JOHN M AND GERTRUDE E PETERSEN FOUNDATION: Form 990PF, tax year 2013
View the entire original 990 at ProPublica ↗
- Organization
- JOHN M AND GERTRUDE E PETERSEN FOUNDATION (EIN 25-1859031)
- Tax period
- 2013-01-01 to 2013-12-31
- Filed
- 2014-05-13
- IRS object ID
- 201441339349102184
- Schema version
- 2013v3.0
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
- Return header
- Form 990-PF
- Accounting Fees Schedule
- Investments Corp Stock Schedule
- Investments Other Schedule2
- Other Decreases Schedule
- Other Professional Fees Schedule
- Taxes Schedule
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return | 2014-05-13T15:47:00-05:00 | ReturnTs |
| Tax Period End | 2013-12-31 | TaxPeriodEndDt |
Preparer Firm PreparerFirmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Firm EIN | 251690617 | PreparerFirmEIN |
Preparer Firm Name PreparerFirmName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SCHAFFNER KNIGHT MINNAUGH & CO PC | BusinessNameLine1 |
Preparer US Address PreparerUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1001 STATE STREET SUITE 1300 | AddressLine1 |
| City | ERIE | City |
| State | PA | State |
| ZIP Code | 16501 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990PF | ReturnTypeCd |
| Tax Period Begin | 2013-01-01 | TaxPeriodBeginDt |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 251859031 | EIN |
Business Name BusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JOHN M AND GERTRUDE E PETERSEN FOUNDATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Control | JOHN | BusinessNameControlTxt |
| Phone | 8148360365 | PhoneNum |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 124 VOYAGEUR DRIVE | AddressLine1 |
| City | ERIE | City |
| State | PA | State |
| ZIP Code | 165055435 | ZIPCode |
Business Officer BusinessOfficerGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Person | JOHN M PETERSEN | PersonNm |
| Person Title | PRESIDENT | PersonTitleTxt |
| Phone | 8148331778 | PhoneNum |
| Signature | 2014-05-13 | SignatureDt |
| Discuss With Paid Preparer | Yes (1) | DiscussWithPaidPreparerInd |
Preparer Person PreparerPersonGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Preparer Person | DENNIS W GROW CPA | PreparerPersonNm |
| PTIN | P00190259 | PTIN |
| Phone | 8144541997 | PhoneNum |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax | 2013 | TaxYr |
| Build TS | 2015-12-30 17:16:21Z | BuildTS |
Form 990-PF IRS990PF
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization501c3 Exempt PF | Yes (X) | Organization501c3ExemptPFInd |
| FMV Assets EOY | $16,507,809 | FMVAssetsEOYAmt |
| Method Of Accounting Cash | Yes (X) | MethodOfAccountingCashInd |
Analysis Of Revenue And Expenses AnalysisOfRevenueAndExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Schedule B Not Required | Yes (X) | ScheduleBNotRequiredInd |
| Interest On Sav Rev And Expnss | $58 | InterestOnSavRevAndExpnssAmt |
| Interest On Sav Net Invst Incm | $58 | InterestOnSavNetInvstIncmAmt |
| Dividends Rev And Expnss | $477,418 | DividendsRevAndExpnssAmt |
| Dividends Net Invst Incm | $477,418 | DividendsNetInvstIncmAmt |
| Net Gain Sale Ast Rev And Expnss | $337,836 | NetGainSaleAstRevAndExpnssAmt |
| Gross Sales Price | $1,187,901 | GrossSalesPriceAmt |
| Cap Gain Net Incm Net Invst Incm | $337,836 | CapGainNetIncmNetInvstIncmAmt |
| Total Rev And Expnss | $815,312 | TotalRevAndExpnssAmt |
| Total Net Invst Incm | $815,312 | TotalNetInvstIncmAmt |
| Comp Ofcr Dir Trst Rev And Expnss | $0 | CompOfcrDirTrstRevAndExpnssAmt |
