JOHN M AND GERTRUDE E PETERSEN FOUNDATION: Form 990PF, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- JOHN M AND GERTRUDE E PETERSEN FOUNDATION (EIN 25-1859031)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-09-11
- IRS object ID
- 201302549349100000
- Schema version
- 2012v2.1
- 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
- Schedule B
- Accounting Fees Schedule
- Investments Corp Stock Schedule
- Investments Other Schedule2
- Other Increases Schedule
- Other Professional Fees Schedule
- Taxes Schedule
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-09-11T07:00:50-05:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 251690617 | EIN |
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | SCHAFFNER KNIGHT MINNAUGH & CO PC | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| 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 | ReturnType |
| Tax Period Begin Date | 2012-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 251859031 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | JOHN M AND GERTRUDE E PETERSEN FOUNDATION | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Control | JOHN | NameControl |
| Phone | 8148360365 | Phone |
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 |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | JOHN M PETERSEN | Name |
| Title | PRESIDENT | Title |
| Phone | 8148331778 | Phone |
| Date Signed | 2013-08-14 | DateSigned |
| Authorize Third Party | 1 | AuthorizeThirdParty |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | DENNIS W GROW CPA | Name |
| PTIN | P00190259 | PTIN |
| Phone | 8144541997 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990-PF IRS990PF
| Field | Value | IRS element (for citing) |
|---|---|---|
| Exempt PF | X | ExemptPF |
| FMV Assets EOY | 14330619 | FMVAssetsEOY |
| Method Of Accounting Cash | X | MethodOfAccountingCash |
Analysis Of Revenue And Expenses AnalysisOfRevenueAndExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contri Received Rev And Expnss | 139046 | ContriReceivedRevAndExpnss |
| Interest On Savings Rev And Expnss | 92 | InterestOnSavingsRevAndExpnss |
| Interest On Savings Net Invst Incm | 92 | InterestOnSavingsNetInvstIncm |
| Dividends Rev And Expnss | 495772 | DividendsRevAndExpnss |
| Dividends Net Invst Incm | 495772 | DividendsNetInvstIncm |
| Capital Gain Net Incm Net Invst Incm | 0 | CapitalGainNetIncmNetInvstIncm |
| Total Revenue And Expenses | 634910 | TotalRevenueAndExpenses |
| Total Net Investment Income | 495864 | TotalNetInvestmentIncome |
| Comp Ofcr Dir Trst Rev And Expnss | 0 | CompOfcrDirTrstRevAndExpnss |
| Comp Ofcr Dir Trst Net Invst Incm | 0 | CompOfcrDirTrstNetInvstIncm |
| Comp Ofcr Dir Trst Dsbrs Chrtbl Prps | 0 | CompOfcrDirTrstDsbrsChrtblPrps |
| Accounting Fees Rev And Expnss | 5000 | AccountingFeesRevAndExpnss |
| Accounting Fees Net Invst Incm | 0 | AccountingFeesNetInvstIncm |
| Accounting Fees Dsbrs Chrtbl Prps | 0 | AccountingFeesDsbrsChrtblPrps |
| Other Prof Fees Rev And Expnss | 1015 | OtherProfFeesRevAndExpnss |
| Other Prof Fees Net Invst Incm | 0 | OtherProfFeesNetInvstIncm |
| Other Prof Fees Dsbrs Chrtbl Prps | 0 | OtherProfFeesDsbrsChrtblPrps |
