2013-11-04T10:50:43-00:00 2012-12-31 Foundation Source One Hollow Lane Suite 212 Lake Success NY 11042 990PF 2012-01-01 203757530 Hugh E & Marjorie S Petersen Foundation Inc HUGH 8008391754 Foundation Source 501 Silverside Rd Wilmington DE 198091377 Lynne M Tahmisian 2013-11-04 true Jeffrey D Haskell 8008391754 2013-11-04 2012 2016-03-07 17:11:31Z X 58745 X 84947 123 123 187 85134 409 85257 532 3229 5825 5825 9054 0 5825 408000 408000 417054 0 413825 -331797 532 390534 58737 58737 8 8 8 390542 58745 58745 0 X 390542 58745 390542 58745 390542 58745 390542 -331797 58745 58745 Publicly-traded Securities 85134 84947 409 409 409 false 445504 247862 001.797387 447657 640419 000.699006 188972 1012883 000.186568 292646 1127659 000.259516 174067 858857 000.202673 003.145150 000.629030 211214 132860 5 132865 413825 X 5 5 5 1219 1219 1219 1214 100 1114 false false false false false false true true true true false false false false true co Foundation Source 8008391754 501 Silverside Road Suite 123 Wilmington DE 198091377 false false false false false false false false false false false false false false false false false false false Ruth Kovacs Foundation Source 501 Silverside Rd Wilmington DE 19809 001.00 0 Sharon Peck Foundation Source 501 Silverside Rd Wilmington DE 19809 001.00 0 Marjorie S Petersen Foundation Source 501 Silverside Rd Wilmington DE 19809 001.00 0 Lynne Tahmisian Foundation Source 501 Silverside Rd Wilmington DE 19809 001.00 0 8 214422 0 214430 214430 3216 211214 10561 10561 5 5 10556 10556 10556 413825 413825 5 413820 10556 139959 238163 138492 415772 438767 1371153 413825 10556 403269 1774422 0 139959 1634463 238163 138492 415772 438767 403269 Marjorie S Petersen X CAMPUS CRUSADE FOR CHRIST INTERNATIONAL 100 LAKE HART DR ORLANDO FL 32832 N/A 509a1 Didier and Donna Heslon Project 2500 CAMPUS CRUSADE FOR CHRIST INTERNATIONAL 100 LAKE HART DR ORLANDO FL 32832 N/A 509a1 Didier and Donna Heslon Project 2500 CANCER SUPPORT COMM VALLEY- VENTURA 530 HAMPSHIRE RD WESTLAKE VLG CA 91361 N/A 509a1 General Unrestricted 25000 CHRISTIAN SCHOOL ASSOC OF SANTA BARBARA 3723 MODOC RD SANTA BARBARA CA 93105 N/A 509a1 General Unrestricted 10000 CHRYSALIS MINISTRIES INC 311 W AVENIDA GAVIOTA SAN CLEMENTE CA 92672 N/A 509a1 General Unrestricted 2000 FAMILY CARE NETWORK INC 3765 S HIGUERA ST STE 100 SN LUIS OBISP CA 93401 N/A 509a1 Building Fund Project 3000 GRACE COMMUNITY CHURCH 13248 ROSCOE BLVD SUN VALLEY CA 91352 N/A 509a1 Alex and Bryan Tahmisian Program 5000 HOPE AND HOME 4945 N 30TH ST COLORADO SPRINGS CO 80919 N/A 509a2 General Unrestricted 1000 INTERVARSITY CHRISTIAN FELLOWSHIP- USA 6400 SCHROEDER RD MADISON WI 53711 N/A 509a2 Charles Barker Graduate and Faculty Ministry Program 6000 JODI HOUSE INC 625 CHAPALA ST SANTA BARBARA CA 93101 N/A 509a1 General Unrestricted 1000 LANGHAM PARTNERSHIP USA INC NFP 1050 CHESTNUT ST STE 203 MENLO PARK CA 94025 N/A 509a1 General Unrestricted 5000 MONTECITO COVENANT CHURCH 671 COLD SPRINGS RD SANTA BARBARA CA 93108 N/A 509a1 General Unrestricted 80000 OPPORTUNITY INTERNATIONAL INC 2122 YORK RD STE 150 OAK BROOK IL 60523 N/A 509a1 Leadership Fund 50000 PALM MISSIONARY MINISTRIES INC 1702 PARKS LAKE RD LAKE WALES FL 33898 N/A 509a1 General Unrestricted 6000 PALM MISSIONARY MINISTRIES INC 1702 PARKS LAKE RD LAKE WALES FL 33898 N/A 509a1 Dan Swanson Division 6000 PRISON FELLOWSHIP MINISTRIES 44180 RIVERSIDE PKWY LANSDOWNE VA 20176 N/A 509a1 General Unrestricted 2000 SAMARITANS PURSE PO BOX 3000 BOONE