Form990-PF


Department of the Treasury
Internal Revenue Service

Return of Private Foundation
or Section 4947(a)(1) Trust Treated as Private Foundation
bulletDo not enter social security numbers on this form as it may be made public.
bulletGo to www.irs.gov/Form990PF for instructions and the latest information.
OMB No. 1545-0047
2021
Open to Public Inspection
For calendar year 2021, or tax year beginning 01-01-2021 , and ending 12-31-2021
Name of foundation
BI-LO HOLDINGS FOUNDATION INC
 
Number and street (or P.O. box number if mail is not delivered to street address)8928 PROMINENCE PARKWAY 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) 783-5000
C bullet
G Check all that apply:

D 1. Foreign organizations, check here............. bullet
2. Foreign organizations meeting the 85%
test, check here and attach computation ... bullet
E bullet
H Check type of organization:
F bullet
I Fair market value of all assets at end
of year (from Part II, col. (c),
line 16)bullet$2,862,094J 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) 1,304,200
2 Check bullet.............
3 Interest on savings and temporary cash investments      
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)....... Click to see attachment 704,233 0  
12 Total. Add lines 1 through 11........ 2,008,433 0  
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 2,000 1,000   1,000
c Other professional fees (attach schedule).... Click to see attachment 45,460 2,625   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 492,510 0   220,047
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 539,970 3,625   221,047
25 Contributions, gifts, grants paid....... 1,251,360 1,251,360
26 Total expenses and disbursements. Add lines 24 and 25 1,791,330 3,625   1,472,407
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements 217,103
b Net investment income (if negative, enter -0-) 0
c Adjusted net income (if negative, enter -0-)...  
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 11289X Form 990-PF (2021)
Form 990-PF (2021)
Page 2
Part II Balance Sheets Attached schedules and amounts in the description column
should be for end-of-year amounts only. (See instructions.) 		Beginning of year End of year
(a) Book Value (b) Book Value (c) Fair Market Value
Assets 1 Cash—non-interest-bearing............. 2,221,886 2,591,989 2,591,989
2 Savings and temporary cash investments.........      
3 Accounts receivable bullet269,600
Less: allowance for doubtful accounts bullet   412,600 269,600 269,600
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.......... 503 503 503
10a Investments—U.S. and state government obligations (attach schedule)      
b Investments—corporate stock (attach schedule).......      
c Investments—corporate bonds (attach schedule)....... 2 Click to see attachment2 2
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)      
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 2,634,991 2,862,094 2,862,094
Liabilities 17 Accounts payable and accrued expenses..........   10,000
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 10,000
Net Assets or Fund Balances Foundations that follow FASB ASC 958, check here bullet
and complete lines 24, 25, 29 and 30.
24 Net assets without donor restrictions...........    
25 Net assets with donor restrictions............    
Foundations that do not follow FASB ASC 958, check here bullet
and complete lines 26 through 30.
26 Capital stock, trust principal, or current funds........ 0 0
27 Paid-in or capital surplus, or land, bldg., and equipment fund 0 0
28 Retained earnings, accumulated income, endowment, or other funds 2,634,991 2,852,094
29 Total net assets or fund balances (see instructions)..... 2,634,991 2,852,094
30 Total liabilities and net assets/fund balances (see instructions). 2,634,991 2,862,094
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
2,634,991
2
Enter amount from Part I, line 27a .....................
2
217,103
3
Other increases not included in line 2 (itemize) bullet
3
0
4
Add lines 1, 2, and 3 ..........................
4
2,852,094
5
Decreases not included in line 2 (itemize) bullet
5
0
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29 .
6
2,852,094
Form 990-PF (2021)
Form 990-PF (2021)
Page 3
Part IV
Capital Gains and Losses for Tax on Investment Income
(a) List and describe the kind(s) of property sold (e.g., real estate,
2-story brick warehouse; or common stock, 200 shs. MLC Co.)		 (b)
How acquired
P—Purchase
D—Donation 		(c)
Date acquired
(mo., day, yr.) 		(d)
Date sold
(mo., day, yr.)
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  
Form 990-PF (2021)
Form 990-PF (2021)
Page 4
Part V
Excise Tax Based on Investment Income (Section 4940(a), 4940(b), 4940(e), or 4948—see instructions)
1a Exempt operating foundations described in section 4940(d)(2), check here Bullet and enter “N/A" on line 1. Bracket for line 1a
Date of ruling or determination letter:   (attach copy of letter if necessary–see instructions)
b All other domestic foundations enter 1.39% (0.0139) of line 27b. Exempt foreign organizations enter 4% (0.04) of Part I, line 12, col. (b)
2 Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) 2 0
3 Add lines 1 and 2........................... 3 0
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 0
6 Credits/Payments:
a 2021 estimated tax payments and 2020 overpayment credited to 2021 6a 503
b Exempt foreign organizations—tax withheld at source...... 6b 0
c Tax paid with application for extension of time to file (Form 8868)... 6c 0
d Backup withholding erroneously withheld ........... 6d 0
7 Total credits and payments. Add lines 6a through 6d.............. 7 503
8 Enter any penalty for underpayment of estimated tax. Check here if Form 2220 is attached. 8 0
9 Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed.......Bullet 9  
10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid...Bullet 10 503
11 Enter the amount of line 10 to be: Credited to 2022 estimated taxBullet503 RefundedBullet 11 0
Part VI-A
Statements Regarding Activities
1a
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did
Yes
No
it participate or intervene in any political campaign? ....................
1a
 
No
b
Did it spend more than $100 during the year (either directly or indirectly) for political purposes? See the instructions
for the definition.................................
1b
 
