TY 2011 Form 990PF

- TIN:

Form990-PF
Click to see attachment

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

2011

For calendar year 2011, or tax year beginning 06-01-2011 , and ending 05-31-2012

Check all that apply:Initial returnInitial return of a former public charityFinal return

Amended returnAddress changeName change

Name of foundation
THE FARMINGTON HOME FOR AGED PEOPLE

Number and street (or P.O. box number if mail is not delivered to street address)204 MAIN STREET Room/suite

City or town, state, and ZIP code
FARMINGTON, ME04938

A Employer identification number

01-0217212

B Telephone number (see page 10 of the instructions)

(207) 778-4745

C If exemption application is pending, check here bullet

D 1. Foreign organizations, check here . bullet

H Check type of organization: Section 501(c)(3) exempt private foundation
Section 4947(a)(1) nonexempt charitable trustOther taxable private foundation 2. Foreign organizations meeting the 85% test,
check here and attach computation bullet

I Fair market value of all assets at end
of year (from Part II, col. (c),
line 16) bullet

$3,784,262J Accounting method: Cash Accrual
Other (specify)
(Part I, column (d) must be on cash basis.)

E If private foundation status was terminated
under section 507(b)(1)(A), check here bullet

F If the foundation is in a 60-month termination
under section 507(b)(1)(B), check here bullet

	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)


1	Contributions, gifts, grants, etc., received (attach schedule)	9,380
2	Check
3	Interest on savings and temporary cash investments	1,906		1,906	1,906
4	Dividends and interest from securities......	74,380		74,380	74,380
5a	Gross rents..............
b	Net rental income or (loss)
6a	Net gain or (loss) from sale of assets not on line 10		127,683
b	Gross sales price for all assets on line 6a 1,199,024
7	Capital gain net income (from Part IV, line 2)...			127,683
8	Net short-term capital gain.........				127,683
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).......		700,817
12	Total. Add lines 1 through 11........	914,166		203,969	203,969
13	Compensation of officers, directors, trustees, etc.
14	Other employee salaries and wages......	392,329		10,000	10,000	382,329
15	Pension plans, employee benefits.......	3,253				3,253
16a	Legal fees (attach schedule).........
b	Accounting fees (attach schedule).......		9,395			9,395
c	Other professional fees (attach schedule)....		20,193	12,612	12,612	7,581
17	Interest...............	10,362				10,362
18	Taxes (attach schedule) (see page 14 of the instructions)		40,438	1,613	1,613	38,825
19	Depreciation (attach schedule) and depletion...		53,146
20	Occupancy..............	61,087		3,665	3,665	57,422
21	Travel, conferences, and meetings.......	2,172				2,172
22	Printing and publications..........
23	Other expenses (attach schedule).......		217,676			216,408
24	Total operating and administrative expenses.
	Add lines 13 through 23..........	810,051		27,890	27,890	727,747
25	Contributions, gifts, grants paid........	0				0
26	Total expenses and disbursements. Add lines 24 and 25	810,051		27,890	27,890	727,747
27	Subtract line 26 from line 12:
a	Excess of revenue over expenses and disbursements	104,115
b	Net investment income (if negative, enter -0-)			176,079
c	Adjusted net income (if negative, enter -0-)...				176,079

For Privacy Act and Paperwork Reduction Act Notice, see page 30 of the instructions.

