2021-11-10T08:31:57-06:00 2020-12-31 910189318 MOSS ADAMS LLP 805 SW BROADWAY STE 1200 PORTLAND OR 97205 990PF 2020-01-01 811099715 HEADWATERS HEALTH FOUNDATION OF WESTERN MONTANA HEAD 4069266526 283 W FRONT STREET NO 301 MISSOULA MT 59802 RICHARD OPPER TREASURER 4069266526 2021-10-05 1 RICHARD OPPER XXX-XX-XXXX WENDY CAMPOS P00448102 5032421447 2021-11-01 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z X 106148941 X 523100 76 76 998570 2243106 163764 23410895 941737 3884693 3856883 5570203 7041802 645422 101094 548068 266452 5581 296761 291891 21889 264445 28580 0 28766 106325 25103 71904 585509 1210843 250914 196364 196364 0 130029 115612 0 27377 0 108647 0 108532 48454 0 48416 38 0 38 120085 0 123626 2555173 1676486 1741470 3603752 3603752 6158925 1676486 5345222 -588722 5365316 379219 4787407 4787407 67104 3398471 1747098 1747098 11708144 8654372 8654372 8791857 7327308 7327308 79722072 82423176 82423176 1257467 47887 92824 1209580 1209580 104159691 106148941 106148941 39433 12805 50 224206 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COLLABORATIVE 202 BROOKS ST MISSOULA MT 59801 PC GENERAL OPERATING 175000 MONTANA ACADEMY OF PEDIATRIC PHYSICIANS INC 3031 GRAND AVE SUITE 157 BILLINGS MT 59102 PC GENERAL OPERATING 2500 MONTANA BUDGET AND POLICY CENTER 15 W 6TH AVE HELENA MT 59601 PC GENERAL OPERATING 125000 MONTANA CHILD CARE RESOURCE & REFERRAL NETWORK INC PO BOX 808 LOLO MT 59847 PC GENERAL OPERATING 50000 MONTANA FOOD BANK NETWORK INC 5625 EXPRESSWAY MISSOULA MT 59808 PC GENERAL OPERATING 130000 MONTANA HUMAN RIGHTS NETWORK INC PO BOX 1509 HELENA MT 59624 PC GENERAL OPERATING 50000 MONTANA LEGAL SERVICES ASSOCIATION 616 HELENA AVE SUITE 100 HELENA MT 59601 PC GENERAL OPERATING 50000 MONTANA NONPROFIT ASSOCIATION INC PO BOX 1744 HELENA MT 59624 PC GENERAL OPERATING 225000 MONTANA WOMEN VOTE 725 W ALDER ST SUITE 21 MISSOULA MT 59802 PC GENERAL OPERATING 75000 MOUNTAIN HOME MONTANA INC 2606 SOUTH AVE W MISSOULA MT 59804 PC GENERAL OPERATING 2500 NEVER ALONE RECOVERY SUPPORT SERVICES PO BOX 383 RONAN MT 59864 PC GENERAL OPERATING 25000 NORTH VALLEY FOOD BANK INC 251 FLATHEAD AVE WHITEFISH MT 59937 PC FUNDS TO SERVE INCREASED CUSTOMERS DURING COVID 8000 NURTURING CENTER INC 146 3RD AVE W KALISPELL MT 59901 PC GENERAL OPERATING 7500 ORPHAN GIRL CHILDRENS THEATRE PO BOX 885 BUTTE MT 59703 PC GENERAL OPERATING 2500 PANTRY PARTNERS FOOD BANK PO BOX 806 STEVENSVILLE MT 59870 PC GENERAL OPERATING 3000 PEAK FOUNDATION PO BOX 36 ALBERTON MT 59820 PC PROMOTING EXCELLENCE