BASICS APPLICATION PACKAGE STANDARDS FOR EXCELLENCE®

The application package and checklist for the Standards for Excellence® voluntary Basic Legal and Regulatory Review and recognition program consists of this form and attachments that the organization will supply and label according to these instructions. Staff may request additional documentation or information for clarification purposes. Please read the Standards for Excellence® and this application package thoroughly before beginning the application process. For questions and concerns, please contact PANO staff. This application is for use by applicants who will be applying for Basic Legal and Regulatory Review as a standalone review or as a step toward applying for full accreditation. For those moving on to full accreditation, before submitting a Full accreditation application, the organization should review the previous sections and provide updated information. Any policies that have been reviewed or updated and any required board actions that have taken place in the ensuing period should be edited. GENERAL GUIDELINES Respond to all questions. If the question is not applicable to your organization, you must provide an explanation. Each attachment requested should be uploaded as one PDF, Word or Excel document. Use discretion with the amount of material uploaded. Provide enough information to respond to the question thoroughly and provide adequate samples, but don't go overboard. Your information should be well-organized and information provided should demonstrate understanding of the concepts involved. You may move through the pages of the application freely, but prior to submitting your application, ensure that all required responses are included. Incomplete applications will be returned to the applicant. If you run out of room in the text response boxes in the application, provide any necessary further explanation in the attachments uploaded.

ORGANIZATION INFORMATIONOrganization Name

 

Street Address 

City 

State Pennsylvania

Zip 

Phone Number 

Is the organization known by any other names or acronyms? 

Basic ProfileWebsite address:

 

Number of paid staff (full time): 

Number of paid staff (part time): 

Number of volunteers (not including board members): 

Total expenditures (last fiscal year completed): 

Organization's fiscal year runs from ___ to ____ 

Number of board members (independent of staff) 

Date of Incorporation 

EIN# 

Basic Legal and Regulatory Review

I. MISSION AND PROGRAM

A. Mission

Type the organization's mission statement.

 

Mission Review: Provide the board minutes documenting the board’s most recent review of the mission statement. The Standards state that this review should occur every 3-5 years.

 

B. Organizational Evaluation

Describe the organization's current activities/programs, indicating how activities are consistent with the organization's mission statement.

 

C. Program Evaluation

Describe the framework for how each of the organization's programs will be or are evaluated. You should provide a response to each question below for each program. The applicant should demonstrate that data collection has begun for each of the programs. What data is collected (qualitative and quantitative);

 

How you measure outcomes in relation to costs (programmatic efficiency); 

How you evaluate outcomes for program participants (programmatic effectiveness);  

How the evaluation methods involve program participants; 

How the evaluation methods are cost effective; 

Why one or all of the above of the above measures are not appropriate for your organization;  

How your evaluation system is used to strengthen and improve your organization. In other words, describe the feedback loop your organization has in place for using evaluation to measure progress toward achieving your mission.

 

Program Evaluation Documents: Applicants are encouraged to attach any evaluation tools (reports, questionnaires, templates) that provide further evidence of the organization's program evaluation planning or efforts. (Please use discretion with the number of pages submitted. Provide just enough information for us to verify your description of your evaluation efforts. All sample documents should be scanned or saved to one PDF and uploaded).

 

D. Program Service

Confidentiality Documents: For organizations serving individuals and/or families, attach a copy of the organization's policies regarding program participants and treatment of participants' confidential information.

 

II. GOVERNING BODY

A. Board Responsibilities

Board Minutes: Attach copies of board minutes from the last 12 - 18 months. Your submission should include a full fiscal year of operations and should include the minutes for the board meeting immediately prior to your application. You may need to provide board minutes for a period of time longer than a calendar year in order to include a full fiscal year.

 

Has the board delegated decision making authority to a committee in any specific subject areas (e.g., executive, HR, finance)?

Yes

No

If so, what areas?

 

Are decisions made by committees with decision-making authority reported to the full board?

Yes

No

Committee Minutes: Attach copies of committee minutes for any committees listed above. The minutes should span a full fiscal year of operations.

 

For the board and any committee minutes attached, indicate the date and page of the following Standards-required board decisions.

Date Page

Board's resolution indicating that the organization will apply for the Basic Legal and Regulatory Review recognition

   

Board’s approval of the organization's most recent budget.    

Board’s approval of the organization's most recent audit. (If the organization has annual revenue in excess of $500,000 or financial review for budgets over $300,000, compilation for budgets over $100,000)

   

Board's most recent evaluation of the executive director.    

Board's most recent approval of executive director's compensation package.    

Who is responsible for the board minutes? 

Where are the board minutes kept? 

Budget Documents: Attach the organization's most recently approved operating budget and capital budget (if applicable).

