Form990-PF

Department of the Treasury
Internal Revenue Service
Return of Private Foundation
or Section 4947(a)(1) Nonexempt Charitable Trust
Treated as a Private Foundation
Note. The foundation may be able to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0052
2010
For calendar year 2010, or tax year beginning 01-01-2010 , and ending 12-31-2010
G
Check all that apply:
Name of foundation
ANNIE MAXIM HOUSE INC
 

Number and street (or P.O. box number if mail is not delivered to street address)706 NORTH AVENUE   Room/suite
City or town, state, and ZIP code
ROCHESTER, MA02770
A Employer identification number

04-2791081
B Telephone number (see page 10 of the instructions)

(508) 763-4810
C bullet
D 1. bullet
H Check type of organization:
2. bullet
I Fair market value of all assets at end
of year (from Part II, col. (c),
line 16)bullet$11,699J Accounting method:
 
(Part I, column (d) must be on cash basis.)
E bullet
F bullet
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 page 11 of the 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) 395,489
2 Check bullet
3 Interest on savings and temporary cash investments 22 22 22
4 Dividends and interest from securities......      
5a Gross rents..............      
b Net rental income or (loss)  
6a Net gain or (loss) from sale of assets not on line 10  
b Gross sales price for all assets on line 6a  
7 Capital gain net income (from Part IV, line 2)...  
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 10,800   10,800
12 Total. Add lines 1 through 11........ 406,311 22 10,822
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 72,786      
14 Other employee salaries and wages...... 117,575 117,575 117,575  
15 Pension plans, employee benefits....... 16,976 16,976 16,976  
16a Legal fees (attach schedule).........        
b Accounting fees (attach schedule).......        
c Other professional fees (attach schedule)....        
17 Interest...............        
18 Taxes (attach schedule) (see page 14 of the instructions)        
19 Depreciation (attach schedule) and depletion... Click to see attachment 93,141    
20 Occupancy.............. 106,819 106,819 106,819  
21 Travel, conferences, and meetings.......        
22 Printing and publications..........        
23 Other expenses (attach schedule)....... Click to see attachment 49,923 49,923 49,923  
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 457,220 291,293 291,293 0
25 Contributions, gifts, grants paid........ 0 0
26 Total expenses and disbursements. Add lines 24 and 25 457,220 291,293 291,293 0
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements -50,909
b Net investment income (if negative, enter -0-) 0
c Adjusted net income (if negative, enter -0-)...  
For Privacy Act and Paperwork Reduction Act Notice, see page 30 of the instructions.
Cat. No. 11289X Form 990-PF (2010)
Form 990-PF (2010)
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............... 4,251 11,699 11,699
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 page 15 of the
instructions)....................      
7 Other notes and loans receivable (attach schedule) bullet  
Less: allowance for doubtful accounts bullet        
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)........      
c Investments—corporate bonds (attach schedule)........      
11 Investments—land, buildings, and equipment: basis bullet  
Less: accumulated depreciation (attach schedule) bullet        
12 Investments—mortgage loans..............      
13 Investments—other (attach schedule)...........      
14 Land, buildings, and equipment: basis bullet2,939,256
Less: accumulated depreciation (attach schedule) bullet2,073,386 924,227 Click to see attachment865,870  
15 Other assets (describe bullet)      
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 928,478 877,569 11,699
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)......    
22 Other liabilities (describe bullet)    
23 Total liabilities (add lines 17 through 22)..........   0
Net Assets or Fund Balances bullet
and complete lines 24 through 26 and lines 30 and 31.
24 Unrestricted.................... 928,478 877,569
25 Temporarily restricted................    
26 Permanently restricted................    
bullet
and complete lines 27 through 31.
27 Capital stock, trust principal, or current funds.........    
28 Paid-in or capital surplus, or land, bldg., and equipment fund    
29 Retained earnings, accumulated income, endowment, or other funds    
30 Total net assets or fund balances (see page 17 of the
instructions).................... 928,478 877,569
31 Total liabilities and net assets/fund balances (see page 17 of
the instructions).................. 928,478 877,569
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 30 (must agree
with end-of-year figure reported on prior year’s return)............... 1 928,478
2 Enter amount from Part I, line 27a...................... 2 -50,909
3 Other increases not included in line 2 (itemize) bullet 3  
4 Add lines 1, 2, and 3.......................... 4 877,569
5 Decreases not included in line 2 (itemize) bullet 5  
6 Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 30.. 6 877,569
Form 990-PF (2010)
Form 990-PF (2010)
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.)
1a
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
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
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  
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 pages 13 and 17 of the instructions).
If (loss), enter -0- in Part I, line 8 . . . . . . . . . . . . . 		Bracket 3  
Part V
Qualification Under Section 4940(e) for Reduced Tax on Net Investment Income
(For optional use by domestic private foundations subject to the section 4940(a) tax on net investment income.)

