2014-05-13T15:47:00-05:00 2013-12-31 251690617 SCHAFFNER KNIGHT MINNAUGH & CO PC 1001 STATE STREET SUITE 1300 ERIE PA 16501 990PF 2013-01-01 251859031 JOHN M AND GERTRUDE E PETERSEN FOUNDATION JOHN 8148360365 124 VOYAGEUR DRIVE ERIE PA 165055435 JOHN M PETERSEN PRESIDENT 8148331778 2014-05-13 1 DENNIS W GROW CPA P00190259 8144541997 2013 2015-12-30 17:16:21Z X 16507809 X X 58 58 477418 477418 337836 1187901 337836 815312 815312 0 0 0 4035 0 0 1015 0 0 5945 0 0 10995 0 0 244000 244000 254995 0 244000 560317 815312 1 1 318844 1752373 1752373 9984393 9134328 14237735 306978 244775 517700 10610215 11131477 16507809 0 0 X 0 0 0 0 10610215 11131477 10610215 11131477 10610215 11131477 10610215 560317 0 11170532 39055 11131477 GENERAL ELECTRIC CAPITAL 6% P 2007-04-20 2013-01-18 750000 750000 0 0 ONYX PHARMACEUTICALS INC P 2005-03-07 2013-10-09 437500 100065 337435 337435 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 337836 0 846941 13721847 0.061722 946227 12789800 0.073983 212984 12159446 0.017516 1000155 11708487 0.085421 0 13364595 0.000000 0.238642 0.047728 15471506 738424 8153 746577 244000 16306 0 16306 0 16306 5321 5321 X 250 11235 0 0 0 0 0 0 0 0 0 0 1 1 PA 1 0 0 0 0 1 N/A JOHN M PETERSEN 8148360365 124 VOYAGEUR DRIVE ERIE PA 165055435 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 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 NONE 0 NONE 0 0 14351859 1355254 0 15707113 0 0 15707113 235607 15471506 773575 773575 16306 16306 757269 0 757269 0 757269 244000 0 244000 0 244000 757269 0 0 30865 321277 170767 522909 244000 0 0 0 244000 0 513269 513269 9640 0 0 0 0 0 0 0 9640 9640 JOHN M PETERSEN GERTRUDE PETERSEN JOHN M PETERSEN 1550 EL CAMINO REAL APT 234 LADY LAKE FL 32159 8148360365 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. N/A NONE ASBURY WOODS NATURE CENTER 4105 ASBURY RD ERIE PA 16506 NONE OTHER PUBLIC CHARITY GENERAL SUPPORT 2000 BECAUSE YOU CARE INC PO BOX 54 MCKEAN PA 16426 NONE OTHER PUBLIC CHARITY GENERAL SUPPORT 3000 BOYS AND GIRLS CLUB OF ERIE 1515 EAST LAKE RD ERIE PA 16511 NONE OTHER PUBLIC CHARITY GENERAL SUPPORT 2000 DR GERTRUDE A BARBER NATIONAL INSTITUTE 136 EAST AVE ERIE PA 16507 NONE OTHER PUBLIC CHARITY GENERAL SUPPORT 5000 EMMAUS SOUP KITCHEN 218 E 11TH ST ERIE PA 16503 NONE OTHER PUBLIC CHARITY GENERAL SUPPORT 5000 ERIE CITY MISSION PO BOX 407 ERIE PA 16512 NONE OTHER PUBLIC CHARITY GENERAL SUPPORT 10000 ERIE COUNTY PUBLIC LIBRARY FOUNDATION 160 E FRONT ST ERIE PA 16507 NONE OTHER PUBLIC CHARITY GENERAL SUPPORT 5000 ERIE ZOOLOGICAL SOCIETY 423 