| Comp Ofcr Dir Trst Net Invst Incm | $0 | CompOfcrDirTrstNetInvstIncmAmt |
| Comp Ofcr Dir Trst Dsbrs Chrtbl | $0 | CompOfcrDirTrstDsbrsChrtblAmt |
| Accounting Fees Rev And Expnss | $4,035 | AccountingFeesRevAndExpnssAmt |
| Accounting Fees Net Invst Incm | $0 | AccountingFeesNetInvstIncmAmt |
| Accounting Fees Chrtbl Prps | $0 | AccountingFeesChrtblPrpsAmt |
| Other Prof Fees Rev And Expnss | $1,015 | OtherProfFeesRevAndExpnssAmt |
| Other Prof Fees Net Invst Incm | $0 | OtherProfFeesNetInvstIncmAmt |
| Other Prof Fees Dsbrs Chrtbl | $0 | OtherProfFeesDsbrsChrtblAmt |
| Taxes Rev And Expnss | $5,945 | TaxesRevAndExpnssAmt |
| Taxes Net Invst Incm | $0 | TaxesNetInvstIncmAmt |
| Taxes Dsbrs Chrtbl | $0 | TaxesDsbrsChrtblAmt |
| Tot Opr Expenses Rev And Expnss | $10,995 | TotOprExpensesRevAndExpnssAmt |
| Tot Opr Expenses Net Invst Incm | $0 | TotOprExpensesNetInvstIncmAmt |
| Tot Opr Expenses Dsbrs Chrtbl | $0 | TotOprExpensesDsbrsChrtblAmt |
| Contri Paid Rev And Expnss | $244,000 | ContriPaidRevAndExpnssAmt |
| Contri Paid Dsbrs Chrtbl | $244,000 | ContriPaidDsbrsChrtblAmt |
| Total Expenses Rev And Expnss | $254,995 | TotalExpensesRevAndExpnssAmt |
| Total Expenses Net Invst Incm | $0 | TotalExpensesNetInvstIncmAmt |
| Total Expenses Dsbrs Chrtbl | $244,000 | TotalExpensesDsbrsChrtblAmt |
| Excess Revenue Over Expenses | $560,317 | ExcessRevenueOverExpensesAmt |
| Net Investment Income | $815,312 | NetInvestmentIncomeAmt |
Form990 PF Balance Sheets Form990PFBalanceSheetsGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Cash EOY | $1 | CashEOYAmt |
| Cash EOYFMV | $1 | CashEOYFMVAmt |
| Sav And Temp Cash Invst BOY | $318,844 | SavAndTempCashInvstBOYAmt |
| Sav And Temp Cash Invst EOY | $1,752,373 | SavAndTempCashInvstEOYAmt |
| Sav And Temp Cash Invst EOYFMV | $1,752,373 | SavAndTempCashInvstEOYFMVAmt |
| Corporate Stock BOY | $9,984,393 | CorporateStockBOYAmt |
| Corporate Stock EOY | $9,134,328 | CorporateStockEOYAmt |
| Corporate Stock EOYFMV | $14,237,735 | CorporateStockEOYFMVAmt |
| Other Investments BOY | $306,978 | OtherInvestmentsBOYAmt |
| Other Investments EOY | $244,775 | OtherInvestmentsEOYAmt |
| Other Investments EOYFMV | $517,700 | OtherInvestmentsEOYFMVAmt |
| Total Assets BOY | $10,610,215 | TotalAssetsBOYAmt |
| Total Assets EOY | $11,131,477 | TotalAssetsEOYAmt |
| Total Assets EOYFMV | $16,507,809 | TotalAssetsEOYFMVAmt |
| Total Liabilities BOY | $0 | TotalLiabilitiesBOYAmt |
| Total Liabilities EOY | $0 | TotalLiabilitiesEOYAmt |
| Org Does Not Follow SFAS117 | Yes (X) | OrgDoesNotFollowSFAS117Ind |
| Capital Stock BOY | $0 | CapitalStockBOYAmt |
| Capital Stock EOY | $0 | CapitalStockEOYAmt |
| Additional Paid In Capital BOY | $0 | AdditionalPaidInCapitalBOYAmt |
| Additional Paid In Capital EOY | $0 | AdditionalPaidInCapitalEOYAmt |
| Retained Earning BOY | $10,610,215 | RetainedEarningBOYAmt |
| Retained Earning EOY | $11,131,477 | RetainedEarningEOYAmt |
| Tot Net Ast Or Fund Balances BOY | $10,610,215 | TotNetAstOrFundBalancesBOYAmt |
| Tot Net Ast Or Fund Balances EOY | $11,131,477 | TotNetAstOrFundBalancesEOYAmt |
| Total Liabilities Net Ast BOY | $10,610,215 | TotalLiabilitiesNetAstBOYAmt |
| Total Liabilities Net Ast EOY | $11,131,477 | TotalLiabilitiesNetAstEOYAmt |
Chg In Net Assets Fund Balances ChgInNetAssetsFundBalancesGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tot Net Ast Or Fund Balances BOY | $10,610,215 | TotNetAstOrFundBalancesBOYAmt |
| Excess Revenue Over Expenses | $560,317 | ExcessRevenueOverExpensesAmt |
