Form990-PF

Department of the Treasury
Internal Revenue Service

Return of Private Foundation
or Section 4947(a)(1) Trust Treated as Private Foundation
right arrowDo not enter social security numbers on this form as it may be made public.
right arrowGo to www.irs.gov/Form990PF for instructions and the latest information.
OMB No. 1545-0047
2022
Open to Public Inspection
For calendar year 2022, or tax year beginning 01-01-2022 , and ending 12-31-2022
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 right arrow
G Check all that apply:

D 1. Foreign organizations, check here............. right arrow
2. Foreign organizations meeting the 85%
test, check here and attach computation ... right arrow
E right arrow
H Check type of organization:
F right arrow
I Fair market value of all assets at end
of year (from Part II, col. (c),
line 16)right arrow$115,738,217J 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) 17,455,855
2 Check right arrow.............
3 Interest on savings and temporary cash investments 46,491 46,491  
4 Dividends and interest from securities... 2,909,312 2,097,440  
5a Gross rents............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10 1,903,613
b Gross sales price for all assets on line 6a 18,060,405
7 Capital gain net income (from Part IV, line 2)... 17,882,809
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
List of Attached Documents:
// Content
-2,798,601 -326,853  
12 Total. Add lines 1 through 11........ 19,516,670 19,699,887  
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 759,860 55,066   645,244
14 Other employee salaries and wages...... 350,660 2,119   345,991
15 Pension plans, employee benefits....... 302,844 34,247   175,271
16a Legal fees (attach schedule)......... Click to see attachment
List of Attached Documents:
// Content
24,095 26,164   24,019
b Accounting fees (attach schedule)....... Click to see attachment
List of Attached Documents:
// Content
126,270 52,785   63,135
c Other professional fees (attach schedule).... Click to see attachment
List of Attached Documents:
// Content
709,782 734,963   316,170
17 Interest............... 19,851 19,851   0
18 Taxes (attach schedule) (see instructions)... Click to see attachment
List of Attached Documents:
// Content
172,933 61,446   0
19 Depreciation (attach schedule) and depletion... Click to see attachment
List of Attached Documents:
// Content
64,250 0  
20 Occupancy.............. 74,142 0   73,936
21 Travel, conferences, and meetings....... 221,607 0   221,607
22 Printing and publications.......... 142 0   142
23 Other expenses (attach schedule)....... Click to see attachment
List of Attached Documents:
// Content
484,673 0   436,082
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 3,311,109 986,641   2,301,597
25 Contributions, gifts, grants paid....... 3,328,075 3,328,075
26 Total expenses and disbursements. Add lines 24 and 25 6,639,184 986,641   5,629,672
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements 12,877,486
b Net investment income (if negative, enter -0-) 18,713,246
c Adjusted net income (if negative, enter -0-)...  
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 11289X Form 990-PF (2022)
Form 990-PF (2022)
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............. 446,270 593,969 593,969
2 Savings and temporary cash investments.........      
3 Accounts receivable right arrow80,553
Less: allowance for doubtful accounts right arrow   52,731 80,553 80,553
4 Pledges receivable right arrow  
Less: allowance for doubtful accounts right arrow        
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) right arrow  
Less: allowance for doubtful accounts right arrow        
8 Inventories for sale or use..............      
9 Prepaid expenses and deferred charges..........      
10a Investments—U.S. and state government obligations (attach schedule) 1,055,660 Click to see attachment
List of Attached Documents:
// Content
4,118,812 		4,118,812
b Investments—corporate stock (attach schedule)....... 33,616,123 Click to see attachment
List of Attached Documents:
// Content
33,906,421 		33,906,421
c Investments—corporate bonds (attach schedule)....... 7,650,602 Click to see attachment
List of Attached Documents:
// Content
7,692,311 		7,692,311
11 Investments—land, buildings, and equipment: basis right arrow  
Less: accumulated depreciation (attach schedule) right arrow        
12 Investments—mortgage loans.............      
13 Investments—other (attach schedule).......... 66,443,956 Click to see attachment
List of Attached Documents:
// Content
66,321,371 		66,321,371
14 Land, buildings, and equipment: basis right arrow3,168,696
Less: accumulated depreciation (attach schedule) right arrow143,916 2,473,685 Click to see attachment
List of Attached Documents:
// Content
3,024,780 		3,024,780
15 Other assets (describe right arrow)      
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 111,739,027 115,738,217 115,738,217
Liabilities 17 Accounts payable and accrued expenses.......... 14,455 64,815
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 right arrow) Click to see attachment
List of Attached Documents:
// Content
1,624,543 		Click to see attachment
List of Attached Documents:
// Content
2,117,115
23 Total liabilities (add lines 17 through 22)......... 1,638,998 2,181,930
Net Assets or Fund Balances Foundations that follow FASB ASC 958, check here right arrow
and complete lines 24, 25, 29 and 30.
24 Net assets without donor restrictions........... 110,100,029 113,556,287
25 Net assets with donor restrictions............    
Foundations that do not follow FASB ASC 958, check here right arrow
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)..... 110,100,029 113,556,287
30 Total liabilities and net assets/fund balances (see instructions). 111,739,027 115,738,217
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
110,100,029
2
Enter amount from Part I, line 27a .....................
2
12,877,486
3
Other increases not included in line 2 (itemize) right arrow
3
0
4
Add lines 1, 2, and 3 ..........................
4
122,977,515
5
Decreases not included in line 2 (itemize) right arrowClick to see attachment
List of Attached Documents:
// Content
5
9,421,228
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29 .
6
113,556,287
Form 990-PF (2022)
Form 990-PF (2022)
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 13,955,855   177,596 13,778,259
b 3,611,570     3,611,570
c 492,980     492,980
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       13,778,259
b       3,611,570
c       492,980
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 17,882,809
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 (2022)
Form 990-PF (2022)
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 right arrow 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) 1 260,114
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........................... 3 260,114
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- ..... 5 260,114
6 Credits/Payments:
a 2022 estimated tax payments and 2021 overpayment credited to 2022 6a 201,649
b Exempt foreign organizations—tax withheld at source...... 6b 0
c Tax paid with application for extension of time to file (Form 8868)... 6c 125,000
d Backup withholding erroneously withheld ........... 6d 0
7 Total credits and payments. Add lines 6a through 6d.............. 7 326,649
8 Enter any penalty for underpayment of estimated tax. Check here if Form 2221 is attached. Click to see attachment
List of Attached Documents:
// Content
8 121
9 Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed.......right arrow 9  
10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid...right arrow 10 66,414
11 Enter the amount of line 10 to be: Credited to 2023 estimated taxright arrow66,414 Refundedright arrow 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. right arrow$ 0(2) On foundation managers.right arrow$ 0
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.right arrow$ 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:
round bullet By language in the governing instrument, or
round bullet 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)
right arrowMT
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 2022 or the taxable year beginning in 2022? 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 (2022)
Form 990-PF (2022)
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 addressright arrowWWW.HEADWATERSMT.ORG
14
The books are in care ofright arrowMYNOR VELIZ Telephone no.right arrow (406) 926-6526

