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.
bulletInformation about Form 990-PF and its instructions is at www.irs.gov/form990pf.
OMB No. 1545-0052
2015
Open to Public Inspection
For calendar year 2015, or tax year beginning 01-01-2015 , and ending 12-31-2015
Name of foundation
BI-LO HOLDINGS FOUNDATION INC
 
Number and street (or P.O. box number if mail is not delivered to street address)8928 PROMINENCE PARKWAY NO 200
  Room/suite
City or town, state or province, country, and ZIP or foreign postal code
JACKSONVILLE, FL32256
A Employer identification number

59-0995428
B Telephone number (see instructions)

(904) 783-5599
C bullet
G Check all that apply:

D 1. bullet
2. 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$1,275,691J Accounting method:
 
(Part I, column (d) must be on cash basis.)
Part I Analysis of Revenue and Expenses (The total of amounts in columns (b), (c), and (d) may not necessarily equal the amounts in column (a) (see instructions).) (a) Revenue and
expenses per
books 		(b) Net investment
income 		(c) Adjusted net
income 		(d) Disbursements
for charitable
purposes
(cash basis only)
Revenue 1 Contributions, gifts, grants, etc., received (attach schedule) 2,972,101
2 Check bullet Sch. B .............
3 Interest on savings and temporary cash investments 469 469  
4 Dividends and interest from securities...      
5a Gross rents............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10  
b Gross sales price for all assets on line 6a  
7 Capital gain net income (from Part IV, line 2)... 0
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........ 2,972,570 469  
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 0 0   0
14 Other employee salaries and wages......        
15 Pension plans, employee benefits.......        
16a Legal fees (attach schedule).........        
b Accounting fees (attach schedule)....... Click to see attachment 3,500 0   0
c Other professional fees (attach schedule).... Click to see attachment 503 0   0
17 Interest...............        
18 Taxes (attach schedule) (see instructions)...        
19 Depreciation (attach schedule) and depletion...      
20 Occupancy..............        
21 Travel, conferences, and meetings.......        
22 Printing and publications..........        
23 Other expenses (attach schedule)....... Click to see attachment 522 0   0
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 4,525 0   0
25 Contributions, gifts, grants paid....... 2,148,041 2,148,041
26 Total expenses and disbursements. Add lines 24 and 25 2,152,566 0   2,148,041
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements 820,004
b Net investment income (if negative, enter -0-) 469
c Adjusted net income (if negative, enter -0-)...  
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 11289X Form 990-PF (2015)
Form 990-PF (2015)
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............. 454,073 1,274,077 1,274,077
2 Savings and temporary cash investments.........      
3 Accounts receivable bullet  
Less: allowance for doubtful accounts bullet        
4 Pledges receivable bullet  
Less: allowance for doubtful accounts bullet        
5 Grants receivable.................      
6 Receivables due from officers, directors, trustees, and other
disqualified persons (attach schedule) (see instructions).....      
7 Other notes and loans receivable (attach schedule) bullet  
Less: allowance for doubtful accounts bullet        
8 Inventories for sale or use..............      
9 Prepaid expenses and deferred charges..........      
10a Investments—U.S. and state government obligations (attach schedule)      
b Investments—corporate stock (attach schedule).......      
c Investments—corporate bonds (attach schedule)....... 900 Click to see attachment900 900
11 Investments—land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
12 Investments—mortgage loans.............      
13 Investments—other (attach schedule)..........      
14 Land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
15 Other assets (describe bullet) Click to see attachment714 Click to see attachment714 Click to see attachment714
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 455,687 1,275,691 1,275,691
Liabilities 17 Accounts payable and accrued expenses..........    
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)......... 0 0
Net Assets or Fund Balances bullet
and complete lines 24 through 26 and lines 30 and 31.
24 Unrestricted..................    
25 Temporarily restricted...............    
26 Permanently restricted...............    
bullet
and complete lines 27 through 31.
27 Capital stock, trust principal, or current funds........ 0 0
28 Paid-in or capital surplus, or land, bldg., and equipment fund 0 0
29 Retained earnings, accumulated income, endowment, or other funds 455,687 1,275,691
30 Total net assets or fund balances (see instructions)..... 455,687 1,275,691
31 Total liabilities and net assets/fund balances (see instructions). 455,687 1,275,691
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 30 (must agree with end-of-year figure reported on prior year’s return) ...............
1
455,687
2
Enter amount from Part I, line 27a .....................
2
820,004
3
Other increases not included in line 2 (itemize) bullet
3
0
4
Add lines 1, 2, and 3 ..........................
4
1,275,691
5
Decreases not included in line 2 (itemize) bullet
5
0
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 30 .
6
1,275,691
Form 990-PF (2015)
Form 990-PF (2015)
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.)
1a
b
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
b
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
b
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  
3 Net short-term capital gain or (loss) as defined in sections 1222(5) and (6):
If gain, also enter in Part I, line 8, column (c) (see instructions). If (loss), enter -0-
in Part I, line 8 ................... 		Bracket 3  
Part V
Qualification Under Section 4940(e) for Reduced Tax on Net Investment Income
(For optional use by domestic private foundations subject to the section 4940(a) tax on net investment income.)
If section 4940(d)(2) applies, leave this part blank.
Was the foundation liable for the section 4942 tax on the distributable amount of any year in the base period?
If "Yes," the foundation does not qualify under section 4940(e). Do not complete this part.
1 Enter the appropriate amount in each column for each year; see instructions before making any entries.
(a)
Base period years Calendar
year (or tax year beginning in) 		(b)
Adjusted qualifying distributions 		(c)
Net value of noncharitable-use assets 		(d)
Distribution ratio
(col. (b) divided by col. (c))
2014 3,584,085 2,255,130 1.589303
2013 4,228,223 2,003,321 2.110607
2012 1,157,646 679,676 1.703232
2011 1,071,810 702,766 1.525131
2010 1,160,000 768,513 1.509408
2
Total of line 1, column (d) .....................
28.437681
3
Average distribution ratio for the 5-year base period—divide the total on line 2 by 5, or by
the number of years the foundation has been in existence if less than 5 years . . .
3
1.687536
4
Enter the net value of noncharitable-use assets for 2015 from Part X, line 5.....
4
2,167,446
5
Multiply line 4 by line 3......................
5
3,657,643
6
Enter 1% of net investment income (1% of Part I, line 27b)...........
6
5
7
Add lines 5 and 6........................
7
3,657,648
8
Enter qualifying distributions from Part XII, line 4.............
8
2,148,041
If line 8 is equal to or greater than line 7, check the box in Part VI, line 1b, and complete that part using a 1% tax rate. See the Part VI instructions.
Form 990-PF (2015)
Form 990-PF (2015)
Page 4
Part VI
Excise Tax Based on Investment Income (Section 4940(a), 4940(b), 4940(e), or 4948—see page 18 of the instructions)
1a Bullet and enter “N/A" on line 1. Bracket
Date of ruling or determination letter:   (attach copy of letter if necessary–see instructions)
b 1 9
hereBulletand enter 1% of Part I, line 27b...................
c All other domestic foundations enter 2% of line 27b. Exempt foreign organizations enter 4% of Part I, line 12, col. (b)
2 Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) 2 0
3 Add lines 1 and 2........................... 3 9
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 9
6 Credits/Payments:
a 2015 estimated tax payments and 2014 overpayment credited to 2015 6a 694
b Exempt foreign organizations—tax withheld at source...... 6b
c Tax paid with application for extension of time to file (Form 8868)... 6c  
d Backup withholding erroneously withheld ........... 6d  
7 Total credits and payments. Add lines 6a through 6d.............. 7 694
8 Enter any penalty for underpayment of estimated tax. if Form 2220 is attached. 8  
9 Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed.......Bullet 9  
10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid...Bullet 10 685
11 Enter the amount of line 10 to be: Credited to 2015 estimated taxBullet685 RefundedBullet 11 0
Part VII-A
Statements Regarding Activities
1a
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did
Yes
No
it participate or intervene in any political campaign? ....................
1a
 