| Taxes Rev And Expnss | 15556 | TaxesRevAndExpnss |
| Taxes Net Invst Incm | 0 | TaxesNetInvstIncm |
| Taxes Dsbrs Chrtbl Prps | 0 | TaxesDsbrsChrtblPrps |
| Tot Opr Expenses Rev And Expnss | 21571 | TotOprExpensesRevAndExpnss |
| Tot Opr Expenses Net Invst Incm | 0 | TotOprExpensesNetInvstIncm |
| Tot Opr Expenses Dsbrs Chrtbl Prps | 0 | TotOprExpensesDsbrsChrtblPrps |
| Contri Gifts Paid Rev And Expnss | 851900 | ContriGiftsPaidRevAndExpnss |
| Contri Gifts Paid Dsbrs Chrtbl Prps | 851900 | ContriGiftsPaidDsbrsChrtblPrps |
| Total Expenses Rev And Expnss | 873471 | TotalExpensesRevAndExpnss |
| Total Expenses Net Invst Incm | 0 | TotalExpensesNetInvstIncm |
| Total Expenses Dsbrs Chrtbl Prps | 851900 | TotalExpensesDsbrsChrtblPrps |
| Excess Of Revenue Over Expenses | -238561 | ExcessOfRevenueOverExpenses |
| Net Investment Income | 495864 | NetInvestmentIncome |
Balance Sheets BalanceSheets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Savings And Temp Cash Invst BOY | 675351 | SavingsAndTempCashInvstBOY |
| Savings And Temp Cash Invst EOY | 318844 | SavingsAndTempCashInvstEOY |
| Savings And Temp Cash Invst EOYFMV | 318844 | SavingsAndTempCashInvstEOYFMV |
| Investments Corp Stock BOY | 9845347 | InvestmentsCorpStockBOY |
| Investments Corp Stock EOY | 9984393 | InvestmentsCorpStockEOY |
| Investments Corp Stock EOYFMV | 13559375 | InvestmentsCorpStockEOYFMV |
| Investments Other BOY | 306978 | InvestmentsOtherBOY |
| Investments Other EOY | 306978 | InvestmentsOtherEOY |
| Investments Other EOYFMV | 452400 | InvestmentsOtherEOYFMV |
| Total Assets BOY | 10827676 | TotalAssetsBOY |
| Total Assets EOY | 10610215 | TotalAssetsEOY |
| Total Assets EOYFMV | 14330619 | TotalAssetsEOYFMV |
| Total Liabilities BOY | 0 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 0 | TotalLiabilitiesEOY |
| Org That Do Not Follow SFAS117 | X | OrgThatDoNotFollowSFAS117 |
| Capital Stock BOY | 0 | CapitalStockBOY |
| Capital Stock EOY | 0 | CapitalStockEOY |
| Paid In Or Capital Surplus BOY | 0 | PaidInOrCapitalSurplusBOY |
| Paid In Or Capital Surplus EOY | 0 | PaidInOrCapitalSurplusEOY |
| Retained Earnings BOY | 10827676 | RetainedEarningsBOY |
| Retained Earnings EOY | 10610215 | RetainedEarningsEOY |
| Total Net Assets BOY | 10827676 | TotalNetAssetsBOY |
| Total Net Assets EOY | 10610215 | TotalNetAssetsEOY |
| Total Liabilities Net Assets BOY | 10827676 | TotalLiabilitiesNetAssetsBOY |
| Total Liabilities Net Assets EOY | 10610215 | TotalLiabilitiesNetAssetsEOY |
Changes In Net Assets Fund Balances ChangesInNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Net Assets Fund Balances BOY | 10827676 | TotalNetAssetsFundBalancesBOY |
| Excess Of Revenue Over Expenses | -238561 | ExcessOfRevenueOverExpenses |
| Other Increases | 21100 | OtherIncreases |
| Subtotal | 10610215 | Subtotal |
| Other Decreases | 0 | OtherDecreases |
| Total Net Assets Fund Balances EOY | 10610215 | TotalNetAssetsFundBalancesEOY |
Qlfy Und Sect4940e For Reduced Tax QlfyUndSect4940eForReducedTax
| Field | Value | IRS element (for citing) |
|---|---|---|
| Liable For4942 Tax | 0 | LiableFor4942Tax |
| Qualifying Distributions Year1 | 946227 | QualifyingDistributionsYear1 |
