2011-2012 IRS Form 990 Return

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2011-2012 IRS Form 990 Return

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Form

990
Address change Name change Initial return Terminated Amended return Application pending

Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation) | The organization may have to use a copy of this return to satisfy state reporting requirements.

OMB No. 1545-0047

Department of the Treasury Internal Revenue Service

Open to Public Inspection

2011

A For the 2011 calendar year, or tax year beginning B
Check if applicable:

JUN 1, 2011

and ending

MAY 31, 2012
D Employer identification number

C Name of organization

GENESIS WORLD MISSION, INC.
Doing Business As Number and street (or P.O. box if mail is not delivered to street address)

82-0505073
Room/suite E Telephone number

215 W 35TH STREET

City or town, state or country, and ZIP + 4

GARDEN CITY, ID

83714

Activities & Governance

REAMES for affiliates? Yes X No 215 W 35TH STREET, GARDEN CITY, ID 83714 H(b) Are all affiliates included? Yes No ) § (insert no.) 501(c) ( 4947(a)(1) or 527 If "No," attach a list. (see instructions) I Tax-exempt status: X 501(c)(3) H(c) Group exemption number | J Website: | WWW.GENESISWORLDMISSION.ORG Trust Association Other | Form of organization: X Corporation Year of formation: 2001 M State of legal domicile: ID K L Part I Summary 1 Briefly describe the organization's mission or most significant activities: GENESIS INSPIRES & OPERATES COMMUNITY DRIVEN HEALTH SOLUTIONS FOR THE MEDICALLY MARGINALIZED.
2 3 4 5 Check this box | if the organization discontinued its operations or disposed of more than 25% of its net assets. Number of voting members of the governing body (Part VI, line 1a) ~~~~~~~~~~~~~~~~~~~~ 3

F Name and address of principal officer:STEVEN

G Gross receipts $ H(a) Is this a group return

2083845218 610,232.

b Net unrelated business taxable income from Form 990-T, line 34 Revenue 8 9

CO P

6 Total number of volunteers (estimate if necessary) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 7 a Total unrelated business revenue from Part VIII, column (C), line 12 ~~~~~~~~~~~~~~~~~~~~ Prior Year

Y

Number of independent voting members of the governing body (Part VI, line 1b) ~~~~~~~~~~~~~~ Total number of individuals employed in calendar year 2011 (Part V, line 2a) ~~~~~~~~~~~~~~~~

4 5 6 7a 7b Current Year

10 9 14 215 0. 0. 508,144. 61,988. 151. 9,154. 579,437. 40,807. 0. 412,623. 0.

Contributions and grants (Part VIII, line 1h) ~~~~~~~~~~~~~~~~~~~~~

Program service revenue (Part VIII, line 2g) ~~~~~~~~~~~~~~~~~~~~~ 10 Investment income (Part VIII, column (A), lines 3, 4, and 7d) ~~~~~~~~~~~~~ 11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) ~~~~~~~~ 12 Total revenue - add lines 8 through 11 (must equal Part VIII, column (A), line 12) 13 Grants and similar amounts paid (Part IX, column (A), lines 1-3) ~~~~~~~~~~~ 14 Benefits paid to or for members (Part IX, column (A), line 4) ~~~~~~~~~~~~~ 15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5-10) ~~~ 16a Professional fundraising fees (Part IX, column (A), line 11e)~~~~~~~~~~~~~~ 93,012. | b Total fundraising expenses (Part IX, column (D), line 25) 17 Other expenses (Part IX, column (A), lines 11a-11d, 11f-24e) ~~~~~~~~~~~~~ 18 Total expenses. Add lines 13-17 (must equal Part IX, column (A), line 25) ~~~~~~~ 19 Revenue less expenses. Subtract line 18 from line 12 20 Total assets (Part X, line 16) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 21 Total liabilities (Part X, line 26) ~~~~~~~~~~~~~~~~~~~~~~~~~~~ 22 Net assets or fund balances. Subtract line 21 from line 20

Expenses

605,408. 50,805. 128. <13,832.> 642,509. 31,430. 0. 329,778. 0.

168,629. 529,837. 112,672.
Beginning of Current Year

201,652. 655,082. <75,645.>
End of Year

Net Assets or Fund Balances

856,732. 238,851. 617,881.

777,442. 235,206. 542,236.

Part II

Signature Block

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 officer) is based on all information of which preparer has any knowledge. Sign Here

STEVEN D. SEVERN SEVERN WINKLE, L.L.P. Firm's name 205 N. 10TH ST., SUITE 300 Use Only Firm's address BOISE, ID 83702
Paid Preparer

Print/Type preparer's name

= =

Signature of officer

Date

STEVEN REAMES, EXECUTIVE DIRECTOR
Type or print name and title Preparer's signature Date
Check if self-employed

PTIN

9 9

Firm's EIN Phone no.

9

P00327386 82-0508032

132001 01-23-12

May the IRS discuss this return with the preparer shown above? (see instructions) LHA For Paperwork Reduction Act Notice, see the separate instructions.

208-433-1500 X Yes No Form 990 (2011)

Form 990 (2011)

GENESIS WORLD MISSION, INC. Part III Statement of Program Service Accomplishments
1 Check if Schedule O contains a response to any question in this Part III Briefly describe the organization's mission:

82-0505073

Page 2

GENESIS WORLD MISSION IS A NON-DENOMINATIONAL CHRISTIAN ORGANIZATION WORKING TO CONVEY THE LOVE OF JESUS CHRIST BY MEETING THE PHYSICAL, MEDICAL, AND SPIRITUAL NEEDS OF THE LESS FORTUNATE, BOTH GLOBALLY AND LOCALLY.
Did the organization undertake any significant program services during the year which were not listed on the prior Form 990 or 990-EZ? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If "Yes," describe these new services on Schedule O. Did the organization cease conducting, or make significant changes in how it conducts, any program services?~~~~~~ Yes Yes

2

X No X No

3 4

If "Yes," describe these changes on Schedule O. Describe the organization's program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.

4a

4b

76,405. including grants of $ 33,450. ) (Code: ) (Expenses $ ) (Revenue $ VOLUNTEER PHYSICIANS NETWORK WORKS TO IMPROVE THE OVERALL HEALTH OF LOWER-INCOME UNINSURED PATIENTS BY REMOVING BARRIERS AND ENABLING ACCESS TO DONATED SPECIALTY CARE. DURING THE FISCAL YEAR, 971 PATIENTS OF LOCAL PRIMARY CARE CLINICS RECEIVED SPECIALTY CARE THROUGH 1,230 REFERRALS, TOTALING ONE MILLION DOLLARS WORTH OF DONATED SERVICES.

4c

83,553. including grants of $ 40,807. ) (Revenue $ (Code: ) (Expenses $ ) INTERNATIONAL PROGRAMS - GENESIS INTERNATIONAL (GI) EMPOWERS COMMUNITIES IN UNDERSERVED COUNTRIES ENABLING THEM TO MITIGATE POVERTY BY IMPROVING THEIR HEALTH AND ECONOMIC SECURITY. GI HAS DETERMINED THE CONDITIONS OF SUCCESS THAT ENSURE SUSTAINABLE RESULTS AND ELIMINATE DEPENDENCY OF AID. GI FACILITATED THE PMM CENTER IN NDUMBERI KENYA WHICH SERVED 28,000 THIS YEAR. IN BURANGI KENYA, GI IS COORDINATING THE CONSTRUCTION OF A CLINIC, CLEAN WATER AND SANITATION PROJECTS. MEDICAL CAMPS HAVE PROVIDED CARE FOR 4,175 PATIENTS.

4d 4e

Other program services (Describe in Schedule O.)

9,683. (Expenses $ Total program service expenses J

CO P
510,915.

341,274. including grants of $ 28,538. ) (Code: ) (Expenses $ ) (Revenue $ GARDEN CITY COMMUNITY CLINIC PROVIDES CHARITY MEDICAL, DENTAL, AND MENTAL HEALTH SERVICES TO LOWER INCOME, UNINSURED PATIENTS BY USING VOLUNTEER HEALTH PROFESSIONALS. DURING FY 11, SERVED OVER 700 PATIENTS WITH 82% REPORTING LESS PAIN AFTER TREATMENT. OVER 3,900 DONATED OR SUBSIDIZED MONTHLY PRESCRIPTIONS WERE FACILITATED FOR PATIENTS. NEARLY 700 DENTAL APPOINTMENTS WERE PROVIDED WITH 73% OF PATIENTS REPORTING DRAMATIC IMPROVEMENT IN PERIODONTAL HEALTH. 1,250 MENTAL HEALTH AND/OR SOCIAL WORK CONSULTS WERE PROVIDED. EXPENSES HERE DO NOT REFLECT $153,000 OF DONATED SERVICES BY 187 VOLUNTEERS; PLUS ANOTHER $121,191 IN DONATED LABS/RADIOLOGY AND $58,000 IN DONATED MEDICAL SUPPLIES AND MEDICATIONS.