No
b
Did it spend more than $100 during the year (either directly or indirectly) for political purposes (see Instructions
for 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 XV..................................
    7
    Yes
     
    8a
    Enter the states to which the foundation reports or with which it is registered (see instructions)
    bulletFL
    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 2015 or the taxable year beginning in 2015 (see instructions for Part XIV)?
    If "Yes," complete Part XIV.............................
    9
     
    No
    10
    Did any persons become substantial contributors during the tax year? If "Yes," attach a schedule listing their names
    and addresses. ...............................
    10
     
    No
    Form 990-PF (2015)
    Form 990-PF (2015)
    Page 5
    Part VII-A
    Statements Regarding Activities (continued)
    11
    At any time during the year, did the foundation, directly or indirectly, own a controlled entity within the
    meaning of section 512(b)(13)? If "Yes," attach schedule. (see instructions) .............
    11
     
    No
    12
    Did the foundation make a distribution to a donor advised fund over which the foundation or a disqualified person had
    advisory privileges? If "Yes," attach statement (see instructions).................
    12
     
    No
    13
    Did the foundation comply with the public inspection requirements for its annual returns and exemption application?
    13
    Yes
     
    Website addressbulletN/A
    14
    The books are in care ofbulletTHE ORGANIZATION Telephone no.bullet (904) 783-5599

    Located atbullet8928 PROMINENCE PARKWAY STE 200JACKSONVILLEFL ZIP+4bullet32256
    15
    Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of Form 1041.......bullet
    and enter the amount of tax-exempt interest received or accrued during the year ......bullet
    15  
    16 At any time during calendar year 2015, 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 instructions for exceptions and filing requirements for FinCEN Form 114, Report of Foreign Bank and Financial Accounts (FBAR). If "Yes", enter the name of the foreign country bullet  
    Part VII-B
    Statements Regarding Activities for Which Form 4720 May Be Required
    File Form 4720 if any item is checked in the "Yes" column, unless an exception applies.
    Yes
    No
    1a
    During the year did the foundation (either directly or indirectly):
    (1) Engage in the sale or exchange, or leasing of property with a disqualified person?
    (2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
    a disqualified person?......................
    (3) Furnish goods, services, or facilities to (or accept them from) a disqualified person?
    (4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person?
    (5) Transfer any income or assets to a disqualified person (or make any of either available
    for the benefit or use of a disqualified person)?...............
    (6) Agree to pay money or property to a government official? (Exception. Check "No"
    if the foundation agreed to make a grant to or to employ the official for a period
    after termination of government service, if terminating within 90 days.).......
    b
    If any answer is "Yes" to 1a(1)–(6), did any of the acts fail to qualify under the exceptions described in Regulations
    section 53.4941(d)-3 or in a current notice regarding disaster assistance (see instructions)? ........
    1b
     
     
    ........bullet
    c
    Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts,
    that were not corrected before the first day of the tax year beginning in 2015?.............
    1c
     
    No
    2
    Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private
    operating foundation defined in section 4942(j)(3) or 4942(j)(5)):
    a
    At the end of tax year 2015, did the foundation have any undistributed income (lines 6d
    and 6e, Part XIII) for tax year(s) beginning before 2015?.............
    If "Yes," list the years bullet20, 20, 20, 20
    b
    Are there any years listed in 2a for which the foundation is not applying the provisions of section 4942(a)(2)
    (relating to incorrect valuation of assets) to the year’s undistributed income? (If applying section 4942(a)(2)
    to all years listed, answer "No" and attach statement—see instructions.) ..............
    2b
     
     
    c
    If the provisions of section 4942(a)(2) are being applied to any of the years listed in 2a, list the years here.
    bullet20, 20, 20, 20
    3a
    Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at
    any time during the year?......................
    b
    If "Yes," did it have excess business holdings in 2015 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 2015.)..................
    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 2015?
    4b
     
    No
    Form 990-PF (2015)
    Form 990-PF (2015)
    Page 6
    Part VII-B
    Statements Regarding Activities for Which Form 4720 May Be Required (Continued)
    5a
    During the year did the foundation pay or incur any amount to:
    (1) Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))?
    (2) Influence the outcome of any specific public election (see section 4955); or to carry
    on, directly or indirectly, any voter registration drive?.............
    (3) Provide a grant to an individual for travel, study, or other similar purposes?
    (4) Provide a grant to an organization other than a charitable, etc., organization described
    in section 4945(d)(4)(A)? (see instructions)................
    (5) Provide for any purpose other than religious, charitable, scientific, literary, or
    educational purposes, or for the prevention of cruelty to children or animals?.....
    b
    If any answer is "Yes" to 5a(1)–(5), did any of the transactions fail to qualify under the exceptions described in
    Regulations section 53.4945 or in a current notice regarding disaster assistance (see instructions)? ......
    5b
     
     
    .........bullet
    c
    If the answer is "Yes" to question 5a(4), does the foundation claim exemption from the
    tax because it maintained expenditure responsibility for the grant?..........
    If "Yes," attach the statement required by Regulations section 53.4945–5(d).
    6a
    Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums on
    a personal benefit contract?.....................
    b
    Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract?....
    6b
     
    No
    If "Yes" to 6b, file Form 8870.
    7a
    At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction?
    b
    If yes, did the foundation receive any proceeds or have any net income attributable to the transaction? ....
    7b
     
