Nonprofit Repositioning Fund Inquiry Form

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Introduction

Thank you for your interest in the Nonprofit Repositioning Fund. Please feel free to reach out to us at any time at lkijewski@seachangecap.org or (844) 869-7842 to discuss your situation directly before completing the form.

Contact Information

First Name

Last Name

Phone Number

Use format ###-###-####

Title

Organization

Website

Project Overview

Amount Requested from the Fund

Project Start Date

Anticipated Project End Date

Project Stage

ExplorationImplementation

How many organizations are involved in this project?

How do the organizations know each other? Check all that apply.

Overlapping board membersCommon fundersJoint programmatic workStaff connectionsOther

How long ago did the discussions begin?

Who first initiated the conversations?

Executive Director/President/CEOBoard member(s)Funder(s)Community leaders/organizationsOther

Is this the first time the organizations have been in discussions?

YesNo

Description of Lead Organization

Organization One Information

Organization Name

What type of organization are you?

Contact Information

First Name

Last Name

Title

Phone

Executive Director Information

First Name

Last Name

Title

Phone

Executive Director's Professional Bio

Street Address

City

State

Zipcode

Website

EIN

Use format ##-#######

Please briefly describe the organization's mission and core programs/services.

Please upload IRS 501(c)3 letter for Organization One

Financial and Personnel Information (Organization One)

How would you describe the organization's financial health?

In the most recent fiscal year, did the organization show a surplus, a deficit, or breakeven?

In the current fiscal year, do you expect a surplus, a deficit, or breakeven?

Primary reasons for considering this collaboration.

(Potential) departure of one or more Executive Directors/CEOsAdvancement of a shared goalCompetition for funding sources and/or clienteleDifficulty funding necessary technological initiativesDifficulty in meeting external standards/requirements imposed on our organizationFinancial problems/pressures within one or more of the partnering organizationsFunder initiated/mandated the collaborationHigh/increasing costsRequest by parent organizationResponse to a community needResponse to a funding opportunity

Do you receive, or have you received in the last three years, support from:

Comcast/NBC UniversalHealthSpark FoundationScattergood FoundationTD Charitable FoundationThe Barra FoundationThe Connelly FoundationThe Hummingbird FoundationThe Lodestar FoundationThe Philadelphia FoundationUnited Way of Greater Philadelphia and Southern New JerseyWilliam Penn FoundationNone of the above

Details of open grants with NRF participating funders

Please list the funder, project name, and amount for all open grants with the funders listed above.

Current & Prior Fiscal Year Operating Budgets

Current FY Operating Budget ($)

Number of FTEs

Number of PTEs

What percentage of the organization's staff identify as BIPOC?

Current Board Member List

What percentage of the organization's board identify as BIPOC?

Board Resolution

Please upload document with Board Resolution to pursue repositioning activities for Lead Organization

Primary Regions Served

Philadelphia CountyMontgomery CountyBucks CountyDelaware CountyChester CountySouthern New JerseyOtherCheck all that apply

Primary Field of Work

Recent Financial Statements (audit preferred)

Organization Two Information

Organization Name

What type of organization are you?

Contact Information

First Name

Last Name

Title

Phone

Executive Director Information

First Name

Last Name

Title

Phone

Executive Director's Professional Bio

Street Address

Town/City

State

Zipcode

Website

EIN

Use format ##-#######

Please briefly describe the organization's mission and core programs/services.

Please upload 501(c)3 letter for Organization Two

Financial and Personnel Information (Organization Two)

How would you describe the organization's financial health?

In the most recent fiscal year, did the organization show a surplus, a deficit, or breakeven?

In the current fiscal year, do you expect a surplus, a deficit, or breakeven?

Primary reasons for considering this collaboration.

Do you receive, or have you received in the last three years, support from:

Details of open grants with NRF participating funders

Please list the funder, project name, and amount for all open grants with the funders listed above.