If section 4940(d)(2) applies, leave this part blank.
Was the foundation liable for the section 4942 tax on the distributable amount of any year in the base period?
If “Yes,” the foundation does not qualify under section 4940(e). Do not complete this part.
1 Enter the appropriate amount in each column for each year; see page 18 of the instructions before making any entries.
(a)
Base period years Calendar
year (or tax year beginning in) 		(b)
Adjusted qualifying distributions 		(c)
Net value of noncharitable-use assets 		(d)
Distribution ratio
(col. (b) divided by col. (c))
2009      
2008      
2007      
2006      
2005      
2 Total of line 1, column (d) ...................... 2  
3 Average distribution ratio for the 5-year base period—divide the total on line 2 by 5, or by
the number of years the foundation has been in existence if less than 5 years. . . 		3  
4 Enter the net value of noncharitable-use assets for 2010 from Part X, line 5..... 4  
5 Multiply line 4 by line 3....................... 5  
6 Enter 1% of net investment income (1% of Part I, line 27b)........... 6  
7 Add lines 5 and 6......................... 7  
8 Enter qualifying distributions from Part XII, line 4.............. 8  
If line 8 is equal to or greater than line 7, check the box in Part VI, line 1b, and complete that part using a 1% tax rate. See
the Part VI instructions on page 18.
Form 990-PF (2010)
Form 990-PF (2010)
Page 4
Part VI
Excise Tax Based on Investment Income (Section 4940(a), 4940(b), 4940(e), or 4948—see page 18 of the instructions)
1a Bulletand enter “N/A” on line 1. Bracket
Date of ruling or determination letter:   (attach copy of letter if necessary–see instructions)
b 1 0
hereBulletand enter 1% of Part I, line 27b...................
c All other domestic foundations enter 2% of line 27b. Exempt foreign organizations enter 4% 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  
3 Add lines 1 and 2............................ 3  
4 Subtitle A (income) tax (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-). 4  
5 Tax based on investment income. Subtract line 4 from line 3. If zero or less, enter -0- ..... 5  
6 Credits/Payments:
a 2010 estimated tax payments and 2009 overpayment credited to 2010 6a  
b Exempt foreign organizations—tax withheld at source....... 6b
c Tax paid with application for extension of time to file (Form 8868) 6c  
d Backup withholding erroneously withheld ........... 6d  
7 Total credits and payments. Add lines 6a through 6d.............. 7  
8 Enter any penalty for underpayment of estimated tax. if Form 2220 is attached. 8  
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  
11 Enter the amount of line 10 to be: Credited to 2011 estimated taxBullet0 Refunded Bullet 11  
Part VII-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 page 19 of
the instructions for 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$   (2) On foundation managers.bullet$  
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.bullet$  
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
     
     
    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 XV.
    7
    Yes
     
    8a
    Enter the states to which the foundation reports or with which it is registered (see page 19 of the
    instructions)bulletMA
    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 2010 or the taxable year beginning in 2010 (see instructions for Part XIV on
    page 27)? If “Yes,” complete Part XIV...........................
    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
    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 page 20 of the instructions) .......
    11
     
    No
    12
    Did the foundation acquire a direct or indirect interest in any applicable insurance contract before August 17, 2008?
    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 ofbulletRACHEL SPAULDING Telephone no.bullet (508) 763-4810
    Located atbullet706 NORTH AVENUEROCHESTERMA ZIP+4bullet02770
    15
    Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of Form 1041.........bullet
    and enter the amount of tax-exempt interest received or accrued during the year ......bullet
    15  
    16
    At any time during calendar year 2010, did the foundation have an interest in or a signature or other authority over
    a bank, securities, or other financial account in a foreign country? .................
    16
     
     
    See page 20 of the instructions for exceptions and filing requirements for Form TD F 90-22.1. If "Yes", enter the name of the foreign country bullet  
    Form 990-PF (2010)
    Form 990-PF (2010)
    Page 5
    Part VII-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?
    (2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
    a disqualified person?.........................
    (3) Furnish goods, services, or facilities to (or accept them from) a disqualified person?
    (4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person?
    (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)?.................
    (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.).........
    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 page 20 of the instructions)?...
    1b
     
     
    .........bullet
    c
    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 2010?.............
    1c
     
     
    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 2010, did the foundation have any undistributed income (lines 6d
    and 6e, Part XIII) for tax year(s) beginning before 2010?...............
    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 page 20 of the 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?.....................
    b
    If “Yes,” did it have excess business holdings in 2010 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 2010.)....................
    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 2010?
    4b
     
    No
    5a
    During the year did the foundation pay or incur any amount to:
    (1) Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))?
    (2) Influence the outcome of any specific public election (see section 4955); or to carry
    on, directly or indirectly, any voter registration drive?...............
    (3) Provide a grant to an individual for travel, study, or other similar purposes?
    (4) Provide a grant to an organization other than a charitable, etc., organization described
    in section 509(a)(1), (2), or (3), or section 4940(d)(2)? (see page 22 of the instructions)...
    (5) Provide for any purpose other than religious, charitable, scientific, literary, or
    educational purposes, or for the prevention of cruelty to children or animals?........
    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 page 22 of the instructions)?
    5b
     
     
    .........bullet
    c
    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?............
    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?....................
    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?
    b
    If yes, did the foundation receive any proceeds or have any net income attributable to the transaction? ....
    7b
     
