BoardsWork! 2.0 Assessment Form for Executive Director

BoardsWork! 2.0 Assessment Form for the Executive Director

On behalf of the Covestro Center for Community Engagement, thank you for being a supporter of effective, purposeful board governance by participating in the BoardsWork! program. We ask that you complete this assessment within two weeks of receiving it, as your input will be used to help shape the agenda for your customized retreat. Please complete this form in its entirety and separately from the Board Chair. Thank you for your service and commitment to your organization’s mission and values. We look forward to working with you to build a productive retreat and stronger nonprofit.

Organizational Information

Today's Date

Organization

Name and Title (if title is different than "Executive Director")

Phone

Nonprofit Website Address

Organizational Overview

Please complete this section as an update from your last BoardsWork! retreat.

Mission Statement

What is your organization's mission statement? Has it changed since your last retreat?

Annual Budget

Fiscal Year-End Date

Number of Full-Time Staff

Number of Part-Time Staff

Number of Volunteers

I certify the following criteria: *

The nonprofit is a still a registered 501(c)(3) in the Commonwealth of Pennsylvania

The nonprofit is currently in good, active status with the IRS

The nonprofit operates with a governing board of directors

The nonprofit has at least 5 active board members

at least 75% of the board will attend the upcoming BoardsWork! retreat

Board Information and Practices

Number of Board Members

How often does the Board of Directors meet? *

What percentage of the Board of Directors attends board meetings? *

If the Board meets in executive session on a regular basis, how often does this occur? *

What are the current board committees, and how often do each of them meet? *

If the board has terms and/or term limits, what are they? *

How is the Board evaluated? *

Do board members receive relevant materials in advance of meetings? *

Yes

Are written minutes of each board meeting are kept and sent to every board member? *

Yes

Does the board have position descriptions for board officers, chairpersons and members? *

Yes

Does the board have an active Conflict of Interest Policy? *

Yes

What is the current process used to attract, train, retain and rotate board members? Does it include recruiting new members with the goal of increasing diversity (age, race, gender, skills, etc.)? *

Human Resources Management

How does the board set goals for and evaluate the Chief Executive? *

Does the board ensure that adequate personnel policies and procedures, including grievance mechanisms, are in place and review them annually? *

Yes

Does the board have an executive succession plan in place? *

Yes

Strategic Planning

Has the board developed a mission statement that accurately reflects and guides the organization? *

Yes

Has the board developed a set of core values that guide the day-to-day operations of the organization? *

Yes

Has the board created a strategic plan within the past 3 years? *

Yes

Does the board use the strategic plan to set program priorities, with staff and stakeholder input? *

Yes

Finances and Taxes

Does the board review and approve the organization's annual budget? *

Yes

Are strategic financial goals set annually? *

Yes

Does the board ensure that financial records are kept and maintained according to generally accepted accounting standards? *

Yes

Do board members receive financial statements at least quarterly for review and approval? *

Yes

Does the board ensure that the organization has an annual audit (or review, as appropriate) that includes a management letter? *

Yes

Does the board ensure that federal tax forms are filed as required and in a timely manner? *

Yes

Fundraising

If your board requires an annual financial contribution, what are the parameters? *

Does the board set fundraising targets and goals? *

Yes

Do board members participate in the solicitation of individual and corporate gifts and foundation grants, as well as in securing government contracts (if applicable)? *

Yes

Does the board attend the majority of events? *

Yes

Does each board member act as an ambassador to the community on behalf of the organization? *

Yes

Has the Board designated a chief spokesperson(s), whether a board or staff member? *

Yes

Legal and Ethical Integrity

Does the board adhere to, review and amend its bylaws on a regular basis? *

Yes

Does the organization have a mission consistent with and work within its Articles of Incorporation and tax-exempt status? *

Yes

Does the Board ensure adherence to local, state and federal laws and regulations that apply to nonprofit organizations? *

Yes

Does the Board ensure that accurate and timely reports required by federal, state and local government agencies, including the IRS Form 990, are filed and made available? *

Yes

Does the Board carry needed levels of insurance to cover its facilities, clients, employees and volunteers, including D&O insurance? *

Yes

Additional Information

What do you see as the 3 most challenging issues facing your organization currently? *

Please list 3 possible dates and times for your 4-hour BoardsWork! Retreat (starting approximately 45 days from today's date). *

Note: Meeting Wizard and Doodle Poll are free and helpful tools that can help you find a date that best works for your board.

Additional Comments or Explanations

Please upload the following documents in PDF format.

If you are unfamiliar with converting documents to PDF, please visit http://bit.ly/192Wgqn for an easy, step-by-step tutorial.

Current Operating Budget

Current By-laws

Board Roster (with Names & Affiliations)

Thank you for taking the time to answer these important questions. Click the “Submit” button once to submit your responses. Please note that uploading files may take a few minutes.

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