Y

including grants of $

) (Revenue $

) Form 990 (2011)

132002 02-09-12

Form 990 (2011)

GENESIS WORLD MISSION, INC. Part IV Checklist of Required Schedules
1 2 3 4 5 6 7 8 9

82-0505073

Page 3 Yes No

Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If "Yes," complete Schedule A ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Is the organization required to complete Schedule B, Schedule of Contributors ~~~~~~~~~~~~~~~~~~~~~~ ? Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If "Yes," complete Schedule C, Part I ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If "Yes," complete Schedule C, Part II ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If "Yes," complete Schedule C, Part III ~~~~~~~~~~~~~~ Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If "Yes," complete Schedule D, Part I Did the organization receive or hold a conservation easement, including easements to preserve open space, the environment, historic land areas, or historic structures? If "Yes," complete Schedule D, Part II~~~~~~~~~~~~~~ Did the organization maintain collections of works of art, historical treasures, or other similar assets? If "Yes," complete Schedule D, Part III ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization report an amount in Part X, line 21; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If "Yes," complete Schedule D, Part IV ~~ Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If "Yes," complete Schedule D, Part V ~~~~~~~~~~~~~~~~~~~~~~~~ If the organization's answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X

1 2 3 4 5 6 7 8 9 10

X X X X X X X X X X

10 11

Y

as applicable. a Did the organization report an amount for land, buildings, and equipment in Part X, line 10? If "Yes," complete Schedule D, Part VI ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

11a 11b 11c 11d 11e 11f 12a 12b 13 14a

X X X X X X X X X X X X X X X X X

c Did the organization report an amount for investments - program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VIII ~~~~~~~~~~~~~~~~~~~~~~~~~ d Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part IX ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ e Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part X ~~~~~~ f Did the organization's separate or consolidated financial statements for the tax year include a footnote that addresses the organization's liability for uncertain tax positions under FIN 48 (ASC 740)? If "Yes," complete Schedule D, Part X ~~~~

12a Did the organization obtain separate, independent audited financial statements for the tax year? If "Yes," complete Schedule D, Parts XI, XII, and XIII ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ b Was the organization included in consolidated, independent audited financial statements for the tax year? If "Yes," and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI, XII, and XIII is optional~~~ 13 Is the organization a school described in section 170(b)(1)(A)(ii)? If "Yes," complete Schedule E ~~~~~~~~~~~~~~ 14a Did the organization maintain an office, employees, or agents outside of the United States? ~~~~~~~~~~~~~~~~ b Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If "Yes," complete Schedule F, Parts I and IV ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 15 16 17 18 19 Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the United States? If "Yes," complete Schedule F, Parts II and IV ~~~~~~~~~~~~~~~~~ Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the United States? If "Yes," complete Schedule F, Parts III and IV ~~~~~~~~~~~~~~~~~~~~~ Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If "Yes," complete Schedule G, Part I ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If "Yes," complete Schedule G, Part II ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If "Yes,"

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b Did the organization report an amount for investments - other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If "Yes," complete Schedule D, Part VII ~~~~~~~~~~~~~~~~~~~~~~~~~

14b 15 16 17 18 19 20a 20b

complete Schedule G, Part III ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 20a Did the organization operate one or more hospital facilities? If "Yes," complete Schedule H ~~~~~~~~~~~~~~~~ b If "Yes" to line 20a, did the organization attach a copy of its audited financial statements to this return?

Form 990 (2011)

132003 01-23-12

Form 990 (2011)

GENESIS WORLD MISSION, INC. Part IV Checklist of Required Schedules (continued)

82-0505073

Page 4 Yes No

21 22 23

Did the organization report more than $5,000 of grants and other assistance to any government or organization in the United States on Part IX, column (A), line 1? If "Yes," complete Schedule I, Parts I and II ~~~~~~~~~~~~~~~~~~ Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If "Yes," complete Schedule I, Parts I and III ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization answer "Yes" to Part VII, Section A, line 3, 4, or 5 about compensation of the organization's current and former officers, directors, trustees, key employees, and highest compensated employees? If "Yes," complete Schedule J ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

21 22

X X X X

23

24a Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If "Yes," answer lines 24b through 24d and complete Schedule K. If "No", go to line 25 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ b Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception? ~~~~~~~~~~~ c Did the organization maintain an escrow account other than a refunding escrow at any time during the year to defease any tax-exempt bonds? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ d Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year? ~~~~~~~~~~~ 25a Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If "Yes," complete Schedule L, Part I ~~~~~~~~~~~~~~~~~~~~~~~~~ b Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization's prior Forms 990 or 990-EZ? If "Yes," complete Schedule L, Part I ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 26 27

24a 24b 24c 24d 25a

X X X X X X X X X X X X X X X X X

25b 26

Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If "Yes," complete Schedule L, Part III ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 27

28

Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions): a A current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L, Part IV ~~~~~~~~~~~ b A family member of a current or former officer, director, trustee, or key employee? If "Yes," complete Schedule L, Part IV ~~ c An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or direct or indirect owner? If "Yes," complete Schedule L, Part IV~~~~~~~~~~~~~~~~~~~~~ Did the organization receive more than $25,000 in non-cash contributions? If "Yes," complete Schedule M ~~~~~~~~~ Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes," complete Schedule M ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization liquidate, terminate, or dissolve and cease operations? If "Yes," complete Schedule N, Part I ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If "Yes," complete Schedule N, Part II ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If "Yes," complete Schedule R, Part I ~~~~~~~~~~~~~~~~~~~~~~~~ Was the organization related to any tax-exempt or taxable entity? If "Yes," complete Schedule R, Parts II, III, IV, and V, line 1 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ ~~~~~~~~~~~~~~~~~~

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Y

Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, or disqualified person outstanding as of the end of the organization's tax year? If "Yes," complete Schedule L, Part II ~~~~~~~~~~~

28a 28b 28c 29 30 31 32 33 34 35a 35b 36 37 38

29 30 31 32 33 34

35a Did the organization have a controlled entity within the meaning of section 512(b)(13)?

b Did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If "Yes," complete Schedule R, Part V, line 2 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 36 Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If "Yes," complete Schedule R, Part V, line 2 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 37 38 Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If "Yes," complete Schedule R, Part VI ~~~~~~~~ Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11 and 19? Note. All Form 990 filers are required to complete Schedule O

X Form 990 (2011)

132004 01-23-12

Form 990 (2011)

Part V

GENESIS WORLD MISSION, INC. Statements Regarding Other IRS Filings and Tax Compliance

82-0505073

Page 5

Check if Schedule O contains a response to any question in this Part V 1a 1a Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable ~~~~~~~~~~~ b Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable ~~~~~~~~~~ 1b c Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? 2a Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements,

3 0
1c

Yes

No

14 2a filed for the calendar year ending with or within the year covered by this return ~~~~~~~~~~ b If at least one is reported on line 2a, did the organization file all required federal employment tax returns?~~~~~~~~~~ 2b Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
3a 3b 4a

X X X X X X

3a Did the organization have unrelated business gross income of $1,000 or more during the year? ~~~~~~~~~~~~~~ b If "Yes," has it filed a Form 990-T for this year? If "No," provide an explanation in Schedule O ~~~~~~~~~~~~~~~ 4a At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)?~~~~~~~ b If "Yes," enter the name of the foreign country: J See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts. 5a Was the organization a party to a prohibited tax shelter transaction at any time during the tax year? ~~~~~~~~~~~~ b Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?~~~~~~~~~ c If "Yes," to line 5a or 5b, did the organization file Form 8886-T? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 6a Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ b If "Yes," did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 7 Organizations that may receive deductible contributions under section 170(c). a Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor? b If "Yes," did the organization notify the donor of the value of the goods or services provided? ~~~~~~~~~~~~~~~ c Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282? 7d d If "Yes," indicate the number of Forms 8282 filed during the year ~~~~~~~~~~~~~~~~ e Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract? ~~~~~~~ Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? ~~~~~~~~~ g If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?~ h If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C? 8 Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year? f 9 Sponsoring organizations maintaining donor advised funds. a Did the organization make any taxable distributions under section 4966?~~~~~~~~~~~~~~~~~~~~~~~~~~ b Did the organization make a distribution to a donor, donor advisor, or related person? ~~~~~~~~~~~~~~~~~~~ 10 Section 501(c)(7) organizations. Enter: a Initiation fees and capital contributions included on Part VIII, line 12 ~~~~~~~~~~~~~~~ b Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities ~~~~~~ 11 Section 501(c)(12) organizations. Enter: a Gross income from members or shareholders ~~~~~~~~~~~~~~~~~~~~~~~~~~ 10a 10b 11a

5a 5b 5c 6a 6b 7a 7b 7c 7e 7f 7g 7h 8 9a 9b

Y

CO P

X X X

b Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 11b 12a Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041? b If "Yes," enter the amount of tax-exempt interest received or accrued during the year 12b 13 Section 501(c)(29) qualified nonprofit health insurance issuers. a Is the organization licensed to issue qualified health plans in more than one state? ~~~~~~~~~~~~~~~~~~~~~ Note. See the instructions for additional information the organization must report on Schedule O. b Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ~~~~~~~~~~~~~~~~~~~~~~ 13b c Enter the amount of reserves on hand ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 13c 14a Did the organization receive any payments for indoor tanning services during the tax year? ~~~~~~~~~~~~~~~~ b If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O

12a

13a

14a

X

14b Form 990 (2011)

132005 01-23-12

Form 990 (2011)

GENESIS WORLD MISSION, INC. 82-0505073 Page 6 For each "Yes" response to lines 2 through 7b below, and for a "No" response Part VI Governance, Management, and Disclosure
to line 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions. Check if Schedule O contains a response to any question in this Part VI

X 10
Yes No

Section A. Governing Body and Management
1a Enter the number of voting members of the governing body at the end of the tax year ~~~~~~ If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O. 1a

9 1b b Enter the number of voting members included in line 1a, above, who are independent ~~~~~~ 2 Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 3 Did the organization delegate control over management duties customarily performed by or under the direct supervision
4 5 of officers, directors, or trustees, or key employees to a management company or other person? ~~~~~~~~~~~~~~ Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? ~~~~~ Did the organization become aware during the year of a significant diversion of the organization's assets? ~~~~~~~~~

2 3 4 5 6 7a 7b 8a 8b 9 Yes 10a 10b 11a 12a 12b 12c 13 14

X X X X X X X X X X
No

6 Did the organization have members or stockholders? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 7a Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ b Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 8 Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:

9

Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization's mailing address? If "Yes," provide the names and addresses in Schedule O

CO P

Section B. Policies

(This Section B requests information about policies not required by the Internal Revenue Code.)