| Noncharitable Assets Year1 | 12789800 | NoncharitableAssetsYear1 |
| Distribution Ratio Year1 | 0.073983 | DistributionRatioYear1 |
| Qualifying Distributions Year2 | 212984 | QualifyingDistributionsYear2 |
| Noncharitable Assets Year2 | 12159446 | NoncharitableAssetsYear2 |
| Distribution Ratio Year2 | 0.017516 | DistributionRatioYear2 |
| Qualifying Distributions Year3 | 1000155 | QualifyingDistributionsYear3 |
| Noncharitable Assets Year3 | 11708487 | NoncharitableAssetsYear3 |
| Distribution Ratio Year3 | 0.085421 | DistributionRatioYear3 |
| Qualifying Distributions Year4 | 0 | QualifyingDistributionsYear4 |
| Noncharitable Assets Year4 | 13364595 | NoncharitableAssetsYear4 |
| Distribution Ratio Year4 | 0.000000 | DistributionRatioYear4 |
| Qualifying Distributions Year5 | 600 | QualifyingDistributionsYear5 |
| Noncharitable Assets Year5 | 15198557 | NoncharitableAssetsYear5 |
| Distribution Ratio Year5 | 0.000039 | DistributionRatioYear5 |
| Total Distribution Ratio | 0.176959 | TotalDistributionRatio |
| Average Distribution Ratio | 0.035392 | AverageDistributionRatio |
| Net Noncharitable Assets | 13721847 | NetNoncharitableAssets |
| Adjusted Noncharitable Assets | 485644 | AdjustedNoncharitableAssets |
| One Percent Net Investment Income | 4959 | OnePercentNetInvestmentIncome |
| Adj Nonchrtbl Assets And One | 490603 | AdjNonchrtblAssetsAndOnePct |
| Qualifying Distributions | 851900 | QualifyingDistributions |
Excise Tax Based On Investment Incm ExciseTaxBasedOnInvestmentIncm
| Field | Value | IRS element (for citing) |
|---|---|---|
| Domestic Org Meeting Sect4940e | X | DomesticOrgMeetingSect4940e |
| Investment Income Excise Tax | 4959 | InvestmentIncomeExciseTax |
| Tax Under Section511 | 0 | TaxUnderSection511 |
| Subtotal | 4959 | Subtotal |
| Subtitle A Tax | 0 | SubtitleATax |
| Tax Based On Investment Income | 4959 | TaxBasedOnInvestmentIncome |
| Est Tax Payments And Overpayment | 7280 | EstTaxPaymentsAndOverpayment |
| Total Credits And Payments | 7280 | TotalCreditsAndPayments |
| Overpayment | 2321 | Overpayment |
| Amount Credited To Next Year | 2321 | AmountCreditedToNextYear |
| Amount To Be Refunded | 0 | AmountToBeRefunded |
Statements Regarding Activities StatementsRegardingActivities
| Field | Value | IRS element (for citing) |
|---|---|---|
| Legislative Political Activities | 0 | LegislativePoliticalActivities |
| More Than100 Spent | 0 | MoreThan100Spent |
| Form1120 POL Filed | 0 | Form1120POLFiled |
| Sect4955 Tax On Organization | 0 | Sect4955TaxOnOrganization |
| Sect4955 Tax On Managers | 0 | Sect4955TaxOnManagers |
| Reimbursement Of Tax | 0 | ReimbursementOfTax |
| Activities Not Prev Reported | 0 | ActivitiesNotPrevReported |
| Changes To Articles Or Bylaws | 0 | ChangesToArticlesOrBylaws |
| Unrelated Bus Income Over1000 | 0 | UnrelatedBusIncomeOver1000 |
| Termination Etc | 0 | TerminationEtc |
| Requirements Of Sect508e | 1 | RequirementsOfSect508e |
| At Least5000 In Assets | 1 | AtLeast5000InAssets |
| States Filed With | PA | StatesFiledWith |
| Form990 PF Filed With AG | 1 | Form990PFFiledWithAG |
| Private Operating Foundation | 0 | PrivateOperatingFoundation |