     
    Form 990-PF (2015)
    Form 990-PF (2015)
    Page 7
    Part VIII
    Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
    and Contractors
    1 List all officers, directors, trustees, foundation managers and their compensation (see instructions).
    (a) Name and address (b) Title, and average
    hours per week
    devoted to position     		(c) Compensation
     (If not paid, enter
    -0-)     		(d) Contributions to employee benefit plans and deferred compensation (e) Expense account,
    other allowances
    SHARRY CRAMOND PRESIDENT
    1.00     		0 0 0
    5050 EDGEWOOD COURT
    JACKSONVILLE,FL32254
    KENNETH JONES TREASURER
    1.00     		0 0 0
    5050 EDGEWOOD COURT
    JACKSONVILLE,FL32254
    M SANDLIN GRIMM SECRETARY
    1.00     		0 0 0
    5050 EDGEWOOD COURT
    JACKSONVILLE,FL32254
    REBECCA SINCLAIR DIRECTOR
    1.00     		0 0 0
    5050 EDGEWOOD COURT
    JACKSONVILLE,FL32254
    MARK SCATES DIRECTOR
    1.00     		0 0 0
    5050 EDGEWOOD COURT
    JACKSONVILLE,FL32254
    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
    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
    NONE
    Total number of others receiving over $50,000 for professional services.............bullet0
    Part IX-A
    Summary of Direct Charitable Activities
    List the foundation’s four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc. Expenses
    1
     
    2  
    3  
    4  
    Part IX-B
    Summary of Program-Related Investments (see instructions)
    Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2. Amount
    1  
    2  
    All other program-related investments. See instructions.
    3  
    Total. Add lines 1 through 3.........................bullet0
    Form 990-PF (2015)
    Form 990-PF (2015)
    Page 8
    Part X
    Minimum Investment Return (All domestic foundations must complete this part. Foreign foundations,see instructions.)
    1
    Fair market value of assets not used (or held for use) directly in carrying out charitable, etc.,
    purposes:
    a
    Average monthly fair market value of securities...................
    1a
    0
    b
    Average of monthly cash balances.......................
    1b
    2,200,453
    c
    Fair market value of all other assets (see instructions)................
    1c
    0
    d
    Total (add lines 1a, b, and c).........................
    1d
    2,200,453
    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
    2,200,453
    4
    Cash deemed held for charitable activities. Enter 1 1/2% of line 3 (for greater amount, see
    instructions) .............................
    4
    33,007
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. Enter here and on Part V, line 4
    5
    2,167,446
    6
    Minimum investment return. Enter 5% of line 5..................
    6
    108,372
    Part XI
    Distributable Amount bullet
    1
    Minimum investment return from Part X, line 6....................
    1
    108,372
    2a
    Tax on investment income for 2015 from Part VI, line 5......
    2a
    9
    b
    Income tax for 2015. (This does not include the tax from Part VI.)...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
    9
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
    108,363
    4
    Recoveries of amounts treated as qualifying distributions................
    4
    0
    5
    Add lines 3 and 4............................
    5
    108,363
    6
    Deduction from distributable amount (see instructions).................
    6
    0
    7
    Distributable amount as adjusted. Subtract line 6 from line 5. Enter here and on Part XIII, line 1 ...
    7
    108,363
    Part XII
    Qualifying Distributions (see instructions)
    1
    Amounts paid (including administrative expenses) to accomplish charitable, etc., purposes:
    a
    Expenses, contributions, gifts, etc.—total from Part I, column (d), line 26 ..........
    1a
    2,148,041
    b
    Program-related investments—total from Part IX-B..................
    1b
    0
    2
    Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,
    purposes...............................
    2
     
    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 V, line 8, and Part XIII, line 4
    4
    2,148,041
    5
    Foundations that qualify under section 4940(e) for the reduced rate of tax on net investment
    income. Enter 1% of Part I, line 27b (see instructions).................
    5
    0
    6
    Adjusted qualifying distributions. Subtract line 5 from line 4..............
    6
    2,148,041
    Note: The amount on line 6 will be used in Part V, column (b), in subsequent years when calculating whether the foundation qualifies for
    the section 4940(e) reduction of tax in those years.
    Form 990-PF (2015)
    Form 990-PF (2015)
    Page 9
    Part XIII
    Undistributed Income (see instructions)
    (a)
    Corpus     		(b)
    Years prior to 2014     		(c)
    2014     		(d)
    2015
    1 Distributable amount for 2015 from Part XI, line 7 108,363
    2 Undistributed income, if any, as of the end of 2015:
    a Enter amount for 2014 only....... 0
    b Total for prior years:20, 20, 20 0
    3 Excess distributions carryover, if any, to 2015:
    a From 2010...... 1,121,587
    b From 2011...... 1,036,672
    c From 2012...... 1,123,664
    d From 2013...... 4,128,067
    e From 2014...... 3,471,341
    fTotal of lines 3a through e........ 10,881,331
    4Qualifying distributions for 2015 from Part
    XII, line 4: bullet$ 2,148,041
    a Applied to 2014, 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 2015 distributable amount..... 108,363
    e Remaining amount distributed out of corpus 2,039,678
    5 Excess distributions carryover applied to 2015. 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 12,921,009
    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 2014. Subtract line
    4a from line 2a. Taxable amount—see
    instructions .............     		0
    f Undistributed income for 2016. Subtract
    lines 4d and 5 from line 1. This amount must
    be distributed in 2015 ..........     		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
    8Excess distributions carryover from 2010 not
    applied on line 5 or line 7 (see instructions) ...     		1,121,587
    9Excess distributions carryover to 2016.
    Subtract lines 7 and 8 from line 6a ......     		11,799,422
    10 Analysis of line 9:
    a Excess from 2011.... 1,036,672
    b Excess from 2012.... 1,123,664
    c Excess from 2013.... 4,128,067
    d Excess from 2014.... 3,471,341
    e Excess from 2015.... 2,039,678
    Form 990-PF (2015)
    Form 990-PF (2015)
    Page 10
    Part XIV
    Private Operating Foundations (see instructions and Part VII-A, question 9)
    1a If the foundation has received a ruling or determination letter that it is a private operating
    foundation, and the ruling is effective for 2015, 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) 2015 (b) 2014 (c) 2013 (d) 2012
             
