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
THE PETERSON FAMILY FOUNDATION INC
 
Number and street (or P.O. box number if mail is not delivered to street address)12500 FAIR LAKES CIRCLE 400
  Room/suite
City or town, state or province, country, and ZIP or foreign postal code
FAIRFAX, VA22033
A Employer identification number

54-1870812
B Telephone number (see instructions)

(703) 631-7316
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$10,465,952J 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) 4,472,830
2 Check bullet.............
3 Interest on savings and temporary cash investments 207,287 207,287  
4 Dividends and interest from securities... 6,492 6,492  
5a Gross rents............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10 1,927,488
b Gross sales price for all assets on line 6a 2,088,800
7 Capital gain net income (from Part IV, line 2)... 1,927,488
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 45,000 0  
12 Total. Add lines 1 through 11........ 6,659,097 2,141,267  
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 4,750 1,000   0
c Other professional fees (attach schedule)....        
17 Interest...............        
18 Taxes (attach schedule) (see instructions)... Click to see attachment 140,520 0   0
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 9,074 0   8,017
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 154,344 1,000   8,017
25 Contributions, gifts, grants paid....... 2,934,854 2,934,854
26 Total expenses and disbursements. Add lines 24 and 25 3,089,198 1,000   2,942,871
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements 3,569,899
b Net investment income (if negative, enter -0-) 2,140,267
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............. 1,488,587 1,237,481 1,237,481
2 Savings and temporary cash investments.........      
3 Accounts receivable bullet  
Less: allowance for doubtful accounts bullet        
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) bullet8,355,200
Less: allowance for doubtful accounts bullet0 0 8,355,200 8,355,200
8 Inventories for sale or use..............      
9 Prepaid expenses and deferred charges..........      
10a Investments—U.S. and state government obligations (attach schedule)      
b Investments—corporate stock (attach schedule)....... 784,984 Click to see attachment872,371 872,371
c Investments—corporate bonds (attach schedule).......      
11 Investments—land, buildings, and equipment: basis bullet900
Less: accumulated depreciation (attach schedule) bullet   4,244,317 900 900
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) 6,517,888 10,465,952 10,465,952
Liabilities 17 Accounts payable and accrued expenses..........    
18 Grants payable.................    
19 Deferred revenue.................    
20 Loans from officers, directors, trustees, and other disqualified persons    
21 Mortgages and other notes payable (attach schedule)...... 3,712,381  
22 Other liabilities (describe bullet)    
23 Total liabilities (add lines 17 through 22)......... 3,712,381 0
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........... 2,805,507 10,465,952
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........    
27 Paid-in or capital surplus, or land, bldg., and equipment fund    
28 Retained earnings, accumulated income, endowment, or other funds    
29 Total net assets or fund balances (see instructions)..... 2,805,507 10,465,952
30 Total liabilities and net assets/fund balances (see instructions). 6,517,888 10,465,952
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
2,805,507
2
Enter amount from Part I, line 27a .....................
2
3,569,899
3
Other increases not included in line 2 (itemize) bulletClick to see attachment
3
7,709,952
4
Add lines 1, 2, and 3 ..........................
4
14,085,358
5
Decreases not included in line 2 (itemize) bulletClick to see attachment
5
3,619,406
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29 .
6
10,465,952
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.)
1 a SALE OF LAND ON INSTALLMENT SALE BASIS D    
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 2,088,800   161,312 1,927,488
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       1,927,488
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 1,927,488
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 29,750
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 29,750
6 Credits/Payments:
a 2021 estimated tax payments and 2020 overpayment credited to 2021 6a 67,000
b Exempt foreign organizations—tax withheld at source...... 6b 0
c Tax paid with application for extension of time to file (Form 8868)... 6c 24,000
d Backup withholding erroneously withheld ........... 6d 0
7 Total credits and payments. Add lines 6a through 6d.............. 7 91,000
8 Enter any penalty for underpayment of estimated tax. Check here if Form 2220 is attached. Click to see attachment 8 180
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 61,070
11 Enter the amount of line 10 to be: Credited to 2022 estimated taxBullet45,000 RefundedBullet 11 16,070
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)
    bulletVA
    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 Click to see attachment.............
    11
    Yes
     