Current & Prior Fiscal Year Operating Budgets

Current FY Operating Budget ($)

Number of FTEs

Number of PTEs

What percentage of the organization's staff identify as BIPOC?

Current Board Member List

What percentage of the organization's board identify as BIPOC?

Board Resolution

Please upload document with Board Resolution to pursue repositioning activities for Collaborating Organization

Primary Regions Served

Philadelphia CountyMontgomery CountyBucks CountyDelaware CountyChester CountySouthern New JerseyOtherCheck all that apply

Primary Field of Work

Recent Financial Statements (audit preferred)

Organization Three Information

Organization Name

What type of organization are you?

Contact Information

First Name

Last Name

Title

Phone

Executive Director Information

First Name

Last Name

Title

Phone

Executive Director's Professional Bio

Street Address

Town/City

State

Zipcode

Website

Please type the full address in this format: http://www.seachangecap.org

EIN

Use format ##-#######

Please briefly describe the organization's mission and core programs/services.

Please upload 501(c)3 letter for Organization Three

Financial and Personnel Information (Organization Three)

How would you describe the organization's financial health?

In the most recent fiscal year, did the organization show a surplus, a deficit, or breakeven?

In the current fiscal year, do you expect a surplus, a deficit, or breakeven?

Primary reasons for considering this collaboration.

Do you receive, or have you received in the last three years, support from:

Details of open grants with NRF participating funders

Please list the funder, project name, and amount for all open grants with the funders listed above.

Current & Prior Fiscal Year Operating Budgets

Current FY Operating Budget ($)

Number of FTEs

Number of PTEs

What percentage of the organization's staff identify as BIPOC?

Current Board Member List

What percentage of the organization's board identify as BIPOC?

Board Resolution

Please upload document with Board Resolution to pursue repositioning activities for Collaborating Organization

Primary Regions Served

Philadelphia CountyMontgomery CountyBucks CountyDelaware CountyChester CountySouthern New JerseyOtherCheck all that apply

Primary Field of Work

Recent Financial Statements (audit preferred)

Organization Four Information

Organization Name

What type of organization are you?

Contact Information

First Name

Last Name

Title

Phone

Executive Director Information

First Name

Last Name

Title

Phone

Executive Director's Professional Bio

Street Address

Town/City

State

Zipcode

Website

Please type the full address in this format: http://www.seachangecap.org

EIN

Use format ##-#######

Please briefly describe the organization's mission and core programs/services.

Please upload 501(c)3 letter for Organization Four

Financial and Personnel Information (Organization Four)

How would you describe the organization's financial health?

In the most recent fiscal year, did the organization show a surplus, a deficit, or breakeven?

In the current fiscal year, do you expect a surplus, a deficit, or breakeven?

Primary reasons for considering this collaboration.

Do you receive, or have you received in the last three years, support from:

Details of open grants with NRF participating funders

Please list the funder, project name, and amount for all open grants with the funders listed above.

Current & Prior Fiscal Year Operating Budgets

Current FY Operating Budget ($)

Number of FTEs

Number of PTEs

What percentage of the organization's staff identify as BIPOC?

Current Board Member List

What percentage of the organization's board identify as BIPOC?

Board Resolution

Please upload document with Board Resolution to pursue repositioning activities for Collaborating Organization

Primary Regions Served

Philadelphia CountyMontgomery CountyBucks CountyDelaware CountyChester CountySouthern New JerseyOtherCheck all that apply

Primary Field of Work

Recent Financial Statements (audit preferred)

Exploration: Collaboration Background and Status

Collaboration Type

Back Office Consolidation - by contract or agreementBack Office Consolidation - creation of a new organizationProgrammatic Joint VentureMerger - fully integrated, including those with some brand independence retainedMerger - merged governance, management, programs, and operation with separate corporate structuresAllianceAcquisitionIdentify the option that best describes the type of collaboration being explored.

Briefly describe the working relationship between the collaborating organizations.

What prompted you to consider a collaboration at this time?

Who initiated these discussions and when?

Briefly describe any confidentiality concerns regarding these deliberations.

