan Drive
    Coeur d Alene,ID83815
      GOV Physical activity equipment or programs at school 500
    Cole Valley Christian School
    8775 Ustick Road
    Boise,ID83704
      GOV Physical activity equipment or programs at school 500
    Couer dAlene Early Learning Center
    4800 N Ramsey Road
    Coeur d Alene,ID83815
      GOV Physical activity equipment or programs at school 1,000
    Downtown Boise Association Inc
    816 W Bannock Ste 310
    Boise,ID83702
      NC Support equipment and material purchase for the downtown Boise free skating rink. 120,000
    Emerson Alternative High School
    335 5th Street
    Idaho Falls,ID83401
      GOV Physical activity equipment or programs at school 1,000
    Endeavor Elementary School
    2824 E Victory Rd
    Nampa,ID83687
      GOV Physical activity equipment or programs at school 1,000
    Family Advocacy Center and Education Services Inc
    417 S 6th St
    Boise,ID83702
      PC Champ Camp and Teen Violence Support Group 5,000
    Farmin Stidwell Elementary
    1326 Spruce St
    Sandpoint,ID83864
      GOV Physical activity equipment or programs at school 1,000
    Fernan Elementary School
    520 North 21st Street
    Coeur d Alene,ID83814
      GOV Physical activity equipment or programs at school 1,000
    Filer School District
    700B Stevens Ave
    Filer,ID83328
      GOV Physical activity equipment or programs at school 500
    Frank Church High School
    8051 W Salt Creek Ct
    Boise,ID83709
      GOV Physical activity equipment or programs at school 1,000
    Fremont County Joint School District #215
    945 W 1st N
    St Anthony,ID83445
      GOV Physical activity equipment or programs at school 1,000
    Fruitland School District
    PO Box A
    Fruitland,ID83619
      GOV Physical activity equipment or programs at school 500
    Garden Valley School District 71
    1053 BANKS LOWMAN RD
    GARDEN VALLEY,ID83622
      GOV Physical activity equipment or programs at school 1,000
    Garfield Elementary
    1914 S Broadway
    Boise,ID83706
      GOV Physical activity equipment or programs at school 1,000
    Garfield Elementary
    1914 S Broadway Ave
    Boise,ID83706
      GOV Physical activity equipment or programs at school 500
    Genesis Community Health Inc
    215 W 35th Street
    Garden City,ID83714
      PC Equipment for Caldwell Clinic 15,000
    Gooding Elementary
    507 Idaho St
    Gooding,ID83330
      GOV Physical activity equipment or programs at school 1,000
    Greenleaf Friends Academy
    PO Box 368
    Greenleaf,ID83626
      GOV Physical activity equipment or programs at school 1,000
    Hansen Elementary School
    350 Walnut Ave E
    Hansen,ID83334
      GOV Physical activity equipment or programs at school 1,000
    Heyburn Elementary School
    1405 Main Ave
    St Maries,ID83861
      GOV Physical activity equipment or programs at school 500
    Hillview Elementary
    3075 Teton
    Ammon,ID83406
      GOV Physical activity equipment or programs at school 500
    Homedale Jt School District #370
    116 E Owyhee Ave
    Homedale,ID83628
      GOV Support for Homedale School District's Early Learning Collaborative 48,000
    House of the Lord Christian Academy
    754 Silver Birch
    Oldtown,ID83822
      GOV Physical activity equipment or programs at school 1,000
    Idaho Community Foundation Inc
    210 W State Street
    Boise,ID83702
      PC Support for Project Neighborly in Northern Idaho and Eastern Idaho 20,400
    Idaho Community Foundation Inc
    210 W State Street
    Boise,ID83702
      PC Support nursing and health science scholarships at Idaho universities. 6,000
    Idaho Educational Services for the Deaf and Blind
    1450 Main Street
    Gooding,ID83330
      GOV Physical activity equipment or programs at school 1,000
    Idaho Farmers Market Association
    PO Box 1194
    Homedale,ID83628
      PC Senior Nutrition program pilot 5,000
    Idaho Hunger Relief Task Force Inc
    963 S Orchard St Ste 206
    Boise,ID83705
      PC Physical activity equipment or programs at school 1,000
    Idaho State University Foundation Inc
    921 S 8th Ave Stop 8050
    Pocatello,ID83209
      GOV Behavioral Health and Accessibility Scholarship and Rural Clinical Training Stipends 300,000
    Idaho Walk Bike Alliance
    PO Box 1594
    Boise,ID83701
      PC Education on improving walkability and bikeability. 1,000
    Idaho Walk Bike Alliance
    PO Box 1594