    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 ofbulletLEYLA DEPRENGER Telephone no.bullet (703) 631-7529

    Located atbullet12500 FAIR LAKES CIRCLEFAIRFAXVA ZIP+4bullet22033
    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)
    Yes
     
    (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
     
    No
    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
    Yes
     
    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
    LAUREN E PETERSON PRESIDENT
    0.00     		0 0 0
    12500 FAIR LAKES CIRCLE SUITE 400
    FAIRFAX,VA22033
    JON M PETERSON TREASURER
    0.00     		0 0 0
    12500 FAIR LAKES CIRCLE SUITE 400
    FAIRFAX,VA22033
    CAROLYN S PETERSON SECRETARY
    0.00     		0 0 0
    12500 FAIR LAKES CIRCLE SUITE 400
    FAIRFAX,VA22033
    STEVEN B PETERSON DIRECTOR
    0.00     		0 0 0
    12500 FAIR LAKES CIRCLE SUITE 400
    FAIRFAX,VA22033
    WILLIAM E PETERSON DIRECTOR
    0.00     		0 0 0
    12500 FAIR LAKES CIRCLE SUITE 400
    FAIRFAX,VA22033
    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 THE PETERSON FAMILY FOUNDATION IS DEDICATED TO HELP INDIVIDUALS OF LIMITED FINANCIAL RESOURCES. THE FOUNDATION HAS BEEN AFFILIATED WITH A CHURCH IN LA ROMANA, DOMINICAN REPUBLIC (IGLESIA AFRICANA METODISTA EPISCOPAL A.M.C. INC.) . THE FOUNDATION BUILT AND IS OPERATING A CHURCH RELATED DAYCARE/EDUCATION CENTER. THE PURPOSE OF THE CENTER IS TO FEED CHILDREN OF LA ROMANA BEFORE AND AFTER SCHOOL, PROVIDE A SAFE PLAYGOUND ARE FOR THEM TO USE AFTER SCHOOL AND TO PROVIDE ADDITIONAL EDUCATIONAL ASSISTANCE TO SUCH CHILDREN. THE PROGRAM CURRENTLY FEEDS AND EDUCATES 250 CHILDREN. THE FOUNDATION HAS ALSO COMPLETED THE CONSTRUCTION OF A GIRLS ORPHANAGE ON THE PROPERTY AND IS RUNNING THE ORPHANAGE IN COMBINATION WITH THE CHURCH. 129,600
    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
    843,082
    b
    Average of monthly cash balances.......................
    1b
    2,061,300
    c
    Fair market value of all other assets (see instructions)................
    1c
    900
    d
    Total (add lines 1a, b, and c).........................
    1d
    2,905,282
    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
    2,905,282
    4
    Cash deemed held for charitable activities. Enter 1.5% (0.015) of line 3 (for greater amount, see
    instructions) .............................
    4
    43,579
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. .......
    5
    2,861,703
    6
    Minimum investment return. Enter 5% (0.05) of line 5................
    6
    143,085
    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
    143,085
    2a
    Tax on investment income for 2021 from Part V, line 5.......
    2a
    29,750
    b
    Income tax for 2021. (This does not include the tax from Part V.) ...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