Cat. No. 11289X Form 990-PF (2011)

Form 990-PF (2011)

Page 2

Part II		Balance Sheets	Beginning of year	End of year
Part II		Balance Sheets	(a) Book Value	(b) Book Value	(c) Fair Market Value
	1	Cash—non-interest-bearing...............	50,012	143,180	143,180
	2	Savings and temporary cash investments..........	233,267	66,529	66,529
	3	Accounts receivable 6,726
		Less: allowance for doubtful accounts	10,569	6,726	6,726
	4	Pledges receivable
		Less: allowance for doubtful accounts
	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)
		Less: allowance for doubtful accounts
	8	Inventories for sale or use...............
	9	Prepaid expenses and deferred charges...........		927	927
	10a	Investments—U.S. and state government obligations (attach schedule)	591,692	309,621	309,621
	b	Investments—corporate stock (attach schedule)........	1,648,682	1,469,817	1,469,817
	c	Investments—corporate bonds (attach schedule)........	123,354	384,390	384,390
	11	Investments—land, buildings, and equipment: basis
		Less: accumulated depreciation (attach schedule)
	12	Investments—mortgage loans..............
	13	Investments—other (attach schedule)...........
	14	Land, buildings, and equipment: basis 1,400,537
		Less: accumulated depreciation (attach schedule) 1,084,748	357,613	315,789	1,400,537
	15	Other assets (describe )	3,803	2,535	2,535
	16	Total assets (to be completed by all filers—see the
		instructions. Also, see page 1, item I)	3,018,992	2,699,514	3,784,262
	17	Accounts payable and accrued expenses..........	21,770	12,799
	18	Grants payable...................
	19	Deferred revenue..................
	20	Loans from officers, directors, trustees, and other disqualified persons
	21	Mortgages and other notes payable (attach schedule)......	200,000	155,000
	22	Other liabilities (describe )
	23	Total liabilities (add lines 17 through 22)..........	221,770	167,799
		Foundations that follow SFAS 117, check here
		and complete lines 24 through 26 and lines 30 and 31.
	24	Unrestricted....................	2,795,012	2,529,777
	25	Temporarily restricted................	2,210	1,938
	26	Permanently restricted................
		Foundations that do not follow SFAS 117, check here
		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)....................	2,797,222	2,531,715
	31	Total liabilities and net assets/fund balances (see page 17 of
		the instructions)..................	3,018,992	2,699,514

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	2,797,222
2	Enter amount from Part I, line 27a.....................	2	104,115
3	Other increases not included in line 2 (itemize)	3
4	Add lines 1, 2, and 3..........................	4	2,901,337
5	Decreases not included in line 2 (itemize)	5	369,622
6	Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 30.	6	2,531,715

Form 990-PF (2011)

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
(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)	If gain, also enter in Part I, line 7 If (loss), enter -0- in Part I, line 7	2	127,683
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 . . . . . . . . . . . . .		3	127,683

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? Yes No

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))
2010
2009
2008
2007
2006

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 2011 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 (2011)

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	Exempt operating foundations described in section 4940(d)(2), check hereand enter “N/A” on line 1.
	Date of ruling or determination letter: 1997-08-06(attach copy of letter if necessary–see instructions)
b	Domestic foundations that meet the section 4940(e) requirements in Part V, check	1	N/A
	hereand 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	2011 estimated tax payments and 2010 overpayment credited to 2011	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. Check hereif Form 2220 is attached.		8
9	Tax due. If the total of lines 5 and 8 is more than line 7, enter amount owed.......		9
10	Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid...		10
11	Enter the amount of line 10 to be: Credited to 2012 estimated tax	Refunded	11

Part VII-A

Statements Regarding Activities

During the tax year, did the foundation attempt to influence any national, state, or local legislation or did

Yes

it participate or intervene in any political campaign? ....................

Did it spend more than $100 during the year (either directly or indirectly) for political purposes (see page 19 of

the instructions for definition)?............................

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.

Did the foundation file Form 1120-POL for this year?.....................

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

Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed

on foundation managers. bullet

Has the foundation engaged in any activities that have not previously been reported to the IRS?.......

If “Yes,” attach a detailed description of the activities.

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....

Did the foundation have unrelated business gross income of $1,000 or more during the year?........

If “Yes,” has it filed a tax return on Form 990-T for this year?...................

Was there a liquidation, termination, dissolution, or substantial contraction during the year?.........

If “Yes,” attach the statement required by General Instruction T.

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?................

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.