     
    Form 990-PF (2010)
    Form 990-PF (2010)
    Page 6
    Part VIII
    Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
    and Contractors
    1 List all officers, directors, trustees, foundation managers and their compensation (see page 22 of the 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
    CHARLES L ROWLEYClick to see attachment DIRECTOR
    5.00     		2,200 0 0
    PO BOX 9
    WEST WAREHAM,MA02576
    DOUGLAS R BEATONClick to see attachment DIRECTOR
    5.00     		2,400 0 0
    27 DISCOVERY HILL
    E SANDWICH,MA02537
    CLAIRE YOUNGClick to see attachment DIRECTOR
    5.00     		2,200 0 0
    1 TAUNTON STREET
    LAKEVILLE,MA02347
    PAUL A TUCKERClick to see attachment PRESIDENT
    5.00     		2,000 0 0
    7 BEACH TREE RD
    RUMFORD,RI02916
    RACHEL SPAULDINGClick to see attachment EXEC. DIR
    40.00     		63,986 640 0
    270 WEST STREET
    MANSFIELD,MA02048
    RACHEL SPAULDINGClick to see attachment TREASURER
    5.00     		0 0 0
    270 WEST STREET
    MANSFIELD,MA02048
    2 Compensation of five highest-paid employees (other than those included on line 1—see page 23 of the 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  
    3 Five highest-paid independent contractors for professional services (see page 23 of the 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.............bullet  
    Part IX-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
     
    2  
    3  
    4  
    Form 990-PF (2010)
    Form 990-PF (2010)
    Page 7
    Part IX-B
    Summary of Program-Related Investments (see page 23 of the instructions)
    Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2. Amount
    1 N/A  
    2  
    All other program-related investments. See page 24 of the instructions.
    3  
    Total. Add lines 1 through 3...........................bullet  
    Part X
    Minimum Investment Return (All domestic foundations must complete this part. Foreign foundations,
    see page 24 of the 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
    0
    b
    Average of monthly cash balances.......................
    1b
    0
    c
    Fair market value of all other assets (see page 24 of the instructions)............
    1c
    0
    d
    Total (add lines 1a, b, and c).........................
    1d
    0
    e
    Reduction claimed for blockage or other factors reported on lines 1a and
    1c (attach detailed explanation) ..............
    1e
     
    2
    Acquisition indebtedness applicable to line 1 assets..................
    2
     
    3
    Subtract line 2 from line 1d..........................
    3
    0
    4
    Cash deemed held for charitable activities. Enter 1 1⁄2% of line 3 (for greater amount, see page 25
    of the instructions) ............................
    4
    0
    5
    Net value of noncharitable-use assets. Subtract line 4 from line 3. Enter here and on Part V, line 4
    5
    0
    6
    Minimum investment return. Enter 5% of line 5...................
    6
    0
    Part XI
    Distributable Amount bullet and do not complete this part.)
    1
    Minimum investment return from Part X, line 6....................
    1
     
    2a
    Tax on investment income for 2010 from Part VI, line 5......
    2a
     
    b
    Income tax for 2010. (This does not include the tax from Part VI.)...
    2b
     
    c
    Add lines 2a and 2b............................
    2c
     
    3
    Distributable amount before adjustments. Subtract line 2c from line 1............
    3
     
    4
    Recoveries of amounts treated as qualifying distributions................
    4
     
    5
    Add lines 3 and 4.............................
    5
     
    6
    Deduction from distributable amount (see page 25 of the instructions)...........
    6
     
    7
    Distributable amount as adjusted. Subtract line 6 from line 5. Enter here and on Part XIII,
    line 1.................................
    7
    0
    Part XII
    Qualifying Distributions (see page 25 of the 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
    0
    b
    Program-related investments—total from Part IX-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 V, line 8, and Part XIII, line 4
    4
    0
    5
    Foundations that qualify under section 4940(e) for the reduced rate of tax on net investment
    income. Enter 1% of Part I, line 27b (see page 26 of the instructions)............
    5
     
    6
    Adjusted qualifying distributions. Subtract line 5 from line 4...............
    6
     
    Note: The amount on line 6 will be used in Part V, column (b), in subsequent years when calculating whether the foundation qualifies for
    the section 4940(e) reduction of tax in those years.
    Form 990-PF (2010)
    Form 990-PF (2010)
    Page 8
    Part XIII
    Undistributed Income (see page 26 of the instructions)
    (a)
    Corpus     		(b)
    Years prior to 2009     		(c)
    2009     		(d)
    2010
    1 Distributable amount for 2010 from Part XI, line 7 0
    2 Undistributed income, if any, as of the end of 2010:
    a Enter amount for 2009 only.......  
    b Total for prior years:20, 20, 20  
    3 Excess distributions carryover, if any, to 2010:
    a From 2005.......  
    b From 2006.......  
    c From 2007.......  
    d From 2008.......  
    e From 2009.......  
    fTotal of lines 3a through e.........  
    4Qualifying distributions for 2010 from Part
    XII, line 4: bullet$  
    a Applied to 2009, but not more than line 2a  
    b Applied to undistributed income of prior years
    (Election required—see page 26 of the instructions)    		  
    c Treated as distributions out of corpus (Election
    required—see page 26 of the instructions)...     		 
    d Applied to 2010 distributable amount.....  
    e Remaining amount distributed out of corpus  
    5 Excess distributions carryover applied to 2010.    
    (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  
    b Prior years’ undistributed income. Subtract
    line 4b from line 2b ...........     		 
    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......     		 
    d Subtract line 6c from line 6b. Taxable
    amount—see page 27 of the instructions ...     		 
    e Undistributed income for 2009. Subtract line
    4a from line 2a. Taxable amount—see page 27
    of the instructions ...........     		 
    f Undistributed income for 2010. Subtract
    lines 4d and 5 from line 1. This amount must
    be distributed in 2011 ..........     		0
    7 Amounts treated as distributions out of
    corpus to satisfy requirements imposed by
    section 170(b)(1)(F) or 4942(g)(3) (see page 27
    of the instructions) ...........     		 
    8Excess distributions carryover from 2005 not
    applied on line 5 or line 7 (see page 27 of the
    instructions) .............     		 
    9Excess distributions carryover to 2011.
    Subtract lines 7 and 8 from line 6a ......     		 
    10 Analysis of line 9:
    a Excess from 2006....  
    b Excess from 2007....  
    c Excess from 2008....  
    d Excess from 2009....  
    e Excess from 2010....  
    Form 990-PF (2010)
    Form 990-PF (2010)
    Page 9
    Part XIV
    Private Operating Foundations (see page 27 of the instructions and Part VII-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 2010, 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) 2010 (b) 2009 (c) 2008 (d) 2007
             