No
If the answer is "Yes" to 1a or 1b, attach a detailed description of the activities and copies of any materials
published or distributed by the foundation in connection with the activities.
c
Did the foundation file Form 1120-POL for this year?.....................
1c
 
No
d
Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
(1) On the foundation. bullet$ 0(2) On foundation managers.bullet$ 0
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.bullet$ 0
2
Has the foundation engaged in any activities that have not previously been reported to the IRS?.......
2
 
No
If "Yes," attach a detailed description of the activities.
3
Has the foundation made any changes, not previously reported to the IRS, in its governing instrument, articles
of incorporation, or bylaws, or other similar instruments? If "Yes," attach a conformed copy of the changes....
3
 
No
4a
Did the foundation have unrelated business gross income of $1,000 or more during the year?.........
4a
 
No
b
If "Yes," has it filed a tax return on Form 990-T for this year?...................
4b
 
 
5
Was there a liquidation, termination, dissolution, or substantial contraction during the year?.........
5
 
No
If "Yes," attach the statement required by General Instruction T.
6
Are the requirements of section 508(e) (relating to sections 4941 through 4945) satisfied either:
  • By language in the governing instrument, or
  • By state legislation that effectively amends the governing instrument so that no mandatory directions
    • that conflict with the state law remain in the governing instrument?................
    6
    Yes
     
    7
    Did the foundation have at least $5,000 in assets at any time during the year? If "Yes," complete Part II, col. (c),
    and Part XIV..................................
    7
    Yes
     
    8a
    Enter the states to which the foundation reports or with which it is registered (see instructions)
    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 2021 or the taxable year beginning in 2021? See the instructions for Part XIII.
    If "Yes," complete Part XIII .............................
    9
     
    No
    10
    Did any persons become substantial contributors during the tax year? If "Yes," attach a schedule listing their names
    and addresses. ...............................
    10
     
    No
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 5
    Part VI-A
    Statements Regarding Activities (continued)
    11
    At any time during the year, did the foundation, directly or indirectly, own a controlled entity within the
    meaning of section 512(b)(13)? If "Yes," attach schedule. See instructions .............
    11
     
    No
    12
    Did the foundation make a distribution to a donor advised fund over which the foundation or a disqualified person had
    advisory privileges? If "Yes," attach statement. See instructions.................
    12
     
    No
    13
    Did the foundation comply with the public inspection requirements for its annual returns and exemption application?
    13
    Yes
     
    Website addressbulletN/A
    14
    The books are in care ofbulletTHE ORGANIZATION Telephone no.bullet (904) 783-5000

    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 —check here .........bullet
    and enter the amount of tax-exempt interest received or accrued during the year ........bullet
    15
     
    16 At any time during calendar year 2021, did the foundation have an interest in or a signature or other authority over YesNo
    a bank, securities, or other financial account in a foreign country? .................
    16   No
    See the instructions for exceptions and filing requirements for FinCEN Form 114. If "Yes", enter the name of the foreign
    country bullet
    Part VI-B
    Statements Regarding Activities for Which Form 4720 May Be Required
    File Form 4720 if any item is checked in the "Yes" column, unless an exception applies.
    Yes
    No
    1a
    During the year did the foundation (either directly or indirectly):
    (1) Engage in the sale or exchange, or leasing of property with a disqualified person? ...........
    1a(1)
     
    No
    (2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
    a disqualified person? ..............................
    1a(2)
     
    No
    (3) Furnish goods, services, or facilities to (or accept them from) a disqualified person? ...........
    1a(3)
     
    No
    (4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person? ............
    1a(4)
     
    No
    (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
     
     
    c
    ........bullet
    d
    Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts,
    that were not corrected before the first day of the tax year beginning in 2021? .............
    1d
     
    No
    2
    Taxes on failure to distribute income (section 4942) (does not apply for years the foundation was a private
    operating foundation defined in section 4942(j)(3) or 4942(j)(5)):
    a
    At the end of tax year 2021, did the foundation have any undistributed income (lines 6d
    and 6e, Part XII) for tax year(s) beginning before 2021?....................
    2a
     
    No
    If "Yes," list the years bullet20, 20, 20, 20
    b
    Are there any years listed in 2a for which the foundation is not applying the provisions of section 4942(a)(2)
    (relating to incorrect valuation of assets) to the year’s undistributed income? (If applying section 4942(a)(2)
    to all years listed, answer "No" and attach statement—see instructions.) ..............
    2b
     
     
    c
    If the provisions of section 4942(a)(2) are being applied to any of the years listed in 2a, list the years here.
    bullet20, 20, 20, 20
    3a
    Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at
    any time during the year? ..............................
    3a
     
    No
    b
    If "Yes," did it have excess business holdings in 2021 as a result of (1) any purchase by the foundation
    or disqualified persons after May 26, 1969; (2) the lapse of the 5-year period (or longer period approved
    by the Commissioner under section 4943(c)(7)) to dispose of holdings acquired by gift or bequest; or (3)
    the lapse of the 10-, 15-, or 20-year first phase holding period? (Use Schedule C, Form 4720, to determine
    if the foundation had excess business holdings in 2021.) .....................
    3b
     
     
    4a
    Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes?
    4a
     
    No
    b
    Did the foundation make any investment in a prior year (but after December 31, 1969) that could jeopardize its
    charitable purpose that had not been removed from jeopardy before the first day of the tax year beginning in 2021? ..
    4b
     
    No
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 6
    Part VI-B
    Statements Regarding Activities for Which Form 4720 May Be Required (continued)
    5a
    During the year did the foundation pay or incur any amount to:
    Yes
    No
    (1) Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))? ..........
    5a(1)
     
    No
    (2) Influence the outcome of any specific public election (see section 4955); or to carry
    on, directly or indirectly, any voter registration drive? ....................
    5a(2)
     