Located atright arrow119 W MAIN STREETMISSOULAMT ZIP+4right arrow59802
15
Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of Form 1041 —check here .........right arrow
and enter the amount of tax-exempt interest received or accrued during the year ........right arrow
15
 
16 At any time during calendar year 2022, 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 right arrow
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
Organizations relying on a current notice regarding disaster assistance check here ........right arrow
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 2022? .............
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 2022, did the foundation have any undistributed income (Part XII, lines 6d
and 6e) for tax year(s) beginning before 2022?....................
2a
 
No
If "Yes," list the years right arrow20, 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.
right arrow20, 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 2022 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 2022.) .....................
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 2022? ..
4b
 
No
Form 990-PF (2022)
Form 990-PF (2022)
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
Yes
 
c
Organizations relying on a current notice regarding disaster assistance check .........right arrow
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
List of Attached Documents:
// Content
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
CARISSA KUHL CHAIR
1.30 		0 0 0
119 W MAIN STREET
MISSOULA,MT59802
KELLEY RISCHKE VICE CHAIR
1.30 		0 0 0
119 W MAIN STREET
MISSOULA,MT59802
RICHARD OPPER SECRETARY/TREASURER
1.30 		0 0 0
119 W MAIN STREET
MISSOULA,MT59802
RACHEL HUFF-DORIA TRUSTEE
1.30 		0 0 0
119 W MAIN STREET
MISSOULA,MT59802
ROBERT J PHILLIPS TRUSTEE
1.30 		0 0 0
119 W MAIN STREET
MISSOULA,MT59802
JASON SMITH TRUSTEE
1.30 		0 0 0
119 W MAIN STREET
MISSOULA,MT59802
MIKE STEWART TRUSTEE
1.30 		0 0 0
119 W MAIN STREET
MISSOULA,MT59802
CHRISTINA TWOHIG TRUSTEE
1.30 		0 0 0
119 W MAIN STREET
MISSOULA,MT59802
JEANNE TWOHIG TRUSTEE
1.30 		0 0 0
119 W MAIN STREET
MISSOULA,MT59802
JORDAN THOMPSON TRUSTEE
1.30 		0 0 0
119 W MAIN STREET
MISSOULA,MT59802
MARILYN ZIMMERMAN TRUSTEE
1.30 		0 0 0
119 W MAIN STREET
MISSOULA,MT59802
BRENDA SOLORZANO-CLAUDLE CHIEF EXECUTIVE OFFICER
40.00 		316,704 24,502 0
119 W MAIN STREET
MISSOULA,MT59802
MYNOR VELIZ CHIEF FINANCIAL OFFICER
40.00 		252,866 17,039 0
119 W MAIN STREET
MISSOULA,MT59802
ERIN SWITALSKI PROGRAM DIRECTOR
40.00 		135,593 13,155 0
119 W MAIN STREET
MISSOULA,MT59802
2 Compensation of five highest-paid employees (other than those included on line 1—see instructions). If none, enter “NONE."
(a) Name and address of each employee paid more than $50,000 (b) Title, and average
hours per week
devoted to position 		(c) Compensation (d) Contributions to
employee benefit
plans and deferred
compensation 		(e) Expense account,
other allowances
ASHLEY N SHAW PROGRAM OFFICER
40.00 		85,598 6,834 0
119 W MAIN STREET
MISSOULA,MT59802
STEPHANIE SCHILLING EVALUATION AND OPERA
40.00 		85,395 4,524 0
119 W MAIN STREET
MISSOULA,MT59802
CARI L CUFFNEY PROGRAM OFFICER
40.00 		79,599 6,589 0
119 W MAIN STREET
MISSOULA,MT59802
ROBYN E WINDHAM COMMUNICATIONS SPECI
40.00 		72,454 7,803 0
119 W MAIN STREET
MISSOULA,MT59802
MARGUERITE SELDIN JIMENEZ EVALUATION AND OPERA
40.00 		51,750 3,105 0
119 W MAIN STREET
MISSOULA,MT59802
Total number of other employees paid over $50,000...................right arrow 0
Form 990-PF (2022)
Form 990-PF (2022)
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 129,516
1411 4TH AVENUE 12TH FLOOR
SEATTLE,WA98101
GECKO DESIGNS CONSULTING 72,194
523 N HIGGINS AVENUE
MISSOULA,MT59802
MOSS ADAMS LLP AUDIT AND TAX 67,240
805 SW BROADWAY STREET SUITE 1200