Yes

Enter the states to which the foundation reports or with which it is registered (see page 19 of the

instructions) bullet

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 .

Yes

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 2011 or the taxable year beginning in 2011 (see instructions for Part XIV on

page 27)? If “Yes,” complete Part XIV..........................

Yes

Did any persons become substantial contributors during the tax year? If “Yes,” attach a schedule listing their names and addresses.

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) .......

Did the foundation acquire a direct or indirect interest in any applicable insurance contract before August 17, 2008?

Did the foundation comply with the public inspection requirements for its annual returns and exemption application?

Yes

Website address bullet

N/A

The books are in care of bullet

ARTHUR PERRYTREASURER Telephone no. bullet

(207) 778-4745

Located at bullet

204 MAIN STREETFARMINGTONME ZIP+4 bullet

04938

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

At any time during calendar year 2011, 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? .................

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 (2011)

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

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? YesNo

(2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from)

a disqualified person?.........................YesNo

(3) Furnish goods, services, or facilities to (or accept them from) a disqualified person? YesNo

(4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person? YesNo

(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)?.................YesNo

(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.).........YesNo

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)?...

Organizations relying on a current notice regarding disaster assistance check here......... bullet

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 2011?.............

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)):

At the end of tax year 2011, did the foundation have any undistributed income (lines 6d

and 6e, Part XIII) for tax year(s) beginning before 2011?...............YesNo

If “Yes,” list the years bullet

20, 20, 20, 20

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.) .........

If the provisions of section 4942(a)(2) are being applied to any of the years listed in 2a, list the years here.

20, 20, 20, 20

Did the foundation hold more than a 2% direct or indirect interest in any business

enterprise at any time during the year?.....................YesNo

If “Yes,” did it have excess business holdings in 2011 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 2011.)....................

Did the foundation invest during the year any amount in a manner that would jeopardize its charitable purposes?

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 2011?

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))? YesNo

(2) Influence the outcome of any specific public election (see section 4955); or to carry

on, directly or indirectly, any voter registration drive?...............YesNo

(3) Provide a grant to an individual for travel, study, or other similar purposes? YesNo

(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)...YesNo

(5) Provide for any purpose other than religious, charitable, scientific, literary, or

educational purposes, or for the prevention of cruelty to children or animals?........YesNo

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)?

Organizations relying on a current notice regarding disaster assistance check here......... bullet

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?............YesNo

If “Yes,” attach the statement required by Regulations section 53.4945–5(d).

Did the foundation, during the year, receive any funds, directly or indirectly, to pay

premiums on a personal benefit contract?....................YesNo

Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract?....

If “Yes” to 6b, file Form 8870.

At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction? YesNo

If yes, did the foundation receive any proceeds or have any net income attributable to the transaction? ....

Form 990-PF (2011)

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
Katie Wyman	Trustee 2.00	0
578 Fairbanks Road Farmington,ME04938	Trustee 2.00	0
Tim Thompson	Trustee 2.00	0
POBox 825 Farmington,ME04938	Trustee 2.00	0
Meredith Kendall	Trustee 2.00	0
184 Voter Hill Road Farmington,ME04938	Trustee 2.00	0
Kate Bean	Trustee 2.00	0
POBox 933 Farmington,ME04938	Trustee 2.00	0
Robert Lively	Trustee 2.00	0
POBox 616 Wilton,ME04294	Trustee 2.00	0
Richard Harvey	Trustee 2.00	0
105 Sunny Hill Drive Farmington,ME04938	Trustee 2.00	0
Carolyn Eaton	Trustee 2.00	0
63 Savage Road Industry,ME04938	Trustee 2.00	0
Jan Brinkman	Trustee 2.00	0
POBox 199 West Farmington,ME04992	Trustee 2.00	0
John Bogar	Trustee 2.00	0
314 Morrison Hill Road Farmington,ME04938	Trustee 2.00	0
Robert BeanIII	Trustee 2.00	0
POBox 933 Farmington,ME04938	Trustee 2.00	0
Melinda Brubaker	Trustee 2.00	0
573 Mosher Hill Road Farmington,ME04938	Trustee 2.00	0
Dan Adams	Trustee 2.00	0
445 Waterville Road Skowhegan,ME04976	Trustee 2.00	0
Arthur Perry	Treasurer 5.00	0
127 Stewart Avenue Farmington,ME04938	Treasurer 5.00	0
Patrica Flint	Trustee 2.00	0
93 Fenderson Hill North Wilton,ME04294	Trustee 2.00	0
Joan Patterson	Vice President 5.00	0
110 Court Street Farmington,ME04938	Vice President 5.00	0
Craig Jordan	President 10.00	0
214 Fairbanks Road Farmington,ME04938	President 10.00	0