Y
83714

a The governing body? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ b Each committee with authority to act on behalf of the governing body? ~~~~~~~~~~~~~~~~~~~~~~~~~~

10a Did the organization have local chapters, branches, or affiliates? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ b If "Yes," did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes? ~~~~~~~~~~~~~ 11a Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? b Describe in Schedule O the process, if any, used by the organization to review this Form 990. 12a Did the organization have a written conflict of interest policy? If "No," go to line 13 ~~~~~~~~~~~~~~~~~~~~ b Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ~~~~~~ c Did the organization regularly and consistently monitor and enforce compliance with the policy? If "Yes," describe in Schedule O how this was done ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 13 14 15 Did the organization have a written whistleblower policy? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization have a written document retention and destruction policy? ~~~~~~~~~~~~~~~~~~~~~~ Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?

X X

X X X X X X X X

a The organization's CEO, Executive Director, or top management official ~~~~~~~~~~~~~~~~~~~~~~~~~~ b Other officers or key employees of the organization ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions). 16a Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ b If "Yes," did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization's exempt status with respect to such arrangements?

15a 15b

16a

16b

Section C. Disclosure
17 18

NONE List the states with which a copy of this Form 990 is required to be filed J Section 6104 requires an organization to make its Forms 1023 (or 1024 if applicable), 990, and 990-T (Section 501(c)(3)s only) available

for public inspection. Indicate how you made these available. Check all that apply. X Another's website X Upon request Own website 19 20 Describe in Schedule O whether (and if so, how), the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.

STEVEN REAMES - (208)384-5218 215 W 35TH STREET, GARDEN CITY, ID

State the name, physical address, and telephone number of the person who possesses the books and records of the organization: |

132006 01-23-12

Form 990 (2011)

Form 990 (2011)

GENESIS WORLD MISSION, INC. 82-0505073 Part VII Compensation of Officers, Directors, Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII

Page 7

Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees 1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization's tax year. ¥ List all of the organization's current officers, directors, trustees (whether individuals or organizations), regardless of amount of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid. ¥ List all of the organization's current key employees, if any. See instructions for definition of "key employee." ¥ List the organization's five current highest compensated employees (other than an officer, director, trustee, or key employee) who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the organization and any related organizations . ¥ List all of the organization's former officers, key employees, and highest compensated employees who received more than $100,000 of reportable compensation from the organization and any related organizations. ¥ List all of the organization's former directors or trustees that received, in the capacity as a former director or trustee of the organization, more than $10,000 of reportable compensation from the organization and any related organizations. List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest compensated employees; and former such persons. Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee. (A) Name and Title (B) Average hours per week (describe hours for related organizations in Schedule O) (C) Position (D) Reportable compensation from the organization (W-2/1099-MISC) (E) Reportable compensation from related organizations (W-2/1099-MISC) (F) Estimated amount of other compensation from the organization and related organizations

(do not check more than one box, unless person is both an officer and a director/trustee) Individual trustee or director

(1) KARL WATTS, MD PRESIDENT (2) VICKI WOOLL, MD, MPH SECRETARY (3) SCOTT NELSON VICE PRESIDENT (4) JOHN HISEL, DDS BOARD MEMBER (5) DAVID HALL BOARD MEMBER (6) DENNIS WARREN BOARD MEMBER (7) RAE CASEY BOARD MEMBER (8) JOAN STEPHENS TREASURER (9) PAT DUNCAN BOARD MEMBER (10) STEVEN REAMES EXECUTIVE DIRECTOR

CO P

3.00 X 1.00 X 1.00 X 2.00 X 2.00 X 1.00 X 1.00 X 1.00 X 1.00 X

Y
Former

Highest compensated employee

Institutional trustee

Key employee

Officer

0. 0. 0. 0. 0. 0. 0. 0. 0.

0. 0. 0. 0. 0. 0. 0. 0. 0. 0.

0. 0. 0. 0. 0. 0. 0. 0. 0. 0.

42.00

X

60,200.

132007 01-23-12

Form 990 (2011)

Form 990 (2011)

GENESIS WORLD MISSION, INC.

82-0505073

Page 8

Part VII

Individual trustee or director

Key employee

Highest compensated employee

Institutional trustee

Officer

CO P

Y
1b Sub-total ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ | c Total from continuation sheets to Part VII, Section A ~~~~~~~~ | | d Total (add lines 1b and 1c) 2 compensation from the organization | 3 4 5

Former

Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued) (B) (C) (A) (D) (E) Position Average Reportable Name and title Reportable (do not check more than one hours per box, unless person is both an compensation compensation officer and a director/trustee) week from related from (describe organizations the hours for (W-2/1099-MISC) organization related (W-2/1099-MISC) organizations in Schedule O)

(F) Estimated amount of other compensation from the organization and related organizations

60,200. 0. 60,200.

0. 0. 0.

0. 0. 0. 0
Yes 3 4 5 No

Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable

Did the organization list any former officer, director, or trustee, key employee, or highest compensated employee on line 1a? If "Yes," complete Schedule J for such individual ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If "Yes," complete Schedule J for such individual~~~~~~~~~~~~~

X X X

Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If "Yes," complete Schedule J for such person Section B. Independent Contractors 1 the organization. Report compensation for the calendar year ending with or within the organization's tax year. (A) (B) Name and business address Description of services NONE

Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from (C) Compensation

2

Total number of independent contractors (including but not limited to those listed above) who received more than 0 $100,000 of compensation from the organization | Form 990 (2011)

132008 01-23-12

Form 990 (2011)

Part VIII

GENESIS WORLD MISSION, INC. Statement of Revenue
(A) Total revenue (B) Related or exempt function revenue

82-0505073
(C) Unrelated business revenue

Page 9

(D) Revenue excluded from tax under sections 512, 513, or 514

Contributions, Gifts, Grants and Other Similar Amounts

1 a Federated campaigns ~~~~~~ b Membership dues ~~~~~~~~ c Fundraising events ~~~~~~~~ d Related organizations ~~~~~~ e Government grants (contributions) f All other contributions, gifts, grants, and similar amounts not included above ~~ g
Noncash contributions included in lines 1a-1f: $

1a 1b 1c 1d 1e 1f

72,479. 63,458. 84,576. 287,631. 32,202.
| Business Code

h Total. Add lines 1a-1f 2 a b c d e f All other program service revenue ~~~~~ g Total. Add lines 2a-2f 3 4 5

508,144. 33,450. 28,538. 33,450. 28,538.

Program Service Revenue

VPN CONTRACTUAL PATIENT SERVICES

621300 621110

|

61,988.

Y
151. 7,063. 2,091. 2,091. 579,437. 61,988. 0.

Investment income (including dividends, interest, and other similar amounts)~~~~~~~~~~~~~~~~~ | Income from investment of tax-exempt bond proceeds Royalties (i) Real | |

151.

6 a Gross rents ~~~~~~~ b Less: rental expenses ~~~ c Rental income or (loss) ~~ d Net rental income or (loss) 7 a Gross amount from sales of assets other than inventory b Less: cost or other basis and sales expenses ~~~ c Gain or (loss) ~~~~~~~ d Net gain or (loss) Other Revenue

(i) Securities

8 a Gross income from fundraising events (not 63,458. of including $ contributions reported on line 1c). See Part IV, line 18 ~~~~~~~~~~~~~ a b Less: direct expenses~~~~~~~~~~ b c Net income or (loss) from fundraising events 9 a Gross income from gaming activities. See Part IV, line 19 ~~~~~~~~~~~~~ a b Less: direct expenses ~~~~~~~~~ b c Net income or (loss) from gaming activities 10 a Gross sales of inventory, less returns and allowances ~~~~~~~~~~~~~ a b Less: cost of goods sold ~~~~~~~~ b c Net income or (loss) from sales of inventory 11 a b c d All other revenue ~~~~~~~~~~~~~ e Total. Add lines 11a-11d ~~~~~~~~~~~~~~~ | Total revenue. See instructions. | 12

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(ii) Personal | (ii) Other |

37,858. 30,795.
|

7,063.

|

| Business Code

NON-PROGRAM SALES

Miscellaneous Revenue

621110

2,091.