PORTLAND,OR97205
PHILANTHROPY NORTHWEST INC CONSULTING 61,984
600 UNIVERSITY STREET SUITE 1725
SEATTLE,WA98101
WIPFLI LLP BOOKKEEPING 59,030
101 E FRONT STREET
MISSOULA,MT59802
Total number of others receiving over $50,000 for professional services.............right arrow4
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.........................right arrow0
Form 990-PF (2022)
Form 990-PF (2022)
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
37,067,051
b
Average of monthly cash balances.......................
1b
1,122,305
c
Fair market value of all other assets (see instructions)................
1c
66,321,371
d
Total (add lines 1a, b, and c).........................
1d
104,510,727
e
Reduction claimed for blockage or other factors reported on lines 1a and
1c (attach detailed explanation) .............
1e
0
2
Acquisition indebtedness applicable to line 1 assets..................
2
0
3
Subtract line 2 from line 1d.........................
3
104,510,727
4
Cash deemed held for charitable activities. Enter 1.5% (0.015) of line 3 (for greater amount, see
instructions) .............................
4
1,567,661
5
Net value of noncharitable-use assets. Subtract line 4 from line 3. ............
5
102,943,066
6
Minimum investment return. Enter 5% (0.05) of line 5................
6
5,147,153
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
5,147,153
2a
Tax on investment income for 2022 from Part V, line 5.......
2a
260,114
b
Income tax for 2022. (This does not include the tax from Part V.) ...
2b
1,169
c
Add lines 2a and 2b............................
2c
261,283
3
Distributable amount before adjustments. Subtract line 2c from line 1............
3
4,885,870
4
Recoveries of amounts treated as qualifying distributions................
4
0
5
Add lines 3 and 4............................
5
4,885,870
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
4,885,870
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
5,629,672
b
Program-related investments—total from Part VIII-B..................
1b
0
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
5,629,672
Form 990-PF (2022)
Form 990-PF (2022)
Page 9
Part XII
Undistributed Income (see instructions)
(a)
Corpus 		(b)
Years prior to 2021 		(c)
2021 		(d)
2022
1 Distributable amount for 2022 from Part X, line 7 4,885,870
2 Undistributed income, if any, as of the end of 2022:
a Enter amount for 2021 only....... 0
b Total for prior years:20, 20, 20 0
3 Excess distributions carryover, if any, to 2022:
a From 2017......  
b From 2018......  
c From 2019......  
d From 2020......  
e From 2021...... 5,315,539
f Total of lines 3a through e ........ 5,315,539
4Qualifying distributions for 2022 from Part
XI, line 4: right arrow$ 5,629,672
a Applied to 2021, 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 2022 distributable amount..... 4,885,870
e Remaining amount distributed out of corpus 743,802
5 Excess distributions carryover applied to 2022. 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 6,059,341
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 2021. Subtract line
4a from line 2a. Taxable amount—see
instructions ............. 		0
f Undistributed income for 2022. Subtract
lines 4d and 5 from line 1. This amount must
be distributed in 2023 .......... 		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 2017 not
applied on line 5 or line 7 (see instructions) ... 		0
9 Excess distributions carryover to 2023.
Subtract lines 7 and 8 from line 6a ...... 		6,059,341
10 Analysis of line 9:
a Excess from 2018....  
b Excess from 2019....  
c Excess from 2020....  
d Excess from 2021.... 5,315,539
e Excess from 2022.... 743,802
Form 990-PF (2022)
Form 990-PF (2022)
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 2022, enter the date of the ruling ...... right arrow
 