    Boise,ID83701
      PC Support Idaho Walking College Pilot Program 42,257
    Idaho Youth Ranch Inc
    5465 West Irving St
    Boise,ID83706
      PC Support ACES campaign 25,000
    Immaculate Conception Academy
    614 E 5th Ave
    Post Falls,ID83854
      GOV Physical activity equipment or programs at school 500
    Indian Creek Elementary School
    911 W 4th St
    Kuna,ID83634
      GOV Physical activity equipment or programs at school 500
    Jannus Inc
    1607 W Jefferson St
    Boise,ID83702
      PC Funding to secure a technology grant from the State Department of Education 1,560
    Jannus Inc
    1607 W Jefferson St
    Boise,ID83702
      PC Idaho Refugee Vaccine Campaign 8,941
    Jannus Inc
    1607 W Jefferson St
    Boise,ID83702
      PC Vaccine clinics for the Idaho Refugees 17,000
    Jannus Inc
    1607 W Jefferson St
    Boise,ID83702
      PC Idaho Out of School Network 10,000
    Kennedy Elementary School (District 321)
    60 S 5th W
    Rexburg,ID83440
      GOV Physical activity equipment or programs at school 1,000
    Koelsch Elementary School
    2015 N Curtis Rd
    Boise,ID83706
      GOV Physical activity equipment or programs at school 500
    Lava Elementary School
    249 W Fife PO Box 660
    Lava Hot Springs,ID83246
      GOV Physical activity equipment or programs at school 1,000
    Leadore School
    111 S 3rd Street
    Leadore,ID83464
      GOV Physical activity equipment or programs at school 1,000
    League of Idaho Cities Inc
    3100 S Vista Ave Suite 201
    Boise,ID83705
      PC Readers as Learners program support 10,000
    League of Idaho Cities Inc
    3100 S Vista Ave Suite 201
    Boise,ID83705
      PC Support Readers Becoming Leaders program 10,000
    LEAP Charities Inc
    1220 S Vista Ave
    Boise,ID83705
      PC LEAP Housing Trust - Mountain Home affordable housing project. 150,000
    Lewis-Clark State College Foundation Inc
    500 8th Avenue
    Lewiston,ID83501
      GOV Scholarship 100,000
    Lincoln County DBA Lincoln County Youth Center
    111 W B Street Suite C
    Shoshone,ID83349
      GOV Lincoln County Youth Center programming support 40,000
    Lincoln Elementary School
    238 Buhl St N
    Twin Falls,ID83301
      GOV Physical activity equipment or programs at school 1,000
    Midvale School District #433
    56 N School Road
    Midvale,ID83645
      GOV Physical activity equipment or programs at school 1,000
    Monroe Elementary
    3615 W Cassia St
    Boise,ID83705
      GOV Physical activity equipment or programs at school 1,000
    Mountain Home School District #193
    470 NORTH 3RD EAST
    MOUNTAIN HOME,ID83647
      GOV Physical activity equipment or programs at school 1,000
    Nampa Farmers' Market
    PO Box 332
    Nampa,ID83653
      PC Support senior program at the winter farmers market. 2,500
    Nampa School District
    619 S Canyon St
    Nampa,ID83686
      GOV Physical activity equipment or programs at school 500
    Nampa School District
    619 S Canyon St
    Nampa,ID83686
      GOV Trauma informed training for the school district. 50,000
    Nezperce High School in Nezperce ID
    1767 Blue Sky Dr
    Idaho Falls,ID83402
      GOV Physical activity equipment or programs at school 1,000
    North Idaho Christian School
    251 W Miles
    Hayden,ID83835
      GOV Physical activity equipment or programs at school 1,000
    North Idaho STEM Charter Academy
    PO Box 434
    Rathdrum,ID83858
      GOV Physical activity equipment or programs at school 1,000
    North Star Charter School
    839 N Linder Rd
    Eagle,ID83616
      GOV Physical activity equipment or programs at school 1,000
    Pinecrest Academy of Idaho
    209 5th Ave N
    Twin Falls,ID83301
      GOV Physical activity equipment or programs at school 1,000
    Preston School District
    105 E 2nd S
    Preston,ID83263
      GOV Physical activity equipment or programs at school 1,000
    Rural Idaho & Mountain West Primary Care Fund Inc
    1401 E Central Dr
    Meridian,ID83642
      PC Medical education debt repayment for rural physicians practicing in Idaho. 100,000
    Rural Idaho & Mountain West Primary Care Fund Inc
    1401 E Central Dr
    Meridian,ID83642
      PC Rural Physician Scholarship 100,000
    Shadow Hills Elementary
    8301 W Sloan St
    Boise,ID83714
      GOV Physical activity equipment or programs at school 500
    Shelley Joint School District #60
    545 Seminary Ave