Exploration Benefits and Risks

Potential Benefits of Collaboration

How might the collaboration meaningfully change the ways the organizations involved will operate?

What can you accomplish together that you cannot do separately?

Potential Impact

What might the potential impact of these changes be on the individuals/communities served?

How do you anticipate this potential collaboration will impact other competitors in the space?

Potential Challenges of Collaboration

Please identify any potential challenges this collaboration presents. Select up to 3.

Accepting changeAchieving a shared visionClarifying partner rolesConcerns about risk/managementConflict and/or lack of trust among partnersCoordinating/merging/integrating operationsCoordination/integration of programs and servicesCosts of collaborationCreating a shared cultureDefining and measuring successFacing competitive factors in the operating environmentInadequate staff time available for leading and/or managing collaborationInternal and external communicationRaising funds or integrating fund development to support collaborationReaching agreement in marketing/brandingRetaining staff or staff departuresZoning/development of physical (shared) space

Essential Questions

What essential questions must be answered before your organizations can make the decision to implement a formal collaboration?

To the extent possible, identify the sequence by which you need to answer these questions (e.g. what questions must you answer first before deciding whether to proceed further in the exploration)?

Exploration: Technical Assistance Requested

Describe the technical assistance (TA) support that is being requested from the Fund.

To conduct financial due diligenceTo draft the governing agreement or provide other legal adviceTo facilitate negotiations that might support the formation of the collaborationTo advise on human resources, benefits, or compensationTo determine the value of assets (intellectual or physical property)To develop a business or strategic plan for the collaborationTo assess fundraising implications of potential collaborationTo assess branding implications of potential collaborationOther

Identify the name, cost, and timing for each technical assistance provider.

What other sources of support have/will you obtain for this collaboration, including in-kind support?

Copy of TA provider proposal(s)

Implementation Plan

Collaboration Type

Provide an overview of the implementation plan detailing the scope of the collaboration, timing, and other critical information. Include the answers to these key questions: What prompted your organizations to consider a collaboration at this time? What can your organizations do together that they cannot do separately? How does collaborating meaningfully change the ways the organizations involved will operate? What impact might this collaboration have on the individuals/communities currently served by the organizations? How will this impact other competitors in the space?

Briefly describe any confidentiality concerns regarding these deliberations.

List five expected outcomes and associated metrics you hope to achieve from this collaboration over the next two years.

Describe any alternatives to formal collaboration explored by the organizations.

Please upload the post-implementation operating budget projections for the newly formed entity or other formal structure(s). Must include operating budget projections and narratives for first and second years following implementation.

Describe the potential business risks and possible mitigants produced by this collaboration.

Describe the integration challenges this collaboration has experienced to date.

Please identify any potential challenges this collaboration presents moving forward. Select up to 3.

Accepting changeAchieving shared visionClarifying partner rolesConcerns about risk managementConflict and/or lack of trust among partnersCoordinating/merging/integrating operationsCoordination/integration of programs and servicesCosts of collaborationCreating a shared cultureDefining and measuring successFacing competitive factors in the operating environmentInadequate staff time available for leading and/or managing collaborationInternal and external communicationRaising funds or integrating fund development to support collaborationReaching agreement in marketing/brandingRetaining staff or staff departuresZoning/development of physical (shared) spaceOther

Implementation Costs

Describe any technical assistance (TA) support and other one-time costs associated with this collaboration that is being requested from the Fund.

Provide an itemized budget detailing the full cost of the implementation. Budget must include name, function, and associated cost for each TA provider or vendor; amount requested from the Fund; and other sources of secured or pending support (including in-kind).

Please upload all proposals from TA providers and other vendors selected to support implementation efforts.

Thanks for your interest

We take confidentiality very seriously. However, in order to move forward with a grant or loan we will need to seek approval from certain of our funding partners. Do we have your permission to share your information with our funders at this time?

We strive to be respectful of the scare time of our potential nonprofit partners. How long did this form take you to complete?

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