| New Substantial Contributors | 0 | NewSubstantialContributors |
| Interest In Controlled Entity | 0 | InterestInControlledEntity |
| Applicable Insurance Contract | 0 | ApplicableInsuranceContract |
| Comply With Public Inspection Rqr | 1 | ComplyWithPublicInspectionRqr |
| Website Address | N/A | WebsiteAddress |
| Books In Care Of Person Name | JOHN M PETERSEN | BooksInCareOfPersonName |
| Books In Care Of Phone Number | 8148360365 | BooksInCareOfPhoneNumber |
Books In Care Of US Address BooksInCareOfUSAddress
| 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 Bank | 0 | ForeignBank |
Statements Regarding Acty4720 StatementsRegardingActy4720
| Field | Value | IRS element (for citing) |
|---|---|---|
| Sale Or Exchange With Dsqfly Person | 0 | SaleOrExchangeWithDsqflyPerson |
| Borrow Or Lend With Dsqfly Person | 0 | BorrowOrLendWithDsqflyPerson |
| Furnished Goods With Dsqfly Person | 0 | FurnishedGoodsWithDsqflyPerson |
| Pay Compensation To Dsqfly Person | 0 | PayCompensationToDsqflyPerson |
| Transfer Assets To Dsqfly Person | 0 | TransferAssetsToDsqflyPerson |
| Payment To Government Offical | 0 | PaymentToGovernmentOffical |
| Uncorrected Prior Acts | 0 | UncorrectedPriorActs |
| Undistributed Income Prior Years | 0 | UndistributedIncomePriorYears |
| Business Holdings | 0 | BusinessHoldings |
| Jeopardy Investments | 0 | JeopardyInvestments |
| Uncorrected Jeopardy Investments | 0 | UncorrectedJeopardyInvestments |
| Influence Legislation | 0 | InfluenceLegislation |
| Influence Election | 0 | InfluenceElection |
| Grants To Individuals | 0 | GrantsToIndividuals |
| Grants To Organizations | 0 | GrantsToOrganizations |
| Noncharitable Purpose | 0 | NoncharitablePurpose |
| Rcv Funds To Pay Prsnl Bnft Contract | 0 | RcvFundsToPayPrsnlBnftContract |
| Pay Premiums Prsnl Bnft Contract | 0 | PayPremiumsPrsnlBnftContract |
| Prohibited Tax Shelter Transactn | 0 | ProhibitedTaxShelterTransactn |
Ofcr Dir Trustees Key Employee Info OfcrDirTrusteesKeyEmployeeInfo
Ofcr Dir Trustees Or Key Employee OfcrDirTrusteesOrKeyEmployee (3 entries)
| Address Line1USAddress/AddressLine1 | CityUSAddress/City | StateUSAddress/State | ZIP CodeUSAddress/ZIPCode | TitleTitle | Avg Hours Per Wk Devoted To PositionAvgHoursPerWkDevotedToPosition | CompensationCompensation | Contri To Empl Benefit Plans EtcContriToEmplBenefitPlansEtc | Expense Account Other AllowancesExpenseAccountOtherAllowances |
|---|---|---|---|---|---|---|---|---|
| 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 Highest Paid Empl NONE | NONE | CompOfHighestPaidEmplNONE |
| Tot Number Of Oth Empl Paid Over50k | 0 | TotNumberOfOthEmplPaidOver50k |
| Comp Of Hghst Paid Cntrct NONE | NONE | CompOfHghstPaidCntrctNONE |
| Tot Number Of Cntrct Paid Over50k | 0 | TotNumberOfCntrctPaidOver50k |
Sum Of Program Related Investments SumOfProgramRelatedInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Minimum Investment Return MinimumInvestmentReturn
| Field | Value | IRS element (for citing) |
|---|---|---|
| Avg Monthly FMV Of Securities | 13516691 | AvgMonthlyFMVOfSecurities |
| Avg Monthly Cash Balances | 414118 | AvgMonthlyCashBalances |
