Form990-PF

Department of the Treasury
Internal Revenue Service

Return of Private Foundation
or Section 4947(a)(1) Trust Treated as Private Foundation
right arrowDo not enter social security numbers on this form as it may be made public.
right arrowGo to www.irs.gov/Form990PF for instructions and the latest information.
OMB No. 1545-0047
2023
Open to Public Inspection
For calendar year 2023, or tax year beginning 01-01-2023 , and ending 12-31-2023
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 or province, country, and ZIP or foreign postal code
ROCHESTER, MA02770
A Employer identification number

04-2791081
B Telephone number (see instructions)

(508) 763-2494
C right arrow
G Check all that apply:

D 1. Foreign organizations, check here............. right arrow
2. Foreign organizations meeting the 85%
test, check here and attach computation ...
right arrow
E right arrow
H Check type of organization:
F right arrow
I Fair market value of all assets at end
of year (from Part II, col. (c),
line 16)right arrow$0
J Accounting method:
 
(Part I, column (d) must be on cash basis.)
Part I Analysis of Revenue and Expenses (The total of amounts in columns (b), (c), and (d) may not necessarily equal the amounts in column (a) (see instructions).) (a) Revenue and
expenses per
books
(b) Net investment
income
(c) Adjusted net
income
(d) Disbursements
for charitable
purposes
(cash basis only)
Revenue 1 Contributions, gifts, grants, etc., received (attach schedule) 675,300
2 Check right arrow.............
3 Interest on savings and temporary cash investments 397 397 397
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)....... 11,713    
12 Total. Add lines 1 through 11........ 687,410 397 397
Operating and Administrative Expenses 13 Compensation of officers, directors, trustees, etc. 140,276   140,276  
14 Other employee salaries and wages...... 204,491   204,491  
15 Pension plans, employee benefits....... 9,790   9,790  
16a Legal fees (attach schedule)......... 1,023   1,023  
b Accounting fees (attach schedule).......        
c Other professional fees (attach schedule).... 13,065   13,065  
17 Interest...............        
18 Taxes (attach schedule) (see instructions)... 32,802   32,802  
19 Depreciation (attach schedule) and depletion... 63,541   63,541
20 Occupancy.............. 118,252   118,252  
21 Travel, conferences, and meetings.......        
22 Printing and publications..........        
23 Other expenses (attach schedule)....... 63,506   63,506  
24 Total operating and administrative expenses.
Add lines 13 through 23.......... 646,746 0 646,746 0
25 Contributions, gifts, grants paid....... 3,000 3,000
26 Total expenses and disbursements. Add lines 24 and 25 649,746 0 646,746 3,000
27 Subtract line 26 from line 12:
a Excess of revenue over expenses and disbursements 37,664
b Net investment income (if negative, enter -0-) 397
c Adjusted net income (if negative, enter -0-)...  
For Paperwork Reduction Act Notice, see instructions.
Cat. No. 11289X Form 990-PF (2023)
Form 990-PF (2023)
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............. 124,080 89,717  
2 Savings and temporary cash investments.........      
3 Accounts receivable right arrow  
Less: allowance for doubtful accounts right arrow        
4 Pledges receivable right arrow  
Less: allowance for doubtful accounts right arrow        
5 Grants receivable.................      
6 Receivables due from officers, directors, trustees, and other
disqualified persons (attach schedule) (see instructions).....      
7 Other notes and loans receivable (attach schedule) right arrow  
Less: allowance for doubtful accounts right arrow        
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 right arrow  
Less: accumulated depreciation (attach schedule) right arrow        
12 Investments—mortgage loans.............      
13 Investments—other (attach schedule)..........      
14 Land, buildings, and equipment: basis right arrow3,888,834
Less: accumulated depreciation (attach schedule) right arrow3,011,706 805,902 Click to see attachment
List of Attached Documents:
// Content
877,128
 
15 Other assets (describe right arrow)      
16 Total assets (to be completed by all filers—see the
instructions. Also, see page 1, item I) 929,982 966,845 0
Liabilities 17 Accounts payable and accrued expenses.......... 3,181 2,380
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 right arrow)    
23 Total liabilities (add lines 17 through 22)......... 3,181 2,380
Net Assets or Fund Balances Foundations that follow FASB ASC 958, check here right arrow
and complete lines 24, 25, 29 and 30.
24 Net assets without donor restrictions........... 926,801 964,465
25 Net assets with donor restrictions............    
Foundations that do not follow FASB ASC 958, check here right arrow
and complete lines 26 through 30.
26 Capital stock, trust principal, or current funds........    
27 Paid-in or capital surplus, or land, bldg., and equipment fund    
28 Retained earnings, accumulated income, endowment, or other funds    
29 Total net assets or fund balances (see instructions)..... 926,801 964,465
30 Total liabilities and net assets/fund balances (see instructions). 929,982 966,845
Part III
Analysis of Changes in Net Assets or Fund Balances
1
Total net assets or fund balances at beginning of year—Part II, column (a), line 29 (must agree with end-of-year figure reported on prior year’s return) ...............
1
926,801
2
Enter amount from Part I, line 27a .....................
2
37,664
3
Other increases not included in line 2 (itemize) right arrow
3
 