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 IX for each
year listed .......... 		Tax year Prior 3 years (e) Total
(a) 2022 (b) 2021 (c) 2020 (d) 2019
         
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 right arrow
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 (2022)
Form 990-PF (2022)
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

ALBERTON SCHOOL

PO BOX 330
ALBERTON,MT59820 		  GOV GENERAL OPERATING 7,500

ALL NATIONS HEALTH CENTER

830 W CENTRAL AVE
MISSOULA,MT59801 		  PC GENERAL OPERATING 100,000

ANACONDA JR HIGH SCHOOL

1410 WEST PARK AVE
ANACONDA,MT59711 		  GOV GENERAL OPERATING 7,500

ANACONDA MINISTERIAL PROJECT CARE

PO BOX 1280
ANACONDA,MT59711 		  PC GENERAL OPERATING 3,000

ANACONDA SR HIGH SCHOOL

1410 WEST PARK AVE
ANACONDA,MT59711 		  GOV GENERAL OPERATING 7,500

ARLEE COMMUNITY DEVELOPMENT CORPORATION

PO BOX 452
ARLEE,MT59821 		  PC GENERAL OPERATING 7,500

ARLEE ELEMENTARY SCHOOL

72220 FYANT ST
ARLEE,MT59821 		  GOV GENERAL OPERATING 7,500

ARLEE HIGH SCHOOL

72220 FYANT ST
ARLEE,MT59821 		  GOV GENERAL OPERATING 7,500

AWARE INC

200 S POLK ST
ANACONDA,MT59711 		  GOV GENERAL OPERATING 7,500

BACKPACK ASSISTANCE PROGRAM

PO BOX 981
WHITEFISH,MT59937 		  PC GENERAL OPERATING 7,500

BEAVERHEAD COMMUNITY WOOD BANK MINISTRY INC

PO BOX 1414
DILLON,MT59725 		  PC GENERAL OPERATING 5,000

BIGFORK ACES INC

439 GRAND DR
BIGFORK,MT59911 		  PC GENERAL OPERATING 7,500

BITTER ROOT RESOURCE CONSERVATION AND DEVELOPMENT AREA INC

PO BOX 870
HAMILTON,MT59840 		  PC FOR THE BENEFIT OF CULTIVATING CONNECTIONS 7,500

BITTERROOT ECOLOGICAL AWARENESS RESOURCES INC

1105 W MAIN ST
HAMILTON,MT59840 		  PC GENERAL OPERATING 7,500

BOYS & GIRLS CLUB OF GLACIER COUNTRY

PO BOX 961
COLUMBIA FLS,MT59912 		  PC GENERAL OPERATING 7,500

BUTTE 4 C'S

101 N MAIN ST
BUTTE,MT59701 		  PC GENERAL OPERATING 7,500

CANVAS EARLY LEARNING CENTER

512 1/2 N WASHINGTON ST
DILLON,MT59725 		  PC GENERAL OPERATING 200,000

CARDWELL SCHOOL

80 MT HWY 359
CARDWELL,MT59721 		  GOV GENERAL OPERATING 7,500

CASA OF LAKE COUNTY

PO BOX 511
POLSON,MT59860 		  GOV GENERAL OPERATING 7,500

CHILDWISE INSTITUTE

500 S LAMBORN ST
HELENA,MT59601 		  PC GENERAL OPERATING 7,500

COMMON GOOD MONTANA

301 W ALDER ST
MISSOULA,MT59802 		  PC GENERAL OPERATING 10,000

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 7,500

CREATIVE ARTS COUNCIL

PO BOX 1164
EUREKA,MT59917 		  PC GENERAL OPERATING 5,000

DOMESTIC SHELTERS

236 E REEDER ST
DILLON,MT59725 		  NC WOMEN'S RESOURCE CENTER 7,500

DREAM ADAPTIVE RECREATION INC

PO BOX 4084
WHITEFISH,MT59937 		  PC 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 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