| Other Increases | $0 | OtherIncreasesAmt |
| Subtotal | $11,170,532 | SubtotalAmt |
| Other Decreases | $39,055 | OtherDecreasesAmt |
| Tot Net Ast Or Fund Balances EOY | $11,131,477 | TotNetAstOrFundBalancesEOYAmt |
Cap Gains Loss Tx Invst Incm Detail CapGainsLossTxInvstIncmDetail
Cap Gains Loss Tx Invst Incm CapGainsLossTxInvstIncmGrp (5 entries)
| PropertyPropertyDesc | How AcquiredHowAcquiredCd | AcquiredAcquiredDt | SoldSoldDt | Gross Sales PriceGrossSalesPriceAmt | Cost Or Other BasisCostOrOtherBasisAmt | Gain Or LossGainOrLossAmt | Gains Minus Excess Or LossesGainsMinusExcessOrLossesAmt |
|---|---|---|---|---|---|---|---|
| GENERAL ELECTRIC CAPITAL 6% | P | 2007-04-20 | 2013-01-18 | $750,000 | $750,000 | $0 | $0 |
| ONYX PHARMACEUTICALS INC | P | 2005-03-07 | 2013-10-09 | $437,500 | $100,065 | $337,435 | $337,435 |
| CARDINAL HEALTH SEC LITIGATION CLAIM | P | 1998-03-15 | 2013-05-02 | $58 | $58 | $58 | |
| BANK OF AMERICA SETTLEMENT FUNDS | P | 1998-03-15 | 2013-01-28 | $220 | $220 | $220 | |
| CAPITAL GAINS DIVIDENDS | P | $123 | $123 | $123 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Capital Gain Net Income | $337,836 | CapitalGainNetIncomeAmt |
Qlfy Und Sect4940e Reduced Tax QlfyUndSect4940eReducedTaxGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Liable Section4942 Tax | 0 | LiableSection4942TaxInd |
| Adjusted Qlfy Distri Yr1 | $846,941 | AdjustedQlfyDistriYr1Amt |
| Net Vl Noncharitable Assets Yr1 | $13,721,847 | NetVlNoncharitableAssetsYr1Amt |
| Distribution Yr1 | 0.061722 | DistributionYr1Rt |
| Adjusted Qlfy Distri Yr2 | $946,227 | AdjustedQlfyDistriYr2Amt |
| Net Vl Noncharitable Assets Yr2 | $12,789,800 | NetVlNoncharitableAssetsYr2Amt |
| Distribution Yr2 | 0.073983 | DistributionYr2Rt |
| Adjusted Qlfy Distri Yr3 | $212,984 | AdjustedQlfyDistriYr3Amt |
| Net Vl Noncharitable Assets Yr3 | $12,159,446 | NetVlNoncharitableAssetsYr3Amt |
| Distribution Yr3 | 0.017516 | DistributionYr3Rt |
| Adjusted Qlfy Distri Yr4 | $1,000,155 | AdjustedQlfyDistriYr4Amt |
| Net Vl Noncharitable Assets Yr4 | $11,708,487 | NetVlNoncharitableAssetsYr4Amt |
| Distribution Yr4 | 0.085421 | DistributionYr4Rt |
| Adjusted Qlfy Distri Yr5 | $0 | AdjustedQlfyDistriYr5Amt |
| Net Vl Noncharitable Assets Yr5 | $13,364,595 | NetVlNoncharitableAssetsYr5Amt |
| Distribution Yr5 | 0.000000 | DistributionYr5Rt |
| Total Distribution | 0.238642 | TotalDistributionRt |
| Average Distribution | 0.047728 | AverageDistributionRt |
| Net Vl Noncharitable Assets | $15,471,506 | NetVlNoncharitableAssetsAmt |
| Adj Net Vl Noncharitable Assets | $738,424 | AdjNetVlNoncharitableAssetsAmt |
| Net Investment Income Pct | $8,153 | NetInvestmentIncomePctAmt |
| Adj Nonchrtbl Net Invst Incm Pct | $746,577 | AdjNonchrtblNetInvstIncmPctAmt |
| Qualifying Distributions | $244,000 | QualifyingDistributionsAmt |
Excise Tax Based On Invst Incm ExciseTaxBasedOnInvstIncmGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Investment Income Excise Tax | $16,306 | InvestmentIncomeExciseTaxAmt |
| Tax Under Section511 | $0 | TaxUnderSection511Amt |
| Subtotal | $16,306 | SubtotalAmt |
| Subtitle A Tax | $0 | SubtitleATaxAmt |
| Tax Based On Investment Income | $16,306 | TaxBasedOnInvestmentIncomeAmt |
| Estimated Plus Ovpmt Incm Tx | $5,321 | EstimatedPlusOvpmtIncmTxAmt |
| Total Payments And Credits | $5,321 | TotalPaymentsAndCreditsAmt |
| Form2220 Attached | Yes (X) | Form2220AttachedInd |
| Es Penalty | $250 | EsPenaltyAmt |
| Tax Due | $11,235 | TaxDueAmt |