    b 85% of line 2a .........          
    c Qualifying distributions from Part XII,
    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 X, 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 XV
    Supplementary Information (Complete this part only if the organization had $5,000 or more in
    assets at any time during the year—see page 27 of the 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.
    2Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
    Check here bullet
    aThe name, address, and telephone number of the person to whom applications should be addressed:
    BOARD OF DIRECTORS
    706 NORTH ST
    ROCHESTER,MA02770
    (508) 763-4810
    bThe form in which applications should be submitted and information and materials they should include:
    NONE
    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 (2010)
    Form 990-PF (2010)
    Page 10
    Part XV
    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
    Total .................................bullet 3a  
    bApproved for future payment
    Total ..................................bullet 3b  
    Form 990-PF (2010)
    Form 990-PF (2010)
    Page 11
    Part XVI-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 page 28 of
    the 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....          
    3Interest on savings and temporary cash investments     14 22  
    4 Dividends and interest from securities....          
    5 Net rental income or (loss) from real estate:
    aDebt-financed property......          
    bNot debt-financed property.....          
    6Net rental income or (loss) from personal property          
    7 Other investment income.....          
    8Gain or (loss) from sales of assets other than inventory          
    9 Net income or (loss) from special events:          
    10 Gross profit or (loss) from sales of inventory..          
    11 Other revenue: aMISCELLANEOUS     3 10,800  
    b
    c
    d
    e
    12 Subtotal. Add columns (b), (d), and (e)..   10,822  
    13Total. Add line 12, columns (b), (d), and (e)...................
    1310,822
    (See worksheet in line 13 instructions on page 28 to verify calculations.)
    Part XVI-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 XVI-A contributed importantly to
    the accomplishment of the organization’s exempt purposes (other than by providing funds for such purposes). (See
    page 28 of the instructions.)
    Form 990-PF (2010)
    Form 990-PF (2010)
    Page 12
    Part XVII
    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
    Yes
    No
    501(c) of the Code (other than section 501(c)(3) organizations) or in section 527, relating to political organizations?
    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) of the Code (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
    SignHere
    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 or fiduciary) is based on all information of which preparer has any knowledge.
    Bullet Bullet
    Signature of officer or trustee Date Title
    PaidPreparersUseOnly Preparer's SignatureBullet Date PTIN
    Firm's namebullet



    Firm's addressbullet







         		Firm's EINbullet
    Phone no.
    Form 990-PF (2010)
    Additional Data


    Software ID:  
    Software Version:  


    Form 990PF - Special Condition Description:
    Special Condition Description
    Schedule B
    (Form 990, 990-EZ,
    or 990-PF)
    Department of the Treasury
    Internal Revenue Service
    Schedule of Contributors
    Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
    OMB No. 1545-0047
    2010
    Name of organization
    ANNIE MAXIM HOUSE INC
     
    Employer identification number

    04-2791081
    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 is not covered by the General Rule and/or the Special Rules does not 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 in the heading of its
    Form 990-EZ, or on line 2 of its Form 990-PF, to certify that it does not 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, 990-EZ, or 990-PF) (2010)

    Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
    Page 1 of 1 of Part I
    Name of organization
    ANNIE MAXIM HOUSE INC
          		Employer identification number

    04-2791081
    Part I
    Contributors (see Instructions)
    		     
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Aggregate contributions    		 (d)
    Type of contribution
    1
     
     

    ESTATE OF GEORGE A COWEN    
    706 NORTH AVENUE
       
    ROCHESTER, MA   02770

    		$394,528




    (Complete Part II if there is
    a noncash contribution.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Aggregate contributions    		 (d)
    Type of contribution
     
     
     

         
     
       

    		$  




    (Complete Part II if there is
    a noncash contribution.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Aggregate contributions    		 (d)
    Type of contribution
     
     
     

         
     
       

    		$  




    (Complete Part II if there is
    a noncash contribution.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Aggregate contributions    		 (d)
    Type of contribution
     
     
     

         
     
       

    		$  




    (Complete Part II if there is
    a noncash contribution.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Aggregate contributions    		 (d)
    Type of contribution
     
     
     

         
     
       

    		$  




    (Complete Part II if there is
    a noncash contribution.)
    (a)
    No.    		 (b)
    Name, address, and ZIP + 4    		 (c)
    Aggregate contributions    		 (d)
    Type of contribution
     
     
     

         
     
       

    		$  




    (Complete Part II if there is
    a noncash contribution.)
    Schedule B (Form 990, 990-EZ, or 990-PF) (2010)

    Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
    Page 1 of 1 of Part II
    Name of organization
    ANNIE MAXIM HOUSE INC
          		Employer identification number

    04-2791081
    Part II
    Noncash Property (see Instructions)
    		     
    (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, 990-EZ, or 990-PF) (2010)

    Schedule B (Form 990, 990-EZ, or 990-PF) (2010)
    Page 1 of 1 of Part III
    Name of organization
    ANNIE MAXIM HOUSE INC
          		Employer identification number

    04-2791081
    Part III
    Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
    aggregating more than $1,000 for the year. (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 $  
    (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, 990-EZ, or 990-PF) (2010)

    Additional Data


    Software ID:  
    Software Version:  

    TY 2010 CompensationExplanation
    Name:
    ANNIE MAXIM HOUSE INC
    EIN: 04-2791081
    Person Name Explanation
    CHARLES L ROWLEY  
    DOUGLAS R BEATON  
    CLAIRE YOUNG  
    PAUL A TUCKER  
    RACHEL SPAULDING  
    RACHEL SPAULDING  

    Note: To capture the full content of this document, please select landscape mode (11" x 8.5") when printing.

    TY 2010 DepreciationSchedule
    Name:
    ANNIE MAXIM HOUSE INC
    EIN: 04-2791081
    Description of Property Date Acquired Cost or Other Basis Prior Years' Depreciation Computation Method Rate /
    Life (# of years)    		 Current Year's Depreciation Expense Net Investment Income Adjusted Net Income Cost of Goods Sold Not Included
    R.F. MORSE TRACTOR 1995-01-12 11,600 11,600 S/L 5.0000        
    88 OLDSMOBILE 1997-02-18 20,252 20,252 S/L 5.0000        
    MAIN BUILDING 1984-01-01 986,388 813,973 S/L 30.0000 32,879      
    MAIN BUILDING 1985-01-01 102 75 S/L 33.0000 3      
    MAIN BUILDING 1986-01-01 4,579 3,506 S/L 30.0000 153      
    BARN, SHED, ETC. 1984-01-01 6,849 6,849 S/L 25.0000        
    BARN, SHED, ETC 1985-01-01 2,208 2,162 S/L 25.0000 46      
    BARN, SHED, ETC 1986-01-01 1,680 1,578 S/L 25.0000 67      
    ADMINISTRATIVE BLDG 1987-10-31 436,613 316,378 S/L 30.0000 14,554      
    PAVEMENT & GRAVEL 1987-10-31 14,744 14,744 S/L 10.0000        
    STORAGE BLDG 1993-12-22 13,868 13,868 S/L 10.0000        
    NEW FENCES 1994-05-13 10,109 10,109 S/L 10.0000        
    CONCRETE FLR&BENCHES 1994-05-13 2,164 2,164 S/L 10.0000        
    NEW CARPETING 1994-11-28 940 940 S/L 5.0000        
    EXTRA'S BLDG 1994 1995-01-21 5,456 2,099 S/L 39.0000 140      
    GENERATOR BLDG 1995-02-24 2,950 2,950 S/L 10.0000        
    MAINTENANCE BLDG 1995-07-31 155,385 57,771 S/L 39.0000 3,984      
    ADMIN BLDG 1995-10-20 31,110 11,369 S/L 39.0000 797      
    SEWER 1995-07-06 589 589 S/L 5.0000        
    ROAD TO MAINT BLDG 1995-08-19 13,860 7,991 S/L 25.0000 555      
    GARAGE WIRING 1995-09-07 3,120 3,120 S/L 5.0000        
    REPLACE 2 PUMPS 1995-09-11 1,661 1,661 S/L 5.0000        
    WIRE MAINT BLDG 1995-09-22 142 142 S/L 5.0000        
    PROPANE GAS HEATER 1995-10-26 1,199 1,199 S/L 5.0000        
    MAINTENANCE BLDG 1996-01-04 42,927 15,411 S/L 39.0000 1,100      
    INSULATION/ SHED 1996-03-29 595 595 S/L 10.0000        
    NEW CARPETING 1996-04-05 2,737 2,737 S/L 5.0000        
    SPRINKLER SYSTE,\M 1996-10-21 64,914 64,914 S/L 10.0000        
    BLACK TOP ADMIN BLDG 1996-09-04 4,425 4,425 S/L 10.0000        
    NEW SIDEWALK 1996-09-04 5,340 2,849 S/L 25.0000 213      
    HOUSEKEEPING ROOM 1996-11-22 28,139 9,501 S/L 39.0000 721      
    SHED FLOOR 1996-10-15 1,175 623 S/L 25.0000 47      
    RAILINGS 1996-10-15 4,890 4,890 S/L 10.0000        
    CARPETING -HOUSEKPGRM 1996-12-12 895 895 S/L 5.0000        
    VINYL SIDING 1996-10-15 67,735 35,898 S/L 25.0000 2,710      
    PLANS FOR SPRINKLER 1997-05-19 3,362 3,362 S/L 10.0000        
    REBUILD STEPS POND 1997-06-20 1,959 1,959 S/L 10.0000        
    LIGHTS @ BARN 1997-07-11 872 872 S/L 5.0000        
    SIDING & NEW COUNTER 1997-12-31 12,332 5,960 S/L 25.0000 493      
    FRANCONIA FUEL 330TK 1998-06-01 550 550 S/L 5.0000        
    HURLEY FUEL INSTALATION 1998-06-22 541 541 S/L 5.0000        
    CSTLD TANK 1998-09-14 1,200 1,200 S/L 5.0000        
    CHEM SEAL ASPHALT 1998-09-14 1,194 1,194 S/L 10.0000        
    KAHANIANS CARPET 1998-09-29 1,013 1,013 S/L 5.0000        
    NEW ROOF HOMESTEAD 1998-09-29 1,835 831 S/L 25.0000 74      
    CHEM SEAL ASPHALT 1998-09-29 2,600 2,600 S/L 10.0000        
    ROB HEATER FOR SHED 1998-10-22 1,575 1,575 S/L 10.0000        