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...................

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	N/A	0
2


3


4

Form 990-PF (2011)

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


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.)

Fair market value of assets not used (or held for use) directly in carrying out charitable, etc.,

purposes:

Average monthly fair market value of securities...................

2,263,378

Average of monthly cash balances.......................

246,494

Fair market value of all other assets (see page 24 of the instructions)............

189,957

Total (add lines 1a, b, and c).........................

2,699,829

Reduction claimed for blockage or other factors reported on lines 1a and

1c (attach detailed explanation) .............

Acquisition indebtedness applicable to line 1 assets..................

Subtract line 2 from line 1d.........................

2,699,829

Cash deemed held for charitable activities. Enter 1 1⁄2% of line 3 (for greater amount, see page 25

of the instructions) ...........................

40,497

Net value of noncharitable-use assets. Subtract line 4 from line 3. Enter here and on Part V, line 4

2,659,332

Minimum investment return. Enter 5% of line 5..................

132,967

Part XI

Distributable Amount (see page 25 of the instructions) (Section 4942(j)(3) and (j)(5) private operating foundations and certain foreign organizations check here bullet

and do not complete this part.)

Minimum investment return from Part X, line 6....................

Tax on investment income for 2011 from Part VI, line 5......

Income tax for 2011. (This does not include the tax from Part VI.)...

Add lines 2a and 2b............................

Distributable amount before adjustments. Subtract line 2c from line 1............

Recoveries of amounts treated as qualifying distributions................

Add lines 3 and 4............................

Deduction from distributable amount (see page 25 of the instructions)...........

Distributable amount as adjusted. Subtract line 6 from line 5. Enter here and on Part XIII,

line 1................................

Part XII

Qualifying Distributions (see page 25 of the instructions)

Amounts paid (including administrative expenses) to accomplish charitable, etc., purposes:

Expenses, contributions, gifts, etc.—total from Part I, column (d), line 26 ..........

727,747

Program-related investments—total from Part IX-B..................

Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,

purposes...............................

Amounts set aside for specific charitable projects that satisfy the:

Suitability test (prior IRS approval required)....................

Cash distribution test (attach the required schedule) .................

Qualifying distributions. Add lines 1a through 3b. Enter here and on Part V, line 8, and Part XIII, line 4

727,747

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)............

Adjusted qualifying distributions. Subtract line 5 from line 4..............

727,747

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 (2011)

Page 8

Part XIII

Undistributed Income (see page 26 of the instructions)

		(a) Corpus	(b) Years prior to 2010	(c) 2010	(d) 2011
1 Distributable amount for 2011 from Part XI, line 7
2 Undistributed income, if any, as of the end of 2011:
a Enter amount for 2010 only.......
b Total for prior years:20, 20, 20
3 Excess distributions carryover, if any, to 2011:
a From 2006.......
b From 2007.......
c From 2008.......
d From 2009.......
e From 2010.......
fTotal of lines 3a through e.........
4Qualifying distributions for 2011 from Part
XII, line 4: $
a Applied to 2010, 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 2011 distributable amount.....
e Remaining amount distributed out of corpus
5 Excess distributions carryover applied to 2011.
(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 2010. Subtract line 4a from line 2a. Taxable amount—see page 27 of the instructions ...........
f Undistributed income for 2011. Subtract lines 4d and 5 from line 1. This amount must be distributed in 2011 ..........
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 2006 not applied on line 5 or line 7 (see page 27 of the instructions) .............
9Excess distributions carryover to 2012. Subtract lines 7 and 8 from line 6a ......
10 Analysis of line 9:
a Excess from 2007....
b Excess from 2008....
c Excess from 2009....
d Excess from 2010....
e Excess from 2011....