132009 01-23-12

9,305. Form 990 (2011)

Form 990 (2011)

GENESIS WORLD MISSION, INC. Part IX Statement of Functional Expenses

82-0505073

Page 10

Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A) but are not required to complete columns (B), (C), and (D). Do not include amounts reported on lines 6b, 7b, 8b, 9b, and 10b of Part VIII. 1 2 3 Check if Schedule O contains a response to any question in this Part IX (A) (B) Total expenses Program service expenses Grants and other assistance to governments and organizations in the United States. See Part IV, line 21 (C) Management and general expenses (D) Fundraising expenses

Grants and other assistance to individuals in the United States. See Part IV, line 22 ~~~ Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16 ~

40,807. 60,200.

40,807. 10,518. 26,976. 22,706.

4 5 6

Benefits paid to or for members ~~~~~~~ Compensation of current officers, directors, trustees, and key employees ~~~~~~~~ Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ~~~ Other salaries and wages ~~~~~~~~~~ Pension plan accruals and contributions (include
section 401(k) and section 403(b) employer contributions)

7 8 9 10

308,555. 10,131. 33,737.

251,355. 8,492. 24,400.

10,197. 751. 3,257.

47,003. 888. 6,080.

~

b Legal ~~~~~~~~~~~~~~~~~~~~ c Accounting ~~~~~~~~~~~~~~~~~ d Lobbying ~~~~~~~~~~~~~~~~~~ e Professional fundraising services. See Part IV, line 17 Investment management fees ~~~~~~~~ g Other ~~~~~~~~~~~~~~~~~~~~ f 12 13 14 15 16 17 18 19 20 21 22 23 24 Office expenses~~~~~~~~~~~~~~~ Information technology ~~~~~~~~~~~ Royalties ~~~~~~~~~~~~~~~~~~

CO P
6,000.

11 Fees for services (non-employees): a Management ~~~~~~~~~~~~~~~~

Y

Other employee benefits ~~~~~~~~~~ Payroll taxes ~~~~~~~~~~~~~~~~

5,040.

480.

480.

Advertising and promotion ~~~~~~~~~

4,628. 3,893. 16,909. 5,600. 24,518. 4,271. 4,813. 12,396. 31,286. 10,058.

3,930. 1,286. 8,633. 4,326.

349. 48. 1,270. 957. 1,927. 25. 899. 893. 2,402. 604.

349. 2,559. 7,006. 317. 845. 78. 1,055. 397. 1,646. 727.

Occupancy ~~~~~~~~~~~~~~~~~ Travel ~~~~~~~~~~~~~~~~~~~ Payments of travel or entertainment expenses for any federal, state, or local public officials Conferences, conventions, and meetings ~~ Interest ~~~~~~~~~~~~~~~~~~ Payments to affiliates ~~~~~~~~~~~~ Depreciation, depletion, and amortization ~~

21,746. 4,168. 2,859. 11,106. 27,238. 8,727.

DENTAL & MEDICAL SUPPLI b DUES
a c

Insurance ~~~~~~~~~~~~~~~~~ Other expenses. Itemize expenses not covered above. (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.) ~~

75,521. 1,759.

75,521. 763.

120.

876.

d e All other expenses 25 Total functional expenses. Add lines 1 through 24e 26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation.
Check here 132010 01-23-12

655,082.

510,915.

51,155.

93,012.

|

if following SOP 98-2 (ASC 958-720)

Form 990 (2011)

Form 990 (2011)

GENESIS WORLD MISSION, INC.
(A) Beginning of year

82-0505073

Page 11

Part X

Balance Sheet
(B) End of year

1 2 3 4 5

Cash - non-interest-bearing ~~~~~~~~~~~~~~~~~~~~~~~~~ Savings and temporary cash investments ~~~~~~~~~~~~~~~~~~ Pledges and grants receivable, net ~~~~~~~~~~~~~~~~~~~~~ Accounts receivable, net ~~~~~~~~~~~~~~~~~~~~~~~~~~ Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary

32,298. 1 92,414. 2 95,872. 3
4

31,014. 60,251. 103,571.

5

6

Assets

employees' beneficiary organizations (see instructions) ~~~~~~~~~~~ 7 8 9 Notes and loans receivable, net ~~~~~~~~~~~~~~~~~~~~~~~ Inventories for sale or use ~~~~~~~~~~~~~~~~~~~~~~~~~~ Prepaid expenses and deferred charges ~~~~~~~~~~~~~~~~~~ 10a 10b

6

68,817. 8 879. 9 566,452. 10c
11 12 13 14

7

41,369. 5,071. 536,166.

10 a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D ~~~ b Less: accumulated depreciation ~~~~~~ 11 12 13 14 15 16 17 18 19 Liabilities 20 21 22

663,538. 127,372.

Investments - publicly traded securities ~~~~~~~~~~~~~~~~~~~ Investments - other securities. See Part IV, line 11 ~~~~~~~~~~~~~~

Accounts payable and accrued expenses ~~~~~~~~~~~~~~~~~~ Grants payable ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Deferred revenue ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Tax-exempt bond liabilities ~~~~~~~~~~~~~~~~~~~~~~~~~ Escrow or custodial account liability. Complete Part IV of Schedule D ~~~~ Payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified persons. Complete Part II of Schedule L ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Secured mortgages and notes payable to unrelated third parties ~~~~~~ Unsecured notes and loans payable to unrelated third parties ~~~~~~~~ Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Total liabilities. Add lines 17 through 25 Organizations that follow SFAS 117, check here | lines 27 through 29, and lines 33 and 34.

CO P
X and complete

Other assets. See Part IV, line 11 ~~~~~~~~~~~~~~~~~~~~~~ Total assets. Add lines 1 through 15 (must equal line 34)

Y

Investments - program-related. See Part IV, line 11 ~~~~~~~~~~~~~ Intangible assets ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

856,732. 16 31,335. 17
18 19 20 21

15

777,442. 31,552.

23 24 25

207,516. 23
24

22

203,654.

26 Net Assets or Fund Balances

238,851. 26 537,352. 27 80,529. 28
29

25

235,206. 515,702. 26,534.

27 28 29

Unrestricted net assets ~~~~~~~~~~~~~~~~~~~~~~~~~~~ Temporarily restricted net assets ~~~~~~~~~~~~~~~~~~~~~~ Permanently restricted net assets ~~~~~~~~~~~~~~~~~~~~~ Organizations that do not follow SFAS 117, check here | and complete lines 30 through 34. Capital stock or trust principal, or current funds ~~~~~~~~~~~~~~~ Paid-in or capital surplus, or land, building, or equipment fund ~~~~~~~~ Retained earnings, endowment, accumulated income, or other funds ~~~~ Total net assets or fund balances ~~~~~~~~~~~~~~~~~~~~~~ Total liabilities and net assets/fund balances

30 31 32 33 34

617,881. 33 856,732. 34

30 31 32

542,236. 777,442. Form 990 (2011)

132011 01-23-12

Form 990 (2011)

GENESIS WORLD MISSION, INC. Part XI Reconciliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI 1 2 3 4 5 6 Total revenue (must equal Part VIII, column (A), line 12) ~~~~~~~~~~~~~~~~~~~~~~~~~~ Total expenses (must equal Part IX, column (A), line 25) ~~~~~~~~~~~~~~~~~~~~~~~~~~ Revenue less expenses. Subtract line 2 from line 1 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ~~~~~~~~~~ Other changes in net assets or fund balances (explain in Schedule O) ~~~~~~~~~~~~~~~~~~~ Net assets or fund balances at end of year. Combine lines 3, 4, and 5 (must equal Part X, line 33, column (B)) Check if Schedule O contains a response to any question in this Part XII

82-0505073

Page 12

1 2 3 4 5 6

579,437. 655,082. <75,645.> 617,881. 0. 542,236.

Part XII Financial Statements and Reporting
Yes 1 Accounting method used to prepare the Form 990: Cash No

X Accrual

Other 2a 2b 2c

If the organization changed its method of accounting from a prior year or checked "Other," explain in Schedule O. 2a Were the organization's financial statements compiled or reviewed by an independent accountant? ~~~~~~~~~~~~ b Were the organization's financial statements audited by an independent accountant? ~~~~~~~~~~~~~~~~~~~ c If "Yes" to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant? ~~~~~~~~~~~~~~~ If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O. d If "Yes" to line 2a or 2b, check a box below to indicate whether the financial statements for the year were issued on a separate basis, consolidated basis, or both: X Separate basis Consolidated basis Both consolidated and separate basis

X X X

Y

3a As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ b If "Yes," did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits.

3a 3b

X

CO P

Form 990 (2011)

132012 01-23-12

SCHEDULE A
(Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service

Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust. | Attach to Form 990 or Form 990-EZ. | See separate instructions.