    b 85% of line 2a .........          
    c Qualifying distributions from Part XII,
    line 4 for each year listed .....     		         
    d Amounts included in line 2c not used directly
    for active conduct of exempt activities ..........     		         
    e Qualifying distributions made directly
    for active conduct of exempt activities.
    Subtract line 2d from line 2c ....     		         
    3 Complete 3a, b, or c for the
    alternative test relied upon:
    a “Assets" alternative test—enter:
    (1) Value of all assets ......          
    (2) Value of assets qualifying
    under section 4942(j)(3)(B)(i)    		          
    b “Endowment" alternative test— enter 2/3
    of minimum investment return shown in
    Part X, line 6 for each year listed...     		         
    c “Support" alternative test—enter:
    (1) Total support other than gross
    investment income (interest,
    dividends, rents, payments
    on securities loans (section
    512(a)(5)), or royalties) ....     		         
    (2) Support from general public
    and 5 or more exempt
    organizations as provided in
    section 4942(j)(3)(B)(iii)....     		         
    (3) Largest amount of support
    from an exempt organization    		          
    (4) Gross investment income          
    Part XV
    Supplementary Information (Complete this part only if the organization had $5,000 or more in
    assets at any time during the year—see instructions.)
    1Information Regarding Foundation Managers:
    aList any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation
    before the close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2).)
    bList any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the
    ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.
    2Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
    Check here bullet
    aThe name, address, and telephone number or e-mail address of the person to whom applications should be addressed:
    CHELSEA RHODES
    8928 PROMINENCE PARKWAY 200
    JACKSONVILLE,FL32256
    (904) 783-5599
    bThe form in which applications should be submitted and information and materials they should include:
    THERE ARE FORMAL GUIDELINES AND AN APPLICATION PROCESS FOR GRANTS. THE ORIGINAL AND PAPER CLIPPED COPES OF THE FOLLOWING MUST BE SUBMITTED: 1.) GRANT APPLICATION 2.) BOARD LIST 3.) GRANT PROPOSAL NARRATIVE 4.) IF ANOTHER PROGRAM, A PROGRESS REPORT MUST BE SUBMITTED AS PART OF THEIR NEW GRANT PROPOSAL 5.) ONE COPY OF THE IRS 501(C)(3) LETTER DETERMINING TAX-EXEMPT STATUS. THE APPLICATION FOR GRANT FUNDING AND THE INSTRUCTIONS FOR THE GRANT PROPOSAL NARRATIVE ARE ATTACHED.
    cAny submission deadlines:
    REQUESTS FOR GIFTS ARE ACCEPTED THROUGHT THE YEAR
    dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
    factors:
    THE FOUNDATION'S OBJECTIVE IS TO CONDUCT, OPERATE AND CARRY ON ACTIVITIES TO BENEFIT ONLY PEOPLE IN THE STATES OF ALABAMA, FLORIDA, GEORGIA, LOUISIANA AND MISSISSIPPI. THE FOUNDATION MAKES GRANTS TO ONLY LOCAL NON-PROFIT 501(C)(3) ORGANIZATIONS IN THOSE AREAS WHICH FOCUS ON HUNGER, WOMEN AND CHILDREN, HEALTH AND EDUCATION INITIATIVES. THE FOUNDATION MAY PUT RESOURCES INTO PROJECTS OF ITS OWN CREATION. IN MAKING GRANT DECISIONS, THE FOUNDATION SEEKS TO SUPPORT INITIATIVES THAT FOSTER SIGNIFICANT VALUE WHICH LASTS BEYOND THE FUNDING PERIOD. THE FOUNDATION WILL NOT CONSIDER REQUESTS FOR MULTI-YEAR COMMITMENTS, CAPITAL CAMPAIGNS OR GENERAL OPERATING SUPPORT.
    Form 990-PF (2015)
    Form 990-PF (2015)
    Page 11
    Part XV
    Supplementary Information (continued)
    3 Grants and Contributions Paid During the Year or Approved for Future Payment
    Recipient If recipient is an individual,
    show any relationship to
    any foundation manager
    or substantial contributor
    		 Foundation
    status of
    recipient     		Purpose of grant or
    contribution     		Amount
    Name and address (home or business)
    aPaid during the year
    ACTION MINISTRIES INC
    17 EXECUTIVE PARK DRIVE NE SUITE
    540
    ATLANTA,GA30329     		NONE 501(C)(3) OPERATIONAL SUPPORT 5,000
    AMERICAN RED CROSS OF NORTHEAST FL
    751 RIVERSIDE AVE
    JACKSONVILLE,FL32204     		NONE 501(C)(3) OPERATIONAL SUPPORT 300,000
    AMERICA'S SECOND HARVEST OF COASTAL GA
    2501 PRESIDENT ST
    SAVANNAH,GA31404     		NONE 501(C)(3) OPERATIONAL SUPPORT 45,500
    BEACHES EMERGENCY ASSISTANCE MINISTRY
    850 6TH AVE S 400
    JACKSONVILLE,FL32250     		NONE 501(C)(3) OPERATIONAL SUPPORT 34,440
    BOY SCOUTS OF AMERICA - NORTH FLORIDA COU
    521 S EDGEWOOD AVENUE
    JACKSONVILLE,FL32205     		NONE 501(C)(3) OPERATIONAL SUPPORT 29,500
    BOYS & GIRLS CLUB OF CENTRAL FLORIDA
    41940 BOY SCOUT RD
    PAISLEY,FL32767     		NONE 501(C)(3) OPERATIONAL SUPPORT 38,024
    CABARRUS COOPERATIVE CHRISTIAN MINISTRY
    PO BOX 1717
    CONCORD,NC28026     		NONE 501(C)(3) OPERATIONAL SUPPORT 16,250
    CAMILLUS HOUSE INC
    336 NW 5TH STREET
    MIAMI,FL331281616     		NONE 501(C)(3) OPERATIONAL SUPPORT 3,750
    CATHOLIC CHARITIES ARCHDIOCESE OF NOL
    1000 HOWARD AVE SUITE 200
    NEW ORLEANS,LA70113     		NONE 501(C)(3) OPERATIONAL SUPPORT 31,200