    No
    (3) Provide a grant to an individual for travel, study, or other similar purposes? .............
    5a(3)
     
    No
    (4) Provide a grant to an organization other than a charitable, etc., organization described
    in section 4945(d)(4)(A)? See instructions ........................
    5a(4)
     
    No
    (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
     
     
    c
    .........bullet
    d
    If the answer is "Yes" to question 5a(4), does the foundation claim exemption from the
    tax because it maintained expenditure responsibility for the grant? .................
    5d
     
     
    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? .............................
    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
    RAYMOND RHEE PRESIDENT
    1.00     		0 0 0
    8928 PROMINENCE PARKWAY SUITE 200
    JACKSONVILLE,FL32256
    ZACK BINGHAM VICE PRESIDENT
    1.00     		0 0 0
    8928 PROMINENCE PARKWAY SUITE 200
    JACKSONVILLE,FL33256
    M SANDLIN GRIMM V.P. & SECRETARY
    1.00     		0 0 0
    8928 PROMINENCE PARKWAY SUITE 200
    JACKSONVILLE,FL32256
    KENNETH JONES TREASURER
    1.00     		0 0 0
    8928 PROMINENCE PARKWAY SUITE 200
    JACKSONVILLE,FL32256
    2 Compensation of five highest-paid employees (other than those included on line 1—see instructions). If none, enter “NONE."
    (a) Name and address of each employee paid more than $50,000 (b) Title, and average
    hours per week
    devoted to position     		(c) Compensation (d) Contributions to
    employee benefit
    plans and deferred
    compensation     		(e) Expense account,
    other allowances
    NONE
    Total number of other employees paid over $50,000...................bullet 0
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 7
    Part VII
    Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
    and Contractors (continued)
    3 Five highest-paid independent contractors for professional services (see instructions). If none, enter "NONE".
    (a) Name and address of each person paid more than $50,000 (b) Type of service (c) Compensation
    NONE
    Total number of others receiving over $50,000 for professional services.............bullet0
    Part VIII-A
    Summary of Direct Charitable Activities
    List the foundation’s four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc. Expenses
    1  
    2  
    3  
    4  
    Part VIII-B
    Summary of Program-Related Investments (see instructions)
    Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2. Amount
    1  
    2  
    All other program-related investments. See instructions.
    3  
    Total. Add lines 1 through 3.........................bullet0
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 8
    Part IX
    Minimum Investment Return (All domestic foundations must complete this part. Foreign foundations, see instructions.)
    1
    Fair market value of assets not used (or held for use) directly in carrying out charitable, etc.,
    purposes:
    a
    Average monthly fair market value of securities...................
    1a
    0
    b
    Average of monthly cash balances.......................
    1b
    2,382,052
    c
    Fair market value of all other assets (see instructions)................
    1c
    0
    d
    Total (add lines 1a, b, and c).........................
    1d
    2,382,052
    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
    2,382,052
    4
    Cash deemed held for charitable activities. Enter 1.5% (0.015) of line 3 (for greater amount, see
    instructions) .............................
    4
    35,731
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. .......
    5
    2,346,321
    6
    Minimum investment return. Enter 5% (0.05) of line 5................
    6
    117,316
    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
    117,316
    2a
    Tax on investment income for 2021 from Part V, line 5.......
    2a
     
    b
    Income tax for 2021. (This does not include the tax from Part V.) ...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
    0
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
    117,316
    4
    Recoveries of amounts treated as qualifying distributions................
    4
    0
    5
    Add lines 3 and 4............................
    5
    117,316
    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
    117,316
    Part XI
    Qualifying Distributions (see instructions)
    1
    Amounts paid (including administrative expenses) to accomplish charitable, etc., purposes:
    a
    Expenses, contributions, gifts, etc.—total from Part I, column (d), line 26 ..........
    1a
     
    b
    Program-related investments—total from Part VIII-B..................
    1b
     
    2
    Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,
    purposes...............................
    2
     
    3
    Amounts set aside for specific charitable projects that satisfy the:
    a
    Suitability test (prior IRS approval required)....................
    3a
     
    b
    Cash distribution test (attach the required schedule) .................
    3b
     
    4
    Qualifying distributions. Add lines 1a through 3b. Enter here and on Part XII, line 4.
    4
     
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 9
    Part XII
    Undistributed Income (see instructions)
    (a)
    Corpus     		(b)
    Years prior to 2020     		(c)
    2020     		(d)
    2021
    1 Distributable amount for 2021 from Part X, line 7 117,316
    2 Undistributed income, if any, as of the end of 2021:
    a Enter amount for 2020 only....... 0
    b Total for prior years:20, 20, 20 0
    3 Excess distributions carryover, if any, to 2021:
    a From 2016...... 281,028
    b From 2017...... 791,119
    c From 2018...... 400,188
    d From 2019...... 440,658
    e From 2020...... 1,553,862
    f Total of lines 3a through e ........ 3,466,855
    4Qualifying distributions for 2021 from Part
    XI, line 4: bullet$ 1,472,407
    a Applied to 2020, but not more than line 2a 0
    b Applied to undistributed income of prior years
    (Election required—see instructions).....     		0
    c Treated as distributions out of corpus (Election
    required—see instructions)........     		0
    d Applied to 2021 distributable amount..... 117,316
    e Remaining amount distributed out of corpus 1,355,091
    5 Excess distributions carryover applied to 2021. 0 0
    (If an amount appears in column (d), the
    same amount must be shown in column (a).)
    6Enter the net total of each column as
    indicated below:
    a Corpus. Add lines 3f, 4c, and 4e. Subtract line 5 4,821,946
    b Prior years’ undistributed income. Subtract
    line 4b from line 2b ..........     		0
    c Enter the amount of prior years’ undistributed
    income for which a notice of deficiency has
    been issued, or on which the section 4942(a)
    tax has been previously assessed......     		0
    d Subtract line 6c from line 6b. Taxable amount
    —see instructions ...........     		0
    e Undistributed income for 2019. Subtract line
    4a from line 2a. Taxable amount—see
    instructions .............     		0
    f Undistributed income for 2021. Subtract
    lines 4d and 5 from line 1. This amount must
    be distributed in 2022 ..........     		0
    7 Amounts treated as distributions out of
    corpus to satisfy requirements imposed by
    section 170(b)(1)(F) or 4942(g)(3) (Election may
    be required - see instructions) .......     		0
    8 Excess distributions carryover from 2016 not
    applied on line 5 or line 7 (see instructions) ...     		281,028
    9 Excess distributions carryover to 2022.
    Subtract lines 7 and 8 from line 6a ......     		4,540,918
    10 Analysis of line 9:
    a Excess from 2017.... 791,119
    b Excess from 2018.... 400,188
    c Excess from 2019.... 440,658
    d Excess from 2020.... 1,553,862
    e Excess from 2021.... 1,355,091
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 10
    Part XIII
    Private Operating Foundations (see instructions and Part VI-A, question 9)
    1a If the foundation has received a ruling or determination letter that it is a private operating
    foundation, and the ruling is effective for 2021, enter the date of the ruling ....... bullet
     