4
Add lines 1, 2, and 3 ..........................
4
964,465
5
Decreases not included in line 2 (itemize) right arrow
5
 
6
Total net assets or fund balances at end of year (line 4 minus line 5)—Part II, column (b), line 29 .
6
964,465
Form 990-PF (2023)
Form 990-PF (2023)
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 instructions). If (loss), enter -0-
in Part I, line 8 ...................
Bracket 3  
Part V
Excise Tax Based on Investment Income (Section 4940(a), 4940(b), 4940(e), or 4948—see instructions)
1a Exempt operating foundations described in section 4940(d)(2), check here right arrow and enter “N/A" on line 1. Bracket for line 1a
Date of ruling or determination letter:   (attach copy of letter if necessary–see instructions) 1 6
b All other domestic foundations enter 1.39% (0.0139) of line 27b. Exempt foreign organizations enter 4% (0.04) of Part I, line 12, col. (b)
2 Tax under section 511 (domestic section 4947(a)(1) trusts and taxable foundations only. Others enter -0-) 2  
3 Add lines 1 and 2........................... 3 6
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
6 Credits/Payments:
a 2023 estimated tax payments and 2022 overpayment credited to 2023 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 here 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.......right arrow 9 6
10 Overpayment. If line 7 is more than the total of lines 5 and 8, enter the amount overpaid...right arrow 10  
11 Enter the amount of line 10 to be: Credited to 2024 estimated taxright arrow0 Refundedright arrow 11  
Form 990-PF (2023)
Form 990-PF (2023)
Page 4
Part VI-A
Statements Regarding Activities
1a
During the tax year, did the foundation attempt to influence any national, state, or local legislation or did
Yes
No
it participate or intervene in any political campaign? ....................
1a
 
No
b
Did it spend more than $100 during the year (either directly or indirectly) for political purposes? See the instructions
for the definition.................................
1b
 
No
If the answer is "Yes" to 1a or 1b, attach a detailed description of the activities and copies of any materials
published or distributed by the foundation in connection with the activities.
c
Did the foundation file Form 1120-POL for this year?.....................
1c
 
No
d
Enter the amount (if any) of tax on political expenditures (section 4955) imposed during the year:
(1) On the foundation. right arrow$   (2) On foundation managers.right arrow$  
e
Enter the reimbursement (if any) paid by the foundation during the year for political expenditure tax imposed
on foundation managers.right arrow$  
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:
round bullet By language in the governing instrument, or
round bullet 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
 
No
7
Did the foundation have at least $5,000 in assets at any time during the year? If "Yes," complete Part II, col. (c),
and Part XIV..................................
7
Yes
 
8a
Enter the states to which the foundation reports or with which it is registered (see instructions)
right arrowMA
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 2023 or the taxable year beginning in 2023? See the instructions for Part XIII.
If "Yes," complete Part XIII .............................
9
 
No
10
Did any persons become substantial contributors during the tax year? If "Yes," attach a schedule listing their names
and addresses. ...............................
10
 
No
11
At any time during the year, did the foundation, directly or indirectly, own a controlled entity within the
meaning of section 512(b)(13)? If "Yes," attach schedule. See instructions .............
11
 
No
12
Did the foundation make a distribution to a donor advised fund over which the foundation or a disqualified person had
advisory privileges? If "Yes," attach statement. See instructions.................
12
 
No
13
Did the foundation comply with the public inspection requirements for its annual returns and exemption application?
13
Yes
 
Website addressright arrowN/A
14
The books are in care ofright arrowEXECUTIVE DIRECTOR Telephone no.right arrow (508) 763-4810

Located atright arrow706 NORTH AVENUEROCHESTERMA ZIP+4right arrow02770
15
Section 4947(a)(1) nonexempt charitable trusts filing Form 990-PF in lieu of Form 1041 —check here .........right arrow
and enter the amount of tax-exempt interest received or accrued during the year ........right arrow
15
 
16 At any time during calendar year 2023, did the foundation have an interest in or a signature or other authority over YesNo
a bank, securities, or other financial account in a foreign country? .................
16   No
See the instructions for exceptions and filing requirements for FinCEN Form 114. If "Yes", enter the name of the foreign
country right arrow
Form 990-PF (2023)
Form 990-PF (2023)
Page 5
Part VI-B
Statements Regarding Activities for Which Form 4720 May Be Required
File Form 4720 if any item is checked in the "Yes" column, unless an exception applies.
Yes
No
1a
During the year did the foundation (either directly or indirectly):
(1) Engage in the sale or exchange, or leasing of property with a disqualified person? ...........
1a(1)
 
No
(2) Borrow money from, lend money to, or otherwise extend credit to (or accept it from)
a disqualified person? ..............................
1a(2)
 
No
(3) Furnish goods, services, or facilities to (or accept them from) a disqualified person? ...........
1a(3)
 