    Shelley,ID83274
      GOV Physical activity equipment or programs at school 1,000
    Skyline High School
    1767 Blue Sky Dr
    Idaho Falls,ID83402
      GOV Physical activity equipment or programs at school 1,000
    South Central Idaho Hispanic Chamber of Commerce Inc
    247 Main Ave West
    Twin Falls,ID83301
      NC Support for Hispanic Vaccine Campaign 25,000
    St Luke's Health Foundation Ltd
    190 E Bannock
    Boise,ID83712
      PC Support children's health mobile van program. 15,000
    State of Idaho Department of Education
    650 W State St
    Boise,ID83720
      GOV Support for the 2021 Idaho Prevention and Support Conference. 7,500
    Stone Elementary
    10808 S 23000 W
    Stone,ID83252
      GOV Physical activity equipment or programs at school 500
    Sts Peter & Paul Elementary
    330 S B Street
    Grangeville,ID83530
      GOV Physical activity equipment or programs at school 1,000
    Summit Elementary School
    200 10th Ave W
    Jerome,ID83338
      GOV Physical activity equipment or programs at school 1,000
    Swan Valley Elementry School
    3389 Swan Valley Hwy
    Irwin,ID83428
      GOV Physical activity equipment or programs at school 500
    Taylorview Middle School
    350 Castlerock Lane
    Idaho Falls,ID83404
      GOV Physical activity equipment or programs at school 1,000
    The College Of Idaho
    2112 Cleveland Blvd Box 49
    Caldwell,ID83605
      GOV Scholarship 100,500
    The Home Partnership Foundation Inc
    PO Box 7899
    Boise,ID83707
      PC Support critical resources to ensure Idahoans have access to safe, stable, affordable housing 10,000
    The Home Partnership Foundation Inc
    PO Box 7899
    Boise,ID83707
      PC Our Path Home campaign to combat family homelessness 25,000
    The Idaho Commission for Libraries
    325 W State Street
    Boise,ID83702
      GOV Grant to fund pilot of telehealth in libraries 30,000
    The Idaho Commission for Libraries
    325 W State Street
    Boise,ID83702
      GOV Expansion of telehealth in libraries in Idaho 50,000
    The Jesse Tree of Idaho
    1121 W Miller Street
    Boise,ID83702
      PC Partnership with FMRI to determine effectiveness of Community Health Worker 100,000
    The Mentoring Network Inc
    711 N Dover Court
    Nampa,ID83651
      PC Support programming & service needs to train and match volunteer mentors with mentee students 10,000
    Thomas Jefferson Charter School
    1209 Adam Smith Ave
    Caldwell,ID83605
      GOV Physical activity equipment or programs at school 500
    United Way of Southeastern Idaho
    PO Box 911
    Pocatello,ID83204
      PC Support Connect East Idaho Initiative 25,000
    University of Idaho Foundation
    875 Perimeter Dr MS 3143
    Moscow,ID83844
      GOV WWAMI Rural Initiative Scholarship 100,000
    University of Idaho Foundation
    875 Perimeter Dr MS 3143
    Moscow,ID83844
      GOV Vandal Promise Scholarship 100,000
    University of Idaho Foundation
    875 Perimeter Dr MS 3143
    Moscow,ID83844
      GOV Project ECHO Idaho Behavioral Health Programming Support Endowment 100,000
    Upriver Elementary
    75 Fern St PO Box 249
    Fernwood,ID83830
      GOV Physical activity equipment or programs at school 500
    Valley View Elementary
    3555 N Milwaukee St
    Boise,ID83704
      GOV Physical activity equipment or programs at school 1,000
    Whitepine Joint School District 288
    P O Box 249
    Deary,ID83823
      GOV Physical activity equipment or programs at school 500
    Wilder School District #133
    419 Huff Rd
    Wilder,ID83676
      GOV Physical activity equipment or programs at school 500
    Total .................................bullet 3a 2,698,953
    bApproved for future payment
    City Of Orofino
    217 1St St
    Orofino,ID83544
      GOV Water Fountains at Orofino Junior Senior HIgh 7,608
    Southwest District Health
    13307 Miami Ln
    Caldwell,ID83607
      GOV Support evaluation project determining impact of a full-time nurse 83,250
    Total .................................bullet 3b 90,858
    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 ............
        18 8,394,962  
    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) .. 0 9,936,090 0
    13Total. Add line 12, columns (b), (d), and (e)..................
    13
    9,936,090
    (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:
    Blue Cross of Idaho Foundation For
     