    29,750
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
    113,335
    4
    Recoveries of amounts treated as qualifying distributions................
    4
    0
    5
    Add lines 3 and 4............................
    5
    113,335
    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
    113,335
    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 7 113,335
    2 Undistributed income, if any, as of the end of 2021:
    a Enter amount for 2020 only....... 138,133
    b Total for prior years:20, 20, 20 0
    3 Excess distributions carryover, if any, to 2021:
    a From 2016......  
    b From 2017......  
    c From 2018......  
    d From 2019......  
    e From 2020......  
    f Total of lines 3a through e ........ 0
    4Qualifying distributions for 2021 from Part
    XI, line 4: bullet$ 2,942,871
    a Applied to 2020, but not more than line 2a 138,133
    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..... 113,335
    e Remaining amount distributed out of corpus 2,691,403
    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 2,691,403
    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) ...     		0
    9 Excess distributions carryover to 2022.
    Subtract lines 7 and 8 from line 6a ......     		2,691,403
    10 Analysis of line 9:
    a Excess from 2017....  
    b Excess from 2018....  
    c Excess from 2019....  
    d Excess from 2020....  
    e Excess from 2021.... 2,691,403
    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.
    LAUREN E PETERSON
    JON M PETERSON
    CAROLYN S PETERSON
    STEVEN B PETERSON
    WILLIAM E PETERSON
    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:
    LEYLA DEPRENGER
    12500 FAIR LAKES CIRCLE SUITE 400
    FAIRFAX,VA22033
    (703) 227-1259
    LDEPRENGER@PETERSONCOS.COM
    bThe form in which applications should be submitted and information and materials they should include:
    PURPOSE FOR WHICH FUNDS ARE SOLICITED, AMOUNT OF FUNDS SOLICITED, COPY OF MOST RECENT FORM 990 AND IRS DETERMINATION LETTER IF APPLICABLE.
    cAny submission deadlines:
    NONE
    dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
    factors:
    NONE
    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
    ST STEPHEN'S & ST AGNES SCHOOL
    400 FONTAINE STREET
    ALEXANDRIA,VA223029912     		  501(C)(3) GENERAL SUPPORT 1,005,000
    YOUTH FOR TOMORROW
    11835 HAZEL CIRCLE DRIVE
    BRISTOW,VA20136     		  501(C)(3) GENERAL SUPPORT 325,250
    INOVA ALEXANDRIA HOSPITAL FOUNDATION
    8110 GATEHOUSE RD SUITE 200E
    FALLS CHURCH,VA22042     		  501(C)(3) GENERAL SUPPORT 281,000
    YORK HOSPITAL
    15 HOSPITAL DRIVE
    YORK,ME03909     		  501(C)(3) GENERAL SUPPORT 208,333
    OGUNQUIT PLAYHOUSE FOUNDATION
    PO BOX 1510