    b Check box to indicate whether the organization is a private operating foundation described in section or
    2a Enter the lesser of the adjusted net
    income from Part I or the minimum
    investment return from Part X for each
    year listed ..........     		Tax year Prior 3 years (e) Total
    (a) 2021 (b) 2020 (c) 2019 (d) 2018
             
    b 85% (0.85) of line 2a .........          
    c Qualifying distributions from Part XI,
    line 4 for each year listed .....     		         
    d Amounts included in line 2c not used directly
    for active conduct of exempt activities ..........     		         
    e Qualifying distributions made directly
    for active conduct of exempt activities.
    Subtract line 2d from line 2c ....     		         
    3 Complete 3a, b, or c for the
    alternative test relied upon:
    a “Assets" alternative test—enter:
    (1) Value of all assets ......          
    (2) Value of assets qualifying
    under section 4942(j)(3)(B)(i)    		          
    b “Endowment" alternative test— enter 2/3
    of minimum investment return shown in
    Part IX, line 6 for each year listed ..     		         
    c “Support" alternative test—enter:
    (1) Total support other than gross
    investment income (interest,
    dividends, rents, payments
    on securities loans (section
    512(a)(5)), or royalties) ....     		         
    (2) Support from general public
    and 5 or more exempt
    organizations as provided in
    section 4942(j)(3)(B)(iii)....     		         
    (3) Largest amount of support
    from an exempt organization    		          
    (4) Gross investment income          
    Part XIV
    Supplementary Information (Complete this part only if the foundation had $5,000 or more in
    assets at any time during the year—see instructions.)
    1Information Regarding Foundation Managers:
    aList any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation
    before the close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2).)
    bList any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the
    ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.
    2Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
    Check here bullet
    aThe name, address, and telephone number or e-mail address of the person to whom applications should be addressed:
    AMY PIERCE
    8928 PROMINENCE PARKWAY 200
    JACKSONVILLE,FL32256
    (904) 783-5000
    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 (2021)
    Form 990-PF (2021)
    Page 11
    Part XIV
    Supplementary Information (continued)
    3 Grants and Contributions Paid During the Year or Approved for Future Payment
    Recipient If recipient is an individual,
    show any relationship to
    any foundation manager
    or substantial contributor
    		 Foundation
    status of
    recipient     		Purpose of grant or
    contribution     		Amount
    Name and address (home or business)
    aPaid during the year
    MONROE COUNTY FIREFIGHTERS BENEVOLENCE FUNDS
    490 63RD STREET W
    MARATHON,FL33050     		NONE 501(C)(3) DISASTER RELIEF - OPERATIONAL SUPPORT 10,000
    AMERICAN RED CROSS
    751 RIVERSIDE AVE
    JACKSONVILLE,FL32204     		NONE 501(C)(3) DISASTER RELIEF - OPERATIONAL SUPPORT 250,000
    GREAT SOUTHERN INDUSTRIES
    1320 BOILING STREET
    JACKSON,MS39209     		NONE   HUNGER RELIEF - MOBILE FOOD PANTRY BOXES 1,360
    JFCS
    1753 RINGLING BOULEVARD
    SARASOTA,FL34236     		NONE 501(C)(3) HUNGER RELIEF - OPERATIONAL SUPPORT 25,000
    FEEDING NORTHEAST FLORIA
    1116 EDGEWOOD AVENUE NORTH D/E
    JACKSONVILLE,FL32254     		NONE 501(C)(3) HUNGER RELIEF - OPERATIONAL SUPPORT 25,000
    SECOND HARVEST FOOD BANK
    700 EDWARDS AVE
    NEW ORLEANS,LA70123     		NONE 501(C)(3) HUNGER RELIEF - OPERATIONAL SUPPORT 25,000
    SECOND HARVEST OF CENTRAL FLORIDA
    411 MERCY DRIVE
    ORLANDO,FL32805     		NONE 501(C)(3) HUNGER RELIEF - OPERATIONAL SUPPORT 25,000
    FEEDING GULF COAST
    5248 MOBILE S ST
    THEODORE,AL36582     		NONE 501(C)(3) HUNGER RELIEF - OPERATIONAL SUPPORT 25,000
    FEEDING AMERICA TAMPA BAY
    4702 TRANSPORT DRIVE BUILDING 6
    TAMPA,FL33605     		NONE 501(C)(3) HUNGER RELIEF - OPERATIONAL SUPPORT 25,000
    FEEDING SOUTH FLOIRDA
    2501 SW 32ND TERRACE
    PEMBROKE PARK,FL33023     		NONE 501(C)(3) HUNGER RELIEF - OPERATIONAL SUPPORT 25,000
    FOLDS OF HONOR
    FOLDS OF HONOR DEPARTMENT 13
    TULSA,OK74182     		NONE 501(C)(3) MILITARY/VETERAN - OPERATIONAL SUPPORT 500,000
    AMERICAN HEART ASSOCIATION
    110 VETERANS MEMORIAL BLVD
    METAIRIE,LA70005     		NONE 501(C)(3) ROMAY DAVIS - OPERATIONAL SUPPORT 20,000
    GRACE MEDICAL HOME
    1417 E CONCORD STREET
    ORLANDO,FL32806     		NONE 501(C)(3) ROMAY DAVIS - OPERATIONAL SUPPORT 20,000
    LOUSIANA CENTER FOR HEALTH EQUITY
    4611 BLUEBONNET BLVD
    BATON ROUGE,LA70809     		NONE 501(C)(3) ROMAY DAVIS - OPERATIONAL SUPPORT 10,000
    MALIVAI WASHINGTON KIDS FOUNDATION
    1055 W 6TH ST
    JACKSONVILLE,FL32209     		NONE 501(C)(3) ROMAY DAVIS - OPERATIONAL SUPPORT 12,000
    SANCTUARY OF NORTHEAST FLORIDA INC
    PO BOX 3301
    JACKSONVILLE,FL32206     		NONE 501(C)(3) ROMAY DAVIS - OPERATIONAL SUPPORT 8,000
    SOCIETY OF ST ANDREW
    PO BOX 536842
    ORLANDO,FL32853     		NONE 501(C)(3) ROMAY DAVIS - OPERATIONAL SUPPORT 15,000
    TEACH FOR AMERICA JACKSONVILLE