 

Please indicate year the current executive director was hired.

 

If the board hired an executive director in the last three years, describe the process.

 

Describe the executive director's compensation package.

 

Executive Director Contract: Enclose a copy of the executive director’s contract (if one exists)

 

B. Board Composition

Board List: Attach a list of current board members with the following information for each member: name, principal employer, occupation, special skills and the date each board member's term expires. Clearly mark the board officers and any employees who serve on the board.

 

Board IndependenceAre any board members related by blood or marriage? Yes

No

If so, please explain. (Standard IIB3) 

Are any board members related to staff members by blood or marriage? Yes

No

If so, please explain. (Standard IIB3) 

Do any employees serve as voting members of the board? Yes

No

If so, describe the circumstances that insure that the employee(s) are not in a position to exercise undue influence.  

Do board members receive compensation for serving as board members (not including out of pocket expenses directly related to their board service)?

Yes

No

If so, please provide details of the compensation arrangement. 

C. Board Conduct

Attach a copy of the organization's bylaws.

 

Indicate below page numbers for the following clauses:Term of service for board members

 

Attendance for board members (this may be included in the Board Responsibilities document.)  

Participation for board members 

Consequences for noncompliance with board policies (this may be included in the Board Responsibilities document.)  

Board Expectations: Provide any documents that outline expectations for board members.

 

Board Minutes: If the above items are addressed in a policy, attach the board minutes which show approval of the policy which addresses these required elements.

 

III. CONFLICT OF INTEREST

Conflict of Interest Policy: Attach a copy of the organization's conflict of interest policy which covers board and staff and volunteers with significant independent decision making authority and identifies conduct or transactions that raise concerns, outlines procedures for disclosure of actual and potential conflicts and provides for transaction review by uninvolved members of the board.

 

IV. HUMAN RESOURCES

A. Personnel Policies

Does the organization have full-time or part-time paid employees?Yes

No

Are any staff members related to one another by blood or marriage?Yes

No

If so, please explain how your organization ensures that no supervisory relationship exists between related staff members.

 

Personnel Policies: Attach a copy of the organization's personnel policies.

 

What year did the board last review the personnel policies?

 

Board Minutes: Attach the board minutes showing the board's approval of the personnel policies.

 

Indicate pages in personnel policies that address the following topics: Working conditions

 

Employee benefits 

Vacation 

Sick leave 

Employee evaluation 

Problem solving/grievance procedures 

Confidentiality of employee, client and organization records and information page  

Growth and development 

D. Employee Orientation

Do all employees have position descriptions outlining their duties and responsibilities?

Yes

No

Job Descriptions: Please provide two sample position descriptions or job descriptions: (1) Position description for nonexempt employee and (2) Position description for exempt employee.

 

V. FINANCIAL and LEGAL

A. Financial Monitoring

Form 990: Attach a copy of the organization's Form 990 Internal Revenue Service filing for the past year.

 

Audit: If the organization has annual revenue in excess of $500,000 (compilation for over $300,000 or review for over $100,000), provide a copy of the organization's audit for the past year (including management letter, if any) conducted by a Certified Public Accountant. If a management letter was issued, provide a copy of management's response.

 

Describe how the board (at least quarterly) reviews material variations between actual and budgeted income and expenses.

 

Internal Financial Statements: Attach the four most recent quarterly internal financial statements or reports reviewed by the board as described above. At a minimum these need to include a Statement of Activities (Income/Expense) and Statement of Financial Position (Balance Sheet). These should span one year.

 

B. Financial Policies

Describe how the organization provides employees, board members and volunteers with a confidential means to report known or suspected financial improprieties or misuse of organization funds

 

Whistleblower Policy: Attach a copy of the organization's whistleblower policy.

 

Financial Policies: Attach the written procedures addressing internal controls.

 

C. Legal Compliance and Accountability

Describe how the organization monitors changes in legal, regulatory, and financial requirements.

 

Describe how the organization internally reviews its compliance with existing legal, regulatory and financial requirements. Include a description of persons or positions responsible for various compliance areas. Areas need to include but are not limited to those on the PANO Legal Checklist.

 

Provide document described above (e.g. checklist or procedure utilized).

 

Does the organization carry general liability insurance?Yes

No

General Liability Insurance: Attach a copy of the declaration page covering the current period. If the organization does not carry insurance, attach a copy of the board minutes which show the board's decision to decline insurance.

 

Does the organization carry directors and officers insurance?Yes

No

Directors and Officers Insurance: Attach a copy of the declaration page covering the current period. If the organization does not carry insurance, attach a copy of the board minutes which show the board's decision to decline insurance.

 

Document Retention: Provide a copy of the organization’s document destruction/retention policy and schedule.