OMB No. 1545-0047

Open to Public Inspection Employer identification number

2011

Name of the organization

Part I

GENESIS WORLD MISSION, INC. Reason for Public Charity Status (All organizations must complete this part.) See instructions.

82-0505073

The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.) 1 A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i). 2 A school described in section 170(b)(1)(A)(ii). (Attach Schedule E.) 3 A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii). A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, 4 city, and state: 5 6 7 8 9 An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.) A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v). An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.) A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.) An organization that normally receives: (1) more than 33 1/3% of its support from contributions, membership fees, and gross receipts from activities related to its exempt functions - subject to certain exceptions, and (2) no more than 33 1/3% of its support from gross investment

X

10 11

e f g

describes the type of supporting organization and complete lines 11e through 11h. a b c d Type I Type II Type III - Functionally integrated Type III - Other By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III supporting organization, check this box ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons? (i) A person who directly or indirectly controls, either alone or together with persons described in (ii) and (iii) below, the governing body of the supported organization? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ (ii) A family member of a person described in (i) above? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ (iii) A 35% controlled entity of a person described in (i) or (ii) above? ~~~~~~~~~~~~~~~~~~~~~~~~ Provide the following information about the supported organization(s). (ii) EIN (iii) Type of (vi) Is the (iv) Is the organization (v) Did you notify the organization in col. (i) listed in your organization in col. organization in col. (i) organized in the (described on lines 1-9 governing document? (i) of your support? U.S.? above or IRC section (see instructions)) Yes No Yes No Yes No (vii) Amount of support Yes 11g(i) 11g(ii) 11g(iii) No

h

(i) Name of supported organization

Total LHA For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
132021 01-24-12

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An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box that

Y

income and unrelated business taxable income (less section 511 tax) from businesses acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.) An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

Schedule A (Form 990 or 990-EZ) 2011

Schedule A (Form 990 or 990-EZ) 2011

Page 2

Part II

Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)

Section A. Public Support
Calendar year (or fiscal year beginning in) | 1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ~~ 2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf ~~~~ 3 The value of services or facilities furnished by a governmental unit to the organization without charge ~ 4 Total. Add lines 1 through 3 ~~~ 5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f) ~~~~~~~~~~~~ (a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (f) Total

Section B. Total Support

Calendar year (or fiscal year beginning in) | 7 Amounts from line 4 ~~~~~~~ 8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources ~ 9 Net income from unrelated business activities, whether or not the business is regularly carried on ~ 10 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.) ~~~~ 11 Total support. Add lines 7 through 10

(a) 2007

(b) 2008

Y
(c) 2009

6 Public support. Subtract line 5 from line 4.

(d) 2010

(e) 2011

(f) Total

12 Gross receipts from related activities, etc. (see instructions) ~~~~~~~~~~~~~~~~~~~~~~~ 12 13 First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here

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| % %

Section C. Computation of Public Support Percentage
14 Public support percentage for 2011 (line 6, column (f) divided by line 11, column (f)) ~~~~~~~~~~~~ 14 15 Public support percentage from 2010 Schedule A, Part II, line 14 ~~~~~~~~~~~~~~~~~~~~~ 15 16a 33 1/3% support test - 2011. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box and stop here. The organization qualifies as a publicly supported organization ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ | b 33 1/3% support test - 2010. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this box and stop here. The organization qualifies as a publicly supported organization ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ | 17a 10% -facts-and-circumstances test - 2011. If the organization did not check a box on line 13, 16a, or 16b, and line 14 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization ~~~~~~~~~~~~~~~ | b 10% -facts-and-circumstances test - 2010. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line 15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization ~~~~~~~~ | 18 Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see instructions | Schedule A (Form 990 or 990-EZ) 2011

132022 01-24-12

(Form 990)

SCHEDULE D

Supplemental Financial Statements
| Complete if the organization answered "Yes," to Form 990, Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b. | Attach to Form 990. | See separate instructions.

OMB No. 1545-0047

Department of the Treasury Internal Revenue Service

Open to Public Inspection Employer identification number

2011

Name of the organization

Part I

GENESIS WORLD MISSION, INC. 82-0505073 Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the
organization answered "Yes" to Form 990, Part IV, line 6. (a) Donor advised funds (b) Funds and other accounts

1 2 3 4 5 6

Total number at end of year ~~~~~~~~~~~~~~~ Aggregate contributions to (during year) ~~~~~~~~ Aggregate grants from (during year) ~~~~~~~~~~ Aggregate value at end of year ~~~~~~~~~~~~~ Did the organization inform all donors and donor advisors in writing that the assets held in donor advised funds are the organization's property, subject to the organization's exclusive legal control? ~~~~~~~~~~~~~~~~~~ Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be used only Yes No Yes No

for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? Part II Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7. 1

Purpose(s) of conservation easements held by the organization (check all that apply). Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area Protection of natural habitat Preservation of open space Preservation of a certified historic structure

day of the tax year.

Y

2

Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last Held at the End of the Tax Year 2a 2b 2c

b Total acreage restricted by conservation easements ~~~~~~~~~~~~~~~~~~~~~~~~~~ c Number of conservation easements on a certified historic structure included in (a) ~~~~~~~~~~~~ d Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure 3 4 5 6 7 8 9

2d listed in the National Register ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the tax year | Number of states where property subject to conservation easement is located |

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ~~~~~~~~~~~~~~~~~~~~~~~~~ Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year | Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year | $

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a Total number of conservation easements ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Yes

No

Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) Yes and section 170(h)(4)(B)(ii)? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and balance sheet, and include, if applicable, the text of the footnote to the organization's financial statements that describes the organization's accounting for conservation easements.

No

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.

1a If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIV, the text of the footnote to its financial statements that describes these items. b If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items: (i) Revenues included in Form 990, Part VIII, line 1 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ | $ (ii) Assets included in Form 990, Part X ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ | $ If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide

2

the following amounts required to be reported under SFAS 116 (ASC 958) relating to these items: a Revenues included in Form 990, Part VIII, line 1 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ | $ b Assets included in Form 990, Part X ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ | $ Schedule D (Form 990) 2011

LHA For Paperwork Reduction Act Notice, see the Instructions for Form 990.
132051 01-23-12

Schedule D (Form 990) 2011

Part III
3 a b c 4 5

GENESIS WORLD MISSION, INC. 82-0505073 Page 2 Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

Using the organization's acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply): Public exhibition Scholarly research Preservation for future generations d e Loan or exchange programs Other

Provide a description of the organization's collections and explain how they further the organization's exempt purpose in Part XIV. During the year, did the organization solicit or receive donations of art, historical treasures, or other similar assets to be sold to raise funds rather than to be maintained as part of the organization's collection? Yes Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21. Yes Amount No

Part IV

1a Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not included on Form 990, Part X? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ b If "Yes," explain the arrangement in Part XIV and complete the following table: c Beginning balance ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ d Additions during the year ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1c 1d

No

e Distributions during the year ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1e f Ending balance ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 1f 2a Did the organization include an amount on Form 990, Part X, line 21? ~~~~~~~~~~~~~~~~~~~~~~~~~ b If "Yes," explain the arrangement in Part XIV. Part V Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10. 1a Beginning of year balance ~~~~~~~ b Contributions ~~~~~~~~~~~~~~ c Net investment earnings, gains, and losses d Grants or scholarships ~~~~~~~~~ e Other expenditures for facilities and programs ~~~~~~~~~~~~~ f Administrative expenses ~~~~~~~~ g End of year balance ~~~~~~~~~~ 2 a Board designated or quasi-endowment | b Permanent endowment | c Temporarily restricted endowment |

Yes

No

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as: % %

The percentages in lines 2a, 2b, and 2c should equal 100% . 3a Are there endowment funds not in the possession of the organization that are held and administered for the organization by: (i) unrelated organizations ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ (ii) related organizations ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ b If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? ~~~~~~~~~~~~~~~~~~~~~~ 4 Describe in Part XIV the intended uses of the organization's endowment funds. Part VI Land, Buildings, and Equipment. See Form 990, Part X, line 10. Description of property 1a Land ~~~~~~~~~~~~~~~~~~~~ b Buildings ~~~~~~~~~~~~~~~~~~ c Leasehold improvements ~~~~~~~~~~ d Equipment ~~~~~~~~~~~~~~~~~ (a) Cost or other basis (investment) (b) Cost or other basis (other) (c) Accumulated depreciation Yes 3a(i) 3a(ii) 3b No

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%

Y

(a) Current year

(b) Prior year

(c) Two years back

(d) Three years back

(e) Four years back

(d) Book value

85,000. 483,687. 94,851.