Statements Regarding Acty StatementsRegardingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Legislative Political Acty | 0 | LegislativePoliticalActyInd |
| More Than100 Spent | 0 | MoreThan100SpentInd |
| Form1120 POL Filed | 0 | Form1120POLFiledInd |
| Section4955 Organization Tax | $0 | Section4955OrganizationTaxAmt |
| Section4955 Managers Tax | $0 | Section4955ManagersTaxAmt |
| Tax Reimbursed | $0 | TaxReimbursedAmt |
| Activities Not Previously Rpt | 0 | ActivitiesNotPreviouslyRptInd |
| Changes To Articles Or Bylaws | 0 | ChangesToArticlesOrBylawsInd |
| Unrelated Bus Incm Over Limit | 0 | UnrelatedBusIncmOverLimitInd |
| Organization Dissolved Etc | 0 | OrganizationDissolvedEtcInd |
| Section508e Rqr Satisfied | Yes (1) | Section508eRqrSatisfiedInd |
| At Least5000 In Assets | Yes (1) | AtLeast5000InAssetsInd |
| Org Report Or Register State | PA | OrgReportOrRegisterStateCd |
| Form990 PF Filed With Atty Gen | Yes (1) | Form990PFFiledWithAttyGenInd |
| Private Operating Foundation | 0 | PrivateOperatingFoundationInd |
| New Substantial Contributors | 0 | NewSubstantialContributorsInd |
| Own Controlled Entity | 0 | OwnControlledEntityInd |
| Donor Advised Fund | 0 | DonorAdvisedFundInd |
| Comply With Public Insp Rqr | Yes (1) | ComplyWithPublicInspRqrInd |
| Website Address | N/A | WebsiteAddressTxt |
Persons With Books Name PersonsWithBooksName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JOHN M PETERSEN | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 8148360365 | PhoneNum |
Location Of Books US Address LocationOfBooksUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 124 VOYAGEUR DRIVE | AddressLine1 |
| City | ERIE | City |
| State | PA | State |
| ZIP Code | 165055435 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Foreign Accounts Question | 0 | ForeignAccountsQuestionInd |
Statements Regarding Acty4720 StatementsRegardingActy4720Grp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Sale Or Exch Disqualified Prsn | 0 | SaleOrExchDisqualifiedPrsnInd |
| Brrw Or Lend Disqualified Prsn | 0 | BrrwOrLendDisqualifiedPrsnInd |
| Furn Goods Disqualified Prsn | 0 | FurnGoodsDisqualifiedPrsnInd |
| Pay Comp Disqualified Prsn | 0 | PayCompDisqualifiedPrsnInd |
| Transfer Ast Disqualified Prsn | 0 | TransferAstDisqualifiedPrsnInd |
| Payment To Government Official | 0 | PaymentToGovernmentOfficialInd |
| Uncorrected Prior Acts | 0 | UncorrectedPriorActsInd |
| Undistributed Income PY | 0 | UndistributedIncomePYInd |
| Business Holdings | 0 | BusinessHoldingsInd |
| Jeopardy Investments | 0 | JeopardyInvestmentsInd |
| Uncorrected PY Jeopardy Invst | 0 | UncorrectedPYJeopardyInvstInd |
| Influence Legislation | 0 | InfluenceLegislationInd |
| Influence Election | 0 | InfluenceElectionInd |
| Grants To Individuals | 0 | GrantsToIndividualsInd |
| Grants To Organizations | 0 | GrantsToOrganizationsInd |
| Noncharitable Purpose | 0 | NoncharitablePurposeInd |
| Rcv Fnds To Pay Prsnl Bnft Cntrct | 0 | RcvFndsToPayPrsnlBnftCntrctInd |
| Pay Premiums Prsnl Bnft Cntrct | 0 | PayPremiumsPrsnlBnftCntrctInd |
| Prohibited Tax Shelter Trans | 0 | ProhibitedTaxShelterTransInd |
Officer Dir Trst Key Empl Info OfficerDirTrstKeyEmplInfoGrp
Officer Dir Trst Key Empl OfficerDirTrstKeyEmplGrp (3 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | TitleTitleTxt | Average Hrs Per Wk Devoted To PosAverageHrsPerWkDevotedToPosRt | CompensationCompensationAmt | Employee Benefit ProgramEmployeeBenefitProgramAmt | Expense Account Other AllwncExpenseAccountOtherAllwncAmt |
|---|---|---|---|---|---|---|---|---|