    Health Inc
    EIN:
    26-0024334
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    Accounting Fees 4,400 440   3,960

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

    TY 2021 DepreciationSchedule
    Name:
    Blue Cross of Idaho Foundation For
     
    Health Inc
    EIN:
    26-0024334
    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
    Furniture 2018-07-15 64,282 16,070 SL 10.000000000000 6,428 0    
    AV Equipment 2018-07-15 9,570 4,785 SL 5.000000000000 1,914 0    
    Construction/Architect (Leasehold Improvement) 2018-07-01 65,487 35,308 SL 5.050000000000 14,146 0    
    Sign 2018-08-01 3,861 1,866 SL 5.000000000000 772 0    
    Wall Mural (Leasehold Improvement) 2018-09-01 4,632 2,177 SL 5.050000000000 917 0    
    Equipment 2019-12-01 3,396 368 SL 10.000000000000 340 0    

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

    TY 2021 ExpenditureResponsibilityStmt
    Name:
    Blue Cross of Idaho Foundation For
     
    Health Inc
    EIN:
    26-0024334
    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
    South Central Idaho Hispanic Chamber of Commerce Inc
     
    752 Addison Ave
    Twin Falls,ID83301
    2021-02-04 25,000 Financial support for a vaccine campaign targeted to HIspanic communities in Idaho 25,000 None   2022-08-11  
    Downtown Boise Association Inc
     
    816 W Bannock Street STE 310
    Boise,ID83702
    2021-11-08 120,000 To support equipment and material purchase for the downtown Boise skating rink that will be accessible free of charge to the community. 0 None   2022-08-17  

    TY 2021 InvestmentsOtherSchedule2
    Name:
    Blue Cross of Idaho Foundation For
     
    Health Inc
    EIN:
    26-0024334
    Category/ Item Listed at Cost or FMV Book Value End of Year Fair Market Value
    Vanguard Total Bond Fund Index Adm FMV 15,709,642 15,709,642
    Vanguard Institutional Index Fund FMV 21,714,413 21,714,413
    Dodge & Cox Int'l Stock Fund FMV 9,564,143 9,564,143
    Vanguard International Stock Fund FMV 9,482,519 9,482,519
    Vanguard Extended Market ETF FMV 7,887,423 7,887,423
    DWS RREEF FMV 4,385,985 4,385,985
    HARDING LOEVNER:IE IZ FMV 9,383,823 9,383,823
    Vanguard Total Bond Fund Index Adm FMV 26,180 26,180

    TY 2021 LandEtcSchedule2
    Name:
    Blue Cross of Idaho Foundation For
     
    Health Inc
    EIN:
    26-0024334
    Category / Item Cost / Other Basis Accumulated Depreciation Book Value End of Year Fair Market Value
    Furniture 64,282 22,498 41,784 41,784
    AV Equipment 9,570 6,699 2,871 2,871
    Construction/Architect (Leasehold Improvement) 65,487 49,454 16,033 16,033
    Sign 3,861 2,638 1,223 1,223
    Wall Mural (Leasehold Improvement) 4,632 3,094 1,538 1,538
    Equipment 3,396 708 2,688 2,688


    TY 2021 OtherAssetsSchedule
    Name:
    Blue Cross of Idaho Foundation For
     
    Health Inc
    EIN:
    26-0024334
    Description Beginning of Year - Book Value End of Year - Book Value End of Year - Fair Market Value
    Investment Receivable 0 2,726,181 2,726,181


    TY 2021 OtherDecreasesSchedule
    Name:
    Blue Cross of Idaho Foundation For
     
    Health Inc
    EIN:
    26-0024334
    Description Amount
    Unrealized Gain/Loss 568,906


    TY 2021 OtherExpensesSchedule
    Name:
    Blue Cross of Idaho Foundation For
     
    Health Inc
    EIN:
    26-0024334
    Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    Miscellaneous Expenses 36,492 0   36,663


    TY 2021 OtherProfessionalFeesSchedule
    Name:
    Blue Cross of Idaho Foundation For
     
    Health Inc
    EIN:
    26-0024334
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    Other Professional Fees 368,154 40,315   314,349


    TY 2021 TaxesSchedule
    Name:
    Blue Cross of Idaho Foundation For
     
    Health Inc
    EIN:
    26-0024334
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    Federal Excise Taxes 202,963 0   0