69,667. 57,705.
|

85,000. 414,020. 37,146. 536,166.

e Other Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)

Schedule D (Form 990) 2011

132052 01-23-12

Schedule D (Form 990) 2011

GENESIS WORLD MISSION, INC. Part VII Investments - Other Securities. See Form 990, Part X, line 12.
(a) Description of security or category (including name of security) (b) Book value

82-0505073 Page 3
(c) Method of valuation: Cost or end-of-year market value

(1) Financial derivatives ~~~~~~~~~~~~~~~ (2) Closely-held equity interests ~~~~~~~~~~~ (3) Other (A) (B) (C) (D) (E) (F) (G) (H) (I) Total. (Col (b) must equal Form 990, Part X, col (B) line 12.) |

Part VIII Investments - Program Related. See Form 990, Part X, line 13.
(a) Description of investment type (1) (2) (3) (b) Book value (c) Method of valuation: Cost or end-of-year market value

(8) (9) (10) Total. (Col (b) must equal Form 990, Part X, col (B) line 13.) | Part IX Other Assets. See Form 990, Part X, line 15. (a) Description (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) Total. (Column (b) must equal Form 990, Part X, col (B) line 15.) Part X Other Liabilities. See Form 990, Part X, line 25. (a) Description of liability 1. (1) Federal income taxes (2) (3) (4) (5) (6) (7) (8) (9) (10)

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| (b) Book value

(6) (7)

Y
(b) Book value Schedule D (Form 990) 2011

(4) (5)

132053 01-23-12

(11) Total. (Column (b) must equal Form 990, Part X, col (B) line 25.) | FIN 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under 2. FIN 48 (ASC 740).

Schedule D (Form 990) 2011

GENESIS WORLD MISSION, INC. 82-0505073 Page 4 Part XI Reconciliation of Change in Net Assets from Form 990 to Audited Financial Statements 579,437. 1 1 Total revenue (Form 990, Part VIII, column (A), line 12) ~~~~~~~~~~~~~~~~~~~~~~ 655,082. 2 2 Total expenses (Form 990, Part IX, column (A), line 25) ~~~~~~~~~~~~~~~~~~~~~~ <75,645.> 3 3 Excess or (deficit) for the year. Subtract line 2 from line 1 ~~~~~~~~~~~~~~~~~~~~~
4 5 6 7 Net unrealized gains (losses) on investments ~~~~~~~~~~~~~~~~~~~~~~~~~~~ Donated services and use of facilities ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Investment expenses ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Prior period adjustments ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Other (Describe in Part XIV.) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Total adjustments (net). Add lines 4 through 8 ~~~~~~~~~~~~~~~~~~~~~~~~~~~ Excess or (deficit) for the year per audited financial statements. Combine lines 3 and 9 4 5 6 7 8 9 10 1

8 9 10 1 2

<75,645.> 908,938.

Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
Total revenue, gains, and other support per audited financial statements ~~~~~~~~~~~~~~~~~~~ Amounts included on line 1 but not on Form 990, Part VIII, line 12: 2a 2b 2c

37,491. 2d d Other (Describe in Part XIV.) ~~~~~~~~~~~~~~~~~~~~~~~~~~ 2e e Add lines 2a through 2d ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 3 Subtract line 2e from line 1 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 3
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1: 4a a Investment expenses not included on Form 990, Part VIII, line 7b ~~~~~~~~ 4b b Other (Describe in Part XIV.) ~~~~~~~~~~~~~~~~~~~~~~~~~~ c Add lines 4a and 4b ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.)

a Net unrealized gains on investments ~~~~~~~~~~~~~~~~~~~~~~ b Donated services and use of facilities ~~~~~~~~~~~~~~~~~~~~~~ c Recoveries of prior year grants ~~~~~~~~~~~~~~~~~~~~~~~~~

292,010. 329,501. 579,437.

Y
4a 4b

4c 5 1

0. 579,437. 984,583.

1 Total expenses and losses per audited financial statements ~~~~~~~~~~~~~~~~~~~~~~~~~~ 2 Amounts included on line 1 but not on Form 990, Part IX, line 25: 292,010. 2a a Donated services and use of facilities ~~~~~~~~~~~~~~~~~~~~~~ 2b b Prior year adjustments ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 2c c Other losses ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 37,491. 2d d Other (Describe in Part XIV.) ~~~~~~~~~~~~~~~~~~~~~~~~~~ e Add lines 2a through 2d ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 3 Subtract line 2e from line 1 ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 4 Amounts included on Form 990, Part IX, line 25, but not on line 1: a Investment expenses not included on Form 990, Part VIII, line 7b ~~~~~~~~ b Other (Describe in Part XIV.) ~~~~~~~~~~~~~~~~~~~~~~~~~~

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Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return

2e 3

329,501. 655,082.

c Add lines 4a and 4b ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.)

4c 5

0. 655,082.

Part XIV Supplemental Information
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part IV, lines 1b and 2b; Part V, line 4; Part X, line 2; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.

PART XII, LINE 2D AND PART XIII, LINE 2D- $6,697 INTERNATIONAL TRAVEL REIMBURSEMENT TREATED AS REVENUE ON AUDITED FINANCIAL STATEMENTS BUT TREATED AS AN OFFSET TO THE RELATED EXPENSE FOR 990 REPORTING.$30,795

DIRECT FUNDRAISING EXPENSE TREATED AS AN EXPENSE ON THE AUDITED FINANCIAL STATEMENTS BUT AS A CONTRA REVENUE AMOUNT ON THE 990.

Schedule D (Form 990) 2011
132054 01-23-12

(Form 990)

SCHEDULE F

Statement of Activities Outside the United States
| Complete if the organization answered "Yes" to Form 990, Part IV, line 14b, 15, or 16. | Attach to Form 990. | See separate instructions.

OMB No. 1545-0047

Department of the Treasury Internal Revenue Service

Open to Public Inspection Employer identification number

2011

Name of the organization

GENESIS WORLD MISSION, INC. 82-0505073 Part I General Information on Activities Outside the United States. Complete if the organization answered "Yes"
to Form 990, Part IV, line 14b. 1 For grantmakers. Does the organization maintain records to substantiate the amount of its grants and other assistance, the grantees' eligibility for the grants or assistance, and the selection criteria used to award the grants or assistance? ~~

X Yes

No

2 3

For grantmakers. Describe in Part V the organization's procedures for monitoring the use of its grants and other assistance outside the United States. Activities per Region. (The following Part I, line 3 table can be duplicated if additional space is needed.) (a) Region (b) Number of (c) Number of (d) Activities conducted in region (e) If activity listed in (d) employees, offices (by type) (e.g., fundraising, program is a program service, agents, and in the region services, investments, grants to describe specific type independent contractors recipients located in the region) of service(s) in region in region (f) Total expenditures for and investments in region

SUB-SAHARAN AFRICA

0

SUPPORT MEDICAL CARE IN TWO 0 COMMUNITIES. MEDICAL/DENTAL SERVICES

40,807.

3 a Sub-total ~~~~~~ b Total from continuation sheets to Part I ~~~ c Totals (add lines 3a and 3b)

0 0 0

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0 0 0

Y
40,807. 0. 40,807.
Schedule F (Form 990) 2011 LHA For Paperwork Reduction Act Notice, see the Instructions for Form 990.
132071 01-23-12

GENESIS WORLD MISSION, INC. 82-0505073 Schedule F (Form 990) 2011 Part II Grants and Other Assistance to Organizations or Entities Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 15, for any
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ | (f) Manner of

Page 2

recipient who received more than $5,000. Check this box if no one recipient received more than $5,000 (d) Purpose of grant (e) Amount

Part II can be duplicated if additional space is needed. (c) Region (g) Amount of non-cash of cash grant cash disbursement assistance (h) Description of non-cash assistance (i) Method of valuation (book, FMV, appraisal, other)

1 (a) Name of organization

(b) IRS code section and EIN (if applicable)

SUB-SAHARAN AFRICA 23,583.WIRE 0.

FOREIGN ORGANIZATIONAL SUPPORT

SUB-SAHARAN AFRICA FOREIGN MEDICAL AID 17,224.WIRE 0.

O C

Y P

2

Enter total number of recipient organizations listed above that are recognized as charities by the foreign country, recognized as tax-exempt by

2
Schedule F (Form 990) 2011

3

the IRS, or for which the grantee or counsel has provided a section 501(c)(3) equivalency letter ~~~~~~~~~~~~~~~~~~~~~~~ | Enter total number of other organizations or entities |

132072 01-23-12

GENESIS WORLD MISSION, INC. 82-0505073 Schedule F (Form 990) 2011 Part III Grants and Other Assistance to Individuals Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 16.
(d) Amount of cash grant (e) Manner of cash disbursement (f) Amount of non-cash assistance (g) Description of non-cash assistance (h) Method of valuation (book, FMV, appraisal, other)

Page 3

Part III can be duplicated if additional space is needed. (c) Number of (a) Type of grant or assistance (b) Region recipients

O C

Y P

Schedule F (Form 990) 2011

132073 01-23-12

Schedule F (Form 990) 2011

Part IV
1

GENESIS WORLD MISSION, INC. Foreign Forms

82-0505073

Page 4

Was the organization a U.S. transferor of property to a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 926, Return by a U.S. Transferor of Property to a Foreign Corporation (see Instructions for Form 926) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Did the organization have an interest in a foreign trust during the tax year? If "Yes," the organization may be required to file Form 3520, Annual Return to Report Transactions with Foreign Trusts and Receipt of Certain Foreign Gifts, and/or Form 3520-A, Annual Information Return of Foreign Trust With a U.S. Owner (see Instructions for Forms 3520 and 3520-A) [[[[[[[[[[[[[[[[[[[[[[[[[[[[[[[[[[