    CATHOLIC CHARITIES OF CENTRAL FL I
    1819 NORTH SEMORAN BLVD
    ORLANDO,FL32707     		NONE 501(C)(3) OPERATIONAL SUPPORT 32,000
    CHARLOTTE RESCUE MISSION
    907 W 1ST ST
    CHARLOTTE,NC28202     		NONE 501(C)(3) OPERATIONAL SUPPORT 6,500
    CHATTAHOOCHEE AREA FOOD BANK
    5928 COCA COLA BOULEVARD
    COLUMBUS,GA319095531     		NONE 501(C)(3) OPERATIONAL SUPPORT 16,250
    CHILDREN'S HARBOR
    1 OUR CHILDRENS HWY
    ALEXANDER CITY,AL35010     		NONE 501(C)(3) OPERATIONAL SUPPORT 750
    CHRISTIANS REACHING OUT TO SOCIETY
    301 1ST AVENUE SOUTH
    LAKE WORTH,FL33460     		NONE 501(C)(3) OPERATIONAL SUPPORT 32,000
    CITY RESCUE MISSION
    426 MCDUFF AVE S
    JACKSONVILLE,FL32254     		NONE 501(C)(3) OPERATIONAL SUPPORT 30,000
    COALITION FOR THE HOMELESS OF CENTRAL FL
    639 W CENTRAL BLVD
    ORLANDO,FL32801     		NONE 501(C)(3) OPERATIONAL SUPPORT 4,000
    COMMUNITIES IN SCHOOLS OF FLORIDA
    444 APPLEYARD DRIVE
    TALLAHASSEE,FL32304     		NONE 501(C)(3) OPERATIONAL SUPPORT 5,000
    COMMUNITY CONNECTIONS OF JACKSONVILLE INC
    327 DUVAL STREET
    JACKSONVILLE,FL32202     		NONE 501(C)(3) OPERATIONAL SUPPORT 2,000
    COMMUNITY COOPERATIVE
    3429 DR MARTIN LUTHER KING JR BLVD
    FORT MYERS,FL33916     		NONE 501(C)(3) OPERATIONAL SUPPORT 9,750
    COMMUNITY KITCHEN INC OF MYRTLE BEACH
    1411 10TH AVE N
    MYRTLE BEACH,SC29577     		NONE 501(C)(3) OPERATIONAL SUPPORT 24,050
    COMMUNITY SOUP
    8645 W BOYNTON BEACH BLVD
    BOYNTON BEACH,FL33472     		NONE 501(C)(3) OPERATIONAL SUPPORT 5,000
    COVENANT HOUSE FLORIDA
    733 BREAKERS AVENUE
    FT LAUDERDALE,FL33304     		NONE 501(C)(3) OPERATIONAL SUPPORT 8,000
    CROSSROADS
    1700 LAKE IDA ROAD
    DELRAY BEACH,FL33445     		NONE 501(C)(3) OPERATIONAL SUPPORT 10,500
    CROSSWINDS YOUTH SERVICES INC
    1407 DIXON BLVD
    COCOA BEACH,FL32992     		NONE 501(C)(3) OPERATIONAL SUPPORT 3,000
    ECUMENICAL MINISTRIES INC
    PO BOX 1103
    FAIRHOPE,AL36533     		NONE 501(C)(3) OPERATIONAL SUPPORT 5,500
    EQUIPPING CHILDREN & FAMILIES FOR SUCCES
    PO BOX 11302
    BRADENTON,FL34282     		NONE 501(C)(3) OPERATIONAL SUPPORT 5,000
    FAMILY RESOURCE CENTER OF SOUTH FLORIDA
    155 S MIAMI AVE 400
    MIAMI,FL33130     		NONE 501(C)(3) OPERATIONAL SUPPORT 1,000
    FARMWORKER ASSOCIATION OF FLORIDA INC
    1264 APOPKA BOULEVARD
    APOPKA,FL32703     		NONE 501(C)(3) OPERATIONAL SUPPORT 4,000
    FEED A HUNGRY CHILD PICKENS CO
    PO BOX 1573
    PICKENS,SC29671     		NONE 501(C)(3) OPERATIONAL SUPPORT 16,250
    FEEDING THE VALLEY
    5928 COCA COLA BOULEVARD
    COLUMBUS,GA319095531     		NONE 501(C)(3) OPERATIONAL SUPPORT 13,582
    FLORIDA KEYS OUTREACH COALITION INC
    PO BOX 4767
    KEY WEST,FL33041     		NONE 501(C)(3) OPERATIONAL SUPPORT 9,000
    FOOD BANK OF EAST ALABAMA
    375 INDUSTRY DR
    AUBURN,AL36832     		NONE 501(C)(3) OPERATIONAL SUPPORT 28,000
    FOOD FOR THOUGHT OUTREACH INC
    174 WATERCOLOR WAY STE 103 286
    SANTA ROSA BEACH,FL32459     		NONE 501(C)(3) OPERATIONAL SUPPORT 17,500
    FOOD OF LIFE OUTREACH MINISTRIES INC
    957 NW 3RD AVE SUITE 3
    FLORIDA CITY,FL33034     		NONE 501(C)(3) OPERATIONAL SUPPORT 5,000
    FOOD PANTRY OF GREEN COVE SPRINGS
    1107 MARTIN LUTHER KING JR BLVD
    GREEN COVE SPRINGS,FL32043     		NONE 501(C)(3) OPERATIONAL SUPPORT 30,000
    GOLDEN HARVEST FOOD BANK INC
    7931 MOOREFIELD MEMORIAL HWY
    LIBERTY,SC29657     		NONE 501(C)(3) OPERATIONAL SUPPORT 30,000
    GRACE JONES COMMUNITY CENTER INC
    240 41ST GULF
    MARATHON,FL33050     		NONE 501(C)(3) OPERATIONAL SUPPORT 1,250
    GREATER BATON ROUGE FOOD BANK
    PO BOX 2996
    BATON ROUGE,LA70821     		NONE 501(C)(3) OPERATIONAL SUPPORT 30,000
    GREATER MIAMI JEWISH FEDERATION
    4200 BISCAYNE BOULEVARD
    MIAMI,FL33137     		NONE 501(C)(3) OPERATIONAL SUPPORT 15,000
    GREATER SPARTANBURG MINISTRIES
    680 ASHEVILLE HWY
    SPARTANBURG,SC29303     		NONE 501(C)(3) OPERATIONAL SUPPORT 8,738
    HALIFAX URBAN MINISTRIES
    215 BAY STREET
    DAYTON BEACH,FL32114     		NONE 501(C)(3) OPERATIONAL SUPPORT 15,000
    HARRY CHAPIN FOOD BANK OF SOUTHWEST FLORI
    3760 FOWLER ST
    FORT MYERS,FL33901     		NONE 501(C)(3) OPERATIONAL SUPPORT 15,000
    HELP OF BEAUFORT
    1910 BAGGETT ST
    BEAUFORT,SC29902     		NONE 501(C)(3) OPERATIONAL SUPPORT 5,000
    HELPING HAND OF MYRTLE BEACH INC
    1411 MR JOE WHITE AVE
    MYRTLE BEACH,SC29577     		NONE 501(C)(3) OPERATIONAL SUPPORT 5,000
    HELPING HANDS OF GOOSE CREEK
    104 COMMERCE PL B
    GOOSE CREEK,SC29445     		NONE 501(C)(3) OPERATIONAL SUPPORT 14,000
    HOPE STATION USA INC
    1116 SAINT CHARLES STREET
    DALTON,GA30721     		NONE 501(C)(3) OPERATIONAL SUPPORT 5,000
    HUMANITIES FOUNDATION
    474 WANDO PARK BOULEVARD SUITE 102
    MOUNT PLEASANT,SC29464     		NONE 501(C)(3) OPERATIONAL SUPPORT 5,000
    HUNGER FIGHT INC
    3811 UNIVERSITY BLVD WEST UNIT 4
    JACKSONVILLE,FL32217     		NONE 501(C)(3) OPERATIONAL SUPPORT 24,600
    INTER-FAITH ALLIANCE CORPORATION
    PO BOX 304
    OCALA,FL34489     		NONE 501(C)(3) OPERATIONAL SUPPORT 32,500