EMMA'S HOUSE CHILDRENS ADVOCACY CENTER INC

PO BOX 2034
HAMILTON,MT59840 		  PC GENERAL OPERATING 7,500

EVERGREEN KIDS CORNER INC

201 S 8TH ST
HAMILTON,MT59840 		  PC GENERAL OPERATING 7,500

FAMILIES FIRST LEARNING LAB

PO BOX 5626
MISSOULA,MT59806 		  PC GENERAL OPERATING 7,500

FIFTH JUDICAL DISTRICT VOICE FOR CHILDREN INC

PO BOX 1464
DILLON,MT59725 		  PC GENERAL OPERATING 7,500

FLINT CREEK CHILDCARE CO

PO BOX 1205
PHILIPSBURG,MT59858 		  PC GENERAL OPERATING 7,500

FLORENCE CRITTENTON HOME & SERVICES

901 N HARRIS ST
HELENA,MT59601 		  PC GENERAL OPERATING 7,500

FREE VERSE PROJECT

28 FORT MISSOULA RD
MISSOULA,MT59804 		  PC GENERAL OPERATING 7,500

FRIENDS OF THE PHILIPSBURG LIBRARY

PO BOX 797
PHILIPSBURG,MT59858 		  PC GENERAL OPERATING 7,000

GRACE LUTHERAN CHURCH

275 HATTIE LN
HAMILTON,MT59840 		  PC GENERAL OPERATING 7,500

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

HELENA AREA HABITAT FOR HUMANITY

PO BOX 459
HELENA,MT59624 		  PC GENERAL OPERATING 107,500

HELPING HANDS

PO BOX 1094
POLSON,MT59860 		  PC GENERAL OPERATING 200,000

HELPING HOOVES

382 ADAMS LN
DILLON,MT59725 		  PC GENERAL OPERATING 7,500

HERE MONTANA

2300 REGENT ST SUITE 101
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 CORPORATION

PO BOX 1079
WHITEHALL,MT59759 		  PC TO DEVELOP AND ENSURE SUSTAINABLE CHILDCARE 50,000

KOOTENAI HERITAGE COUNCIL INC

PO BOX 360
LIBBY,MT59923 		  PC GENERAL OPERATING 7,500

KUKI A KILWIY INC

PO BOX 116
ELMO,MT59915 		  PC GENERAL OPERATING 7,500

LAUNDRY LOVE HAMILTON DBA LOADS OF DIGNITY

177 ALICE AVE
HAMILTON,MT59840 		  PC GENERAL OPERATING 7,500

LIBBY FOOD PANTRY INC

PO BOX 311
LIBBY,MT59923 		  PC GENERAL OPERATING 7,500

LINCOLN COUNTY PUBLIC LIBRARIES FOUNDATION

220 W 6TH ST
LIBBY,MT59923 		  GOV GENERAL OPERATING 7,500

LINCOLN PRIMARY SCHOOL

506 CHESTNUT
ANACONDA,MT59711 		  GOV PRESCHOOL 7,500

LITERACY VOLUNTEERS OF AMERICA BITTERROOT INC

303 N THIRD ST
HAMILTON,MT59840 		  PC LITERARCY BITTERRROOT 7,500

MAPS MEDIA INSTITUTE INC

515 MADISON ST
HAMILTON,MT59840 		  PC GENERAL OPERATING 12,500

MINERAL COUNTY COMMUNITY FOUNDATION

PO BOX 93
SUPERIOR,MT59872 		  PC GENERAL OPERATING 7,500

MISSOULA NONPROFIT CENTER

2412 55TH ST UNIT B
MISSOULA,MT59803 		  PC CHAMPIONSHIP BOXING MISSOULA 25,000

MONTANA ADVOCATES FOR CHILDREN

PO BOX 808
LOLO,MT59847 		  PC GENERAL OPERATING 75,000

MONTANA ASSOCIATION FOR THE EDUCATION OF YOUNG CHILDREN

PO BOX 11568
BOZEMAN,MT59719 		  PC GENERAL OPERATING 7,500

MONTANA CONTINUUM OF CARE COALITION

PO BOX 7644
MISSOULA,MT59807 		  PC GENERAL OPERATING 7,500

MONTANA DEPARTMENT OF PUBLIC HEALTH AND HUMAN SERVICES

1625 11TH AVE
HELENA,MT59620 		  GOV NO KID HUNGRY MONTANA 13,500

MONTANA FOOD BANK NETWORK INC

5625 EXPRESSWAY
MISSOULA,MT59808 		  PC GENERAL OPERATING 35,000

MONTANA FOOD BANK NETWORK

34 RIVERVIEW DR
TROY,MT59935 		  PC YAAK FOOD CUPBOARD 7,500

MONTANA FOOD BANK NETWORK

PO BOX 767
PLAINS,MT59859 		  PC PLAINS COMMUNITY FOOD BANK 7,500

MONTANA FREE PRESS

PO BOX 1425
HELENA,MT59624 		  PC GENERAL OPERATING 40,000

MONTANA NONPROFIT ASSOCIATION INC

PO BOX 1744
HELENA,MT59624 		  PC GENERAL OPERATING 210,000

MTAEYC

PO BOX 601
KALISPELL,MT59901 		  PC FLATHEAD CHAPTER 7,500

NEVER ALONE RECOVERY SUPPORT SERVICES

PO BOX 406
RONAN,MT59864 		  PC GENERAL OPERATING 5,800

NKWUSM SALISH LANGUAGE INSTITUTE

PO BOX 5
ARLEE,MT59821 		  PC GENERAL OPERATING 7,500

NORTH MISSOULA COMMUNITY DEVELOPMENT CORPORATION

1500 BURNS ST
MISSOULA,MT59802 		  PC GENERAL OPERATING 100,000

NORTH VALLEY FOOD BANK INC

251 FLATHEAD AVE
WHITEFISH,MT59937 		  PC GENERAL OPERATING 7,500

NURTURING CENTER INC