| FMV All Other Noncharitable Assets | 0 | FMVAllOtherNoncharitableAssets |
| Total FMV Of Unused Assets | 13930809 | TotalFMVOfUnusedAssets |
| Reduction Claimed | 0 | ReductionClaimed |
| Acquisition Indebtedness | 0 | AcquisitionIndebtedness |
| Adj Total FMV Of Unused Assets | 13930809 | AdjTotalFMVOfUnusedAssets |
| Cash Deemed Charitable | 208962 | CashDeemedCharitable |
| Net Noncharitable Assets | 13721847 | NetNoncharitableAssets |
| Minimum Investment Return | 686092 | MinimumInvestmentReturn |
Distributable DistributableAmount
| Field | Value | IRS element (for citing) |
|---|---|---|
| Minimum Investment Return | 686092 | MinimumInvestmentReturn |
| Tax Based On Investment Income | 4959 | TaxBasedOnInvestmentIncome |
| Total Tax | 4959 | TotalTax |
| Distributable Amount Before Adj | 681133 | DistributableAmountBeforeAdj |
| Recoveries Qlfy Distributions | 0 | RecoveriesQlfyDistributions |
| Distributable Amount Before Ded | 681133 | DistributableAmountBeforeDed |
| Deduction Fr Distributable | $0 | DeductionFrDistributableAmount |
| Distributable Amount As Adjusted | 681133 | DistributableAmountAsAdjusted |
Qualifying Distributions QualifyingDistributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Expenses And Contributions | 851900 | ExpensesAndContributions |
| Program Related Investments Total | 0 | ProgramRelatedInvestmentsTotal |
| Qualifying Distributions | 851900 | QualifyingDistributions |
| One Pct Sect4940e Org Net Invst Incm | 4959 | OnePctSect4940eOrgNetInvstIncm |
| Adj Qualifying Distributions | 846941 | AdjQualifyingDistributions |
Undistributed Income UndistributedIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Distributable Amount As Adjusted | 681133 | DistributableAmountAsAdjusted |
| Undistributed Income Prior Year | 0 | UndistributedIncomePriorYear |
| Total For Prior Years | 0 | TotalForPriorYears |
| Excess Distri Carryover Year3 | 30865 | ExcessDistriCarryoverYear3 |
| Excess Distri Carryover Year1 | 321277 | ExcessDistriCarryoverYear1 |
| Total Excess Distri Carryover | 352142 | TotalExcessDistriCarryover |
| Qualifying Distributions | 851900 | QualifyingDistributions |
| Applied To Year1 | 0 | AppliedToYear1 |
| Applied To Prior Years | 0 | AppliedToPriorYears |
| Treated As Distri From Corpus | 0 | TreatedAsDistriFromCorpus |
| Applied To Current Year | 681133 | AppliedToCurrentYear |
| Remaining Distri From Corpus | 170767 | RemainingDistriFromCorpus |
| Excess Distri Cyov App CY Corpus | 0 | ExcessDistriCyovAppCYCorpus |
| Excess Distri Cyov Applied CY | 0 | ExcessDistriCyovAppliedCY |
| Total Corpus | 522909 | TotalCorpus |
| Prior Year Undistributed Income | 0 | PriorYearUndistributedIncome |
| Prior Year Deficiency Or Tax | 0 | PriorYearDeficiencyOrTax |
| Taxable Amount1 | 0 | TaxableAmount1 |
| Taxable Amount2 | 0 | TaxableAmount2 |
| Undistributed Income CY | 0 | UndistributedIncomeCY |
| Distri From Corpus170b1 E Or4942g3 | 0 | DistriFromCorpus170b1EOr4942g3 |
| Excess Distri Cyov From Year5 | 0 | ExcessDistriCyovFromYear5 |
| Excess Distri Cyov To Next Year | 522909 | ExcessDistriCyovToNextYear |
| Excess From Year3 | 30865 | ExcessFromYear3 |
| Excess From Year1 | 321277 | ExcessFromYear1 |