| JOHN M PETERSEN | ||||||||
| 124 VOYAGEUR DRIVE | ERIE | PA | 165055435 | PRESIDENT | 5.00 | $0 | $0 | $0 |
| GERTRUDE PETERSEN | ||||||||
| 124 VOYAGEUR DRIVE | ERIE | PA | 165055435 | VICE PRESIDENT/TREASURER | 5.00 | $0 | $0 | $0 |
| JAMES D CULLEN | ||||||||
| 100 STATE STREET SUITE 700 | ERIE | PA | 165071498 | SECRETARY | 1.00 | $0 | $0 | $0 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Comp Of Hghst Pd Empl Or NONE | NONE | CompOfHghstPdEmplOrNONETxt |
| Other Employee Paid Over50k | 0 | OtherEmployeePaidOver50kCnt |
| Comp Of Hghst Pd Cntrct Or NONE | NONE | CompOfHghstPdCntrctOrNONETxt |
| Contractor Paid Over50k | 0 | ContractorPaidOver50kCnt |
Sum Of Program Related Invst SumOfProgramRelatedInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | $0 | TotalAmt |
Minimum Investment Return MinimumInvestmentReturnGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Average Monthly FMV Of Sec | $14,351,859 | AverageMonthlyFMVOfSecAmt |
| Average Monthly Cash Balances | $1,355,254 | AverageMonthlyCashBalancesAmt |
| FMV All Other Noncharitable Ast | $0 | FMVAllOtherNoncharitableAstAmt |
| Total FMV Of Unused Assets | $15,707,113 | TotalFMVOfUnusedAssetsAmt |
| Reduction Claimed | $0 | ReductionClaimedAmt |
| Acquisition Indebtedness | $0 | AcquisitionIndebtednessAmt |
| Adjusted Total FMV Of Unused Ast | $15,707,113 | AdjustedTotalFMVOfUnusedAstAmt |
| Cash Deemed Charitable | $235,607 | CashDeemedCharitableAmt |
| Net Vl Noncharitable Assets | $15,471,506 | NetVlNoncharitableAssetsAmt |
| Minimum Investment Return | $773,575 | MinimumInvestmentReturnAmt |
Distributable Amount DistributableAmountGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Minimum Investment Return | $773,575 | MinimumInvestmentReturnAmt |
| Tax Based On Investment Income | $16,306 | TaxBasedOnInvestmentIncomeAmt |
| Total Tax | $16,306 | TotalTaxAmt |
| Distributable Before Adj | $757,269 | DistributableBeforeAdjAmt |
| Recoveries Qualfied Distri | $0 | RecoveriesQualfiedDistriAmt |
| Distributable Before Ded | $757,269 | DistributableBeforeDedAmt |
| Deduction From Distributable | $0 | DeductionFromDistributableAmt |
| Distributable As Adjusted | $757,269 | DistributableAsAdjustedAmt |
Qualifying Distri Part XII QualifyingDistriPartXIIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expenses And Contributions | $244,000 | ExpensesAndContributionsAmt |
| Program Related Invst Total | $0 | ProgramRelatedInvstTotalAmt |
| Qualifying Distributions | $244,000 | QualifyingDistributionsAmt |
| Pct Sect4940e Org Net Invst Incm | $0 | PctSect4940eOrgNetInvstIncmAmt |
| Adjusted Qualifying Distri | $244,000 | AdjustedQualifyingDistriAmt |
Undistributed Income UndistributedIncomeGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Distributable As Adjusted | $757,269 | DistributableAsAdjustedAmt |
| Undistributed Income PY | $0 | UndistributedIncomePYAmt |
| Total For Prior Years | $0 | TotalForPriorYearsAmt |
| Excess Distribution Cyov Yr4 | $30,865 | ExcessDistributionCyovYr4Amt |
| Excess Distribution Cyov Yr2 | $321,277 | ExcessDistributionCyovYr2Amt |
| Excess Distribution Cyov Yr1 | $170,767 | ExcessDistributionCyovYr1Amt |
| Total Excess Distribution Cyov | $522,909 | TotalExcessDistributionCyovAmt |
| Qualifying Distributions | $244,000 | QualifyingDistributionsAmt |
| Applied To Year1 | $0 | AppliedToYear1Amt |
| Applied To Prior Years | $0 | AppliedToPriorYearsAmt |
| Treated As Distri From Corpus | $0 | TreatedAsDistriFromCorpusAmt |
| Applied To Current Year | $244,000 | AppliedToCurrentYearAmt |
