Transition and Renewal Stage General Operating Support Application by 50A1Mpa2


									Organization:                                    Counties Served:
Date:                                            incorporated:
Director:                                        Tax ID #:
Address:                                         City, State, ZIP:
Phone No.                                        Website URL:

Email address:
Fiscal Sponsor                                   Fiscal Sponsor's
(if applicable)                                  Tax ID #:
FS Address:                                      City, State, ZIP:
FS Phone No.                                     FS Website URL:

FS Fax No.                                       FS Email address:

Your organization MUST complete the online Eligibility Wizard in order to
submit an application. Have you completed the Eligibility Wizard on The                          YES        NO
Philadelphia Foundation's website? Click in the appropriate box to the right.

                                         Up to 8% of the organizations' budget (up to no more than
                                        $40,000) may be supported. Awards are then based on budget
Request Amount:         $               size and overall application score.
Has your organization incurred any
deficits in the past three years?                              If YES, Please briefly explain in the box provided
                                                      No       below.

     Organizational Budget*
                                              REVENUE                 EXPENSE           Surplus/(Deficit)

                       Current year
                      Previous year
                       2 years prior
                       3 years prior

*Refer to organization’s audited financials or completed 990 in reflecting revenue and expense in previous years.
Current year’s figures can be based on budget forecast.

Populations Served
What percentage of the constituency you serve or represent could be classified as low-income?
What is the methodology used to determine the figure quoted above?

Check any that apply and indicate what percentage of your constituency, where appropriate.

     Immigrants            %        Disabled             %            Terminal Illness        %
     Incarcerated           %       Seniors              %            Women                  %
     History of abuse        %      Mental Illness       %            Substance Abuse             %
     LGBTI        %                 Blind         %

    Infants (0-3)       %                 Adults          %
    Children (3-12)       %               Elderly         %
    Teenage Youth (13-19)          %

What is the total number of unduplicated individuals served or represented by your
organization's programs and services in the past year?

Mission of organization:

Overview of organization's history, programs and activities:

Financial Information
Describe your business model: asset allocation, sources and types of income, cost centers,
revenue generating activities (earned and contributed).

How is your capital structure related to your financial planning? (For instance, if you own or
manage a building, do you maintain a building reserve fund?)

Describe the checks and balances used in ensuring segregation of financial responsibilities.

Briefly describe the role of your board in understanding and contributing to the financial
condition of your organization.

Describe your current financial systems: your budget development process, budget forecasting,
accounting systems, and systems for cash flow, investments, budget reviews; and staffing for
this work. What is the role of volunteers?

Describe how your organization evaluates the success of its programs, include how data is
collected and how often. If you evaluate your program, describe how the organization uses that
evaluation to identify strengths and weaknesses in the program.
Please provide an explanation.

 High Performance Standards for Leadership Capacity
 Transition/Renewal Stage

  Leadership                                                               Organizational
   Organization retires some veteran board members who are not               YES            NO
 engaged and adds new board members who support the renewal effort.

   Organization affirms or revises its mission, vision, and values, and
                                                                             YES            NO
 they are well understood by board, staff, and volunteers.

   The board plays a hands-on role during the renewal effort and             YES            NO
 ensures the financial viability of the organization.

   Chief executive is adept at managing a turnaround process.                YES            NO

   Board determines if chief executive is able to renew the organization
                                                                             YES            NO
 and, if necessary, hires a new chief executive who is more able to do

 Use this space for any other comments you may have on your organization's leadership capacity.

 High Performance Standards for Adaptive Capacity
 Transition/Renewal Stage

 Adaptive                                                                  Organizational
   Organization re-establishes connections among community leaders,           YES           NO
 funders, and constituents and reassesses needs among constituents.

  Organization conducts comprehensive needs assessments using
                                                                              YES           NO
 market research methods.


 Organization candidly assesses itself, recognizes the need for             YES           NO
organizational renewal, identifies critical areas for organizational
improvement, and incorporates this thinking into a renewal process.

  Organization conducts program evaluation and uses the results to
                                                                            YES           NO
inform and revise programs as part of renewal effort.

 Staff and board revamp and improve systems for integrating and             YES           NO
using data from needs assessment, organizational assessment,
program evaluation, and other sources, and relating it to the
organizational renewal effort.

  Organization affirms or revises a theory of change.                       YES           NO

  Organization creates a turnaround plan that has clear goals and           YES           NO
objectives and creates an annual operating plan based on it.

  Organization has a plan for restoring the confidence of dedicated
                                                                            YES           NO
funders and enlisting the support of new ones so that the organization
stabilizes financially.
  Organization maintains relationships with other organizations,            YES           NO
develops new relationships, and considers collaborations and
partnerships as a part of its renewal effort;
  Use this space for any other comments you may have on your organization's adaptive capacity.

High Performance Standards for Management Capacity
Transition/Renewal Stage

Management                                                               Organizational
  Organizational leaders revise staff job descriptions and restructure     YES            NO
staff to reflect plan to renew the organization.

  Organizational leaders freely share information with all staff about     YES            NO
the organizational renewal efforts.


  Organizational leaders assess the financial situation frequently,           YES            NO
strengthen financial controls, and ensure that the organization is living
within its means.
  Organization continues to maintain a well-developed accrual
                                                                              YES            NO
accounting system and creates quarterly financial reports and annual
audited financial statements.
                                                                              YES            NO
  Organization has adequate human resources to handle the financial
management function during the renewal effort and may need to hire a
new staff person to handle the financial management function and/or
replace the outside auditor.
  Use this space for any other comments you may have on your organization's management

High Performance Standards for Operational Capacity
Transition/Renewal Stage

Operational                                                                 Organizational
  Organization has skills to revise programs to be responsive to needs        YES            NO
as part of organizational renewal effort.

  Organization has skills to evaluate programs to inform decisions            YES            NO
about program revisions.

  Organization has skills to effectively maintain and develop strong          YES            NO
connections with constituents, and revise outreach and advocacy
efforts as part of organizational renewal effort.
  Organization has legal skills necessary for the organization, such as
                                                                              YES            NO
for renegotiating debt with creditors, restructuring, or terminating
  Organization has skills to reassure current funders and maintain their      YES            NO
support, and enlist new ones to support the renewal effort.

  Organization has ability to maintain or increase any earned income          YES            NO
during renewal effort.

   Organization has skills to manage, operate, and maintain its facilities,                 YES             NO
 such as by consolidating space, selling property, or subletting.

   Organization has skills to use and manage technology to support the                      YES             NO
 organization’s renewal efforts.

   Use this space for any other comments you may have on your organization's operational

For your application to be considered, you must include your supplemental materials.
• A copy of 501c3 designation letter
• Current year budget with detailed income sources, expenses and the most current year-to-date P&L statement
• Executive Summary of most recent Strategic/Business Plan (no more than 2 years old)
• Audits for the past three years. (If none are available, please submit 990s for past three years)
• Current list of Board of Directors and their affiliations
• Current bios of key staff members
• A current copy of the PA Bureau of Charitable Organizations Certificate
Please upload this form as well as a copy of the documents listed above to: General Operating Services Drop Box
If you have any questions, please call Grantmaking Services 215-563-6417


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