WEST 38TH ST ERIE PA 16508 NONE OTHER PUBLIC CHARITY GENERAL SUPPORT 4000 INNER CITY NEIGHBORHOOD ART HOUSE 201 EAST 10TH ST ERIE PA 16503 NONE OTHER PUBLIC CHARITY GENERAL SUPPORT 5000 LUTHER MEMORIAL CHURCH 225 WEST 10TH ST ERIE PA 16501 NONE OTHER PUBLIC CHARITY GENERAL SUPPORT 10000 MERCY CENTER FOR WOMEN 1039 EAST 27TH ST ERIE PA 16504 NONE OTHER PUBLIC CHARITY GENERAL SUPPORT 5000 PENN STATE UNIVERSITY SCHOLARSHIP FUND 314 SHIELDS BUILDING UNIVERSITY PARK PA 16802 NONE OTHER PUBLIC CHARITY GENERAL SUPPORT 150000 SAINT PAUL'S NEIGHBORHOOD FREE CLINIC 1608 WALNUT STREET ERIE PA 16502 NONE OTHER PUBLIC CHARITY GENERAL SUPPORT 5000 SALVATION ARMY 1944 KEYSTONE DRIVE STE 24 ERIE PA 16509 NONE OTHER PUBLIC CHARITY GENERAL SUPPORT 5000 THE HUMANE SOCIETY OF NORTHWEST PA 2507 ZIMMERLY RD ERIE PA 16506 NONE OTHER PUBLIC CHARITY GENERAL SUPPORT 10000 UNITED WAY OF ERIE COUNTY 420 WEST 6TH ST ERIE PA 16507 NONE OTHER PUBLIC CHARITY GENERAL SUPPORT 10000 WOUNDED WARRIOR PROJECT PO BOX 758517 TOPEKA KS 66675 NONE OTHER PUBLIC CHARITY GENERAL SUPPORT 5000 YOUTH FOR CHRIST 4814 IROQUOIS AVE ERIE PA 16511 NONE OTHER PUBLIC CHARITY GENERAL SUPPORT 3000 244000 0 58 477418 337836 0 0 815312 815312 3,4, ALL INCOME EARNED WILL BE USED FOR THE STATED CHARITABLE PURPOSE OF 7& 8 THE FOUNDATION. 0 0 0 0 0 0 0 0 0 0 ACCOUNTING FEE 4035 0 0 5000 SH FEDERAL HOME LOAN MORTGAGE 305500 14500 12000 SH TEREX CORP NEW 63300 503880 2000 SH COACH INC 42800 112260 8300 SH CHEVRON CORP NEW 703046 1036753 15000 SH MONSANTO CO 600056 1748250 10000 SH EDWARDS LIFESCIENCES 258319 657600 20800 SH MERCK AND CO 708442 1041040 16000 SH BARCLAYS 400000 402720 9900 SH POTASH CORP SASK INC 228590 326304 2000 SH FREEPORT MCMORAN 67112 75480 7000 SH CREE INC 244699 437640 5500 SH STEEL DYNAMICS INC 80619 107470 18000 SH VERIZON COMMUNICATIONS 508882 884520 25000 SH ALTRIA GROUP INC 492743 959750 17000 AVON PRODUCTS INC 515593 292740 8200 SH PEPSICO INC 498674 680108 80000 HSBC HLDGS PLC PERP PRF 2000000 2155200 13000 SH BP PLC SPONSORED ADR 498411 631930 4500 SH CLIFFS NATURAL RESOURCES 369135 117945 24000 SH RUBICON TECHNOLOGY INC 409361 238800 15891 SH AMGEN INC 139046 1812845 3500 SH ONYX PHARMACEUTICALS INC 0 0 30000 SH GENERAL ELEC CAP CORP 0 0 10000 UNITS PLAIN ALLAMERICAN PIPELINE LP AT COST 244775 517700 RECLASSIFY PRIOR YEAR PARTNERSHIP DISTRIBUTIONS 26075 PRIOR YEAR PARTNERSHIP LOSSES 10729 PARTNERSHIP LOSS 2251 TRUSTEE FEES 1000 0 0 COMM OF PA REGISTRATION FEE 15 0 0 INTERNAL REVENUE SERVICE 3000 0 0 FOREIGN TAXES WITHHELD 2945 0 0