Yes

X No

2

Yes

X No

3

Did the organization have an ownership interest in a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 5471, Information Return of U.S. Persons With Respect To Certain Foreign Corporations. (see Instructions for Form 5471) ~~~~~~~~~~~~~~~~~~~~~~~~~~~ Was the organization a direct or indirect shareholder of a passive foreign investment company or a qualified electing fund during the tax year? If "Yes," the organization may be required to file Form 8621, Information Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. (see Instructions for Form 8621) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Yes

X No

4

Yes

X No

5

6

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Did the organization have any operations in or related to any boycotting countries during the tax year? If "Yes," the organization may be required to file Form 5713, International Boycott Report (see Instructions for Form 5713) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Y

Did the organization have an ownership interest in a foreign partnership during the tax year? If "Yes," the organization may be required to file Form 8865, Return of U.S. Persons With Respect To Certain Foreign Partnerships. (see Instructions for Form 8865) ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Yes

X No

Yes

X No

Schedule F (Form 990) 2011

132074 01-23-12

Schedule F (Form 990) 2011

Part V

GENESIS WORLD MISSION, INC. Supplemental Information

82-0505073

Page 5

Complete this part to provide the information required by Part I, line 2 (monitoring of funds); Part I, line 3, column (f) (accounting method; amounts of investments vs. expenditures per region); Part II, line 1 (accounting method); Part III (accounting method); and Part III, column (c) (estimated number of recipients), as applicable. Also complete this part to provide any additional information.

SCHEDULE F, PART I, LINE 2: PART 1 LINE 2 GENESIS WORLD MISSION TAKES AN ACTIVE ROLE IN ASSISTING WITH THE ONGOING SUCCESS OF THE PEFA MERCY MEDICAL CENTRE LOCATED IN NDUMBERI KENYA, FOR WHICH THESE GRANT MONIES PERTAIN. US BASED STAFF ARE IN ONGOING MONTHLY CONTACT WITH THE MEDICAL CENTRE ADMINISTRATOR. MONTHLY REPORTS OF OUTPUTS, OUTCOMES, SUCCESSES AND CHALLENGES ARE PROVIDED VIA EMAIL. AN ANNUAL IN PERSON JOINT-BOARD MEEING IS HELD BETWEEN PEFA MERCY MINISTRIES AND GENESIS WORLD MISSION TO REVIEW ANNUAL OPERATIONS AND PARTNERSHIP.

AN ADDITIONAL PROJECT IN MALINDI KENYA INVOLVES A PARTNERSHIP WITH MAP

THERE. THREE MEDICAL CAMP TRIPS WERE HELD DURING THE YEAR, AS WELL AS COMMUNITY ENGAGEMENT DISCUSSIONS.

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INTERNATIONAL TO ESTABLISH A TOTAL HEALTH VILLAGE IN A REMOTE VILLAGE

Y

132075 01-23-12

Schedule F (Form 990) 2011

SCHEDULE G
(Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service

Supplemental Information Regarding Fundraising or Gaming Activities

OMB No. 1545-0047

Name of the organization

Complete if the organization answered "Yes" to Form 990, Part IV, lines 17, 18, or 19, Open To Public or if the organization entered more than $15,000 on Form 990-EZ, line 6a. Inspection | Attach to Form 990 or Form 990-EZ. | See separate instructions. Employer identification number

2011

GENESIS WORLD MISSION, INC. Part I
required to complete this part.

82-0505073

Fundraising Activities. Complete if the organization answered "Yes" to Form 990, Part IV, line 17. Form 990-EZ filers are not

1 Indicate whether the organization raised funds through any of the following activities. Check all that apply. a e Mail solicitations Solicitation of non-government grants b f Internet and email solicitations Solicitation of government grants c g Phone solicitations Special fundraising events d In-person solicitations 2 a Did the organization have a written or oral agreement with any individual (including officers, directors, trustees or Yes key employees listed in Form 990, Part VII) or entity in connection with professional fundraising services? b If "Yes," list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is to be compensated at least $5,000 by the organization. (i) Name and address of individual or entity (fundraiser) (iii) Did fundraiser have custody or control of contributions? Yes No (v) Amount paid (iv) Gross receipts to (or retained by) fundraiser from activity listed in col. (i) No

(ii) Activity

(vi) Amount paid to (or retained by) organization

| Total 3 List all states in which the organization is registered or licensed to solicit contributions or has been notified it is exempt from registration or licensing.

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LHA Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
132081 01-23-12

Y
Schedule G (Form 990 or 990-EZ) 2011

Schedule G (Form 990 or 990-EZ) 2011

GENESIS WORLD MISSION, INC.

82-0505073 Page 2

Part II

Fundraising Events. Complete if the organization answered "Yes" to Form 990, Part IV, line 18, or reported more than $15,000 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000.
(a) Event #1 (b) Event #2 (c) Other events

ANNUAL DINNER
Revenue (event type) 1 2 3 4 Direct Expenses 5 6 7 8 Gross receipts ~~~~~~~~~~~~~~ Less: Charitable contributions ~~~~~~ Gross income (line 1 minus line 2) Cash prizes ~~~~~~~~~~~~~~~ Noncash prizes ~~~~~~~~~~~~~ Rent/facility costs ~~~~~~~~~~~~ Food and beverages ~~~~~~~~~~

GOLF TOURNAMENT
(event type) (total number)

(d) Total events

1 8,898. 7,598. 1,300.

(add col. (a) through col. (c))

81,452. 51,720. 29,732.

10,966. 4,140. 6,826.

101,316. 63,458. 37,858.

14,727.

3,924.

159.

18,810. 11,985. 30,795. ) 7,063.

$15,000 on Form 990-EZ, line 6a. Revenue

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(a) Bingo Yes % Yes No No

Part III

| 11 Net income summary. Combine line 3, column (d), and line 10 Gaming. Complete if the organization answered "Yes" to Form 990, Part IV, line 19, or reported more than (b) Pull tabs/instant bingo/progressive bingo

Y

8,531. 116. 3,338. 9 Other direct expenses ~~~~~~~~~~ 10 Direct expense summary. Add lines 4 through 9 in column (d) ~~~~~~~~~~~~~~~~~~~~~~~~ | (

Entertainment ~~~~~~~~~~~~~~

(c) Other gaming

(d) Total gaming (add col. (a) through col. (c))

1 2 3 4 5 6 7 8

Gross revenue

Direct Expenses

Cash prizes ~~~~~~~~~~~~~~~

Noncash prizes ~~~~~~~~~~~~~ Rent/facility costs ~~~~~~~~~~~~ Other direct expenses