    HOMESTEAD PARKING LOT 1998-10-30 5,100 2,295 S/L 25.0000 204      
    NEW ROOF HOMESTEAD 1998-10-09 3,665 1,650 S/L 25.0000 146      
    POWERS CNSTR RAMP AC 1998-11-23 8,669 3,872 S/L 25.0000 347      
    C ROWLEY PLANS 1998-12-06 2,952 2,952 S/L 10.0000        
    HOMESTEAD PLUMBING 1998-10-21 926 926 S/L 10.0000        
    1984 FURN/FIXT PURCH 1984-01-01 70,664 70,664 S/L 10.0000        
    1985 FURN/FIXT PURCH 1985-01-01 4,526 4,526 S/L 10.0000        
    1986 FURN/FIXT PURCH 1986-01-01 1,473 1,473 S/L 10.0000        
    1987 FURN/FIXT PURCH 1987-01-01 12,084 12,084 S/L 10.0000        
    1988 FURN/FIXT PURCH 1988-01-01 67,051 67,051 S/L 10.0000        
    1989 FURN/FIXT PURCH 1989-01-01 8,332 8,332 S/L 10.0000        
    1190 FURN/FIXT PURCH 1990-01-01 27,303 27,303 S/L 10.0000        
    1991 FURN/FIXT PURCH 1991-01-01 8,511 8,511 S/L 10.0000        
    EQUIPMENT 1992-12-31 2,494 2,494 S/L 10.0000        
    VACUUM 1993-01-29 899 899 S/L 10.0000        
    TRACTOR 1993-01-26 1,200 1,200 S/L 10.0000        
    8 BAR CHAIRS 1994-01-15 2,036 2,036 S/L 10.0000        
    COMPUTER & PRINTER 1994-02-15 2,204 2,204 S/L 5.0000        
    DIRECTORS FURNITURE 1994-12-19 1,011 1,011 S/L 10.0000        
    BOILER 1994-11-29 2,831 2,831 S/L 7.0000        
    PRIDE TILLER 1994-05-03 1,588 1,588 S/L 5.0000        
    PRIDE MOTOR 1994-06-02 2,000 2,000 S/L 5.0000        
    NEW CARPETING APT 6 1995-04-28 1,148 1,148 S/L 5.0000        
    MAINT/BLDG/FURN 1995-08-19 477 477 S/L 5.0000        
    CARPETING ADM BLDG 1995-10-24 2,737 2,737 S/L 5.0000        
    MORSE LANDSCAPE RAKE 1995-06-02 655 655 S/L 5.0000        
    DUNN EQMT COPIER 1995-08-21 2,889 2,889 S/L 5.0000        
    CURTAINS & BLINDS 1995-10-28 3,349 3,349 S/L 5.0000        
    ROASTER & RANGE 1995-11-03 1,330 1,330 S/L 5.0000        
    TWO DISHWASHERS 1995-12-01 800 800 S/L 5.0000        
    BLINDS/SHADES 1996-01-17 3,444 3,444 S/L 5.0000        
    KITCHEN ITEMS 1996-01-23 574 574 S/L 5.0000        
    CHAIRS & MATS 1996-02-07 3,152 3,152 S/L 7.0000        
    TABLES & CURTAINS 1996-02-16 1,696 1,696 S/L 7.0000        
    GATEWAY COMP & PRINTER 1996-02-26 2,882 2,882 S/L 5.0000        
    OFFICE FURNITURE 1996-03-04 1,295 1,295 S/L 10.0000        
    OFFICE FURNITURE 1996-03-04 1,352 1,352 S/L 10.0000        
    25" TV & VCR 1996-03-05 1,880 1,880 S/L 5.0000        
    OFFICE FURNITURE 1996-03-26 529 529 S/L 10.0000        
    TRIMMER & BLOWER 1996-04-08 1,000 1,000 S/L 5.0000        
    MOWER 1996-08-14 1,428 1,428 S/L 5.0000        
    SCREENS 1996-08-30 724 724 S/L 5.0000        
    CIRCULATOR 1996-09-12 929 929 S/L 10.0000        
    WOOD STOVE - TREAS OFFICE 1996-10-17 2,038 2,038 S/L 10.0000        
    FURNACE 1997-02-05 1,579 1,579 S/L 5.0000        
    OUTDOOR LAMP 1997-02-11 539 539 S/L 5.0000        
    GAZEBO 1997-04-14 3,995 3,995 S/L 10.0000        
    WINDOW TREATMENT 1997-10-31 2,380 2,380 S/L 5.0000        
    CARPETING 1997-12-15 1,048 1,048 S/L 5.0000        
    REFRIDGERATOR APT 3 1997-12-26 550 550 S/L 5.0000        
    GATEWAY 2000 COMPUTER 1998-01-27 2,940 2,940 S/L 5.0000        
    POWERHOUSE 72" MOWER 1998-02-28 8,500 8,500 S/L 5.0000        
    DUNN DUS EQMT FAX 1998-02-06 979 979 S/L 5.0000        
    DUNN BUS EQMT COPIER 1998-02-06 1,500 1,500 S/L 5.0000        
    DRAPES 1998-02-17 2,153 2,153 S/L 5.0000        
    FLOORING 1998-02-17 2,085 2,085 S/L 5.0000        
    FD JONES LIGHT FIXTR 1998-02-24 568 568 S/L 5.0000        
    SALISB.INDSRL..MAILBX 1998-04-13 571 571 S/L 5.0000        
    COMP USA DIGITAL CAMERA 1998-05-13 553 553 S/L 5.0000        
    DENMARKS WHEELCHAIR 1998-11-04 772 772 S/L 5.0000        
    PAVE ROAD/SIGNS,HDRT 1984-01-01 3,708 3,708 S/L 10.0000        
    PAVE ROAD/SIGNS,HDRT 1985-01-01 47,445 47,445 S/L 1.0000        
    LAND 1984-01-01 74,370     30.0000        
    WELL & INSTALLATION 1984-01-01 3,227 3,227 S/L 15.0000        
    VINYL SIDING 1999-06-02 12,305 5,209 S/L 25.0000 492      
    FERRIS 3 WHEEL RIDER 1999-10-04 6,625 6,625 S/L 5.0000        
    99 OLDS 88 SEDAN 1999-02-24 20,345 20,345 S/L 5.0000        
    SIDEWALKS 2000-04-21 5,165 1,997 S/L 25.0000 207      
    ROOF 2000-06-27 2,700 1,026 S/L 25.0000 108      
    TRIM WRAPPED BARN REPAIR 2001-08-31 3,623 3,019 S/L 10.0000 362      
    POST & RAIL FENCE 2001-08-31 4,131 4,131 S/L 7.0000        
    COURTYARD ALUMINUM, SKIRT, RAIL BASES 2001-10-16 2,770 2,262 S/L 10.0000 277      
    TREASURERS COMPUTER 2001-08-08 1,235 1,235 S/L 5.0000        