| Remaining Distri From Corpus | $0 | RemainingDistriFromCorpusAmt |
| Excess Distri Cyov App CY Corpus | $513,269 | ExcessDistriCyovAppCYCorpusAmt |
| Excess Distribution Cyov App CY | $513,269 | ExcessDistributionCyovAppCYAmt |
| Total Corpus | $9,640 | TotalCorpusAmt |
| Prior Year Undistributed Incm | $0 | PriorYearUndistributedIncmAmt |
| Prior Year Deficiency Or Tax | $0 | PriorYearDeficiencyOrTaxAmt |
| Taxable1 | $0 | Taxable1Amt |
| Taxable2 | $0 | Taxable2Amt |
| Undistributed Income CY | $0 | UndistributedIncomeCYAmt |
| Corpus Distri170b1 E Or4942g3 | $0 | CorpusDistri170b1EOr4942g3Amt |
| Excess Distri Cyov From Yr5 | $0 | ExcessDistriCyovFromYr5Amt |
| Excess Distri Cyov To Next Yr | $9,640 | ExcessDistriCyovToNextYrAmt |
| Excess From Year1 | $9,640 | ExcessFromYear1Amt |
Supplementary Information SupplementaryInformationGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributing Manager | JOHN M PETERSEN | ContributingManagerNm |
| Contributing Manager | GERTRUDE PETERSEN | ContributingManagerNm |
Application Submission Info ApplicationSubmissionInfoGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient Person | JOHN M PETERSEN | RecipientPersonNm |
Recipient US Address RecipientUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 1550 EL CAMINO REAL APT 234 | AddressLine1 |
| City | LADY LAKE | City |
| State | FL | State |
| ZIP Code | 32159 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient Phone | 8148360365 | RecipientPhoneNum |
| Form And Info And Materials | REQUEST FOR FUNDING APPLICATION THE FOLLOWING ATTACHMENTS SHOULD BE INCLUDED WITH THE FUNDING APPLICATION: COPY OF IRS DETERMINATION LETTER REGARDING YOUR AGENCY'S TAX EXEMPT STATUS; ROSTER OF CURRENT BOARD OF DIRECTORS, TO INCLUDE ADDRESSES, PHONE NUMBERS AND OCCUPATIONS; AUDITED FINANCIAL STATEMENT FOR THE MOST RECENT FISCAL YEAR; PROGRAM/AGENCY BUDGET; ANNUAL REPORT (IF AVAILABLE) FOR MOST RECENT FISCAL YEAR AS DISTRIBUTED TO YOUR MEMBERS OR BOARD OF DIRECTORS; AND ANY OTHER MATERIAL YOU FEEL MIGHT BE HELPFUL. | FormAndInfoAndMaterialsTxt |
| Submission Deadlines | N/A | SubmissionDeadlinesTxt |
| Restrictions On Awards | NONE | RestrictionsOnAwardsTxt |
Grant Or Contribution Pd Dur Yr GrantOrContributionPdDurYrGrp (18 entries)
| Address Line1RecipientUSAddress/AddressLine1 | CityRecipientUSAddress/City | StateRecipientUSAddress/State | ZIP CodeRecipientUSAddress/ZIPCode | Recipient RelationshipRecipientRelationshipTxt | Recipient Foundation StatusRecipientFoundationStatusTxt | Grant Or Contribution PurposeGrantOrContributionPurposeTxt | AmtAmt |
|---|---|---|---|---|---|---|---|
| ASBURY WOODS NATURE CENTER | |||||||
| 4105 ASBURY RD | ERIE | PA | 16506 | NONE | OTHER PUBLIC CHARITY | GENERAL SUPPORT | $2,000 |
| BECAUSE YOU CARE INC | |||||||
| PO BOX 54 | MCKEAN | PA | 16426 | NONE | OTHER PUBLIC CHARITY | GENERAL SUPPORT | $3,000 |
| BOYS AND GIRLS CLUB OF ERIE | |||||||
| 1515 EAST LAKE RD | ERIE | PA | 16511 | NONE | OTHER PUBLIC CHARITY | GENERAL SUPPORT | $2,000 |
| DR GERTRUDE A BARBER NATIONAL INSTITUTE | |||||||
| 136 EAST AVE | ERIE | PA | 16507 | NONE | OTHER PUBLIC CHARITY | GENERAL SUPPORT | $5,000 |
| EMMAUS SOUP KITCHEN | |||||||
| 218 E 11TH ST | ERIE | PA | 16503 | NONE | OTHER PUBLIC CHARITY | GENERAL SUPPORT | $5,000 |
| ERIE CITY MISSION | |||||||
| PO BOX 407 | ERIE | PA | 16512 | NONE | OTHER PUBLIC CHARITY | GENERAL SUPPORT | $10,000 |
| ERIE COUNTY PUBLIC LIBRARY FOUNDATION | |||||||
| 160 E FRONT ST | ERIE | PA | 16507 | NONE | OTHER PUBLIC CHARITY | GENERAL SUPPORT | $5,000 |