IN ALBERTON-AREA 5000 PLAINS COMMUNITY FOOD BANK PO BOX 767 PLAINS MT 59859 PC GENERAL OPERATING 1500 POLSON LOAVES AND FISH PANTRY INC 904 1ST ST E POLSON MT 59860 PC GENERAL OPERATING 10000 POLSON SCHOOL DISTRICT 23 111 4TH AVE E POLSON MT 59860 GOV CHERRY VALLEY ELEMENTARY 5000 RAVALLI HEAD START INC 81 KURTZ LN HAMILTON MT 59840 PC GENERAL OPERATING 5000 REMNANT CHURCH 34 RIVERVIEW DR TROY MT 59935 PC GENERAL OPERATING 2000 SAFE HARBOUR INC PO BOX 497 RONAN MT 59864 PC GENERAL OPERATING 10000 SALISH & KOOTENAI HOUSING AUTHORITY PO 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ANACONDA MT 59711 PC GENERAL OPERATING 5000 SNQWELMISTN 533116 MARSH CREEK RD CHARLO MT 59824 PC GENERAL OPERATING 5000 SOFT LANDING MISSOULA 939 STEPHENS AVE SUITE C MISSOULA MT 59801 PC GENERAL OPERATING 2500 SOMERS LAKESIDE SCHOOL DISTRICT 29 315 SCHOOL ADDITION RD SOMERS MT 59932 PC AMERICORPS VISTA SERVICE MEMBER 5000 SPARROWS NEST OF NW MT PO BOX 8384 KALISPELL MT 59904 PC GENERAL OPERATING 5000 SPARROWS VINE PO BOX 864 SEELEY LAKE MT 59868 PC GENERAL OPERATING 5000 SPECIAL OLYMPICS MONTANA INC PO BOX 3507 GREAT FALLS MT 59403 PC GENERAL OPERATING 2500 ST IGNATIUS COMMUNITY SENIOR CITIZENS CENTER PO BOX 758 ST IGNATIUS MT 59865 PC GENERAL OPERATING 11000 ST IGNATIUS HIGH SCHOOL PO BOX 1540 ST IGNATIUS MT 59865 PC MISSION SPECIAL OLYMPICS 5000 ST REGIS SCHOOL DISTRICT 1 90 TIGER ST ST REGIS MT 59866 PC GENERAL OPERATING 5000 THE HENRY J KAISER FAMILY FOUNDATION 185 BERRY ST SUITE 2000 SAN FRANCISCO CA 94107 PC GENERAL OPERATING 50000 THE IRWIN AND FLORENCE ROSTEN FOUNDATION INC 515 MADISON HAMILTON MT 59840 PC GENERAL OPERATING 5000 TOBACCO VALLEY FOOD PANTRY AND THRIFT STORE PO BOX 714 EUREKA MT 59917 PC GENERAL OPERATING 1500 UNITED WAY OF BUTTE AND ANACONDA PO BOX 4447 BUTTE MT 59702 PC HELPING PARTNER AGENCIES 5000 UNITED WAY OF MISSOULA COUNTY 412 W ALDER ST MISSOULA MT 59802 PC GENERAL OPERATING 250000 UNITED WAY OF THE LEWIS AND CLARK AREA PO BOX 862 HELENA MT 59624 PC GENERAL OPERATING 25000 UNIVERSITY OF MONTANA FOUNDATION 32 CAMPUS DR MISSOULA MT 59812 GOV RURAL INSTITUTE FOR INCLUSIVE COMMUNITIES 5000 UNIVERSITY OF MONTANA FOUNDATION 32 CAMPUS DR MISSOULA MT 59812 GOV SPECTRUM 2500 UNIVERSITY OF MONTANA 203 B PFNAC MISSOULA MT 59812 GOV NATIVE AMERICAN STUDIES 26500 UNIVERSITY OF MONTANA 32 CAMPUS DR ORSP UH116 MISSOULA MT 59812 GOV CENTER FOR CHILDREN, FAMILIES AND WORKFORCE DEVELOPMENT 260000 VALLEY OAK EDUCATION RESOURCE CENTER PO BOX 870 HAMILTON MT 59840 PC GENERAL