    ALARM SYSTEM - ADT 2002-10-01 2,646 2,646 S/L 25.0000        
    WELL REPAIRS 2002-10-01 15,957 8,688 S/L 15.0000 1,064      
    CARPETS-D.J. CARPET 2004-09-28 513 269 S/L 10.0000 52      
    CARPETS-CREDIT CARD SERVICES 2004-12-07 513 261 S/L 10.0000 51      
    LOCKS-CORNER LOCK CO. 2004-06-16 5,000 1,100 S/L 25.0000 200      
    LOCKS-CORNER LOCK CO. 2004-10-06 5,123 1,076 S/L 25.0000 205      
    LOCKS-CORNER LOCK CO. 2004-11-10 1,339 277 S/L 25.0000 53      
    CRACK SEALING 2004-10-06 1,600 215 S/L 39.0000 41      
    GENERATOR 2004-04-13 2,350 346 S/L 39.0000 61      
    MAIN HOUSE-ROOF 2004-05-24 10,000 2,233 S/L 25.0000 400      
    MAIN HOUSE-ROOF 2004-08-18 60,000 12,800 S/L 25.0000 2,400      
    MAIN HOUSE-ROOF 2004-10-29 40,000 8,267 S/L 25.0000 1,600      
    MOTION DETECTOR 2004-01-22 1,202 285 S/L 25.0000 48      
    OTHER REPLACEMENTS-RECEPTICLES 2004-02-05 595 141 S/L 25.0000 24      
    HOMESTEAD PORCH STEPS 2004-09-23 762 103 S/L 39.0000 19      
    LOUVERS (8) 2004-12-06 1,200 244 S/L 25.0000 48      
    LIGHTING INSTALLATION-NSTAR 2004-12-17 636 127 S/L 25.0000 26      
    ROOF 2005-02-17 18,228 3,524 S/L 25.0000 729      
    FRONT LOUVERS 2005-02-15 3,492 687 S/L 25.0000 139      
    HVAC 2005-10-07 2,400 408 S/L 25.0000 96      
    CIRCULATOR 2005-09-21 3,000 510 S/L 25.0000 120      
    COPY STAR 2005-06-13 3,100 2,842 S/L 5.0000 258      
    COMPUTERS 2005-08-15 2,428 2,145 S/L 5.0000 283      
    2005 GMC PICKUP 2005-02-22 20,975 20,276 S/L 5.0000 699      
    TRUCK CAP 2005-05-05 1,059 988 S/L 5.0000 71      
    CARPET UNIT 5 2006-09-01 1,113 371 S/L 10.0000 111      
    CARPET UNIT 7 2006-09-01 1,113 371 S/L 10.0000 111      
    BARN FLOOR 2006-03-22 3,639 1,365 S/L 10.0000 364      
    LOUVERS 2006-03-22 3,492 524 S/L 25.0000 139      
    BARN ROAD SIDE WALL 2006-02-10 4,819 755 S/L 25.0000 193      
    WATER STORAGE TANK 2006-03-29 4,556 683 S/L 25.0000 183      
    WATER STORAGE TANK 2006-04-30 5,586 819 S/L 25.0000 224      
    HVAC 2006-07-31 1,250 171 S/L 25.0000 50      
    WATER HEATER 2006-07-26 5,246 717 S/L 25.0000 210      
    TRACTOR IMPROVEMENTS 2006-08-14 2,105 1,438 S/L 5.0000 421      
    BRIDGE 2006-02-24 4,091 1,045 S/L 15.0000 273      
    BAKER CONSTRUCTION-DECK WORK 2007-09-05 25,823 6,025 S/L 10.0000 2,583      
    WINDOWS & LOUVERS 2007-09-25 2,328 524 S/L 10.0000 233      
    PAINTING 2007-12-10 1,320 275 S/L 10.0000 132      
    ELECTRICAL WORK 2007-11-20 2,264 472 S/L 10.0000 226      
    L.W. SAWYER-WATER STORAGE 2007-11-23 7,998 3,007 200DB 10.0000 998      
    L.W. SAWYER-WATER STORAGE 2007-11-20 2,226 464 S/L 10.0000 222      
    RF MORSE EQUIPMENT 2007-11-06 12,337 2,673 S/L 10.0000 1,234      
    KITCHEN EQUIPMENT FOR YEAR 2007 2007-08-13 1,082 523 S/L 5.0000 216      
    KITCHEN EQUIPMENT 2007-10-13 1,484 668 S/L 5.0000 297      
    CARPET 2007-09-27 1,113 250 S/L 10.0000 112      
    SYLVIA HEATING & AC 2007-08-08 4,380 1,059 S/L 10.0000 438      
    HOUGHTON'S HEATING 2007-04-04 6,208 1,707 S/L 10.0000 621      
    HEATING EQUIPMENT REPLACEMENT 2007-12-26 2,351 470 S/L 10.0000 235      
    LIGHTS 2007-10-04 1,141 257 S/L 10.0000 114      
    BUILDING EXTERIOR IMPROVEMENTS 2008-09-18 8,609 1,076 S/L 10.0000 861      
    EMERGENCY GENERATOR 2008-11-24 40,801 4,420 S/L 10.0000 4,080      
    WATER STORAGE TANK 2008-04-04 27,365 4,789 S/L 10.0000 2,736      
    WELL 2008-04-22 14,274 2,379 S/L 10.0000 1,427      
    DISHWASHERS (2) 2008-04-10 2,398 839 S/L 5.0000 480      
    COMPUTER EQUIPMENT 2008-12-05 937 203 S/L 5.0000 187      
    AC CONDENSER 2008-05-20 4,580 1,450 S/L 5.0000 916      
    DINING ROOM SHADES 2009-11-13 2,958 99 S/L 5.0000 591      
    ELECTRICAL WORK 2009-08-12 572 24 S/L 10.0000 57      
    GENERATOR ADDITIONS 2009-02-11 4,063 372 S/L 10.0000 407      
    WATER TANK CONNECTIONS 2009-11-04 1,283 21 S/L 10.0000 129      
    REGLAZING TUBS 2009-11-24 648 5 S/L 10.0000 65      
    APT. 1 CARPET 2009-12-07 1,168 10 S/L 10.0000 117      
    BOILER, MAIN HOUSE 2009-02-11 6,900 633 S/L 10.0000 690      
    BOILER HYDRO SEAL AND OTHER 2009-02-11 2,172 199 S/L 10.0000 217      
    DOOR INSTALLATION 2010-10-25 30,240   S/L 10.0000 504      
    CIRCULATOR 2010-11-15 670   S/L 5.0000 22      
    WALL OVEN 2010-11-12 966   S/L 7.0000 23      
    HVAC UNIT - TUNE UP 2010-09-10 800   S/L 5.0000 53      
    OUTDOOR LIGHTING 2010-06-22 626   S/L 5.0000 63      
    SLEEPY'S BED 2010-04-16 713   S/L 5.0000 95      
    GENERATOR CALIBRATION 2010-03-20 768   S/L 5.0000 115      