| ERIE ZOOLOGICAL SOCIETY | |||||||
| 423 WEST 38TH ST | ERIE | PA | 16508 | NONE | OTHER PUBLIC CHARITY | GENERAL SUPPORT | $4,000 |
| INNER CITY NEIGHBORHOOD ART HOUSE | |||||||
| 201 EAST 10TH ST | ERIE | PA | 16503 | NONE | OTHER PUBLIC CHARITY | GENERAL SUPPORT | $5,000 |
| LUTHER MEMORIAL CHURCH | |||||||
| 225 WEST 10TH ST | ERIE | PA | 16501 | NONE | OTHER PUBLIC CHARITY | GENERAL SUPPORT | $10,000 |
| MERCY CENTER FOR WOMEN | |||||||
| 1039 EAST 27TH ST | ERIE | PA | 16504 | NONE | OTHER PUBLIC CHARITY | GENERAL SUPPORT | $5,000 |
| PENN STATE UNIVERSITY SCHOLARSHIP FUND | |||||||
| 314 SHIELDS BUILDING | UNIVERSITY PARK | PA | 16802 | NONE | OTHER PUBLIC CHARITY | GENERAL SUPPORT | $150,000 |
| SAINT PAUL'S NEIGHBORHOOD FREE CLINIC | |||||||
| 1608 WALNUT STREET | ERIE | PA | 16502 | NONE | OTHER PUBLIC CHARITY | GENERAL SUPPORT | $5,000 |
| SALVATION ARMY | |||||||
| 1944 KEYSTONE DRIVE STE 24 | ERIE | PA | 16509 | NONE | OTHER PUBLIC CHARITY | GENERAL SUPPORT | $5,000 |
| THE HUMANE SOCIETY OF NORTHWEST PA | |||||||
| 2507 ZIMMERLY RD | ERIE | PA | 16506 | NONE | OTHER PUBLIC CHARITY | GENERAL SUPPORT | $10,000 |
| UNITED WAY OF ERIE COUNTY | |||||||
| 420 WEST 6TH ST | ERIE | PA | 16507 | NONE | OTHER PUBLIC CHARITY | GENERAL SUPPORT | $10,000 |
| WOUNDED WARRIOR PROJECT | |||||||
| PO BOX 758517 | TOPEKA | KS | 66675 | NONE | OTHER PUBLIC CHARITY | GENERAL SUPPORT | $5,000 |
| YOUTH FOR CHRIST | |||||||
| 4814 IROQUOIS AVE | ERIE | PA | 16511 | NONE | OTHER PUBLIC CHARITY | GENERAL SUPPORT | $3,000 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Grant Or Contri Pd Dur Yr | $244,000 | TotalGrantOrContriPdDurYrAmt |
| Total Grant Or Contri Apprv Fut | $0 | TotalGrantOrContriApprvFutAmt |
Analysis Income Producing Acty AnalysisIncomeProducingActyGrp
Int On Sav And Temp Cash Invst IntOnSavAndTempCashInvstGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Related Or Exempt Function Incm | $58 | RelatedOrExemptFunctionIncmAmt |
Div And Int From Sec Part VII DivAndIntFromSecPartVIIGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Related Or Exempt Function Incm | $477,418 | RelatedOrExemptFunctionIncmAmt |
Gain Sales Ast Oth Than Invntry GainSalesAstOthThanInvntryGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Related Or Exempt Function Incm | $337,836 | RelatedOrExemptFunctionIncmAmt |
Subtotals Incm Producing Acty SubtotalsIncmProducingActyGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Unrelated Business Taxbl Incm | $0 | UnrelatedBusinessTaxblIncmAmt |
| Exclusion | $0 | ExclusionAmt |
| Related Or Exempt Function Incm | $815,312 | RelatedOrExemptFunctionIncmAmt |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Income Producing Acty | $815,312 | TotalIncomeProducingActyAmt |
Rln Of Acty To Accom Of Exmpt Prps RlnOfActyToAccomOfExmptPrpsGrp
Rln Of Acty To Accom Of Exmpt Prps RlnOfActyToAccomOfExmptPrpsGrp (2 entries)
| Line NumberLineNumberTxt | Relationship StatementRelationshipStatementTxt |
|---|---|
| 3,4, | ALL INCOME EARNED WILL BE USED FOR THE STATED CHARITABLE PURPOSE OF |
| 7& 8 | THE FOUNDATION. |
Trnsfr Trans Rln Nonchrtbl EO TrnsfrTransRlnNonchrtblEOGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trnsfr Of Cash To Nonchrtbl EO | 0 | TrnsfrOfCashToNonchrtblEOInd |
| Trnsfr Other Asset Nonchrtbl EO | 0 | TrnsfrOtherAssetNonchrtblEOInd |
| Sales Or Exchanges Of Assets | 0 | SalesOrExchangesOfAssetsInd |
| Purchase Of Assets Nonchrtbl EO | 0 | PurchaseOfAssetsNonchrtblEOInd |