    JEWISH FED OF VOLUSIA & FLAGLER COUNTIES
    470 ANDALUSIA AVE
    ORMOND BEACH,FL32174     		NONE 501(C)(3) OPERATIONAL SUPPORT 33,000
    JUNIOR LEAGUE OF BIRMINGHAM
    2212 20TH AVE S
    BIRMINGHAM,AL35223     		NONE 501(C)(3) OPERATIONAL SUPPORT 2,500
    KIDS HOUSE OF SEMINOLE INC
    5467 N RONALD REGAN BLVD
    SANFORD,FL32773     		NONE 501(C)(3) OPERATIONAL SUPPORT 1,500
    LAKE CARES INC
    4759 DUSTYS RD
    NEW FRANKLIN,OH44319     		NONE 501(C)(3) OPERATIONAL SUPPORT 10,250
    LOAVES & FISHES - CHARLOTTE
    648 GRIFFITH ROAD SUITE B
    CHARLOTTE,NC28217     		NONE 501(C)(3) OPERATIONAL SUPPORT 9,750
    LOAVES & FISHES - GREENVILLE
    25 WOODS LAKE RD 810
    GREENVILLE,SC29607     		NONE 501(C)(3) OPERATIONAL SUPPORT 17,500
    LOVING FOOD RESOURCES INC
    123 KENILWORTH RD
    ASHEVILLE,NC28803     		NONE 501(C)(3) OPERATIONAL SUPPORT 5,000
    LOWCOUNTY FOOD BANK INC
    2864 AZALEA DR
    NORTH CHARLESTON,SC29405     		NONE 501(C)(3) OPERATIONAL SUPPORT 16,250
    LUTHERAN SOCIAL SERV NE FLA
    4615 4479-4 PHILLIPS AP
    JACKSONVILLE,FL32207     		NONE 501(C)(3) OPERATIONAL SUPPORT 15,000
    MAGNOLIA PT WOMEN'S CLUB (MPWC CHARITIES)
    PO BOX 143
    GREEN COVE SPRINGS,FL320430143     		NONE 501(C)(3) OPERATIONAL SUPPORT 9,400
    MEALS ON WHEELS ANDERSON
    105 S FANT ST
    ANDERSON,SC29624     		NONE 501(C)(3) OPERATIONAL SUPPORT 6,500
    MEALS ON WHEELS BLUFFTON-HILTON HEAD
    PO BOX 23691
    HILTON HEAD ISLAND,SC29925     		NONE 501(C)(3) OPERATIONAL SUPPORT 5,000
    MEALS ON WHEELS GREENVILLE COUNTY
    15 OREGON ST
    GREENVILLE,SC29605     		NONE 501(C)(3) OPERATIONAL SUPPORT 44,350
    MEALS ON WHEELS OF ASHE & BUNCOME CTY INC
    146 VICTORIA RD
    ASHEVILLE,NC28801     		NONE 501(C)(3) OPERATIONAL SUPPORT 5,000
    MEALS ON WHEELS OF POLK COUNTY INC
    620 SIXTH STREET NW
    WINTER HAVEN,FL33881     		NONE 501(C)(3) OPERATIONAL SUPPORT 6,000
    MEALS ON WHEELS PLUS OF MANATEE
    811 23RD AVENUE EAST
    BRADENTON,FL34208     		NONE 501(C)(3) OPERATIONAL SUPPORT 23,550
    MIDDLE GEORGIA COMMUNITY FOOD BANK
    4490 OCMULGEE E BLVD
    MACON,GA31217     		NONE 501(C)(3) OPERATIONAL SUPPORT 17,500
    MISSION IN CITRUS INC
    2472 N PENNSYLVANIA AVE
    CRYSTAL RIVER,FL34428     		NONE 501(C)(3) OPERATIONAL SUPPORT 5,000
    MISSISSIPPI FOOD NETWORK INC
    440 BEATTY ST
    JACKSON,MS39201     		NONE 501(C)(3) OPERATIONAL SUPPORT 27,235
    MOBILE MEAL SERVICE OF SPARTANBURG COUNTY
    419 E MAIN STREET
    SPARTANBURG,SC29302     		NONE 501(C)(3) OPERATIONAL SUPPORT 32,500
    MOBILE MEALS OF THE GRAND STRAND
    2637 HIGHWAY 17 SOUTH
    GARDEN CITY,SC29576     		NONE 501(C)(3) OPERATIONAL SUPPORT 5,000
    MONTGOMERY AREA COALITION FOR THE HOMELES
    101 COLISEUM BOULEVARD
    MONTGOMERY,AL36109     		NONE 501(C)(3) OPERATIONAL SUPPORT 1,000
    NEW BEGINNINGS OF LAKE COUNTY INC
    792 E MONTROSE ST
    CLERMONT,FL34711     		NONE 501(C)(3) OPERATIONAL SUPPORT 1,500
    NEW ORLEANS MISSION
    1134 BARONNE ST
    NEW ORLEANS,LA70113     		NONE 501(C)(3) OPERATIONAL SUPPORT 15,600
    NORTH STRAND HELPING HAND
    2501 LONG BAY RD
    LONGS,SC29568     		NONE 501(C)(3) OPERATIONAL SUPPORT 7,000
    NORTHWOOD BAPTIST CHURCH
    3762 CAPITAL CIR NW
    TALLAHASSEE,FL32303     		NONE 501(C)(3) OPERATIONAL SUPPORT 13,000
    OPEN ARMS INC
    6205 BALBOA ST
    COCOA BEACH,FL32927     		NONE 501(C)(3) OPERATIONAL SUPPORT 6,000
    PANAMA CITY RESCUE MISSION
    609 ALLEN AVE
    PANAMA CITY,FL32401     		NONE 501(C)(3) OPERATIONAL SUPPORT 21,500
    PASS IT ON MINISTRIES OF S FL
    14617 NW 7TH AVE
    MIAMI,FL33168     		NONE 501(C)(3) OPERATIONAL SUPPORT 19,500
    PENELOPE HOUSE FAMILY VIOLENCE CENTER IN
    PO BOX 9127
    MOBILE,AL36691     		NONE 501(C)(3) OPERATIONAL SUPPORT 750
    PRODISEE PANTRY INC
    9315 SPANISH FORT BLVD
    SPANISH FORT,AL36527     		NONE 501(C)(3) OPERATIONAL SUPPORT 7,000
    PROJECT HOST
    525 S ACADEMY ST
    GREENVILLE,SC29601     		NONE 501(C)(3) OPERATIONAL SUPPORT 19,500
    REGIONAL FOOD BANK OF NE FL
    1116 EDGEWOOD AVE N D/E
    JACKSONVILLE,FL32254     		NONE 501(C)(3) OPERATIONAL SUPPORT 30,000
    RELIGIOUS COMMUNITY SERVICES INC
    503 S MARTIN LUTHER KING JR AVE
    CLEARWATER,FL33756     		NONE 501(C)(3) OPERATIONAL SUPPORT 9,750
    RONALD MCDONALD HOUSE OF NW FLORIDA
    5200 BAYOU BLVD
    PENSACOLA,FL32503     		NONE 501(C)(3) OPERATIONAL SUPPORT 12,000
    RUTH & NORMAN RALES JEWISH FAMILY SERV
    21300 RUTH AND BARON COLEMAN BLVD
    BOCA RATON,FL33428     		NONE 501(C)(3) OPERATIONAL SUPPORT 12,000
    S4P SYNERGY INC
    PO BOX 1626
    FT WALTON BEACH,FL32549     		NONE 501(C)(3) OPERATIONAL SUPPORT 8,188
    SALVATION ARMY
    5631 VAN DYKE RD
    LUTZ,FL33558     		NONE 501(C)(3) OPERATIONAL SUPPORT 260,900
    SARAH'S KITCHEN TREASURE COAST
    295 NW PRIMA VISTA BLVD
    PORT ST LUCIE,FL34983     		NONE 501(C)(3) OPERATIONAL SUPPORT 13,000
    SCOTT CITY HOMELESS SHELTER
    820 ANDERSON
    SIKESTON,MO63801     		NONE 501(C)(3) OPERATIONAL SUPPORT 5,000
    SECOND HARVEST FD BK-GRTR NOL & ACADIANA
    700 EDWARDS AVE
    NEW ORLEANS,LA70123     		NONE 501(C)(3) OPERATIONAL SUPPORT 35,000