Form 990-PF (2011)

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 2011, enter the date of the ruling....... bullet

1997-08-06

b Check box to indicate whether the organization is a private operating foundation described in section4942(j)(3) or4942(j)(5)

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) 2011	(b) 2010	(c) 2009	(d) 2008	(e) Total
	132,967	80,522	39,949	145,834	399,272
b 85% of line 2a .........	113,022	68,444	33,957	123,959	339,382
c Qualifying distributions from Part XII, line 4 for each year listed .....	727,747	688,736	668,459	658,673	2,743,615
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 ....	727,747	688,736	668,459	658,673	2,743,615
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...	87,758	94,272	104,515	97,125	383,670
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

if the foundation only makes contributions to preselected charitable organizations and does not accept
unsolicited requests for funds. If the foundation makes gifts, grants, etc. (see page 28 of the instructions) to individuals or organizations
under other conditions, complete items 2a, b, c, and d.

aThe name, address, and telephone number of the person to whom applications should be addressed:

The Farmington Home for Aged People
204 Main Street
Farmington,ME04938

bThe form in which applications should be submitted and information and materials they should include:

A written request that includes the name,address,telephone number of the person or organization making the request.

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 (2011)

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)		Foundation status of recipient	Purpose of grant or contribution	Amount
aPaid during the year

Total ................................. 3a

bApproved for future payment

Total ................................. 3b

Form 990-PF (2011)

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					1,906
4 Dividends and interest from securities....					74,380
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					127,683
9 Net income or (loss) from special events:
10 Gross profit or (loss) from sales of inventory..
11 Other revenue: aResident Fees					700,817
bOther Income
c
d
e
12 Subtotal. Add columns (b), (d), and (e)..					904,786

13Total. Add line 12, columns (b), (d), and (e)..................

13904,786

(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.	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.)
11	Medicaid payments and resident fees provide the necessary funds to operate the facility and perform elderly care services.
348	Interest and dividends and rental income provide funds to offset operating expenses for the organization.

Form 990-PF (2011)

Page 12

Part XVII

Information Regarding Transfers To and Transactions and Relationships With Noncharitable Exempt Organizations

Did the organization directly or indirectly engage in any of the following with any other organization described in section

Yes

501(c) of the Code (other than section 501(c)(3) organizations) or in section 527, relating to political organizations?

Transfers from the reporting foundation to a noncharitable exempt organization of:

(1) Cash...................................

1a(1)

(2) Other assets.................................

1a(2)

Other transactions:

(1) Sales of assets to a noncharitable exempt organization....................

1b(1)

(2) Purchases of assets from a noncharitable exempt organization..................

1b(2)

(3) Rental of facilities, equipment, or other assets.......................

1b(3)

(4) Reimbursement arrangements...........................

1b(4)

(5) Loans or loan guarantees.............................

1b(5)

(6) Performance of services or membership or fundraising solicitations................

1b(6)

Sharing of facilities, equipment, mailing lists, other assets, or paid employees..............

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

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?...........YesNo

If “Yes,” complete the following schedule.

(a) Name of organization	(b) Type of organization	(c) Description of relationship

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.

	Signature of officer or trustee	Date	Title

Preparer's Signature	Date	Check if self- employed	PTIN
Firm's name Firm's address		Firm's EIN
		Phone no.