    OGUNQUIT,ME03907     		  501(C)(3) GENERAL SUPPORT 166,666
    ANONYMOUS
    12500 FAIR LAKES CIRCLE
    FAIRFAX,VA22033     		  501(C)(3) GENERAL SUPPORT 129,600
    POTOMAC RIVERKEEPER INC
    3070 M STREET NW
    WASHINGTON,DC20007     		  501(C)(3) GENERAL SUPPORT 65,000
    NORTHERN VIRGINIA FAMILY SERVICE
    10455 WHITE GRANITE DR SUITE 100
    OAKTON,VA22124     		  501(C)(3) GENERAL SUPPORT 60,800
    FAIRFAX UNITED METHODIST CHURCH
    10300 STRATFORD AVENUE
    FAIRFAX,VA220303217     		  501(C)(3) GENERAL SUPPORT 56,600
    FLINT HILL SCHOOL FOUNDATION
    3320 JERMANTOWN ROAD
    OAKTON,VA22124     		  501(C)(3) GENERAL SUPPORT 50,000
    GREATER WASHINGTON COMMUNITY FOUNDATION
    1325 G STREET NW SUITE 480
    WASHINGTON,DC20005     		  501(C)(3) GENERAL SUPPORT 50,000
    VENTURE PHILANTHROPY PARTNERS
    1201 15TH STREET NW SUITE 510
    WASHINGTON,DC20005     		  501(C)(3) GENERAL SUPPORT 50,000
    GREATER NEW ORLEANS FOUNDATION
    PO BOX 57749
    NEW ORLEANS,LA70157     		  501(C)(3) GENERAL SUPPORT 35,000
    CORNERSTONES INC
    11150 SUNSET HILLS RD SUITE 210
    RESTON,VA20190     		  501(C)(3) GENERAL SUPPORT 25,000
    MIDDLEBURG FILM FESTIVAL
    PO BOX 1566
    MIDDLEBURG,VA20118     		  501(C)(3) GENERAL SUPPORT 25,000
    PROJECT CURE
    10377 E GEDDES AVE STE 200
    CENTENNIAL,CO801123740     		  501(C)(3) GENERAL SUPPORT 25,000
    RAINBOW THERAPEUTIC RIDING CENTER
    PO BOX 479
    HAYMARKET,VA20168     		  501(C)(3) GENERAL SUPPORT 23,000
    YORK COMMUNITY SERVICE ASSOCIATION
    PO BOX 180
    YORK,ME03909     		  501(C)(3) GENERAL SUPPORT 20,652
    GEORGE MASON UNIVERSITY FOUNDATION INC
    4400 UNIVERSITY DRIVE
    FAIRFAX,VA220304444     		  501(C)(3) GENERAL SUPPORT 20,000
    LOUDOUN HUNGER RELIEF INC
    750 MILLER DRIVE STE A-1
    LEESBURG,VA20175     		  501(C)(3) GENERAL SUPPORT 20,000
    WAKE FOREST UNIVERSITY
    499 DEACON BLVD
    WINSTON SALEM,NC27105     		  501(C)(3) GENERAL SUPPORT 20,000
    A WIDER CIRCLE INC
    4808 MOORLAND LANE STE 802
    BETHESDA,MD20814     		  501(C)(3) GENERAL SUPPORT 15,000
    HELPING CHILDREN WORLDWIDE
    14101 PARKE LONG COURT SUITE T
    CHANTILLY,VA20151     		  501(C)(3) GENERAL SUPPORT 15,000
    SHENANDOAH UNIVERSITY
    1460 UNIVERSITY DRIVE
    WINCHESTER,VA22601     		  501(C)(3) GENERAL SUPPORT 15,000
    MANNA FOOD CENTER INC
    12301 OLD COLUMBIA PIKE STE 200
    SILVER SPRING,MD20904     		  501(C)(3) GENERAL SUPPORT 12,500
    VIRGINIA TECH FOUNDATION
    215 DUCK POND DR SUITE 2002J
    BLACKSBURG,VA24061     		  501(C)(3) GENERAL SUPPORT 11,000
    HAYMARKET REGIONAL FOOD PANTRY
    PO BOX 132
    HAYMARKET,VA20168     		  501(C)(3) GENERAL SUPPORT 10,000
    STAFFORD EDUCATION FOUNDATION INC
    TO 31 STAFFORD AVE
    STAFFORD,VA22554     		  501(C)(3) GENERAL SUPPORT 10,000