OPERATING 5000 VIOLENCE FREE CRISIS LINE DBA ABBIE SHELTER PO BOX 1401 KALISPELL MT 59903 PC GENERAL OPERATING 2500 WESTSHORE COMMUNITY ASSISTANCE PROGRAM PO BOX 630 LAKESIDE MT 59922 PC GENERAL OPERATING 1500 YES YOUTH EMPOWERMENT SERVICES PO BOX 686 ANACONDA MT 59711 PC GENERAL OPERATING 5000 ZION LUTHERAN CHURCH PO BOX 942 ST IGNATIUS MT 59865 PC GENERAL OPERATING 5000 3603752 0 14 76 901101 1910 14 996660 901101 2117 18 161647 ALTERNATIVE INVESTMENTS 901101 -30919 14 3915612 -26892 5073995 0 5047103 0 0 0 0 0 0 0 0 0 0 X X 1 COMMUNITY MEDICAL CENTER 2827 FORT MISSOULA RD MISSOULA MT 59804 500000 X 2 ALPS PROPERTY & CASUALTY INSURANCE COMPANY 111 NORTH HIGGINS AVE MISSOULA MT 59802 23100 X 2 COMMUNICATION SYSTEM COMPONENTS 23100 2020-01-27 ACCOUNTING 106325 25103 71904 ORGANIZATION: HEADWATERS HEALTH FOUNDATION OF WESTERN MONTANATIN: 81-1099715TAX YEAR ENDED: DECEMBER 31, 2020FORM 990-PF, PART XII, LINE 3B - REPORTING SET-ASIDES UNDER THE CASH DISTRIBUTION TEST1. FUNDS WERE SET ASIDE FOR GENERATING FUTURE CASH FLOW TO FULFILL MULTI-INSTALLMENT GRANTS THAT WILL COVER MORE THAN ONE TAXABLE YEAR. THE START-UP PERIOD WILL ALSO ALLOW THE FOUNDATION TO MONTIOR THESE GRANTS AND RECEIVE PROGRESS REPORTS BEFORE MAKING FURTHER DISTRIBUTIONS TO THE RECIPIENTS. 2. THE AMOUNTS SET ASIDE FOR THE PROJECT DESCRIBED IN ITEM 1 WILL ACTUALLY BE PAID WITHIN THE 24 MONTH PERIOD THAT ENDS NO MORE THAN 60 MONTHS AFTER THE DATE OF THE SET-ASIDE. 3. THE PROJECT WAS NOT COMPLETED BEFORE THE END OF THE ABOVE-REFERENCED TAX YEAR. 4. BELOW IS A LIST OF THE DISTRIBUTABLE AMOUNTS DETERMINED UNDER IRC SECTION 4942(D) FOR ALL PAST TAX YEARS IN THE TAXPAYER'S START-UP PERIOD:2017 - $765,4312018 - $2,189,5572019 - $3,043,7572020 - $3,949,4395. BELOW IS A LIST OF ACTUAL PAYMENTS MADE IN CASH OR ITS EQUIVALENT FOR EXEMPT PURPOSES DURING EACH TAX YEAR IN THE TAXPAYER'S START-UP PERIOD:2017 - $990,6472018 - $3,555,1952019 - $5,341,1002020 - $6,489,355 INTERACTIVE DISPLAY SYSTEM 2017-02-16 5661 3208 NC 5.000000000000 0 0 SMARTSIMPLE SOFTWARE LTD 2018-07-05 57673 17302 NC 5.000000000000 0 0 BUILDING 2019-12-23 688431 NC 39.000000000000 0 0 LAND 2020-01-01 387243 L 0 0 FURNITURE AND EQUIPMENT 2020-01-01 23100 NC 7.000000000000 0 0 CONSTRUCTION IN PROGRESS 2020-01-01 95359 NC 0.000000000000 0 0 MISSION FALLS FARMERS MARKET PO BOX 7025 MISSOULA MT 59807 2020-03-12 2500 2020 ASPARAGUS FESTIVAL SPONSORSHIP 2500 NO 2/1/21 2021-02-01 MISSION FALLS FARMERS MARKET PO BOX 7025 MISSOULA MT 59807 2020-01-28 5000 MARKET OPERATING