    TY 2010 LandEtcSchedule2
    Name:
    ANNIE MAXIM HOUSE INC
    EIN: 04-2791081
    Category / Item Cost / Other Basis Accumulated Depreciation Book Value End of Year Fair Market Value
    MOTOR VEHICLES 76,336 76,090 246  
    FURNITURE & FIXTURES 319,490 304,743 14,747  
    BUILDINGS 2,469,060 1,692,553 776,507  
    LAND 74,370   74,370  


    TY 2010 OtherExpensesSchedule
    Name:
    ANNIE MAXIM HOUSE INC
    EIN: 04-2791081
    Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
    EXPENSES        
    EDUCATION 2,466 2,466 2,466  
    INSURANCE 34,857 34,857 34,857  
    OFFICE SUPPLIES 1,359 1,359 1,359  
    BANK FEE 15 15 15  
    SECURITY 287 287 287  
    ADMIN OFFICE CONTRACTS 757 757 757  
    MISCELLANEOUS 4,037 4,037 4,037  
    PROFESSIONAL FEES 6,145 6,145 6,145  


    TY 2010 OtherIncomeSchedule2
    Name:
    ANNIE MAXIM HOUSE INC
    EIN: 04-2791081
    Description Revenue And Expenses Per Books Net Investment Income Adjusted Net Income
    MISCELLANEOUS 10,800   10,800