| Rental Of Facilities Oth Assets | 0 | RentalOfFacilitiesOthAssetsInd |
| Reimbursement Arrangements | 0 | ReimbursementArrangementsInd |
| Loans Or Loan Guarantees | 0 | LoansOrLoanGuaranteesInd |
| Performance Of Services Etc | 0 | PerformanceOfServicesEtcInd |
| Sharing Of Facilities Etc | 0 | SharingOfFacilitiesEtcInd |
| Relationships Nonchrtbl EO | 0 | RelationshipsNonchrtblEOInd |
Accounting Fees Schedule AccountingFeesSchedule
Accounting Fees Detail AccountingFeesDetail
| Field | Value | IRS element (for citing) |
|---|---|---|
| Category | ACCOUNTING FEE | CategoryTxt |
| Amt | $4,035 | Amt |
| Net Investment Income | $0 | NetInvestmentIncomeAmt |
| Disbursements Charitable Prps | $0 | DisbursementsCharitablePrpsAmt |
Investments Corp Stock Schedule InvestmentsCorpStockSchedule
Investments Corporate Stock InvestmentsCorporateStockGrp (23 entries)
| StockStockNm | EOY Book ValueEOYBookValueAmt | EOYFMVEOYFMVAmt |
|---|---|---|
| 5000 SH FEDERAL HOME LOAN MORTGAGE | $305,500 | $14,500 |
| 12000 SH TEREX CORP NEW | $63,300 | $503,880 |
| 2000 SH COACH INC | $42,800 | $112,260 |
| 8300 SH CHEVRON CORP NEW | $703,046 | $1,036,753 |
| 15000 SH MONSANTO CO | $600,056 | $1,748,250 |
| 10000 SH EDWARDS LIFESCIENCES | $258,319 | $657,600 |
| 20800 SH MERCK AND CO | $708,442 | $1,041,040 |
| 16000 SH BARCLAYS | $400,000 | $402,720 |
| 9900 SH POTASH CORP SASK INC | $228,590 | $326,304 |
| 2000 SH FREEPORT MCMORAN | $67,112 | $75,480 |
| 7000 SH CREE INC | $244,699 | $437,640 |
| 5500 SH STEEL DYNAMICS INC | $80,619 | $107,470 |
| 18000 SH VERIZON COMMUNICATIONS | $508,882 | $884,520 |
| 25000 SH ALTRIA GROUP INC | $492,743 | $959,750 |
| 17000 AVON PRODUCTS INC | $515,593 | $292,740 |
| 8200 SH PEPSICO INC | $498,674 | $680,108 |
| 80000 HSBC HLDGS PLC PERP PRF | $2,000,000 | $2,155,200 |
| 13000 SH BP PLC SPONSORED ADR | $498,411 | $631,930 |
| 4500 SH CLIFFS NATURAL RESOURCES | $369,135 | $117,945 |
| 24000 SH RUBICON TECHNOLOGY INC | $409,361 | $238,800 |
| 15891 SH AMGEN INC | $139,046 | $1,812,845 |
| 3500 SH ONYX PHARMACEUTICALS INC | $0 | $0 |
| 30000 SH GENERAL ELEC CAP CORP | $0 | $0 |
Investments Other Schedule2 InvestmentsOtherSchedule2
Investments Other InvestmentsOtherGrp
| Field | Value | IRS element (for citing) |
|---|---|---|
| Category Or Item | 10000 UNITS PLAIN ALLAMERICAN PIPELINE LP | CategoryOrItemTxt |
| Listed At Cost Or FMV | AT COST | ListedAtCostOrFMVCd |
| Book Value | $244,775 | BookValueAmt |
| EOYFMV | $517,700 | EOYFMVAmt |
Other Decreases Schedule OtherDecreasesSchedule
Other Decreases Detail OtherDecreasesDetail (3 entries)
| DescriptionDescription | AmountAmount |
|---|---|
| RECLASSIFY PRIOR YEAR PARTNERSHIP DISTRIBUTIONS | $26,075 |
| PRIOR YEAR PARTNERSHIP LOSSES | $10,729 |
| PARTNERSHIP LOSS | $2,251 |
Other Professional Fees Schedule OtherProfessionalFeesSchedule
Other Professional Fees Detail OtherProfessionalFeesDetail (2 entries)
| CategoryCategoryTxt | AmtAmt | Net Investment IncomeNetInvestmentIncomeAmt | Disbursements Charitable PrpsDisbursementsCharitablePrpsAmt |
|---|---|---|---|
| TRUSTEE FEES | $1,000 | $0 | $0 |
| COMM OF PA REGISTRATION FEE | $15 | $0 | $0 |
Taxes Schedule TaxesSchedule
Taxes Detail TaxesDetail (2 entries)
| CategoryCategoryTxt | AmtAmt | Net Investment IncomeNetInvestmentIncomeAmt | Disbursements Charitable PrpsDisbursementsCharitablePrpsAmt |
|---|---|---|---|
| INTERNAL REVENUE SERVICE | $3,000 | $0 | $0 |
| FOREIGN TAXES WITHHELD | $2,945 | $0 | $0 |
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