    214 N HOGAN ST SUITE 6010
    JACKSONVILLE,FL32202     		NONE 501(C)(3) ROMAY DAVIS - OPERATIONAL SUPPORT 15,000
    TANKPROOF
    15114 WOODSTONE DRIVE
    PRAIRIEVILLE,LA70769     		NONE 501(C)(3) ROMAY DAVIS - OPERATIONAL SUPPORT 10,000
    BIG BROTHERS BIG SISTERS OF NE FL INC
    40 EAST ADAMS STREET SUITE 220
    JACKSONVILLE,FL32202     		NONE 501(C)(3) ROMAY DAVIS - OPERATIONAL SUPPORT 10,000
    BOYS & GIRLS CLUBS OF PALM BEACH COUNTY
    1700 KIRK ROAD
    WEST PALM BEACH,FL33406     		NONE 501(C)(3) ROMAY DAVIS - OPERATIONAL SUPPORT 10,000
    TREE HILL NATURE CENTER
    7152 LONE STAR ROAD
    JACKSONVILLE,FL32211     		NONE 501(C)(3) ROMAY DAVIS - OPERATIONAL SUPPORT 10,000
    ORLANDO COMMUNITY AND YOUTH TRUST
    595 N PRIMROSE DRIVE
    ORLANDO,FL32803     		NONE 501(C)(3) ROMAY DAVIS - OPERATIONAL SUPPORT 10,000
    POLICE ATHLETIC LEAGUE OF JACKSONVILLE INC
    PO BOX 351060
    JACKSONVILLE,FL32235     		NONE 501(C)(3) ROMAY DAVIS - OPERATIONAL SUPPORT 10,000
    WOMEN'S BREAST & HEART INITIATIVE FL
    14125 NW 80TH AVE SUITE 306
    MIAMI LAKES,FL33016     		NONE 501(C)(3) ROMAY DAVIS - OPERATIONAL SUPPORT 15,000
    SCHOOLYARD ROOTS
    PO BOX 2374
    TUSCALOOSA,AL35403     		NONE 501(C)(3) ROMAY DAVIS - OPERATIONAL SUPPORT 10,000
    VISION IS PRICELESS COUNCIL INC
    4615 PHILIPS HIGHWAY 100A
    JACKSONVILLE,FL32207     		NONE 501(C)(3) ROMAY DAVIS - OPERATIONAL SUPPORT 15,000
    GIRL SCOUTS OF GATEWAY COUNCIL
    1000 SHEARER AVENUE
    JACKSONVILLE,FL32205     		NONE 501(C)(3) ROMAY DAVIS - OPERATIONAL SUPPORT 10,000
    JACKSONVILLE HUMANE SOCIETY
    8464 BEACH BOULEVARD
    JACKSONVILLE,FL32216     		NONE 501(C)(3) ROMAY DAVIS - OPERATIONAL SUPPORT 10,000
    BOYS AND GIRLS CLUB OF BROWARD CTY
    877 NW 61ST STREET
    FORT LAUDERDALE,FL33309     		NONE 501(C)(3) ROMAY DAVIS - OPERATIONAL SUPPORT 10,000
    START THE ADVENTURE IN READING (STAIR)
    1545 STATE STREET
    NEW ORLEANS,LA70118     		NONE 501(C)(3) ROMAY DAVIS - OPERATIONAL SUPPORT 15,000
    COVENANT HOUSE NEW ORLEANS LA
    611 N RAMPART STREET
    NEW ORLEANS,LA70112     		NONE 501(C)(3) ROMAY DAVIS - OPERATIONAL SUPPORT 10,000
    HOPE HAVEN ASSOCIATION INC
    4600 BEACH BOULEVARD
    JACKSONVILLE,FL32207     		NONE 501(C)(3) ROMAY DAVIS - OPERATIONAL SUPPORT 10,000
    JUNIOR ACHIEVEMENT OF FLORIDA FIRST COAST
    4049 WOODCOCK DRIVE 200
    JACKSONVILLE,FL32207     		NONE 501(C)(3) ROMAY DAVIS - OPERATIONAL SUPPORT 10,000
    COMMUNITIES IN SCHOOLS OF JACKSONVILLE
    6261 DUPONT STATION COURT E
    JACKSONVILLE,FL32217     		NONE 501(C)(3) ROMAY DAVIS - OPERATIONAL SUPPORT 10,000
    WE CARE FUND
    8928 PROMINENCE PARKWAY STE 200
    JACKSONVILLE,FL32256     		NONE 501(C)(3) OPERATIONS 30,000
    Total .................................bullet 3a 1,251,360
    bApproved for future payment
    Total .................................bullet 3b 0
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 12
    Part XV-A
    Analysis of Income-Producing Activities
    Enter gross amounts unless otherwise indicated. Unrelated business income Excluded by section 512, 513, or 514 (e)
    Related or exempt
    function income
    (See instructions.)
    1Program service revenue: (a)
    Business code     		(b)
    Amount     		(c)
    Exclusion code     		(d)
    Amount
    a
    b
    c
    d
    e
    f
    gFees and contracts from government agencies          
    2 Membership dues and assessments ....          
    3 Interest on savings and temporary cash
    investments ...........     		         
    4 Dividends and interest from securities ....          
    5 Net rental income or (loss) from real estate:
    aDebt-financed property......          
    bNot debt-financed property.....          
    6 Net rental income or (loss) from personal property          
    7 Other investment income .....          
    8 Gain or (loss) from sales of assets other than
    inventory ............     		         
    9 Net income or (loss) from special events:     01 699,865  
    10 Gross profit or (loss) from sales of inventory          
    11 Other revenue:
    aOTHER INCOME     		    01 4,368  
    b
    c
    d
    e
    12 Subtotal. Add columns (b), (d), and (e) .. 0 704,233 0
    13Total. Add line 12, columns (b), (d), and (e)..................
    13
    704,233
    (See worksheet in line 13 instructions to verify calculations.)
    Part XV-B
    Relationship of Activities to the Accomplishment of Exempt Purposes
    Line No.
    DownArrow     		Explain below how each activity for which income is reported in column (e) of Part XV-A contributed importantly to
    the accomplishment of the foundation’s exempt purposes (other than by providing funds for such purposes). (See
    instructions.)
    Form 990-PF (2021)
    Form 990-PF (2021)
    Page 13
    Part XVI
    Information Regarding Transfers To and Transactions and Relationships With Noncharitable Exempt Organizations
    1
    Did the organization directly or indirectly engage in any of the following with any other organization described in section 501(c) (other than section 501(c)(3) organizations) or in section 527, relating to political organizations?
    Yes
    No
    a
    Transfers from the reporting foundation to a noncharitable exempt organization of:
    (1) Cash...................................
    1a(1)
     