No
(4) Pay compensation to, or pay or reimburse the expenses of, a disqualified person? ............
1a(4)
 
No
(5) Transfer any income or assets to a disqualified person (or make any of either available
for the benefit or use of a disqualified person)? ......................
1a(5)
 
No
(6) Agree to pay money or property to a government official? (Exception. Check "No"
if the foundation agreed to make a grant to or to employ the official for a period
after termination of government service, if terminating within 90 days.) ...............
1a(6)
 
No
b
If any answer is "Yes" to 1a(1)–(6), did any of the acts fail to qualify under the exceptions described in Regulations
section 53.4941(d)-3 or in a current notice regarding disaster assistance? See instructions ..........
1b
 
No
c
Organizations relying on a current notice regarding disaster assistance check here ........right arrow
d
Did the foundation engage in a prior year in any of the acts described in 1a, other than excepted acts,
that were not corrected before the first day of the tax year beginning in 2023? .............
1d
 
No
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 2023, did the foundation have any undistributed income (Part XII, lines 6d
and 6e) for tax year(s) beginning before 2023?....................
2a
 
No
If "Yes," list the years right arrow20, 20, 20, 20
b
Are there any years listed in 2a for which the foundation is not applying the provisions of section 4942(a)(2)
(relating to incorrect valuation of assets) to the year’s undistributed income? (If applying section 4942(a)(2)
to all years listed, answer "No" and attach statement—see instructions.) ..............
2b
 
 
c
If the provisions of section 4942(a)(2) are being applied to any of the years listed in 2a, list the years here.
right arrow20, 20, 20, 20
3a
Did the foundation hold more than a 2% direct or indirect interest in any business enterprise at
any time during the year? ..............................
3a
 
No
b
If "Yes," did it have excess business holdings in 2023 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 2023.) .....................
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 2023? ..
4b
 
No
Form 990-PF (2023)
Form 990-PF (2023)
Page 6
Part VI-B
Statements Regarding Activities for Which Form 4720 May Be Required (continued)
5a
During the year did the foundation pay or incur any amount to:
Yes
No
(1) Carry on propaganda, or otherwise attempt to influence legislation (section 4945(e))? ..........
5a(1)
 
No
(2) Influence the outcome of any specific public election (see section 4955); or to carry
on, directly or indirectly, any voter registration drive? ....................
5a(2)
 
No
(3) Provide a grant to an individual for travel, study, or other similar purposes? .............
5a(3)
 
No
(4) Provide a grant to an organization other than a charitable, etc., organization described
in section 4945(d)(4)(A)? See instructions ........................
5a(4)
 
No
(5) Provide for any purpose other than religious, charitable, scientific, literary, or
educational purposes, or for the prevention of cruelty to children or animals? .............
5a(5)
 
No
b
If any answer is "Yes" to 5a(1)–(5), did any of the transactions fail to qualify under the exceptions described in
Regulations section 53.4945 or in a current notice regarding disaster assistance? See instructions ........
5b
 
 
c
Organizations relying on a current notice regarding disaster assistance check .........right arrow
d
If the answer is "Yes" to question 5a(4), does the foundation claim exemption from the
tax because it maintained expenditure responsibility for the grant? .................
5d
 
 
If "Yes," attach the statement required by Regulations section 53.4945–5(d).
6a
Did the foundation, during the year, receive any funds, directly or indirectly, to pay premiums on
a personal benefit contract? .............................
6a
 
No
b
Did the foundation, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ....
6b
 
No
If "Yes" to 6b, file Form 8870.
7a
At any time during the tax year, was the foundation a party to a prohibited tax shelter transaction?
7a
 
No
b
If "Yes", did the foundation receive any proceeds or have any net income attributable to the transaction? .....
7b
 
 
8
Is the foundation subject to the section 4960 tax on payment(s) of more than $1,000,000 in remuneration or
excess parachute payment during the year? .........................
8
 