    STAFFORD FOOD SECURITY
    282 DEACON RD SUITE 102
    FREDERICKSBURG,VA22405     		  501(C)(3) GENERAL SUPPORT 10,000
    STAFFORD JUNCTION
    791 TRUSLOW RD
    FREDERICKSBURG,VA22406     		  501(C)(3) GENERAL SUPPORT 10,000
    UNITED CAJUN NAVY
    2053 W MAGNA CARTA PL
    BATON ROUGE,LA70815     		  501(C)(3) GENERAL SUPPORT 10,000
    UNITED WAY OF THE NATIONAL CAPITAL AREA
    8391 OLD COURTHOUSE RDSUITE 200
    VIENNA,VA22182     		  501(C)(3) GENERAL SUPPORT 10,000
    WASHINGTON INTERNATIONAL HORSE SHOW
    3299 K ST NW SUITE 600
    WASHINGTON,DC20007     		  501(C)(3) GENERAL SUPPORT 10,000
    FOOD FOR OTHERS
    2938 PROSPERITY AVE
    FAIRFAX,VA22031     		  501(C)(3) GENERAL SUPPORT 7,500
    MIDDLEBURG HUMANE FOUNDATION
    P O BOX 1238
    MIDDLEBURG,VA20118     		  501(C)(3) GENERAL SUPPORT 7,500
    BOOST OTHERS
    480 MALCOLM RD NW
    VIENNA,VA22180     		  501(C)(3) GENERAL SUPPORT 5,000
    CLEMSON UNIVERSITY FUND
    110 DANIEL DRIVE
    CLEMSON,SC29631     		  501(C)(3) GENERAL SUPPORT 5,000
    CULTURE AID NOLA
    1526 MANDEVILLE ST
    NEW ORLEANS,LA70117     		  501(C)(3) GENERAL SUPPORT 5,000
    FAIRFAX COUNTY POLICE ASSOCIATION
    5625 REVERCOMB COURT
    FAIRFAX,VA22030     		  501(C)(3) GENERAL SUPPORT 5,000
    FRIENDS FOR NEIGHBORHOOD PROGRESS
    100 SOUTH MARKET STREET
    FREDERICK,MD21701     		  501(C)(3) GENERAL SUPPORT 5,000
    MCINTIRE SCHOOL FOUNDATION
    PO BOX 400173
    CHARLOTTESVILLE,VA229044173     		  501(C)(3) GENERAL SUPPORT 5,000
    NORTHERN VIRGINIA CONSERVATION TRUST
    4022-A HUMMER ROAD
    ANNANDALE,VA22003     		  501(C)(3) GENERAL SUPPORT 5,000
    ST PAULS EPISCOPAL CHURCH OF ALEXANDRIA
    228 SOUTH PITT STREET
    ALEXANDRIA,VA22314     		  501(C)(3) GENERAL SUPPORT 5,000
    THE BALDWIN SCHOOL
    701 MONTGOMERY AVE
    BRYN MAWR,PA19010     		  501(C)(3) GENERAL SUPPORT 5,000
    UPPERVILLE COLT & HORSE ASSOCIATION INC
    PO BOX 239
    UPPERVILLE,VA20185     		  501(C)(3) GENERAL SUPPORT 5,000
    BLESSINGS IN A BACKPACK
    PO BOX 3508
    FREDERICK,MD217053508     		  501(C)(3) GENERAL SUPPORT 3,500
    CLIFTON BETTERMENT ASSOCIATION
    PO BOX 94
    CLIFTON,VA20124     		  501(C)(3) GENERAL SUPPORT 3,500
    THE LEUKEMIA & LYMPHOMA SOCIETY
    4780 CORRIDOR PLACE SUITE B
    BELTSVILLE,MD20705     		  501(C)(3) GENERAL SUPPORT 3,500
    EMERGING SCHOLARS PROGRAM INC
    2009 14TH STREET N SUITE ONE
    ARLINGTON,VA22201     		  501(C)(3) GENERAL SUPPORT 2,500
    GOOD SHEPHERD ALLIANCE INC
    20684 ASHBURN RD
    ASHBURN,VA20147     		  501(C)(3) GENERAL SUPPORT 2,500
    LEUKEMIA & LYMPHOMA SOCIETY
    PO BOX 4072
    PITTSFIELD,MA01202     		  501(C)(3) GENERAL SUPPORT 2,500
    NATIONAL BRAIN TUMOR SOCIETY INC
    55 CHAPEL STREET SUITE 200
    NEWTON,MA024581050     		  501(C)(3) GENERAL SUPPORT 2,500