NC 28607 N/A 509a1 General Unrestricted 1000 SANTA BARBARA COTTAGE HOSPITAL FOUNDATION PO BOX 689 PUEBLO AT BATH ST SANTA BARBARA CA 93102 N/A 509a1 General Unrestricted 5000 SANTA BARBARA RESCUE MISSION 535 E YANONALI ST SANTA BARBARA CA 93103 N/A 509a1 General Unrestricted 30000 THE CAMPUS FOR HUMAN DEVELOPMENT PO BOX 25309 NASHVILLE TN 37202 N/A 509a1 Mark Harmon Initiative 5000 WESTMONT COLLEGE 955 LA PAZ RD SANTA BARBARA CA 93108 N/A 509a1 General Unrestricted 60000 WHEATON COLLEGE 501 COLLEGE AVE WHEATON IL 60187 N/A 509a1 Wheaton Associates Division 5000 WORLD VISION INTERNATIONAL 800 W CHESTNUT AVE MONROVIA CA 91016 N/A 509a1 Empowerment, Respect Equality Project in Zambia 25000 WYCLIFFE BIBLE TRANSLATORS INC PO BOX 628200 ORLANDO FL 32862 N/A 509a1 General Unrestricted 5000 YOUNG LIFE PO BOX 520 COLORADO SPRINGS CO 80901 N/A 509a1 Capernaum Pam Harmon Division 5000 YOUNG LIFE PO BOX 520 COLORADO SPRINGS CO 80901 N/A 509a1 Gold Coast Region Rob Crawford Division 25000 YOUNG LIFE PO BOX 520 COLORADO SPRINGS CO 80901 N/A 509a1 Gold Coast, CA 1250 YOUNG LIFE PO BOX 520 COLORADO SPRINGS CO 80901 N/A 509a1 Gold Coast, CA Region 3750 YOUNG LIFE PO BOX 520 COLORADO SPRINGS CO 80901 N/A 509a1 Santa Barbara CA 50 Division 4500 YOUNG LIFE PO BOX 520 COLORADO SPRINGS CO 80901 N/A 509a1 Santa Barbara, CA 50 Division 7500 YOUNG LIFE PO BOX 520 COLORADO SPRINGS CO 80901 N/A 509a1 Traverse City, MI / Dr. Sherry Phelps Division 1000 YOUNG LIFE PO BOX 520 COLORADO SPRINGS CO 80901 N/A 509a1 Young Life Santa Barbara CA 50 Division 6000 YOUNG LIFE PO BOX 520 COLORADO SPRINGS CO 80901 N/A 509a1 Jaime Lisea AF56 Fund 500 YOUNG LIFE PO BOX 520 COLORADO SPRINGS CO 80901 N/A 509a1 Jaime Lisea AF56 Fund 2000 YOUNG LIFE PO BOX 520 COLORADO SPRINGS CO 80901 N/A 509a1 Jaime Lisea AF56 Fund 500 YOUNG LIFE PO BOX 520 COLORADO SPRINGS CO 80901 N/A 509a1 Santa Barbara, CA Jaime Licea Fund 3000 YOUNG LIFE PO BOX 520 COLORADO SPRINGS CO 80901 N/A 509a1 Ted Johnson 1180 Campership Legacy Fund 5000 408000 14 123 18 187 310 310 false false false false false false false false false false X X 1 Petersen Marjorie S 1114 State Street Suite 243 Santa Barbara CA 93101 84947 X 1 AMAZON COM AMZN, 340 sh. 84947 2012-12-14 Publicly-traded Securities 85134 84947 187 1 shares of PIMCO FUNDS SHORT TERM CLASS A FUND 8 8 This statement is submitted to report the distribution of certain assets during the above-referenced year. The distributions resulted in a substantial contraction of assets. The following information is submitted in accordance with Treasury Regulation Section 1.6043-3a1 and the Form 990-PF instructions During the taxable year ending December 31, 2012, Hugh E. Marjorie S. Petersen Foundation Inc. the Foundation made distributions from assets from sources other than current income. Collectively, the distributions in excess of current income totaled 408,000. This amount represents over 25 of the Foundations net assets of 390,542 as measured by fair market value at the beginning of the Foundations taxable year ending December 31, 2012. Although the Foundation technically experienced a substantial contraction, it will continue in existence and has no plans for dissolution. The Foundation made distributions of cash to the grantees listed in the attachment to Part XV, Line 3a each such grant was made solely for the charitable purpose specified therein. Administrative Fees 5800 5800 State or Local Filing Fees 25 25 IRS Excise Tax Payment with 1st ext 990-PF 3229