No
Part VII
Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
and Contractors
1 List all officers, directors, trustees, foundation managers and their compensation. See instructions
(a) Name and address (b) Title, and average
hours per week
devoted to position
(c) Compensation
(If not paid, enter
-0-)
(d) Contributions to employee benefit plans and deferred compensation (e) Expense account,
other allowances
CHARLES L ROWLEY President
5.00
2,400    
PO BOX 9
WEST WAREHAM,MA02576
DOUGLAS R BEATON Treasurer
5.00
1,800    
27 DISCOVERY HILL
E SANDWICH,MA02537
ANDREW HEWITT Director
5.00
2,400    
1 ALLEN ROAD
ROCHESTER,MA02770
KRISTINA GARDINER Executive Dir.
40.00
123,028 6,648  
250 SUMMER ST
BRIDGEWATER,MA02324
JEANIE THERRIEN Secretary
5.00
2,000    
740 SNIPATUIT RD
ROCHESTER,MA02770
BRUCE SMITH Director
5.00
2,000    
21 PIERCE ST
MIDDLEBORO,MA02346
2 Compensation of five highest-paid employees (other than those included on line 1—see instructions). If none, enter “NONE."
(a) Name and address of each employee paid more than $50,000 (b) Title, and average
hours per week
devoted to position
(c) Compensation (d) Contributions to
employee benefit
plans and deferred
compensation
(e) Expense account,
other allowances
NONE
Total number of other employees paid over $50,000...................right arrow  
Form 990-PF (2023)
Form 990-PF (2023)
Page 7
Part VII
Information About Officers, Directors, Trustees, Foundation Managers, Highly Paid Employees,
and Contractors (continued)
3 Five highest-paid independent contractors for professional services (see instructions). If none, enter "NONE".
(a) Name and address of each person paid more than $50,000 (b) Type of service (c) Compensation
NONE
Total number of others receiving over $50,000 for professional services.............right arrow  
Part VIII-A
Summary of Direct Charitable Activities
List the foundation’s four largest direct charitable activities during the tax year. Include relevant statistical information such as the number of organizations and other beneficiaries served, conferences convened, research papers produced, etc. Expenses
1  
2  
3  
4  
Part VIII-B
Summary of Program-Related Investments (see instructions)
Describe the two largest program-related investments made by the foundation during the tax year on lines 1 and 2. Amount
1  
2  
All other program-related investments. See instructions.
3  
Total. Add lines 1 through 3.........................right arrow  
Form 990-PF (2023)
Form 990-PF (2023)
Page 8
Part IX
Minimum Investment Return (All domestic foundations must complete this part. Foreign foundations, see instructions.)
1
Fair market value of assets not used (or held for use) directly in carrying out charitable, etc.,
purposes:
a
Average monthly fair market value of securities...................
1a
0
b
Average of monthly cash balances.......................
1b
0
c
Fair market value of all other assets (see 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
0
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 1.5% (0.015) of line 3 (for greater amount, see
instructions) .............................
4
0
5
Net value of noncharitable-use assets. Subtract line 4 from line 3. ............
5
0
6
Minimum investment return. Enter 5% (0.05) of line 5................
6
0
Part X
Distributable Amount (see instructions) (Section 4942(j)(3) and (j)(5) private operating foundations and certain foreign organizations check here right arrow and do not complete this part.)
1
Minimum investment return from Part IX, line 6..................
1
 
2a
Tax on investment income for 2022 from Part V, line 5.......
2a
6
b
Income tax for 2022. (This does not include the tax from Part V.) ...
2b
 
c
Add lines 2a and 2b............................
2c
6
3
Distributable amount before adjustments. Subtract line 2c from line 1............
3
6
4
Recoveries of amounts treated as qualifying distributions................
4
 
5
Add lines 3 and 4............................
5
6
6
Deduction from distributable amount (see instructions).................
6
 
7
Distributable amount as adjusted. Subtract line 6 from line 5. Enter here and on Part XII, line 1 ...
7
0
Part XI
Qualifying Distributions (see instructions)
1
Amounts paid (including administrative expenses) to accomplish charitable, etc., purposes:
a
Expenses, contributions, gifts, etc.—total from Part I, column (d), line 26 ..........
1a
3,000
b
Program-related investments—total from Part VIII-B..................
1b
 
2
Amounts paid to acquire assets used (or held for use) directly in carrying out charitable, etc.,
purposes...............................
2
 
3
Amounts set aside for specific charitable projects that satisfy the:
a
Suitability test (prior IRS approval required)....................
3a
 
b
Cash distribution test (attach the required schedule) .................
3b
 
4
Qualifying distributions. Add lines 1a through 3b. Enter here and on Part XII, line 4. .......
4
3,000
Form 990-PF (2023)
Form 990-PF (2023)
Page 9
Part XII
Undistributed Income (see instructions)
(a)
Corpus
(b)
Years prior to 2022
(c)
2022
(d)
2023
1 Distributable amount for 2023 from Part X, line 7 0
2 Undistributed income, if any, as of the end of 2022:
a Enter amount for 2022 only.......  
b Total for prior years:20 , 20, 20  
3 Excess distributions carryover, if any, to 2022:
a From 2018...... 3,000
b From 2019...... 2,750
c From 2020...... 3,000
d From 2021......  
e From 2022...... 3,063
f Total of lines 3a through e ........ 11,813
4Qualifying distributions for 2023 from Part
XI, line 4: right arrow$ 3,000
a Applied to 2022, but not more than line 2a  
b Applied to undistributed income of prior years
(Election required—see instructions).....
 
c Treated as distributions out of corpus (Election
required—see instructions)........
0
d Applied to 2023 distributable amount.....  
e Remaining amount distributed out of corpus 3,000
5 Excess distributions carryover applied to 2023.    
(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 14,813
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 instructions ...........
 
e Undistributed income for 2022. Subtract line
4a from line 2a. Taxable amount—see
instructions .............
 
f Undistributed income for 2023. Subtract
lines 4d and 5 from line 1. This amount must
be distributed in 2024 ..........
0
7 Amounts treated as distributions out of
corpus to satisfy requirements imposed by
section 170(b)(1)(F) or 4942(g)(3) (Election may
be required - see instructions) .......
 