    NATIONAL FIBROMYALGIA ASSOCIATION
    3857 BIRCH STREET SUITE 312
    NEWPORT BEACH,CA92660     		  501(C)(3) GENERAL SUPPORT 2,500
    SEVEN LOAVES SERVICES
    PO BOX 1924
    MIDDLEBURG,VA20118     		  501(C)(3) GENERAL SUPPORT 2,500
    WETA
    PO BOX 96100
    WASHINGTON,DC200906100     		  501(C)(3) GENERAL SUPPORT 2,500
    WOUNDED WARRIOR PROJECT INC
    PO BOX 758540
    TOPEKA,KS666758540     		  501(C)(3) GENERAL SUPPORT 2,500
    WOMEN GIVING BACK
    20 EXPORT DRIVE
    STERLING,VA20164     		  501(C)(3) GENERAL SUPPORT 2,250
    HAMPDEN-SYDNEY COLLEGE
    PO BOX 637
    HAMPDENSYDNEY,VA23943     		  501(C)(3) GENERAL SUPPORT 2,021
    WINDY HILL FOUNDATION
    PO BOX 1593
    MIDDLEBURG,VA20118     		  501(C)(3) GENERAL SUPPORT 2,000
    YOUNG LIFE
    PO BOX 70065
    PRESCOTT,AZ863047065     		  501(C)(3) GENERAL SUPPORT 2,000
    APPALACHIAN TRAIL CONSERVANCY
    PO BOX 807
    HARPERS FERRY,WV254259988     		  501(C)(3) GENERAL SUPPORT 1,500
    BRITEPATHS
    3959 PENDER DRIVE SUITE 200
    FAIRFAX,VA22030     		  501(C)(3) GENERAL SUPPORT 1,500
    CAPITAL AREA FOOD BANK
    4900 PUERTO RICO AVENUE NE
    WASHINGTON,DC20017     		  501(C)(3) GENERAL SUPPORT 1,500
    CHESAPEAKE BAY TRUST
    108 SEVERN AVENUE
    ANNAPOLIS,MD21403     		  501(C)(3) GENERAL SUPPORT 1,500
    FREDERICK STEEPLECHASERS RUNNING CLUB
    PO BOX 681
    FREDERICK,MD21705     		  501(C)(3) GENERAL SUPPORT 1,500
    PATRIOTS 4 INC
    28 VETERANS LANE
    ST GEORGE,WV26287     		  501(C)(3) GENERAL SUPPORT 1,500
    SERVE OUR WILLING WARRIORS
    16013 WATERFALL ROAD
    HAYMARKET,VA201692126     		  501(C)(3) GENERAL SUPPORT 1,500
    THE FIRST TEE OF GREATER WASHINGTON DC
    2020 PENNSYLVANIA AVE NW 106
    WASHINGTON,DC20006     		  501(C)(3) GENERAL SUPPORT 1,500
    THE SERENITY CLUB INC
    8121 B RICHMOND HIGHWAY
    ALEXANDRIA,VA223093613     		  501(C)(3) GENERAL SUPPORT 1,500
    THE WARRENTON MEETING PLACE
    BOX 3103
    WARRENTON,VA20188     		  501(C)(3) GENERAL SUPPORT 1,500
    DOMINICAN SISTERS OF MARY
    4597 WARREN ROAD
    ANN ARBOR,MI48105     		  501(C)(3) GENERAL SUPPORT 1,000
    EARTH DAY NETWORK INC
    1752 N STREET NW SUITE 700
    WASHINGTON,DC20036     		  501(C)(3) GENERAL SUPPORT 1,000
    FISHER HOUSE FOUNDATION INC
    12300 TWINBROOK PKWY STE 410
    ROCKVILLE,MD20852     		  501(C)(3) GENERAL SUPPORT 1,000
    GONZAGA COLLEGE HIGH SCHOOL
    19 EYE STREET NW
    WASHINGTON,DC20001     		  501(C)(3) GENERAL SUPPORT 1,000
    MARCH OF DIMES
    2110 WASHINGTON BLVD SUITE 325
    ARLINGTON,VA22204     		  501(C)(3) GENERAL SUPPORT 1,000
    MIR CHARITIES INC
    626 N DIXIE HIGHWAY
    WEST PALM BEACH,FL33401     		  501(C)(3) GENERAL SUPPORT 1,000
    MONTGOMERY COUNTY FAMILY JUSTICE CENTER
    PO BOX 10692
    ROCKVILLE,MD20849     		  501(C)(3) GENERAL SUPPORT 1,000