    No
    (2) Other assets.................................
    1a(2)
     
    No
    b
    Other transactions:
    (1) Sales of assets to a noncharitable exempt organization....................
    1b(1)
     
    No
    (2) Purchases of assets from a noncharitable exempt organization..................
    1b(2)
     
    No
    (3) Rental of facilities, equipment, or other assets.......................
    1b(3)
     
    No
    (4) Reimbursement arrangements...........................
    1b(4)
     
    No
    (5) Loans or loan guarantees.............................
    1b(5)
     
    No
    (6) Performance of services or membership or fundraising solicitations................
    1b(6)
     
    No
    c
    Sharing of facilities, equipment, mailing lists, other assets, or paid employees..............
    1c
     
    No
    d
    If the answer to any of the above is "Yes," complete the following schedule. Column (b) should always show the fair market value
    of the goods, other assets, or services given by the reporting foundation. If the foundation received less than fair market value
    in any transaction or sharing arrangement, show in column (d) the value of the goods, other assets, or services received.
    (a) Line No. (b) Amount involved (c) Name of noncharitable exempt organization (d) Description of transfers, transactions, and sharing arrangements
    2a
    Is the foundation directly or indirectly affiliated with, or related to, one or more tax-exempt organizations
    described in section 501(c) (other than section 501(c)(3)) or in section 527? ...........
    b
    If "Yes," complete the following schedule.

    (a) Name of organization (b) Type of organization (c) Description of relationship
    Sign Here
    Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
    Bullet Bullet
    May the IRS discuss this return
    with the preparer shown below?
    See instructions.
    Signature of officer or trustee Date Title
    Paid Preparer Use Only Print/Type preparer's name Preparer's Signature Date PTIN
    Firm's name SmallBullet
    		 Firm's EIN SmallBullet
    Firm's address SmallBullet


    		 Phone no.
    Form 990-PF (2021)
    Additional Data


    Software ID:  
    Software Version:  


    Form 990PF - Special Condition Description:
    Special Condition Description
    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
    2021
    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 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) (2021)
    Schedule B (Form 990) (2021) Page 2
    Name of organization
    BI-LO HOLDINGS FOUNDATION INC
          		Employer identification number
    59-0995428
    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
    NIAGARA BOTTLING
     
    565 ATLANTIS DR
     
    MIDDLEBURG, FL32068

    		$ 150,000


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    2
    SANDERSON FARMS
     
    PO BOX 988
     
    LAUREL, MS39441

    		$ 75,000


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    3
    KELLOGGS
     
    1 KELLOGG SQUARE
     
    BATTLE CREEK, MI49016

    		$ 75,000


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    4
    SMITHFIELD FOODS
     
    15855 NC-87
     
    TAR HEEL, NC28392

    		$ 65,000


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    5
    UNFI
     
    313 IRON HORSE WAY
     
    PROVIDENCE, RI02908

    		$ 65,000


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    6
    PEPIN DISTRIBUINGANHEUSER BUSCH
     