8 Excess distributions carryover from 2018 not
applied on line 5 or line 7 (see instructions) ...
3,000
9 Excess distributions carryover to 2024.
Subtract lines 7 and 8 from line 6a ......
11,813
10 Analysis of line 9:
a Excess from 2019.... 2,750
b Excess from 2020.... 3,000
c Excess from 2021....  
d Excess from 2022.... 3,063
e Excess from 2023.... 3,000
Form 990-PF (2023)
Form 990-PF (2023)
Page 10
Part XIII
Private Operating Foundations (see instructions and Part VI-A, question 9)
1a If the foundation has received a ruling or determination letter that it is a private operating
foundation, and the ruling is effective for 2023, enter the date of the ruling ...... right arrow
 
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 IX for each
year listed ..........
Tax year Prior 3 years (e) Total
(a) 2023 (b) 2022 (c) 2021 (d) 2020
         
b 85% (0.85) of line 2a .........          
c Qualifying distributions from Part XI,
line 4 for each year listed .....
         
d Amounts included in line 2c not used directly
for active conduct of exempt activities ..........
         
e Qualifying distributions made directly
for active conduct of exempt activities.
Subtract line 2d from line 2c ....
         
3 Complete 3a, b, or c for the
alternative test relied upon:
a “Assets" alternative test—enter:
(1) Value of all assets ......          
(2) Value of assets qualifying
under section 4942(j)(3)(B)(i)
         
b “Endowment" alternative test— enter 2/3
of minimum investment return shown in
Part IX, line 6 for each year listed ..
         
c “Support" alternative test—enter:
(1) Total support other than gross
investment income (interest,
dividends, rents, payments
on securities loans (section
512(a)(5)), or royalties) ....
         
(2) Support from general public
and 5 or more exempt
organizations as provided in
section 4942(j)(3)(B)(iii)....
         
(3) Largest amount of support
from an exempt organization
         
(4) Gross investment income          
Part XIV
Supplementary Information (Complete this part only if the foundation had $5,000 or more in
assets at any time during the year—see instructions.)
1Information Regarding Foundation Managers:
aList any managers of the foundation who have contributed more than 2% of the total contributions received by the foundation
before the close of any tax year (but only if they have contributed more than $5,000). (See section 507(d)(2).)
bList any managers of the foundation who own 10% or more of the stock of a corporation (or an equally large portion of the
ownership of a partnership or other entity) of which the foundation has a 10% or greater interest.
2Information Regarding Contribution, Grant, Gift, Loan, Scholarship, etc., Programs:
Check here right arrow
aThe name, address, and telephone number or email address of the person to whom applications should be addressed:
bThe form in which applications should be submitted and information and materials they should include:
cAny submission deadlines:
dAny restrictions or limitations on awards, such as by geographical areas, charitable fields, kinds of institutions, or other
factors:
Form 990-PF (2023)
Form 990-PF (2023)
Page 11
Part XIV
Supplementary Information (continued)
3 Grants and Contributions Paid During the Year or Approved for Future Payment
Recipient If recipient is an individual,
show any relationship to
any foundation manager
or substantial contributor
Foundation
status of
recipient
Purpose of grant or
contribution
Amount
Name and address (home or business)
aPaid during the year
GENERAL DONATIONS


C/O 706 NORTH AVE
ROCHESTER,MA02770
NONE PC GENERAL PROGRAM SUPPORT 3,000
Total .................................right arrow 3a 3,000
bApproved for future payment
Total ................................. right arrow 3b  
Form 990-PF (2023)
Form 990-PF (2023)
Page 12
Part XV-A
Analysis of Income-Producing Activities
Enter gross amounts unless otherwise indicated. Unrelated business income Excluded by section 512, 513, or 514 (e)
Related or exempt
function income
(See instructions.)
1Program service revenue: (a)
Business code
(b)
Amount
(c)
Exclusion code
(d)
Amount
a
b
c
d
e
f
gFees and contracts from government agencies          
2 Membership dues and assessments ....          
3 Interest on savings and temporary cash
investments ...........
    14 397  
4 Dividends and interest from securities ....          
5 Net rental income or (loss) from real estate:
aDebt-financed property......          
bNot debt-financed property.....          
6 Net rental income or (loss) from personal property          
7 Other investment income .....          
8 Gain or (loss) from sales of assets other than
inventory ............
         