    SPECIAL OLYMPICS VIRGINIA
    PO BOX 90019
    RICHMOND,VA232259019     		  501(C)(3) GENERAL SUPPORT 1,000
    UVA LAW SCHOOL FOUNDATION
    580 MASSIE ROAD
    CHARLOTTESVILLE,VA22903     		  501(C)(3) GENERAL SUPPORT 1,000
    AMERICAN DIABETES ASSOCIATION
    PO BOX 7023
    MERRIFIELD,VA221167023     		  501(C)(3) GENERAL SUPPORT 795
    ST JUDE CHILDREN'S RESEARCH HOSPITAL
    12796 YATES FORDS ROAD
    CLIFTON,VA20124     		  501(C)(3) GENERAL SUPPORT 625
    CHRIST CHURCH
    118 NORTH WASHINGTON ST
    ALEXANDRIA,VA22314     		  501(C)(3) GENERAL SUPPORT 500
    HOPECAM INC
    12100 SUNSET HILLS RD
    RESTON,VA20190     		  501(C)(3) GENERAL SUPPORT 500
    MARYLAND FOOD BANK
    PO BOX 17379
    BALTIMORE,MD212971379     		  501(C)(3) GENERAL SUPPORT 500
    MEDECINS SANS FRONTIERS USA INC
    PO BOX 5030
    HAGERSTOWN,MD217415030     		  501(C)(3) GENERAL SUPPORT 500
    SALVATION ARMY
    1804 MOUNT VERNON AVENUE
    ALEXANDRIA,VA22301     		  501(C)(3) GENERAL SUPPORT 500
    THE FATHER MCKENNA CENTER
    19 EYE STREET NW
    WASHINGTON,DC20001     		  501(C)(3) GENERAL SUPPORT 500
    AUTISM SPEAKS
    5455 WILSHIRE BLVD SUITE 2250
    LOS ANGELES,CA90036     		  501(C)(3) GENERAL SUPPORT 262
    COMMUNITY OF HOPE
    4 ATLANTIC STREET SW
    WASHINGTON,DC20032     		  501(C)(3) GENERAL SUPPORT 250
    COVENANT HOUSE CALIFORNIA
    1352 N WESTERN AVE
    HOLLYWOOD,CA90027     		  501(C)(3) GENERAL SUPPORT 250
    FAUQUIER FISH
    P O BOX 891
    WARRENTON,VA20188     		  501(C)(3) GENERAL SUPPORT 250
    HOUSE OF MERCY
    8170 FLANNERY CT
    MANASSAS,VA20109     		  501(C)(3) GENERAL SUPPORT 250
    JEWISH SOCIAL SERVICE AGENCY
    PO BOX 392492
    PITTSBURGH,PA152519492     		  501(C)(3) GENERAL SUPPORT 250
    MARTHAS TABLE
    2114 14TH STREET NW
    WASHINGTON,DC20009     		  501(C)(3) GENERAL SUPPORT 250
    NVTRP
    6429 CLIFTON RD
    CLIFTON,VA20124     		  501(C)(3) GENERAL SUPPORT 250
    SCLERODERMA FOUNDATION
    300 ROSEWOOD DRIVE SUITE 105
    DANVERS,MA01923     		  501(C)(3) GENERAL SUPPORT 250
    Total .................................bullet 3a 2,934,854
    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 ...........     		    14 207,287  
    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 ............     		    18 1,927,488  
    9 Net income or (loss) from special events:          
    10 Gross profit or (loss) from sales of inventory          
    11 Other revenue:
    aREIMBURSEMENT INCOME     		    03 45,000  
    b
    c
    d
    e
    12 Subtotal. Add columns (b), (d), and (e) .. 0 2,186,267 0
    13Total. Add line 12, columns (b), (d), and (e)..................
    13
    2,186,267
    (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
    THE PETERSON FAMILY FOUNDATION INC
     