    SECOND HARVEST FOOD BANK OF MIDDLE TN
    331 GREAT CIRCLE RD
    NASHVILLE,TN37228     		NONE 501(C)(3) OPERATIONAL SUPPORT 21,000
    SENIOR RESOURCES
    2310 ISLAND VW
    CANYON LAKE,TX78133     		NONE 501(C)(3) OPERATIONAL SUPPORT 8,700
    SENIORS FIRST
    5395 L B MCLEOD RD
    ORLANDO,FL32811     		NONE 501(C)(3) OPERATIONAL SUPPORT 2,000
    SERVICE CLUB OF MANATEE COUNTY INC
    PO BOX 15435
    BRADENTON,FL342805435     		NONE 501(C)(3) OPERATIONAL SUPPORT 17,500
    ST LUKE THE EVAN CATHOLIC CHURCH
    13700 LAWYERS RD
    MINT HILL,NC28227     		NONE 501(C)(3) OPERATIONAL SUPPORT 12,000
    ST PETER'S LUTHERAN CHURCH
    719 5TH ST
    COLUMBUS,IN47201     		NONE 501(C)(3) OPERATIONAL SUPPORT 6,500
    STAR OF THE SEA FOUNDATION INC
    5640 MALONEY AVE
    STOCK ISLAND,FL33040     		NONE 501(C)(3) OPERATIONAL SUPPORT 16,250
    SWEETWATER MISSION INC
    6289 VETERANS MEMORIAL HWY 12A
    AUSTELL,GA30168     		NONE 501(C)(3) OPERATIONAL SUPPORT 7,000
    TAMPA JEWISH FAMILY SERVICES
    13009 COMMUNITY CAMPUS DR
    TAMPA,FL33625     		NONE 501(C)(3) OPERATIONAL SUPPORT 17,500
    TENNESSEE WESLEYAN COLLEGE
    204 E COLLEGE ST
    ATHENS,TN37303     		NONE 501(C)(3) OPERATIONAL SUPPORT 7,000
    THE PASTOR'S PANTRY
    307 N STATE ST
    LEXINGTON,NC27292     		NONE 501(C)(3) OPERATIONAL SUPPORT 5,000
    THE POVERELLO CENTER INC
    1110 W BROADWAY ST
    MISSOULA,MT59802     		NONE 501(C)(3) OPERATIONAL SUPPORT 16,800
    TREASURE COAST FOOD BANK
    3051 INDUSTRIAL 25TH STREET
    FT PIERCE,FL349468635     		NONE 501(C)(3) OPERATIONAL SUPPORT 13,320
    TRINITY CAFE'
    2801 N NEBRASKA AVE
    TAMPA,FL33602     		NONE 501(C)(3) OPERATIONAL SUPPORT 23,888
    TRINITY RESCUE MISSION
    622 UNION ST W
    JACKSONVILLE,FL32202     		NONE 501(C)(3) OPERATIONAL SUPPORT 9,000
    UNITED NEGRO COLLEGE FUND INC
    1805 7TH STREET NW
    WASHINGTON,DC20001     		NONE 501(C)(3) OPERATIONAL SUPPORT 12,500
    UNITED WAY OF BROWARD COUNTY
    1300 S ANDREWS AVE
    FORT LAUDERDALE,FL33316     		NONE 501(C)(3) OPERATIONAL SUPPORT 16,250
    UNITED WAY OF LAKE & SUMTER COUNTIES
    32644 BLOSSOM LANE
    LEESBURG,FL34788     		NONE 501(C)(3) OPERATIONAL SUPPORT 4,102
    URBAN JAX (AGING TRUE COMM SR SERV)
    4250 LAKESIDE DR 116
    JACKSONVILE,FL32210     		NONE 501(C)(3) OPERATIONAL SUPPORT 16,250
    WASTE NOT WANT NOT INC
    2050 CARNES ST
    ORANGE PARK,FL32073     		NONE 501(C)(3) OPERATIONAL SUPPORT 10,439
    WE CARE FOOD PANTRY
    5530 S MASON CREEK RD
    HOMOSASSA,FL34448     		NONE 501(C)(3) OPERATIONAL SUPPORT 2,575
    WEST ALABAMA FOOD BANK
    3160 MCFARLAND BLVD
    NORTHPORT,AL35476     		NONE 501(C)(3) OPERATIONAL SUPPORT 12,500
    WOMEN IN DISTRESS OF BROWARD COUNTY
    1372 FL-7
    MARGATE,FL33063     		NONE 501(C)(3) OPERATIONAL SUPPORT 4,500
    WOMENS RECOVERY CENTER OF TAMPA BAY
    8210 STATE ROAD 52
    PORT RICHEY,FL80112     		NONE 501(C)(3) OPERATIONAL SUPPORT 1,500
    CROP CREATIVE MEDIA
    1024 KINGS AVE
    JACKSONVILLE,FL32207     		NONE 501(C)(3) OPERATIONAL SUPPORT 54,610
    Total .................................bullet 3a 2,148,041
    bApproved for future payment
    Total .................................bullet 3b 0
    Form 990-PF (2015)
    Form 990-PF (2015)
    Page 12
    Part XVI-A
    Analysis of Income-Producing Activities
    Enter gross amounts unless otherwise indicated. Unrelated business income Excluded by section 512, 513, or 514 (e)
    Related or exempt
    function income
    (See instructions.)
    1Program service revenue: (a)
    Business code     		(b)
    Amount     		(c)
    Exclusion code     		(d)
    Amount
    a
    b
    c
    d
    e
    f
    gFees and contracts from government agencies          
    2 Membership dues and assessments....          
    3
    Interest on savings and temporary cash investments ...........     		    14 469  
    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 ............     		         
    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).. 0 469 0
    13Total. Add line 12, columns (b), (d), and (e)..................
    13469
    (See worksheet in line 13 instructions to verify calculations.)
    Part XVI-B
    Relationship of Activities to the Accomplishment of Exempt Purposes
    Line No.
    DownArrow     		Explain below how each activity for which income is reported in column (e) of Part XVI-A contributed importantly to
    the accomplishment of the foundation’s exempt purposes (other than by providing funds for such purposes). (See
    instructions.)
    Form 990-PF (2015)
    Form 990-PF (2015)
    Page 13
    Part XVII
    Information Regarding Transfers To and Transactions and Relationships With Noncharitable Exempt Organizations
    1
    Did the organization directly or indirectly engage in any of the following with any other organization described in section 501(c) of the Code (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) of the Code (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 instr.)?
    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 (2015)
    Additional Data