9 Net income or (loss) from special events:          
10 Gross profit or (loss) from sales of inventory          
11 Other revenue:
aRENTAL INCOME
    3 11,713  
b
c
d
e
12 Subtotal. Add columns (b), (d), and (e) ..   12,110  
13Total. Add line 12, columns (b), (d), and (e)..................
13
12,110
(See worksheet in line 13 instructions to verify calculations.)
Part XV-B
Relationship of Activities to the Accomplishment of Exempt Purposes
Line No.
DownArrow
Explain below how each activity for which income is reported in column (e) of Part XV-A contributed importantly to
the accomplishment of the foundation’s exempt purposes (other than by providing funds for such purposes). (See
instructions.)
Form 990-PF (2023)
Form 990-PF (2023)
Page 13
Part XVI
Information Regarding Transfers To and Transactions and Relationships With Noncharitable Exempt Organizations
1
Did the organization directly or indirectly engage in any of the following with any other organization described in section 501(c) (other than section 501(c)(3) organizations) or in section 527, relating to political organizations?
Yes
No
a
Transfers from the reporting foundation to a noncharitable exempt organization of:
(1) Cash...................................
1a(1)
 
No
(2) Other assets.................................
1a(2)
 
No
b
Other transactions:
(1) Sales of assets to a noncharitable exempt organization....................
1b(1)
 
No
(2) Purchases of assets from a noncharitable exempt organization..................
1b(2)
 
No
(3) Rental of facilities, equipment, or other assets.......................
1b(3)
 
No
(4) Reimbursement arrangements...........................
1b(4)
 
No
(5) Loans or loan guarantees.............................
1b(5)
 
No
(6) Performance of services or membership or fundraising solicitations................
1b(6)
 
No
c
Sharing of facilities, equipment, mailing lists, other assets, or paid employees..............
1c
 
No
d
If the answer to any of the above is "Yes," complete the following schedule. Column (b) should always show the fair market value
of the goods, other assets, or services given by the reporting foundation. If the foundation received less than fair market value
in any transaction or sharing arrangement, show in column (d) the value of the goods, other assets, or services received.
(a) Line No. (b) Amount involved (c) Name of noncharitable exempt organization (d) Description of transfers, transactions, and sharing arrangements
2a
Is the foundation directly or indirectly affiliated with, or related to, one or more tax-exempt organizations
described in section 501(c) (other than section 501(c)(3)) or in section 527? ...........
b
If "Yes," complete the following schedule.

(a) Name of organization (b) Type of organization (c) Description of relationship
Sign Here
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge.
right arrow right arrow
May the IRS discuss this return
with the preparer shown below?
See instructions.
Signature of officer or trustee Date Title
Paid Preparer Use Only Print/Type preparer's name Preparer's Signature Date Check if self-
employed right arrow
PTIN
Firm's name SmallBullet
Firm's EIN SmallBullet
Firm's address SmallBullet


Phone no.
Form 990-PF (2023)
Additional Data


Software ID: 23017517
Software Version: 2023v4.0


Form 990PF - Special Condition Description:
Special Condition Description
Schedule B
(Form 990)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors

Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
Arrow Bullet Go to www.irs.gov/Form990 for the latest information.
OMB No. 1545-0047
2023
Name of the 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 isn't covered by the General Rule and/or the Special Rules doesn't file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its Form 990-EZ
or on its Form 990PF, Part I, line 2, to certify that it doesn't meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990) (2023)
Schedule B (Form 990) (2023) Page 2
Name of organization
ANNIE MAXIM HOUSE INC
 
Employer identification number
04-2791081
Part I
Contributors
Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
1
ESTATE OF GEORGE A COWEN
706 NORTH AVENUE
 
ROCHESTER, MA02770

$ 675,250


(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
 
 
 
 

$  


(Complete Part II for noncash contributions.)
Schedule B (Form 990) (2023)
Schedule B (Form 990) (2023)
Page 3
Name of organization
ANNIE MAXIM HOUSE INC
 
Employer identification number

04-2791081
Part II
Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
(a)
No. from Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(See instructions)
(d)
Date received
 
$    
(a)
No. from Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(See instructions)
(d)
Date received
 
$    
(a)
No. from Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(See instructions)
(d)
Date received
 
$    
(a)
No. from Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(See instructions)
(d)
Date received
 
$    
(a)
No. from Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(See instructions)
(d)
Date received
 
$    
(a)
No. from Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(See instructions)
(d)
Date received
 
$    
Schedule B (Form 990) (2023)
Schedule B (Form 990) (2023)
Page 4
Name of organization
ANNIE MAXIM HOUSE INC
 
Employer identification number

04-2791081
Part III
Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. Complete columns (a) through (e) and the following line entry. For organizations completing Part III, enter the total of exclusively religious, charitable, etc., contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  
Use duplicate copies of Part III if additional space is needed.
(a)
No. from Part I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a)
No. from Part I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a)
No. from Part I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
(a)
No. from Part I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
     