EXPENSES 5000 NO 4/14/20 2021-02-01 GOLDMAN SACHS 326670 326670 MEAD JOHNSON NUTRITIONAL 299648 299648 PNC FINANCIAL SERVICES GROUP 442403 442403 ARTISAN HIGH INCOME INSTITUTIONAL 1367898 1367898 DELTA AIRLINES 226125 226125 ALLY FINL INC 263125 263125 BECTON, DICKINS 352101 352101 CVS HEALTH CORP 365282 365282 DUKE ENERGY CORP 414320 414320 MORGAN STANLEY 457683 457683 MIRCOCHIP TECHNOLOGIES 243432 243432 L3HARRIS TECHNOLOGIES 269464 269464 GILEAD SCIENCES 473655 473655 ROPER TECHNOLOGIES 459933 459933 VERIZON COMMUNICATIONS 422076 422076 FISERV INC 462962 462962 AMERICAN TOWER CORP 480531 480531 DFA EMERGING MKTS VALUE 4440945 4440945 PIMCO RAE FUNDAMENTAL 4213427 4213427 1747098 1747098 0 0 ABS GLOBAL FMV 6703273 6703273 ACCOLADE PARTNERS VII LP FMV 418041 418041 ACCRUED INTEREST FMV 58343 58343 AMBERBROOK VIII LP FMV 780980 780980 AUDAX DIRECT LENDING SOLUTIONS FUND-C LP FMV 982955 982955 COLLER INTERNATIONAL PARTNERS VII FEEDER FUND LP FMV 1661835 1661835 EDGE PRINCIPAL INVESTMENTS IV LP FMV 415407 415407 FALCON PRIVATE CREDIT OPPORTUNITIES VI LP FMV 900437 900437 FEG SELECT LLC FMV 39733496 39733496 HARVEST MLP INCOME FUND II LLC FMV 2654637 2654637 IRONWOOD INTERNATIONAL LTD FMV 8858048 8858048 MAP RE 2018 LP FMV 1299885 1299885 RCP ADVISORS FMV 571199 571199 SEAPORT GLOBAL PROPERTY SECURITIES FUND LLC FMV 2022958 2022958 THE HIGHCLERE INTERNATIONAL INVESTORS EMERGING MARKETS SMID FUND FMV 4672106 4672106 WCP NEWCOLD LP FMV 39702 39702 WEATHERLOW OFFSHORE FUND I LTD FMV 9902723 9902723 STRATEGIC VALUE FMV 747151 747151 INTERACTIVE DISPLAY SYSTEM 5661 3208 2453 SMARTSIMPLE SOFTWARE LTD 57673 17302 40371 BUILDING 688431 0 688431 LAND 387243 0 387243 FURNITURE AND EQUIPMENT 23100 0 23100 CONSTRUCTION IN PROGRESS 95359 0 95359 LEGAL FEES 28580 0 28766 INSURANCE 22198 0 22198 COMPUTER AND SOFTWARE 37963 0 38367 ADVERTISING AND PROMOTIONS 203 0 203 FEES AND SUBSCRIPTIONS 19183 0 19183 OFFICE EXPENSE 3657 0 3657 REPAIRS AND MAINTENANCE 391 0 421 EQUIPMENT RENT 2933 0 2933 SMALL EQUIPMENT 7004 0 7004 MISCELLANEOUS 5447 0 5447 STATE FILING FEES 70 0 70 GRANTEE VISITS 324 0 324 NONPROFIT CENTER 20712 0 23819 ALTERNATIVE INVESTMENTS 3884693 3856883 3884693 UNREALIZED GAIN ON INVESTMENTS 2564901 PAYROLL LIABILITIES 109354 99869 DEFERRED EXCISE TAX 114852 138800 TAXES PAYABLE 0 25286 INVESTMENT MANAGEMENT 275867 275867 0 CONSULTING 251016 0 249316 RECRUITING 1598 0 1598 ALTERNATIVE INVESTMENTS 57028 934976 0 FOREIGN TAX 12877 115612 0 EXCISE TAX 117102 0 0 STATE INCOME TAX 50 0 0