%

Yes No

%

Volunteer labor ~~~~~~~~~~~~~

Direct expense summary. Add lines 2 through 5 in column (d)

~~~~~~~~~~~~~~~~~~~~~~~~ | |

(

)

Net gaming income summary. Combine line 1, column d, and line 7

9 Enter the state(s) in which the organization operates gaming activities: a Is the organization licensed to operate gaming activities in each of these states? ~~~~~~~~~~~~~~~~~~~~ b If "No," explain:

Yes

No

10a Were any of the organization's gaming licenses revoked, suspended or terminated during the tax year? ~~~~~~~~~ b If "Yes," explain:

Yes

No

132082 01-23-12

Schedule G (Form 990 or 990-EZ) 2011

82-0505073 Page 3 Schedule G (Form 990 or 990-EZ) 2011 GENESIS WORLD MISSION, INC. 11 Does the organization operate gaming activities with nonmembers?~~~~~~~~~~~~~~~~~~~~~~~~~~~ Yes No
12 Is the organization a grantor, beneficiary or trustee of a trust or a member of a partnership or other entity formed to administer charitable gaming? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 13 Indicate the percentage of gaming activity operated in: a The organization's facility ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ b An outside facility ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ 14 Enter the name and address of the person who prepares the organization's gaming/special events books and records: Name | Address | 15a Does the organization have a contract with a third party from whom the organization receives gaming revenue? ~~~~~~ b If "Yes," enter the amount of gaming revenue received by the organization | $ of gaming revenue retained by the third party | $ c If "Yes," enter name and address of the third party: Name | Address | . and the amount Yes No 13a 13b Yes No % %

Name | Gaming manager compensation | $ Description of services provided |

Director/officer

Employee

17 Mandatory distributions: a Is the organization required under state law to make charitable distributions from the gaming proceeds to retain the state gaming license? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

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Independent contractor

Y
Yes No Schedule G (Form 990 or 990-EZ) 2011

16 Gaming manager information:

b Enter the amount of distributions required under state law to be distributed to other exempt organizations or spent in the organization's own exempt activities during the tax year | $ Part IV Supplemental Information. Complete this part to provide the explanations required by Part I, line 2b, columns (iii) and (v), and Part III, lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also complete this part to provide any additional information (see instructions).

132083 01-23-12

SCHEDULE M (Form 990)
Department of the Treasury Internal Revenue Service

Noncash Contributions
J Complete if the organizations answered "Yes" on Form
990, Part IV, lines 29 or 30.

OMB No. 1545-0047

Name of the organization

J Attach to Form 990.

Open to Public Inspection Employer identification number

2011

Part I

GENESIS WORLD MISSION, INC. Types of Property
(a) (b) (c) Number of Noncash contribution Check if amounts reported on applicable contributions or items contributed Form 990, Part VIII, line 1g

82-0505073
(d) Method of determining noncash contribution amounts

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29

Art - Works of art ~~~~~~~~~~~~~ Art - Historical treasures ~~~~~~~~~ Art - Fractional interests ~~~~~~~~~~ Books and publications ~~~~~~~~~~ Clothing and household goods ~~~~~~ Cars and other vehicles ~~~~~~~~~~ Boats and planes ~~~~~~~~~~~~~ Intellectual property ~~~~~~~~~~~ Securities - Publicly traded ~~~~~~~~ Securities - Closely held stock ~~~~~~~ Securities - Partnership, LLC, or trust interests ~~~~~~~~~~~~~~

Real estate - Residential ~~~~~~~~~ Real estate - Commercial ~~~~~~~~~ Real estate - Other ~~~~~~~~~~~~ Collectibles ~~~~~~~~~~~~~~~~ Food inventory ~~~~~~~~~~~~~~ Drugs and medical supplies ~~~~~~~~ Taxidermy ~~~~~~~~~~~~~~~~ Historical artifacts ~~~~~~~~~~~~ Scientific specimens ~~~~~~~~~~~ Archeological artifacts ~~~~~~~~~~ Other J ( IN KIND GOODS ) Other Other Other

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X 14 X 24

Qualified conservation contribution - Other~

J J J

( ( (

) ) ) 29 Yes No

Number of Forms 8283 received by the organization during the tax year for contributions for which the organization completed Form 8283, Part IV, Donee Acknowledgement ~~~~

30a During the year, did the organization receive by contribution any property reported in Part I, lines 1-28 that it must hold for at least three years from the date of the initial contribution, and which is not required to be used for exempt purposes for the entire holding period? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ b If "Yes," describe the arrangement in Part II. 31 Does the organization have a gift acceptance policy that requires the review of any non-standard contributions? ~~~~~~ 32a Does the organization hire or use third parties or related organizations to solicit, process, or sell noncash contributions? ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ b If "Yes," describe in Part II. 33 If the organization did not report an amount in column (c) for a type of property for which column (a) is checked, describe in Part II. LHA For Paperwork Reduction Act Notice, see the Instructions for Form 990. Schedule M (Form 990) (2011) 30a 31 32a

Y
29,690. FAIR MARKET VALUE 2,362. FAIR MARKET VALUE X X X

Securities - Miscellaneous ~~~~~~~~ Qualified conservation contribution Historic structures ~~~~~~~~~~~~

132141 01-23-12

SCHEDULE O
(Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on Form 990 or 990-EZ or to provide any additional information. | Attach to Form 990 or 990-EZ.

OMB No. 1545-0047

Open to Public Inspection Employer identification number

2011

Name of the organization

GENESIS WORLD MISSION, INC.

82-0505073

FORM 990, PART VI, SECTION B, LINE 11: THE ORGANIZATION CONTRACTS WITH AN INDEPENDENT CPA WHO COMPLETES FORM 990 AND ALL RELATED SCHEDULES AFTER COMPLETION AND ACCEPTANCE BY THE BOARD OF THE INDEPENDENT FINANCIAL AUDIT. IT IS REVIEWED BY THE EXECUTIVE DIRECTOR. BECAUSE IT USUALLY NEEDS TO BE FILED IN A TIMELY MANNER IT IS SUBMITTED TO THE IRS BEFORE BOARD REVIEW OF THE 990 IS COMPLETE. A SUBMITTED COPY IS PROVIDED TO THE BOARD MEMBERS.

FORM 990, PART VI, SECTION B, LINE 15: COMPENSATION REVIEW IS PROVIDED BY

COMPENSATION FOR THE EXECUTIVE DIRECTOR IS SET BY THE BOARD OF DIRECTORS ANNUALLY.

FORM 990, PART VI, SECTION C, LINE 19: THE ORGANIZATION HAS FEW REQUESTS FROM THE PUBLIC FOR CONFLICT OF INTEREST POLICIES, FINANCIAL STATEMENTS, OR GOVERNING DOCUMENTS. REQUESTS FOR THESE ITEMS WOULD BE REVIEWED BY THE EXECUTIVE DIRECTOR FOR THE MERIT OF SUCH DISCLOSURE, OR WHEN REQUIRED BY FUNDERS. IN GENERAL, GENESIS WORLD MISSION MAINTAINS AN OPEN POLICY OF INFORMATION THAT IS NOT CONSIDERED CONFIDENTIAL (SUCH AS DONOR NAMES AND AMOUNTS) AND WILLINGLY PROVIDES INFORMATION DEEMED TO BE IN THE BEST INTEREST OF DISCLOSURE.

LHA For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
132211 01-23-12

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Y

THE EXECUTIVE BOARD IN DETAIL WHEN REVIEWING THE UPCOMING YEAR'S BUDGET;

Schedule O (Form 990 or 990-EZ) (2011)

Form

8868

(Rev. January 2012)
Department of the Treasury Internal Revenue Service

Application for Extension of Time To File an Exempt Organization Return
| File a separate application for each return.

OMB No. 1545-1709

¥ If you are filing for an Automatic 3-Month Extension, complete only Part I and check this box ~~~~~~~~~~~~~~~~~~~ | ¥ If you are filing for an Additional (Not Automatic) 3-Month Extension, complete only Part II (on page 2 of this form). Do not complete Part II unless you have already been granted an automatic 3-month extension on a previously filed Form 8868.

X

Electronic filing (e-file) . You can electronically file Form 8868 if you need a 3-month automatic extension of time to file (6 months for a corporation required to file Form 990-T), or an additional (not automatic) 3-month extension of time. You can electronically file Form 8868 to request an extension of time to file any of the forms listed in Part I or Part II with the exception of Form 8870, Information Return for Transfers Associated With Certain Personal Benefit Contracts, which must be sent to the IRS in paper format (see instructions). For more details on the electronic filing of this form, visit www.irs.gov/efile and click on e-file for Charities & Nonprofits.

Part I

Automatic 3-Month Extension of Time. Only submit original (no copies needed).

A corporation required to file Form 990-T and requesting an automatic 6-month extension - check this box and complete Part I only ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ | All other corporations (including 1120-C filers), partnerships, REMICs, and trusts must use Form 7004 to request an extension of time to file income tax returns. Type or print
File by the due date for filing your return. See instructions.

Name of exempt organization or other filer, see instructions.

Employer identification number (EIN) or

GENESIS WORLD MISSION, INC.
Number, street, and room or suite no. If a P.O. box, see instructions.

X

82-0505073

215 W 35TH STREET GARDEN CITY, ID

Social security number (SSN)

City, town or post office, state, and ZIP code. For a foreign address, see instructions.

Y

83714

Enter the Return code for the return that this application is for (file a separate application for each return) ~~~~~~~~~~~~~~~~~ Application Is For Form 990 Form 990-BL Form 990-EZ Form 990-PF Form 990-T (sec. 401(a) or 408(a) trust) Form 990-T (trust other than above)

0 1
Return Code 07 08 09 10 11 12

STEVEN REAMES ¥ The books are in the care of | 215 W 35TH STREET - GARDEN CITY, ID 83714 Telephone No. | (208)384-5218 FAX No. |

¥ If the organization does not have an office or place of business in the United States, check this box ~~~~~~~~~~~~~~~~~ | ¥ If this is for a Group Return, enter the organization's four digit Group Exemption Number (GEN) . If this is for the whole group, check this box | . If it is for part of the group, check this box | and attach a list with the names and EINs of all members the extension is for. 1 I request an automatic 3-month (6 months for a corporation required to file Form 990-T) extension of time until JANUARY 15, 2013 , to file the exempt organization return for the organization named above. The extension is for the organization's return for: calendar year or | | 2

X tax year beginning

JUN 1, 2011

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Return Code 01 02 01 04 05 06 Form 5227 Form 6069 Form 8870 , and ending

Application Is For Form 990-T (corporation) Form 1041-A Form 4720

MAY 31, 2012
Initial return Final return

.

If the tax year entered in line 1 is for less than 12 months, check reason: Change in accounting period

3a b c

If this application is for Form 990-BL, 990-PF, 990-T, 4720, or 6069, enter the tentative tax, less any nonrefundable credits. See instructions. If this application is for Form 990-PF, 990-T, 4720, or 6069, enter any refundable credits and estimated tax payments made. Include any prior year overpayment allowed as a credit. Balance due. Subtract line 3b from line 3a. Include your payment with this form, if required, by using EFTPS (Electronic Federal Tax Payment System). See instructions.

3a 3b 3c

$ $ $

0. 0. 0.

Caution. If you are going to make an electronic fund withdrawal with this Form 8868, see Form 8453-EO and Form 8879-EO for payment instructions. For Privacy Act and Paperwork Reduction Act Notice, see Instructions. LHA Form 8868 (Rev. 1-2012)
123841 01-04-12

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