    4121 NORTH 50TH STREET
     
    TAMPA, FL33610

    		$ 65,000


    (Complete Part II for noncash contributions.)
    Schedule B (Form 990) (2021)
    Name of organization
    BI-LO HOLDINGS FOUNDATION INC
          		Employer identification number
    59-0995428
    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
    7
    KRAFTHEINZ
     
    236 HATTERAS AVE
     
    CLERMONT, FL34711

    		$ 55,000


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    8
    MASTERCARD
     
    2000 PURCHASE STREET
     
    PURCHASE, NY10577

    		$ 45,000


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    9
    THE BGJ GROUP
     
    2377 LINWOOD AVE 211
     
    NAPLES, FL34112

    		$ 45,000


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    10
    CROWNECONSTELLATION BRANDS
     
    131 SOUTH DEARBORN STREETSUITE 1200
     
    CHICAGO, IL60603

    		$ 45,000


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    11
    SPRINGER MOUNTAIN FARM
     
    PO BOX 558
     
    BALDWIN, GA30511

    		$ 40,000


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    12
    FLOWERS FOODS
     
    2261 W 30TH ST
     
    JACKSONVILLE, FL32209

    		$ 35,000


    (Complete Part II for noncash contributions.)
    Schedule B (Form 990) (2021)
    Name of organization
    BI-LO HOLDINGS FOUNDATION INC
          		Employer identification number
    59-0995428
    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
    13
    VALASSIS A VERICAST BUSINESS
     
    1 TARGETING CENTER
     
    WINDSOR, CT06095

    		$ 35,000


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    14
    BRILL INC
     
    BRILL2 LIBERTY SQUARE 11TH FLOOR
     
    BOSTON, MA02109

    		$ 17,000


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    15
    PIPING ROCK HEALTH PRODUCTS
     
    3900 VETERANS MEMORIAL HIGHWAY SUIT
     
    BOHEMIA, NY11716

    		$ 17,000


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    16
    CATELLI BROTHERS
     
    50 FERRY AVE
     
    CAMDEN, NJ08103

    		$ 15,000


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    17
    CONAGRA BRANDS
     
    222 W MERCHANDISE MART PLAZA SUITE
     
    CHICAGO, IL60654

    		$ 15,000


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    18
    DFA DAIRY BRANDS FLUID
     
    1405 NORTH 98TH STREET
     
    KANSAS CITY, MO66111

    		$ 15,000


    (Complete Part II for noncash contributions.)
    Schedule B (Form 990) (2021)
    Name of organization
    BI-LO HOLDINGS FOUNDATION INC
          		Employer identification number
    59-0995428
    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
    19
    MISSION FOODS
     
    5601 EXECUTIVE DRIVE STE 800
     
    IRVING, TX75038

    		$ 15,000


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    20
    SAGE FRUIT COMPANY
     
    191 IRON HORSE CT
     
    YAKIMA, WA98901

    		$ 15,000


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    21
    UTZ SNACKS
     
    900 HIGH STREET
     
    HANOVER, PA17331

    		$ 15,000


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    22
    CHOBANI
     
    147 STATE HIGHWAY 320
     
    NORWICH, NY13815

    		$ 15,000


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    23
    GROWER NETWORK
     
    972 GA HIGHWAY 376
     
    LAKE PARK, GA31635

    		$ 15,000


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    24
    BUTTERBALL
     
    ONE BUTTERBALL LANE
     
    GARNER, NC27529

    		$ 14,000


    (Complete Part II for noncash contributions.)
    Schedule B (Form 990) (2021)
    Name of organization
    BI-LO HOLDINGS FOUNDATION INC
          		Employer identification number
    59-0995428
    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
    25
    NAVAJO INCORPORATED
     
    5330 FOX STREET
     
    DENVER, CO80216

    		$ 12,000


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    26
    LAND O' FROST INC
     
    16850 CHICAGO AVENUE
     
    LANSING, IL60438

    		$ 12,000


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    27
    LITTLE KENTUCKY SMOKEHOUSE
     
    400 T FRANK WATHEN RD
     
    UNIONTOWN, KY42461

    		$ 12,000


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    28
    LITTLE KENTUCKY SMOKEHOUSE
     
    400 T FRANK WATHEN RD
     
    UNIONTOWN, KY42461

    		$ 12,000


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    29
    NAVAJO INCORPORATED
     
    5330 FOX ST
     
    DENVER, CO80216

    		$ 12,000


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    30
    NESTLE PURINA PETCARE
     
    01 CHOUTEAU AVE
     
    ST LOUIS, MO63102

    		$ 12,000


    (Complete Part II for noncash contributions.)
    Schedule B (Form 990) (2021)
    Name of organization
    BI-LO HOLDINGS FOUNDATION INC
          		Employer identification number
    59-0995428
    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
    31
    PETE AND GERRY'S ORGANICS
     
    140 BUFFUM ROAD
     
    MONROE, NH03771

    		$ 12,000


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    32
    PRASCO
     
    6125 COMMERCE COURT
     
    MASON, OH45040

    		$ 12,000


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    33
    ADVANTAGE SOLUTIONS
     