 
Schedule B (Form 990) (2023)
Additional Data


Software ID: 23017517
Software Version: 2023v4.0

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

TY 2023 DepreciationSchedule
Name:
ANNIE MAXIM HOUSE INC
EIN:
04-2791081
Software ID:
23017517
Software Version:
2023v4.0
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
EXTRA'S BLDG 1994 1995-01-21 5,456 3,918 SL 39.0000 140      
MAINTENANCE BLDG 1995-07-31 155,385 109,564 SL 39.0000 3,984      
ADMIN BUILDING 1995-10-20 31,110 21,741 SL 39.0000 798      
MAINTENANCE BLDG 1996-01-04 42,927 29,722 SL 39.0000 1,101      
HOUSEKEEPING ROOM 1996-11-22 28,139 18,884 SL 39.0000 722      
NEW ROOF HOMESTEAD 1998-09-29 1,835 1,782 SL 25.0000 53      
HOMESTEAD PARKING LOT 1998-10-30 5,100 4,947 SL 25.0000 153      
NEW ROOF HOMESTEAD 1998-10-09 3,665 3,559 SL 25.0000 106      
POWERS CNSTR RAMP AC 1998-11-23 8,669 8,382 SL 25.0000 287      
VINYL SIDING 1999-06-02 12,305 11,606 SL 25.0000 492      
SIDEWALKS 2000-04-21 5,165 4,686 SL 25.0000 207      
ROOF 2000-06-27 2,700 2,430 SL 25.0000 108      
LOCKS - CORNER LOCK CO 2004-06-16 5,000 3,700 SL 25.0000 200      
LOCKS - CORNER LOCK CO 2004-10-06 5,123 3,740 SL 25.0000 205      
LOCKS - CORNER LOCK CO 2004-11-10 1,339 976 SL 25.0000 54      
CRACK SEALING 2004-10-06 1,600 749 SL 39.0000 41      
GENERATOR 2004-04-13 2,350 1,128 SL 39.0000 60      
MAIN HOUSE - ROOF 2004-05-24 10,000 7,433 SL 25.0000 400      
MAIN HOUSE - ROOF 2004-08-18 60,000 44,000 SL 25.0000 2,400      
MAIN HOUSE - ROOF 2004-10-29 40,000 29,067 SL 25.0000 1,600      
MOTION DETECTOR 2004-01-22 1,202 909 SL 25.0000 48      
OTHER REPLACEMENTS-RECPTI 2004-02-05 595 452 SL 25.0000 24      
HOMESTEAD PORCH STEPS 2004-09-23 762 360 SL 39.0000 20      
LOUVERS (8) 2004-12-08 1,200 868 SL 25.0000 48      
LIGHTING INSTALL-NSTAR 2004-12-17 636 454 SL 25.0000 25      
ROOF 2005-02-17 18,228 13,002 SL 25.0000 729      
FRONT LOUVERS 2005-02-15 3,492 2,505 SL 25.0000 140      
HVAC 2005-10-07 2,400 1,656 SL 25.0000 96      
CIRCULATOR 2005-09-21 3,000 2,070 SL 25.0000 120      
LOUVERS 2006-03-22 3,492 2,342 SL 25.0000 140      
BARN ROAD SIDE WALL 2006-02-10 4,819 3,263 SL 25.0000 193      
WATER STORAGE TANK 2006-03-29 4,556 3,051 SL 25.0000 182      
WATER STORAGE TANK 2006-04-30 5,586 3,720 SL 25.0000 223      
HVAC 2006-07-31 1,250 821 SL 25.0000 50      
WATER HEATER 2006-07-26 5,246 3,446 SL 25.0000 210      
TACO 1600 CIRCULATORS 2013-11-29 4,200 3,815 SL 10.0000 385      
ELECTRICAL WORK/TERMOSTAT 2013-05-09 750 725 SL 10.0000 25      
WINDOW REPLACEMENT 2013-07-11 685 655 SL 10.0000 30      
SMOKE ALARM WIRING 2013-11-09 797 733 SL 10.0000 64      
IMPROVEMENTS - WELL 2014-06-04 5,500 4,721 SL 10.0000 550      
IMPROVEMENTS - LIGHTING 2014-07-01 11,106 9,443 SL 10.0000 1,111      
GENERATOR VOLTAGE REGULAT 2013-07-17 1,200 1,130 SL 10.0000 70      
KUBOTA LAWN TRACTOR 2013-05-09 14,098 13,630 SL 10.0000 468      
AMH STRUCTURE - GUTTERS 2015-09-21 8,960 2,168 SL 30.0000 299      
BATHROOM RENOVATION 2015-05-14 20,800 5,313 SL 30.0000 693      
BIG DRIVEWAY WORK 2015-11-16 49,000 23,141 SL 15.0000 3,267      
GENERATORS 2015-11-16 9,303 7,385 200DB 10.0000 384      
BATHROOM RENOVATIONS 2016-05-18 22,101 4,852 SL 30.0000 737      
DRAPERIES 2016-10-03 18,258 11,412 SL 10.0000 1,826      
CARPETING 2016-10-06 5,529 4,937 SL 7.0000 592      
SEPTIC SYSTEM 2017-09-20 6,410 2,242 SL 15.0000 427      
RM 1, 5, 7 & 11 BATHROOM 2017-05-18 21,457 3,992 SL 30.0000 715      
ELECTRICAL UPDATES 2018-03-26 8,722 2,760 SL 15.0000 581      
WINDOWS 2018-02-28 18,180 5,858 SL 15.0000 1,212      
ELECTRICAL UPGRADES 2018-03-26 8,722 2,760 SL 15.0000 581      
FLOORING FOR 2 APTS 2018-11-28 4,341 2,532 SL 7.0000 620      
STAFF TRUCK 2018-09-15 38,669 23,937 SL 7.0000 5,524      
OFFICE EQUIPMENT 2018-08-31 1,508 1,309 SL 5.0000 199      
APPLIANCES 2018-12-17 4,597 3,676 SL 5.0000 921      
WINDOWS 2018-10-07 54,550 11,594 SL 20.0000 2,728      
NEW TEMERATURE CONTROL 2019-10-18 1,193 253 SL 15.0000 80      
WATER HEATER REPLACEMENT 2019-10-18 3,050 643 SL 15.0000 203      
ROOF 2019-08-16 17,500 2,917 SL 20.0000 875      
KITCHEN RECONSTRUCTION 2020-09-14 21,246 2,478 SL 20.0000 1,062      
TILE FLOORING IN KITCHEN 2020-09-03 5,799 1,932 SL 7.0000 828      
TILE FLOORING IN APTS 2020-05-19 5,815 2,147 SL 7.0000 831      
APT APPLIANCES 2020-06-30 3,280 1,640 SL 5.0000 656      
DRAPERIES 2020-06-09 1,093 566 SL 5.0000 219      
REFRIGERATOR 2020-04-06 515 283 SL 5.0000 103      
WATER MAIN PROJECT 2020-04-27 206,949 22,075 SL 25.0000 8,278      
REPLACEMENT PUMP FOR WELL 2021-01-08 2,619 262 SL 20.0000 131      
INTERIOR DESIGN PROJECT 2021-07-01 17,793 1,335 SL 20.0000 890      
HOT WATER HEATER 2021-08-24 10,400 1,387 SL 10.0000 1,040      
SPRINKLER/WATER MAIN PROJECT 2022-01-01 97,000 3,880 SL 25.0000 3,880      
BALANCE OF WATER MAIN PROJECT 2022-01-01 22,560 902 SL 25.0000 902      
SPRINKLER PROJECT 2023-05-01 64,032   SL 25.0000 1,708      
SPRINKLERS 2023-05-01 13,752   SL 25.0000 367      
TILE & CARPET 2023-02-01 7,756   SL 7.0000 1,016      
OIL TANK 2023-03-31 4,546   SL 10.0000 341      
HEAT & AC 2023-11-14 101,900   SL 25.0000 679      
BOARD ROOM FURNITURE 2023-11-14 2,513   SL 5.0000 84      