    Software ID:  
    Software Version:  


    Form 990PF - Special Condition Description:
    Special Condition Description
    Schedule B
    (Form 990, 990-EZ,
    or 990-PF)
    Department of the Treasury
    Internal Revenue Service
    Schedule of Contributors
    Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
    Arrow Bullet Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.
    OMB No. 1545-0047
    2015
    Name of the organization
    BI-LO HOLDINGS FOUNDATION INC
     
    Employer identification number

    59-0995428
    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 is not covered by the General Rule and/or the Special Rules does not 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 does not meet the filing requirements of Schedule B (Form 990,
    990-EZ, or 990-PF).
    For Paperwork Reduction Act Notice, see the Instructions
    for Form 990, 990-EZ, or 990-PF.
    Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2015)
    Schedule B (Form 990, 990-EZ, or 990-PF) (2015) Page 2
    Name of organization
    BI-LO HOLDINGS FOUNDATION INC
          		Employer identification number
    59-0995428
    Part I
    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
     
     

    FALCON FARMS INC  
    1401 NW 78TH AVE
     
    DORAL, FL33126

    		$ 10,517


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    2
     
     

    DIRECT FLOWERS DISTRIBUTORS INC  
    2605 NW 77TH AVE
     
    MIAMI, FL33122

    		$ 8,610


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    3
     
     

    JEFF SANDERS  
    5671 SW ARCTIC DRIVE
     
    BEAVERTON, OR97005

    		$ 2,841,453


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

    FLOWERS PROVIDERS 2 LLC  
    2330 NW 82ND AVE
     
    DORAL, FL33122

    		$ 20,800


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    5
     
     

    PROCTER AND GAMBLE  
    700 WILMER AVE
     
    CINCINNATI, OH45226

    		$ 35,000


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    6
     
     

    ONSTEAD FOUNDATION  
    5298 MEMORIAL DR
     
    HOUSTON, TX770078260

    		$ 5,000


    (Complete Part II for noncash contributions.)
    Schedule B (Form 990, 990-EZ, or 990-PF) (2015)
    Name of organization
    BI-LO HOLDINGS FOUNDATION INC
          		Employer identification number
    59-0995428
    Part I
    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
    7
     
     

    EXTENTUS  
    14241 DALLAS PARKWAY STE 400
     
    DALLAS, TX35000

    		$ 35,000


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

       
     
     

    		$  


    (Complete Part II for noncash contributions.)
    Schedule B (Form 990, 990-EZ, or 990-PF) (2015)
    Schedule B (Form 990, 990-EZ, or 990-PF) (2015)
    Page 3
    Name of organization
    BI-LO HOLDINGS FOUNDATION INC
          		Employer identification number

    59-0995428
    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
     
    		$    
    (a)
    No.from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    (a)
    No.from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    (a)
    No.from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    (a)
    No.from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    (a)
    No.from Part I    		 (b)
    Description of noncash property given    		 (c)
    FMV (or estimate)
    (see instructions)     		(d)
    Date received
     
    		$    
    Schedule B (Form 990, 990-EZ, or 990-PF) (2015)
    Schedule B (Form 990, 990-EZ, or 990-PF) (2015)
    Page 4
    Name of organization
    BI-LO HOLDINGS FOUNDATION INC
          		Employer identification number

    59-0995428
    Part III
    Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
    Use duplicate copies of Part III if additional space is needed.
    (a)
    No.from Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
         
     
    (a)
    No.from Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
         
     
    (a)
    No.from Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
         
     
    (a)
    No.from Part I    		 (b) Purpose of gift (c) Use of gift (d) Description of how gift is held
     
    (e) Transfer of gift
    Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
     
     
         
     
    Schedule B (Form 990, 990-EZ, or 990-PF) (2015)

    Additional Data


    Software ID:  
    Software Version:  

    TY 2015 AccountingFeesSchedule
    Name:
    BI-LO HOLDINGS FOUNDATION INC
    EIN:
    59-0995428
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    ACCOUNTING FEES 3,500 0   0

    TY 2015 InvestmentsCorpBondsSchedule
    Name:
    BI-LO HOLDINGS FOUNDATION INC
    EIN:
    59-0995428
    Name of Bond End of Year Book Value End of Year Fair Market Value
    MADISON CO. TOBACCO WAREHOUSE 800 800
    MADISON INDUSTRIES 100 100

    TY 2015 OtherAssetsSchedule
    Name:
    BI-LO HOLDINGS FOUNDATION INC
    EIN:
    59-0995428
    Description Beginning of Year - Book Value End of Year - Book Value End of Year - Fair Market Value
    PREPAID TAXES 714 714 714


    TY 2015 OtherExpensesSchedule
    Name:
    BI-LO HOLDINGS FOUNDATION INC
    EIN:
    59-0995428
    Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    MISCELLANEOUS EXPENSE 522 0   0


    TY 2015 OtherProfessionalFeesSchedule
    Name:
    BI-LO HOLDINGS FOUNDATION INC
    EIN:
    59-0995428
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    BANK FEES 503 0   0