| Excess From Current Year | 170767 | ExcessFromCurrentYear |
Supplementary Information SupplementaryInformation
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributing Manager | JOHN M PETERSEN | ContributingManager |
| Contributing Manager | GERTRUDE PETERSEN | ContributingManager |
Appication Submission Info AppicationSubmissionInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Recipient Name | JOHN M PETERSEN | RecipientName |
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 Number | 8148360365 | RecipientPhoneNumber |
| 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. | FormAndInfoAndMaterials |
| Submission Deadlines | N/A | SubmissionDeadlines |
| Restrictions On Awards | NONE | RestrictionsOnAwards |
Grant Or Contri Paid During Year GrantOrContriPaidDuringYear (25 entries)
| Address Line1RecipientUSAddress/AddressLine1 | CityRecipientUSAddress/City | StateRecipientUSAddress/State | ZIP CodeRecipientUSAddress/ZIPCode | Recipient RelationshipRecipientRelationship | Recipient Foundation StatusRecipientFoundationStatus | Purpose Of Grant Or ContributionPurposeOfGrantOrContribution | AmountAmount |
|---|---|---|---|---|---|---|---|
| ASBURY WOODS NATURE CENTER | |||||||
| 4105 ASBURY RD | ERIE | PA | 16506 | NONE | OTHER PUBLIC CHARITY | GENERAL SUPPORT | $1,000 |
| 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 | $1,000 |
| 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 | $5,000 |
| 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 | $50,000 |
| MERCY CENTER FOR WOMEN | |||||||
| 1039 EAST 27TH ST | ERIE | PA | 16504 | NONE | OTHER PUBLIC CHARITY | GENERAL SUPPORT | $5,000 |
| SAINT PAUL'S NEIGHBORHOOD FREE CLINIC | |||||||
| 1608 WALNUT STREET | ERIE | PA | 16502 | NONE | OTHER PUBLIC CHARITY | GENERAL SUPPORT | $4,000 |
| THE HUMANE SOCIETY OF NORTHWEST PA | |||||||
| 2507 ZIMMERLY RD | ERIE | PA | 16506 | NONE | OTHER PUBLIC CHARITY | GENERAL SUPPORT | $10,000 |
| THE SIGHT CENTER OF NORTHWEST PA | |||||||
| 2545 WEST 26TH ST | ERIE | PA | 16506 | NONE | OTHER PUBLIC CHARITY | GENERAL SUPPORT | $5,000 |
| UNITED WAY OF ERIE COUNTY | |||||||
| 420 WEST 6TH ST | ERIE | PA | 16507 | NONE | OTHER PUBLIC CHARITY | GENERAL SUPPORT | $10,000 |
| UNIVERSITY OF PITTSBURGH | |||||||
| 4200 FIFTH AVENUE | PITTSBURGH | PA | 15260 | NONE | OTHER PUBLIC CHARITY | GENERAL SUPPORT | $50,000 |
| YOUTH FOR CHRIST | |||||||
| 4814 IROQUOIS AVE | ERIE | PA | 16511 | NONE | OTHER PUBLIC CHARITY | GENERAL SUPPORT | $3,000 |
| PENN STATE UNIVERSITY SCHOLARSHIP FUND | |||||||
| 314 SHIELDS BUILDING | UNIVERSITY PARK | PA | 16802 | NONE | OTHER PUBLIC CHARITY | GENERAL SUPPORT | $150,000 |
| BETHESDA FOUNDATION FOR CHILDREN | |||||||
| 15667 STATE HIGHWAY 86 | MEADVILLE | PA | 16335 | NONE | OTHER PUBLIC CHARITY | GENERAL SUPPORT | $20,000 |
| SALVATION ARMY | |||||||
| 1944 KEYSTONE DRIVE STE 24 | ERIE | PA | 16509 | NONE | OTHER PUBLIC CHARITY | GENERAL SUPPORT | $3,000 |
| THE ANNA SHELTER | |||||||
| 1555 EAST 10TH STREET | ERIE | PA | 16511 | NONE | OTHER PUBLIC CHARITY | GENERAL SUPPORT | $2,000 |
| MARIANO RIVERA FOUNDATION | |||||||
| 321 CHATTAHOOCHEE DRIVE | BEAR | DE | 19701 | NONE | OTHER PUBLIC CHARITY | GENERAL SUPPORT | $5,000 |