TY 2023 LandEtcSchedule2
Name:
ANNIE MAXIM HOUSE INC
EIN:
04-2791081
Software ID:
23017517
Software Version:
2023v4.0
Category / Item Cost / Other Basis Accumulated Depreciation Book Value End of Year Fair Market Value
Auto./Transportation Equip. 131,453 122,245 9,208  
Furniture and Fixtures 368,574 361,125 7,449  
Buildings 3,011,866 2,481,246 530,620  
Improvements 119,560 13,675 105,885  
Land 74,370   74,370  
Miscellaneous 183,011 33,415 149,596  


TY 2023 LegalFeesSchedule
Name:
ANNIE MAXIM HOUSE INC
EIN:
04-2791081
Software ID:
23017517
Software Version:
2023v4.0
Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
LEGAL FEES 1,023 0 1,023 0


TY 2023 OtherExpensesSchedule
Name:
ANNIE MAXIM HOUSE INC
EIN:
04-2791081
Software ID:
23017517
Software Version:
2023v4.0
Description Revenue and Expenses per Books Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
AUTO EXPENSES 3,712   3,712  
EDUCATION 234   234  
HAP PROJECT 8,331   8,331  
INSURANCE 46,393   46,393  
MISCELLANEOUS 1,622   1,622  
OFFICE SUPPLIES 3,014   3,014  
SMALL GIFTS 200   200  


TY 2023 OtherIncomeSchedule2
Name:
ANNIE MAXIM HOUSE INC
EIN:
04-2791081
Software ID:
23017517
Software Version:
2023v4.0
Description Revenue And Expenses Per Books Net Investment Income Adjusted Net Income
RENTAL INCOME 11,713    


TY 2023 OtherProfessionalFeesSchedule
Name:
ANNIE MAXIM HOUSE INC
EIN:
04-2791081
Software ID:
23017517
Software Version:
2023v4.0
Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
ACCOUNTING 4,275 0 4,275 0
BOOKKEEPING 3,300 0 3,300 0
PAYROLL PROCESSING 3,990 0 3,990 0
RETIREMENT 1,500 0 1,500 0


TY 2023 TaxesSchedule
Name:
ANNIE MAXIM HOUSE INC
EIN:
04-2791081
Software ID:
23017517
Software Version:
2023v4.0
Category Amount Net Investment Income Adjusted Net Income Disbursements for Charitable Purposes
PAYROLL TAXES 32,802   32,802