Form 990-PF (2011)

Additional Data

Software ID:	11000144
Software Version:	2011v1.2

Form 990PF - Special Condition Description:

Special Condition Description

- TIN:

TY 2011 AccountingFeesSchedule

Name:

THE FARMINGTON HOME FOR AGED PEOPLE

EIN: 01-0217212

Software ID:11000144

Software Version:2011v1.2

Category	Amount	Net Investment Income	Adjusted Net Income	Disbursements for Charitable Purposes
Accounting Fees	9,395	0	0	9,395

- TIN:

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

TY 2011 DepreciationSchedule

Name:

THE FARMINGTON HOME FOR AGED PEOPLE

EIN: 01-0217212

Software ID:11000144

Software Version:2011v1.2

Description of Property	Date Acquired	Cost or Other Basis	Prior Years' Depreciation	Computation Method	Rate / Life (# of years)	Current Year's Depreciation Expense
ARM CHAIRS (2)	2012-04-17	770		91	10.0000	6
FURNITURE (BOUFFORDS)	2011-11-25	270		91	10.0000	14
EQUIPMENT (SEARS)\	2011-08-02	300		91	10.0000	25
SEWER LINE - BASEMENT	2012-01-11	3,200		91	39.0000	34
IMPROVEMENTS- PAINT EXT.	2011-06-28	5,120		91	39.0000	120
SECURITY SYSTEM	2010-12-16	898	37	91	10.0000	90
COMPUTER - HEC ATX	2010-11-17	1,107	55	91	10.0000	111
BOX SPRING	2010-09-30	135	9	91	10.0000	14
COMPUTER - AMD SEMPRON	2010-08-05	525	44	91	10.0000	53
VACUUM CLEANER	2010-07-29	285	24	91	10.0000	29
AIRCONDITIONER	2010-07-15	374	34	91	10.0000	37
ELECTRICAL IMPROVEMENTS	2010-12-14	2,156	28	91	39.0000	55
DOOR INSTALATION	2010-10-06	468	8	91	39.0000	12
KITCHEN RENOVATION	2010-08-25	21,597	415	91	39.0000	554
EQUIPMENT (B of A)	2010-05-31	511	51	91	10.0000	51
COMMUNICATION SYSTEM	2010-04-09	6,393	746	91	10.0000	639
EQUIPMENT (B of A)	2009-11-06	2,795	443	91	10.0000	280
NEW SIGN	2009-10-22	755	120	91	10.0000	76
FURNACE	2010-05-25	4,427	114	91	39.0000	114
PORCH FLOOR	2010-04-09	3,940	118	91	39.0000	101
ELECTRIC IMPROVE.	2010-04-08	1,424	43	91	39.0000	37
DRYER VENTING	2010-03-18	693	21	91	39.0000	18
PORCH AWNING	2010-04-09	8,866	265	91	39.0000	227
IMPROVE. (FARM. CONST)	2009-12-10	4,947	190	91	39.0000	127
ICE MAKER	2009-05-29	200	50	91	10.0000	20
EQUIPMENT	2009-05-07	374	93	91	10.0000	37
DRYER	2008-12-16	575	145	91	10.0000	58
LAPTOP	2008-12-10	400	100	91	10.0000	40
EQUIPMENT	2008-10-08	1,500	375	91	10.0000	150
EQUIPMENT	2008-07-31	120	30	91	10.0000	12
AIR CONDITIONER	2008-06-09	274	68	91	10.0000	27
EQUIPMENT	2007-12-05	566	199	91	10.0000	57
SIMPLEX	2007-09-26	6,052	2,218	91	10.0000	605
COMPUTER	2007-10-31	2,332	835	91	10.0000	233
EQUIPMENT	2007-07-27	400	153	91	10.0000	40
APPLIANCES	2007-06-27	890	349	91	10.0000	89
EQUIPMENT	2007-05-14	449	184	91	10.0000	45
EQUIPMENT	2007-04-02	257	108	91	10.0000	26
EQUIPMENT	2007-03-12	1,230	523	91	10.0000	123