    8100 VON KARMAN STE 1000
     
    IRVINE, CA92612

    		$ 12,000


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    34
    SABRA
     
    777 WESTCHESTER AVENUE
     
    HARRISON, NY10604

    		$ 11,000


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    35
    DIAGEO
     
    801 MAIN AVENUE
     
    NORWALK, CT06851

    		$ 10,000


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    36
    ORDERINSITE LLC
     
    40 BURTON HILLS BLVD
     
    NASHVILLE, TN37215

    		$ 10,000


    (Complete Part II for noncash contributions.)
    Schedule B (Form 990) (2021)
    Name of organization
    BI-LO HOLDINGS FOUNDATION INC
          		Employer identification number
    59-0995428
    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
    37
    SHOES FOR CREWS
     
    5000 T-REX AVENUE SUITE 100
     
    BOCA RATON, FL33431

    		$ 10,000


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    38
    WASTE HARMONICS
     
    7620 OMNITECH PL SUITE 1
     
    VICTOR, NY14564

    		$ 10,000


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    39
    WEIL GOTSHAL & MANGES LLP
     
    767 FIFTH AVENUE
     
    NEW YORK, NY10153

    		$ 10,000


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    40
    CLOROX
     
    4900 JOHNSON DRIVE
     
    PLEASANTON, CA94588

    		$ 10,000


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    41
    DELMONTE
     
    205 N WIGET LANE
     
    WALNUT CREEK, CA94598

    		$ 10,000


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    42
    WESTON
     
    11808 W CENTER RD
     
    OMAHA, NE68144

    		$ 9,200


    (Complete Part II for noncash contributions.)
    Schedule B (Form 990) (2021)
    Name of organization
    BI-LO HOLDINGS FOUNDATION INC
          		Employer identification number
    59-0995428
    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
    43
    PEGGS COMPANY
     
    4851 FELSPAR STREET
     
    RIVERSIDE, CA92509

    		$ 9,000


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    44
    DEWITT LAW FIRM
     
    135 W CENTRAL BLVD SE 320
     
    ORLANDO, FL32901

    		$ 9,000


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    45
    MCCORMICK
     
    24 SCHILLING RD STE 1
     
    HUNT VALLEY, MD21031

    		$ 8,000


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    46
    EPOCA
     
    931 CLINT MOORE RD
     
    BOCA RATON, FL33487

    		$ 7,000


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    47
    AON CORPORATION
     
    200 E RANDOLPH ST
     
    CHICAGO, IL60601

    		$ 5,000


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    48
    COLORADO BOXED BEEF
     
    330 N INGRAHAM AVE
     
    LAKELAND, FL33801

    		$ 5,000


    (Complete Part II for noncash contributions.)
    Schedule B (Form 990) (2021)
    Name of organization
    BI-LO HOLDINGS FOUNDATION INC
          		Employer identification number
    59-0995428
    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
    49
    DAIRY FARMERS OF AMERICA
     
    1405 NORTH 98TH STREET
     
    KANSAS CITY, MO66111

    		$ 5,000


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    50
    DIAGEO
     
    801 MAIN AVENUE NORWALK
     
    NORWALK, CT06851

    		$ 5,000


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    51
    INTERACTIONS MARKETING
     
    9520 TOWNE CENTRE DR
     
    SAN DIEGO, CA92121

    		$ 5,000


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    52
    JM SMUCKER
     
    ONE STRAWBERRY LANE
     
    ORRVILLE, OH44667

    		$ 5,000


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    53
    KALOS SERVICES INC
     
    236 HATTERAS AVE
     
    CLERMONT, FL34711

    		$ 5,000


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    54
    SEALANE MARKETING LLC
     
    130 MARITIME DR
     
    SANFORD, FL32771

    		$ 5,000


    (Complete Part II for noncash contributions.)
    Schedule B (Form 990) (2021)
    Name of organization
    BI-LO HOLDINGS FOUNDATION INC
          		Employer identification number
    59-0995428
    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
    55
    SMITHFIELD FOODS
     
    15855 NC-87
     
    TAR HEEL, NC28392

    		$ 5,000


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    56
    WASTE HARMONICS
     
    7620 OMNITECH PL SUITE 1
     
    VICTOR, NY14564

    		$ 5,000


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    57
    WYCO PRODUCE INC
     
    1002 B S CHURCH AVE 320527
     
    TAMPA, FL33679

    		$ 5,000


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    58
    KIMBERLY CLARK
     
    351 PHELPS DR
     
    IRVING, TX75038

    		$ 55,000


    (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.)
    Schedule B (Form 990) (2021)
    Schedule B (Form 990) (2021)
    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) (2021)
    Schedule B (Form 990) (2021)
    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) (2021)
    Additional Data


    Software ID:  
    Software Version:  

    TY 2021 AccountingFeesSchedule
    Name:
    BI-LO HOLDINGS FOUNDATION INC
    EIN:
    59-0995428
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    ACCOUNTING FEES 2,000 1,000   1,000

    TY 2021 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 2 2

    TY 2021 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
    VENDOR SUMMIT - PRINTED MATERIALS 9,543 0   0
    VENDOR SUMMIT - PROFESSIONAL FEES 3,160 0   0
    VENDOR SUMMIT - OTHER 259,760 0   0
    HUNGER RELIEF 197,991 0   197,991
      0 0   0
    HUNGER & DISASTER RELIEF - OTHER 22,056 0   22,056


    TY 2021 OtherIncomeSchedule2
    Name:
    BI-LO HOLDINGS FOUNDATION INC
    EIN:
    59-0995428
    Description Revenue And Expenses Per Books Net Investment Income Adjusted Net Income
    OTHER INCOME 4,368   4,368
    GROSS INCOME FROM SPECIAL FUNDRAISING EVENTS 699,865   699,865


    TY 2021 OtherProfessionalFeesSchedule
    Name:
    BI-LO HOLDINGS FOUNDATION INC
    EIN:
    59-0995428
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    BANK FEES 2,625 2,625   0
    MISCELLANEOUS 33,250 0   0
    SERCVICE CHARGES 9,585 0   0