| UNIVERSITY OF PITTSBURGH | |||||||
| 4200 FIFTH AVENUE | PITTSBURGH | PA | 15260 | NONE | OTHER PUBLIC CHARITY | GENERAL SUPPORT | $500,000 |
| WEST LAKE FIRE DEPARTMENT | |||||||
| 3762 WEST LAKE ROAD | ERIE | PA | 16505 | NONE | OTHER PUBLIC CHARITY | GENERAL SUPPORT | $400 |
| CWSCROP | |||||||
| 28606 PHILLIPS STREET | ELKHART | IN | 46514 | NONE | OTHER PUBLIC CHARITY | GENERAL SUPPORT | $500 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tot Grant Or Contri Paid During Year | 851900 | TotGrantOrContriPaidDuringYear |
| Tot Grant Or Contri Approved Future | 0 | TotGrantOrContriApprovedFuture |
Analysis Income Producing Acty AnalysisIncomeProducingActy
Int On Savings And Temp Cash Invst IntOnSavingsAndTempCashInvst
| Field | Value | IRS element (for citing) |
|---|---|---|
| Related Or Exempt Function Income | 92 | RelatedOrExemptFunctionIncome |
Dividends And Int From Sec Part VII DividendsAndIntFromSecPartVII
| Field | Value | IRS element (for citing) |
|---|---|---|
| Related Or Exempt Function Income | 495772 | RelatedOrExemptFunctionIncome |
Subtotals Part XVIA SubtotalsPartXVIA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Unrelated Business Income | $0 | UnrelatedBusinessIncomeAmount |
| Exclusion | $0 | ExclusionAmount |
| Related Or Exempt Function Income | 495864 | RelatedOrExemptFunctionIncome |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Part XVIA | 495864 | TotalPartXVIA |
Rln Of Acty To Accom Of Exempt Prps RlnOfActyToAccomOfExemptPrps
Rln Of Acty To Accom Of Exempt Prps RlnOfActyToAccomOfExemptPrps (2 entries)
| Line NumberLineNumber | Relationship StatementRelationshipStatement |
|---|---|
| 3,4, | ALL INCOME EARNED WILL BE USED FOR THE STATED CHARITABLE PURPOSE OF |
| 7& 8 | THE FOUNDATION. |
Trnsfr Tr Rln With Noncharitable EO TrnsfrTrRlnWithNoncharitableEO
| Field | Value | IRS element (for citing) |
|---|---|---|
| Trnsfr Of Cash To Noncharitable EO | 0 | TrnsfrOfCashToNoncharitableEO |
| Trnsfr Oth Assets Noncharitable EO | 0 | TrnsfrOthAssetsNoncharitableEO |
| Sales Or Exchanges Of Assets | 0 | SalesOrExchangesOfAssets |
| Purchase Assets Noncharitable EO | 0 | PurchaseAssetsNoncharitableEO |
| Rental Of Facilities Etc | 0 | RentalOfFacilitiesEtc |
| Reimbursement Arrangements | 0 | ReimbursementArrangements |
| Loans Or Loan Guarantees | 0 | LoansOrLoanGuarantees |
| Performance Of Services Etc | 0 | PerformanceOfServicesEtc |
| Sharing Of Facilities Etc | 0 | SharingOfFacilitiesEtc |
| Relationships Noncharitable E Os | 0 | RelationshipsNoncharitableEOs |
Schedule B IRS990ScheduleB
| Field | Value | IRS element (for citing) |
|---|---|---|
| Organization501c3 Exempt PF | X | Organization501c3ExemptPF |
| General Rule | X | GeneralRule |
Contributor Info ContributorInfo
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number | 1 | ContributorNumber |
| Contributor Name Individual | JOHN M PETERSEN | ContributorNameIndividual |
Contributor Address US ContributorAddressUS
| 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) |
|---|---|---|
| Aggregate Contributions | 139046 | AggregateContributions |
| Noncash Contribution Type | X | NoncashContributionType |