EQUIPMENT	2007-03-02	1,340	570	91	10.0000	134
EQUIPMENT	2007-02-05	1,398	607	91	10.0000	140
EQUIPMENT	2007-02-02	348	152	91	10.0000	35
EQUIPMENT	2007-01-22	500	217	91	10.0000	50
EQUIPMENT	2007-01-05	729	322	91	10.0000	73
EQUIPMENT	2006-10-27	1,650	756	91	10.0000	165
EQUIPMENT	2006-09-06	200	95	91	10.0000	20
EQUIPMENT	2006-08-04	510	246	91	10.0000	51
EQUIPMENT	2006-07-19	2,339	1,131	91	10.0000	234
EQUIPMENT	2005-11-15	2,071	1,156	91	10.0000	207
FURNITURE UPHOLSTERING	2005-04-10	1,000	617	91	10.0000	100
EQUIPMENT	2005-01-12	309	199	91	10.0000	31
FURNITURE	2004-09-15	1,600	1,080	91	10.0000	160
COPIER	2004-10-27	2,480	1,633	91	10.0000	248
DESK CHAIR	2004-09-29	418	280	91	10.0000	42
EQUIPMENT	2004-06-29	925	639	91	10.0000	93
SOUND SYSTEM	2003-12-03	2,421	1,815	91	10.0000	242
EQUIPMENT	2004-02-29	247	181	91	10.0000	25
EQUIPMENT	2004-02-04	500	367	91	10.0000	50
FURNITURE	2003-11-18	545	412	91	10.0000	55
EQUIPMENT	2003-07-15	300	238	91	10.0000	30
APPLIANCES	2003-06-16	1,745	1,385	91	10.0000	175
TABLES & CHAIRS	2003-08-16	7,113	5,510	91	10.0000	711
WATER HEATERS	2003-05-20	4,220	3,411	91	10.0000	422
TRACTOR	2003-04-14	3,699	3,022	91	10.0000	370
DISHWASHER	2003-04-09	2,800	2,287	91	10.0000	280
BUILDING EXPANSION	1995-09-01	717,236	564,826	91	20.0000	35,862
ELECTRIC IMPROVE.	2008-10-30	397	26	91	39.0000	10
ELECTRIC IMPROVE.	2008-09-15	1,613	111	91	39.0000	41
PAVING	2007-10-15	2,500	232	91	39.0000	64
IMPROVEMENTS	2007-06-22	900	91	91	39.0000	23
IMPROVEMENTS	2008-05-30	410	33	91	39.0000	11
IMPROVEMENTS	2007-12-14	435	38	91	39.0000	11
IMPROVEMENTS	2007-12-13	4,500	398	91	39.0000	115
IMPROVEMENTS	2007-08-22	5,200	505	91	39.0000	133
IMPROVEMENTS	2007-06-11	7,500	760	91	39.0000	192
IMPROVEMENTS	2007-03-12	4,657	501	91	39.0000	119
ELECTRIC IMPROVE.	2007-02-19	367	39	91	39.0000	9
IMPROVEMENTS	2006-03-08	4,828	646	91	39.0000	124
IMPROVEMENTS	2006-01-27	12,592	1,736	91	39.0000	323
IMPROVEMENTS	2005-12-12	7,647	1,070	91	39.0000	196
IMPROVEMENTS	2005-10-10	1,804	259	91	39.0000	46
IMPROVEMENTS	2005-08-01	6,446	956	91	39.0000	165
IMPROVEMENTS	2004-10-24	17,666	2,982	91	39.0000	453
IMPROVEMENTS	2004-04-30	835	297	91	20.0000	42
IMPROVEMENTS	2004-05-04	15,042	5,327	91	20.0000	752
IMPROVEMENTS	2003-10-22	8,120	3,079	91	20.0000	406
CURTAINS	2002-09-18	2,915	1,682	91	15.0000	194
IMPROVEMENTS	2002-10-30	4,884	2,094	91	20.0000	244
CARPET	2002-04-09	4,013	2,445	91	15.0000	268
ELECTRIC IMPROVE.	2001-08-19	1,713	1,112	91	15.0000	114
IMPROVEMENTS	2000-11-16	2,252	1,575	91	15.0000	150
ADDITIONS	1998-11-30	40,036	33,363	91	15.0000	2,669
THIRD FLOOR RENOVATION	1998-04-30	22,600	14,784	91	20.0000	1,130
FURNACE	1997-06-30	15,025	10,452	91	20.0000	751