    Employer identification number

    54-1870812
    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
    THE PETERSON FAMILY FOUNDATION INC
          		Employer identification number
    54-1870812
    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
    CSP REV TRUST
     
    12500 FAIR LAKES CIRCLE SUITE 400
     
    FAIRFAX, VA22033

    		$ 3,712,381


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    2
    WILLIAM E PETERSON MASTER LIMITED PARTNERSHIP
     
    12500 FAIR LAKES CIRCLE SUITE 400
     
    FAIRFAX, VA22033

    		$ 289,043


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    3
    JON M PETERSON MASTER LIMITED PARTNERSHIP
     
    12500 FAIR LAKES CIRCLE SUITE 400
     
    FAIRFAX, VA22033

    		$ 262,987


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    4
    STEVEN B PETERSON MASETER LIMITED PARTNERSHIP
     
    12500 FAIR LAKES CIRCLE SUITE 400
     
    FAIRFAX, VA22033

    		$ 149,839


    (Complete Part II for noncash contributions.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Total contributions    		 (d)
    Type of contribution
    5
    LAUREN E PETERSON MASTER LIMITED PARTNERSHIP
     
    12500 FAIR LAKES CIRCLE SUITE 400
     
    FAIRFAX, VA22033

    		$ 55,629


    (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
    THE PETERSON FAMILY FOUNDATION INC
          		Employer identification number

    54-1870812
    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
    THE PETERSON FAMILY FOUNDATION INC
          		Employer identification number

    54-1870812
    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:
    THE PETERSON FAMILY FOUNDATION INC
    EIN:
    54-1870812
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    PROFESSIONAL FEES 4,750 1,000   0

    TY 2021 InvestmentsCorpStockSchedule
    Name:
    THE PETERSON FAMILY FOUNDATION INC
    EIN:
    54-1870812
    Name of Stock End of Year Book Value End of Year Fair Market Value
    SECURITIES 872,371 872,371

    TY 2021 OtherDecreasesSchedule
    Name:
    THE PETERSON FAMILY FOUNDATION INC
    EIN:
    54-1870812
    Description Amount
    UNREALIZED GAIN/LOSS 252,646
    ADJUSTMENTS TO BEGINNING BALANCE 3,366,760


    TY 2021 OtherExpensesSchedule
    Name:
    THE PETERSON FAMILY FOUNDATION INC
    EIN:
    54-1870812
    Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    BANK CHARGES -20 0   0
    OTHER EXPENSE 2 0   0
    BUSINESS EXPENSES- CORNERSTONE 8,017 0   8,017
    REGISTRATION FEES 75 0   0
    PENALTY 1,000 0   0


    TY 2021 OtherIncomeSchedule2
    Name:
    THE PETERSON FAMILY FOUNDATION INC
    EIN:
    54-1870812
    Description Revenue And Expenses Per Books Net Investment Income Adjusted Net Income
    REIMBURSEMENT INCOME 45,000   45,000


    TY 2021 OtherIncreasesSchedule
    Name:
    THE PETERSON FAMILY FOUNDATION INC
    EIN:
    54-1870812
    Description Amount
    UNRECOGNIZED GAIN AND BASIS OF LAND SOLD ON THE INSTALLMENT BASIS 7,709,952


    TY 2021 TaxesSchedule
    Name:
    THE PETERSON FAMILY FOUNDATION INC
    EIN:
    54-1870812
    Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    REAL ESTATE TAXES 3,576 0   0
    FEDERAL TAXES 136,944 0   0


    TY 2021 TransfersToControlledEntities
    Name:
    THE PETERSON FAMILY FOUNDATION INC
    EIN:
    54-1870812
    Name US /
    Foreign Address    		 EIN Description Amount
    VM STAFFORD LC 12500 FAIR LAKES CIRCLE SUITE 400
    FAIRFAX,VA22033     		85-0921586 LAND WAS DONATED TO THE FOUNDATION AND WAS TILED IN THE NAME OF THIS DISREGARDED ENTITY 0
    Total     0