Noncash Property NoncashProperty
| Field | Value | IRS element (for citing) |
|---|---|---|
| Contributor Number From Part I | 1 | ContributorNumberFromPartI |
| Noncash Property Description | 15,891 SHARES AMGEN, INC COMMON STOCK | NoncashPropertyDescription |
| Fair Market Value | 139046 | FairMarketValue |
| Date Received | 2012-02-14 | DateReceived |
Accounting Fees Schedule AccountingFeesSchedule
Accounting Fees AccountingFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Category | ACCOUNTING FEE | Category |
| Amount | $5,000 | Amount |
| Net Investment Income | 0 | NetInvestmentIncome |
| Disbursements Charitable Prps | 0 | DisbursementsCharitablePrps |
Investments Corp Stock Schedule InvestmentsCorpStockSchedule
Investments Corp Stock InvestmentsCorpStock (23 entries)
| Name Of StockNameOfStock | EOY Book ValueEOYBookValue | EOYFMVEOYFMV |
|---|---|---|
| 5000 SH FEDERAL HOME LOAN MORTGAGE | 305500 | 1315 |
| 12000 SH TEREX CORP NEW | 63300 | 337320 |
| 2000 SH COACH INC | 42800 | 111020 |
| 8300 SH CHEVRON CORP NEW | 703046 | 897562 |
| 15000 SH MONSANTO CO | 600056 | 1419750 |
| 3500 SH ONYX PHARMACEUTICALS INC | 100065 | 264355 |
| 10000 SH EDWARDS LIFESCIENCES | 258319 | 901700 |
| 20800 SH MERCK AND CO | 708442 | 851552 |
| 16000 SH BARCLAYS | 400000 | 400960 |
| 30000 SH GENERAL ELEC CAP CORP | 750000 | 783000 |
| 9900 SH POTASH CORP SASK INC | 228590 | 402831 |
| 2000 SH FREEPORT MCMORAN | 67112 | 68400 |
| 7000 SH CREE INC | 244699 | 237860 |
| 5500 SH STEEL DYNAMICS INC | 80619 | 75515 |
| 18000 SH VERIZON COMMUNICATIONS | 508882 | 778860 |
| 25000 SH ALTRIA GROUP INC | 492743 | 786000 |
| 17000 AVON PRODUCTS INC | 515593 | 244120 |
| 8200 SH PEPSICO INC | 498674 | 561126 |
| 80000 HSBC HLDGS PLC PERP PRF | 2000000 | 2204800 |
| 13000 SH BP PLC SPONSORED ADR | 498411 | 541320 |
| 4500 SH CLIFFS NATURAL RESOURCES | 369135 | 173565 |
| 24000 SH RUBICON TECHNOLOGY INC | 409361 | 146640 |
| 15891 SH AMGEN INC | 139046 | 1369804 |
Investments Other Schedule2 InvestmentsOtherSchedule2
Investments Other InvestmentsOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Category Or Item | 10000 UNITS PLAIN ALLAMERICAN PIPELINE LP | CategoryOrItem |
| Listed At Cost Or FMV | AT COST | ListedAtCostOrFMV |
| Book Value | 306978 | BookValue |
| EOYFMV | 452400 | EOYFMV |
Other Increases Schedule OtherIncreasesSchedule
Other Increases OtherIncreases
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | PARTNERSHIP DISTRIBUTION | Description |
| Amount | $21,100 | Amount |
Other Professional Fees Schedule OtherProfessionalFeesSchedule
Other Professional Fees OtherProfessionalFees (2 entries)
| CategoryCategory | AmountAmount | Net Investment IncomeNetInvestmentIncome | Disbursements Charitable PrpsDisbursementsCharitablePrps |
|---|---|---|---|
| TRUSTEE FEES | $1,000 | 0 | 0 |
| COMM OF PA REGISTRATION FEE | $15 | 0 | 0 |
Taxes Schedule TaxesSchedule
Taxes Taxes (2 entries)
| CategoryCategory | AmountAmount | Net Investment IncomeNetInvestmentIncome | Disbursements Charitable PrpsDisbursementsCharitablePrps |
|---|---|---|---|
| INTERNAL REVENUE SERVICE | $14,724 | 0 | 0 |
| FOREIGN TAXES WITHHELD | $832 | 0 | 0 |
Comments