- TIN:

TY 2011 LandEtcSchedule2

Name:

THE FARMINGTON HOME FOR AGED PEOPLE

EIN: 01-0217212

Software ID:11000144

Software Version:2011v1.2

Category / Item	Cost / Other Basis	Accumulated Depreciation	Book Value	End of Year Fair Market Value
Land	12,100		12,100	12,100
Buildings	1,285,686	1,013,352	272,334	1,285,686
Machinery and Equipment	87,751	56,396	31,355	87,751
Auto./Transportation Equip.	15,000	15,000		15,000

- TIN:

TY 2011 MortgagesAndNotesPayableSch

Name:

THE FARMINGTON HOME FOR AGED PEOPLE

EIN: 01-0217212

Software ID:11000144

Software Version:2011v1.2

Total Mortgage Amount: 155000

- TIN:

TY 2011 OtherAssetsSchedule

Name:

THE FARMINGTON HOME FOR AGED PEOPLE

EIN: 01-0217212

Software ID:11000144

Software Version:2011v1.2

Description	Beginning of Year - Book Value	End of Year - Book Value	End of Year - Fair Market Value
Net Intangible Assets	3,803	2,535	2,535

- TIN:

TY 2011 OtherDecreasesSchedule

Name:

THE FARMINGTON HOME FOR AGED PEOPLE

EIN: 01-0217212

Software ID:11000144

Software Version:2011v1.2

Description	Amount
Unrealized Losses on Investments	369,350
Change in Restricted Fund	272

- TIN:

TY 2011 OtherExpensesSchedule

Name:

THE FARMINGTON HOME FOR AGED PEOPLE

EIN: 01-0217212

Software ID:11000144

Software Version:2011v1.2

Description	Revenue and Expenses per Books	Disbursements for Charitable Purposes
Residents' Medical Expenses	2,909	2,909
Repairs & Maintenance	38,598	38,598
Insurance	28,743	28,743
Household Activities	16,911	16,911
Health Insurance	59,084	59,084
Food & Provisions	57,100	57,100
Casual Labor	764	764
Amortization	1,268
Administrative Expense	12,299	12,299

- TIN:

TY 2011 OtherIncomeSchedule2

Name:

THE FARMINGTON HOME FOR AGED PEOPLE

EIN: 01-0217212

Software ID:11000144

Software Version:2011v1.2

Description	Revenue And Expenses Per Books	Net Investment Income	Adjusted Net Income
Resident Fees	700,817

- TIN:

TY 2011 OtherProfessionalFeesSchedule

Name:

THE FARMINGTON HOME FOR AGED PEOPLE

EIN: 01-0217212

Software ID:11000144

Software Version:2011v1.2

Category	Amount	Net Investment Income	Adjusted Net Income	Disbursements for Charitable Purposes
Other Professional Fees	20,193	12,612	12,612	7,581

- TIN:

TY 2011 TaxesSchedule

Name:

THE FARMINGTON HOME FOR AGED PEOPLE

EIN: 01-0217212

Software ID:11000144

Software Version:2011v1.2

Category	Amount	Net Investment Income	Adjusted Net Income	Disbursements for Charitable Purposes
Payroll Taxes	32,268	1,613	1,613	30,655
Maine Provider Tax	8,170			8,170