322 2ND AVE W
KALISPELL,MT59901 		  PC GENERAL OPERATING 7,500

OPPORTUNITY CLUB

909 STEWART ST
ANACONDA,MT59711 		  PC GENERAL OPERATING 7,500

PARTNERSHIP HEALTH CENTER

401 RAILROAD ST W
MISSOULA,MT59802 		  PC GENERAL OPERATING 70,000

PLAINS 7-8 HIGH SCHOOL

412 RITTENOUR ST
PLAINS,MT59859 		  GOV PLAINS ELEMENTARY SCHOOL DISTRICT 7,500

PLAINS ELEMENTARY SCHOOL

412 RITTENOUR ST
PLAINS,MT59859 		  GOV GENERAL OPERATING 7,500

POLSON SCHOOL DISTRICT 23

111 E 4TH AVE
POLSON,MT59860 		  GOV CHERRY VALLEY ELEMENTARY 7,500

POSTPARTUM RESOURCE GROUP

PO BOX 10394
KALISPELL,MT59904 		  PC GENERAL OPERATING 7,500

POVERELLO CENTER

1110 W BROADWAY ST
MISSOULA,MT59802 		  PC GENERAL OPERATING 84,000

PROJECT ASCENT

PO BOX 1954
THOMPSON FLS,MT59873 		  PC GENERAL OPERATING 6,500

PROMISE686

19 HOLCOMB BRIDGE RD
ATLANTA,GA30071 		  PC GENERAL OPERATING 7,500

REFRAMING RURAL

3204 NW 64TH ST APARTMENT C
SEATTLE,WA98107 		  PC GENERAL OPERATING 5,000

RESOURCE ASSISTANCE CENTER

BEAVERHEAD COUNTY 205 E CENTER ST
DILLON,MT59725 		  GOV GENERAL OPERATING 7,500

RONAN HIGH SCHOOL

421 ANDREW ST NW
RONAN,MT59864 		  GOV GENERAL OPERATING 7,500

RONAN SCHOOL DISTRICT 30

421 ANDREW ST NW
RONAN,MT59864 		  GOV RONAN HIGH SCHOOL 7,500

SAFE HARBOUR INC

PO BOX 497
RONAN,MT59864 		  PC GENERAL OPERATING 7,500

SANDERS COUNTY COMMUNITY HOUSING ORGANIZATION INC

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 		  GOV GENERAL OPERATING 7,500

SMELTER CITY RECREATION COMPLEX

123 MAIN ST
ANACONDA,MT59711 		  PC GENERAL OPERATING 7,500

SOUTHWEST MONTANA YOUTH PARTNERS

PO BOX 1132
BOULDER,MT59631 		  PC GENERAL OPERATING 50,000

ST REGIS FRIENDS AND NEIGHBORS CLUB

6 TIGER ST
SAINT REGIS,MT59866 		  PC GENERAL OPERATING 7,500

SUPPORTERS OF ABUSE FREE ENVIRONMENTS INC

PO BOX 534
HAMILTON,MT59840 		  PC GENERAL OPERATING 7,500

TFS COMMUNITY HALL

PO BOX 393
TREGO,MT59934 		  PC GENERAL OPERATING 5,775

THE HENRY J KAISER FAMILY FOUNDATION

185 BERRY ST SUITE 2000
SAN FRANCISCO,CA94107 		  PC GENERAL OPERATING 130,000

UNITED WAY OF MISSOULA COUNTY

412 W ALDER ST
MISSOULA,MT59802 		  PC GENERAL OPERATING 20,000

UNIVERSITY OF MONTANA

32 CAMPUS DR
MISSOULA,MT59812 		  GOV CENTER FOR CHILDREN, FAMILIES, AND WORKFORCE DEVELOPMENT 250,000

WATSON CHILDRENS SHELTER INC

4978 BUCKHOUSE LN
MISSOULA,MT59804 		  PC GENERAL OPERATING 5,000

WESTERN MONTANA PROFESSIONAL LEARNING COLLABORATIVE

4978 BUCKHOUSE LN
LOLO,MT59847 		  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

3240 DREDGE DR
HELENA,MT59602 		  PC GENERAL OPERATING 850,000
Total .................................right arrow 3a 3,328,075
bApproved for future payment
Total ................................. right arrow 3b 0
Form 990-PF (2022)
Form 990-PF (2022)
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 ........... 		    14 46,491  
4 Dividends and interest from securities .... 901101 225 14 2,909,087  
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 9,214 18 1,894,399  
9 Net income or (loss) from special events:          
10 Gross profit or (loss) from sales of inventory          
11 Other revenue:
aALTERNATIVE INVESTMENTS 		901101 37,831 14 -2,836,432  
b
c
d
e
12 Subtotal. Add columns (b), (d), and (e) .. 47,270 2,013,545 0
13Total. Add line 12, columns (b), (d), and (e)..................
13
2,060,815
(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 (2022)
Form 990-PF (2022)
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.
right arrow right arrow
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 Check if self-
employed right arrow		 PTIN
Firm's name SmallBullet
 Firm's EIN SmallBullet
Firm's address SmallBullet


