FORM 1023-EZ for GENESIS INCORPORATED

Field Data
EIN 80-0965193
Case Number EO-2014316-000201
Form 1023-EZ version 62014
Eligibility Worksheet 1
Organization Name GENESIS INCORPORATED
Organization’s Mailing Address 907 15TH STREET
City DES MOINES
State IA
ZIP 50314-1716
Accounting period End 12
Primary contact name SAM GABRIEL
Primary contact phone [Hidden]
Primary contact phone extension [Hidden]
Primary contact fax [Hidden]
User fee submitted $400.00
Officer/Director/Trustee One

SAM GABRIEL
DIRECTOR
907 15TH STREET
DES MOINES IA 50314-1716

Officer/Director/Trustee Two

GAYLA NESBITT
DIRECTOR
907 15TH STREET
DES MOINES IA 50314-1716

Officer/Director/Trustee Three

FRANCIS BOGGUS
DIRECTOR
907 15TH STREET
DES MOINES IA 50314-1716

Officer/Director/Trustee Four

SETH MOULTON
DIRECTOR
907 15TH STREET
DES MOINES IA 50314-1716

Officer/Director/Trustee Five

SUSAN BROWN
DIRECTOR
907 15TH STREET
DES MOINES IA 50314-1716

Organization’s website
Organization’s email
Organization Incorporated Yes
Organization trust No
Necessary Organizing Documents Yes
Organization Incorporation Date 12/5/2013
Organization Incorporation State IA
Contains Limitation Yes
Does not expressly empower Yes
Contains dissolution Yes
National Taxonomy of Exempt Entities (NTEE) code O50 - Youth Development Programs, Other
Organization’s purpose Charitable: Yes
Religious: No
Educational: Yes
Scientific: No
Literary: No
Public Safety: No
Amateur Sports: No
Cruelty Prevention: No
Qualify For Exemption No
Legislation influence No
Compensation of Officer director trustee No
Donation of funds No
Conducting Activities Outside of United States Yes
Financial transactions with officers No
Unrelated Gross Income $1,000 or More No
Gaming Activity No
Disaster relief assistance No
One Third Support Public Yes
One Third Support Gifts No
Benefit of College No
Private Foundation 508(e) No
Seeking Retroactive Reinstatement No
Seeking Section 7 Reinstatement No
Correctness Declaration Yes
Signature Name
Signature Title
Signature Date

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