 

Is there any other information that the Standards for Excellence reviewers should know about the health of the organization and if it will continue to stay in business in the future?

Yes

No

If so, please describe.

 

VII. FUNDRAISING

Does the organization solicit funds outside its own state?Yes

No

List the states where the organization solicits funds.

 

Is the organization properly registered in all required jurisdictions where it is required?

Yes

No

Fundraising Registration: Attach copies of documents illustrating that the organization is properly registered in all states where it solicits donations. Please provide the Bureau of Charitable Organization Registration Certificate, if applicable.

 

Solicitations: Attach a template of the organization's solicitation material that includes all required disclosure

 

Fundraising Receipts: Attach one copy of a sample or template (for future use) fundraising receipt including all required disclosures.

 

B. Fundraising Policies

Fundraising Policies: Provide copies of the organization's fundraising policies.

 

Indicate the pages which address the following topics:Privacy of donors

 

Confidentiality of information donors reasonably would expect to be private  

Provision for donors to state that they prefer to remain anonymous and that their name, the amount of their gift, or other information not be publicly released

 

Provision for donors to have their names removed from any mailing lists other than the organization's  

Honor requests by a donor to curtail repeated mailings or telephone solicitations generated from in-house lists  

Ensure that personal solicitations are free from undue influence or excessive pressure, and are respectful of the needs and interests of the donor or potential donor

 

How the organization ensures that it complies with donor restrictions 

C: Fundraising Personnel and Consultants

Are the organization's fundraising personnel, either employees or independent consultants, compensated based on a percentage of the amount raised or other commission formula?

Yes

No

If the answer is “yes” provide an explanation.

 

Has the organization hired an outside professional fundraising counsel or professional solicitor in the past three years?

Yes

No

Fundraising Contracts: Attach any contracts signed with outside fundraising consultants or professional solicitors, other than grant writers.

 

If required in the state where the fundraising consultant or professional solicitor was hired, attach a copy of the documentation which provides evidence they are registered with the state.

 

VIII. PUBLIC AFFAIRS AND PUBLIC POLICY

A. Advocacy and LobbyingAdvocacy is defined as "active support...(for)...a cause, idea, or policy." (American Heritage Dictionary) while lobbying is considered a special type of advocacy. Lobbying is specifically defined by federal, state, and local laws and generally consists of communications that are intended to influence specific legislation (Please consult applicable laws and regulations for details).

Does the organization engage in advocacy?Yes

No

If so, provide a description of the organization's advocacy activities.

 

Do the organization’s executive director, staff, or board members lobby on behalf of the organization?

Yes

No

Does the organization have a paid lobbyist?Yes

No

If activity is above the registration threshold, are all lobbyists for the organization registered with applicable federal, state and local lobbyist’s registration agencies?

Yes

No

Please provide an explanation of their lobbying activities for the past fiscal year and whether they are appropriately registered in PA and/or with the federal government if activity is above the registration threshold. . Please note: Pennsylvania's Lobbying Registration and Disclosure Act requires organizations and individuals that spend more than $2,500 per calendar quarter on lobbying or advocacy communications to influence state government decisions to register as lobbyists with the PA Department of State, track their communications activities and disclose their expenses quarterly. Failure to comply could result in civil or criminal penalties. [Act 134 of 2006: 65 Pa.C.S. §1301-A, et seq.] [Regulations: 51 Pa. Code §51.1 et seq.] See PANO Legal Checklist for more details. Organizations lobbying at the federal level must follow registration requirements with the Clerk of the US House of Representatives and with the Secretary of the US Senate.

 

For any internal or external parties that lobby on behalf of the organization, provide evidence that they are registered with the appropriate local, state, or federal authorities, if required.

 

C. Promoting Public Participation

Describe how the organization assures that it does not participate or intervene in any political campaign on behalf of or in opposition to any candidate for public office. (Standards VIIIC1). Reference any policies (advocacy policy, personnel policies) which describe this practice.

 

IX. ADDITIONAL DISCLOSURES

Are there currently, or has there been in the last five years, any lawsuits or formal administrative complaints (such as Equal Employee Opportunity Commission, complaint pending before a regulatory body) brought against the organization?

Yes

No

If so, please describe such lawsuits or administrative complaints (or any pending administrative complaints or lawsuits). Address the following: (1) involvement of senior staff as subjects of lawsuit(s); (2) board involvement responding to the lawsuit(s); and (3) finding of liability or guilt.

 

Has your organization been the subject of any negative or unfavorable print or electronic media in the last year?

Yes

No

Unfavorable Media: If so, please attach.

 

If so, please describe.

 

IRS Determination Letter: Attach a copy of the organization’s IRS determination letter.

 

Articles of Incorporation: Attach copy of the organization’s Articles of Incorporation and any related Articles of Amendment.