 Phone no.
Form 990-PF (2022)
Additional Data


Software ID:  
Software Version:  


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

Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
Arrow Bullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2022
Name of the organization
HEADWATERS HEALTH FOUNDATION
OF WESTERN MONTANA
Employer identification number

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






Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note: Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......... Arrow Bullet $  
Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ
or on its Form 990PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990) (2022)
Schedule B (Form 990) (2022) Page 2
Name of organization
HEADWATERS HEALTH FOUNDATION
OF WESTERN MONTANA 		Employer identification number
81-1099715
Part I
Contributors
Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
1
CMC
 
6565 N MACARTHUR BLVD SUITE 800
 
IRVING, TX75039

$ 3,500,000


(Complete Part II for noncash contributions.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
2
MACKENZIE SCOTT
7683 SE 27TH ST
 
MERCER ISLAND, WA98040

$ 13,955,855


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

$  


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

$  


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

$  


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

$  


(Complete Part II for noncash contributions.)
Schedule B (Form 990) (2022)
Schedule B (Form 990) (2022)
Page 3
Name of organization
HEADWATERS HEALTH FOUNDATION
OF WESTERN MONTANA 		Employer identification number

81-1099715
Part II
Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a)
No. from Part I 		(b)
Description of noncash property given 		(c)
FMV (or estimate)
(See instructions) 		(d)
Date received
2
 PUBLICLY TRADED SECURITIES $ 13,955,855 2022-11-17
(a)
No. from Part I 		(b)
Description of noncash property given 		(c)
FMV (or estimate)
(See instructions) 		(d)
Date received
 
$    
(a)
No. from Part I 		(b)
Description of noncash property given 		(c)
FMV (or estimate)
(See instructions) 		(d)
Date received
 
$    
(a)
No. from Part I 		(b)
Description of noncash property given 		(c)
FMV (or estimate)
(See instructions) 		(d)
Date received
 
$    
(a)
No. from Part I 		(b)
Description of noncash property given 		(c)
FMV (or estimate)
(See instructions) 		(d)
Date received
 
$    
(a)
No. from Part I 		(b)
Description of noncash property given 		(c)
FMV (or estimate)
(See instructions) 		(d)
Date received
 
$    
Schedule B (Form 990) (2022)
Schedule B (Form 990) (2022)
Page 4
Name of organization
HEADWATERS HEALTH FOUNDATION
OF WESTERN MONTANA 		Employer identification number

81-1099715
Part III
Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
Use duplicate copies of Part III if additional space is needed.
(a)
No. from Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a)
No. from Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a)
No. from Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a)
No. from Part I		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
Schedule B (Form 990) (2022)
Additional Data


Software ID:  
Software Version:  

TY 2022 AccountingFeesSchedule
Name:
HEADWATERS HEALTH FOUNDATION
 
OF WESTERN MONTANA
EIN:
81-1099715
Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
ACCOUNTING 126,270 52,785   63,135

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

TY 2022 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
BUILDING 2019-12-23 2,632,969 84,760 NC 39.000000000000 0 0    
LAND 2020-01-01 387,243   L   0 0    
FURNITURE AND EQUIPMENT 2021-01-01 148,484 59,156 NC 7.000000000000 0 0    

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TY 2022 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, 3/11/22, 8/31/22, 10/2/22    
JEFFERSON LOCAL DEVELOPMENT CORPORATION
  		PO BOX 1079
WHITEHALL,MT59759 		2022-12-15 50,000 TO SUPPORT JEFFERSON LOCAL DEVELOPMENT CORPORATION IN CHILDCARE DEVELOPMENT AND CAPACITY BUILDING PROJECTS IN JEFFERSON COUNTY. TO SUPPORT JEFFERSON LOCAL DEVELOPMENT CORPORATION IN CHILDCARE DEVELOPMENT AND CAPACITY BUILDING PROJECTS IN JEFFERSON COUNTY 50,000 NONE 3/9/23, 6/19/23    

TY 2022 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
ALLY FINL INC 522,247 522,247
AMERICAN TOWER CORP 423,952 423,952
BANK OF AMERICA COR 523,776 523,776
GILEAD SCIENCES 442,367 442,367
IHS MARKIT LTD4 323,375 323,375
JPMORGAN CHASE & VAR 528,546 528,546
L3HARRIS TECHNOLOGIES 247,832 247,832
LENNAR CORP 518,128 518,128
MEAD JOHNSON NUTRITIONAL 254,712 254,712
MICROCHIP TECHN 223,968 223,968
MOTOROLA SOLUTIONS 350,316 350,316
NETFLIX INC 525,925 525,925
PIMCO INCOME INSTL 1,602,200 1,602,200
PNC FINANCIAL SERVICES GROUP 394,550 394,550
TRIMBLE INC. 521,359 521,359
UNITED PARCEL SER 289,058 289,058

TY 2022 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
BLACK HILLS CORP 296,842 296,842
DFA EMERGING MKTS VALUE 5,029,975 5,029,975
PIMCO RAE US SMALL INSTL 4,382,489 4,382,489
VANGUARD DEVELOPED MARKET 8,649,099 8,649,099
VANGUARD EMERGING MKTS 4,956,627 4,956,627
VANGUARD INSTITUTIONAL 10,591,389 10,591,389

TY 2022 InvestmentsGovtObligationsSch
Name:
HEADWATERS HEALTH FOUNDATION
 
OF WESTERN MONTANA
EIN:
81-1099715
US Government Securities - End of Year Book Value:

4,118,812
US Government Securities - End of Year Fair Market Value:

4,118,812
State & Local Government Securities - End of Year Book Value:


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


0


TY 2022 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 5,275,371 5,275,371
ACCOLADE PARTNERS VII LP FMV 1,483,061 1,483,061
ACCRUED INTEREST FMV 22,572 22,572
AMBERBROOK VIII LP FMV 2,241,409 2,241,409
AUDAX DIRECT LENDING SOLUTIONS FUND-C LP FMV 1,766,855 1,766,855
COLLER INTERNATIONAL PARTNERS VII FEEDER FUND LP FMV 1,154,233 1,154,233
EDGE PRINCIPAL INVESTMENTS IV LP FMV 743,681 743,681
FALCON PRIVATE CREDIT OPPORTUNITIES VI LP FMV 1,789,013 1,789,013
FEG SELECT LLC FMV 20,823,384 20,823,384
FIDELITY REAL ESTATE FMV 2,410,161 2,410,161
HARVEST MLP INCOME FUND II LLC FMV 4,804,911 4,804,911
IRONWOOD INTERNATIONAL LTD FMV 8,547,519 8,547,519
RCP ADVISORS FMV 2,268,546 2,268,546
SEAPORT GLOBAL PROPERTY SECURITIES FUND LLC FMV 2,885,477 2,885,477
STRATEGIC VALUE FMV 1,602,012 1,602,012
WEATHERLOW OFFSHORE FUND I LTD FMV 8,503,166 8,503,166

TY 2022 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
BUILDING 2,632,969 84,760 2,548,209  
LAND 387,243 0 387,243  
FURNITURE AND EQUIPMENT 148,484 59,156 89,328  


TY 2022 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 24,095 26,164   24,019


TY 2022 OtherDecreasesSchedule
Name:
HEADWATERS HEALTH FOUNDATION
 
OF WESTERN MONTANA
EIN:
81-1099715
Description Amount
UNREALIZED LOSS ON INVESTMENTS 9,421,228


TY 2022 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 23,013 0   23,013
COMPUTER AND SOFTWARE 45,195 0   45,195
ADVERTISING AND PROMOTIONS 2,755 0   2,755
FEES AND SUBSCRIPTIONS 27,263 0   19,836
OFFICE EXPENSE 18,921 0   18,921
REPAIRS AND MAINTENANCE 3,152 0   3,122
EQUIPMENT RENT 82,310 0   88,969
SMALL EQUIPMENT 7,405 0   7,405
MISCELLANEOUS 1,865 0   1,865
STATE FILING FEES 6 0   6
GRANTEE VISITS 899 0   899
NONPROFIT CENTER 243,041 0   195,248
GRANTEE CONVENINGS 5,634 0   5,634
CONTRACTORS 23,214 0   23,214


TY 2022 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 -2,798,601 -326,853 -2,798,601


TY 2022 OtherLiabilitiesSchedule
Name:
HEADWATERS HEALTH FOUNDATION
 
OF WESTERN MONTANA
EIN:
81-1099715
Description Beginning of Year - Book Value End of Year - Book Value
PAYROLL LIABILITIES 90,874 93,822
DEFERRED EXCISE TAX 277,498 226,539
TAXES PAYABLE 69,095 2,023
CLEARWATER CONSTRUCTION LOAN 1,187,076 1,731,212
CURRENT PORTION OF LONG-TERM DEBT 0 63,519


TY 2022 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 311,577 311,577   0
CONSULTING 214,675 0   314,522
RECRUITING 1,648 0   1,648
ALTERNATIVE INVESTMENTS 181,882 423,386   0


TY 2022 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 0 61,446   0
EXCISE TAX 172,933 0   0