Department of the Treasury Internal Revenue Service
Public Charity Status and Public Support
Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
Attach to Form 990 or Form 990-EZ. See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
Penn Foundation Inc
Employer identification number
23-1496225
Part I
Reason for Public Charity Status
(All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II, or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the supported organization?
................
11g(i)
(ii)
A family member of a person described in (i) above?
......................
11g(ii)
(iii)
A 35% controlled entity of a person described in (i) or (ii) above?
................
11g(iii)
h
Provide the following information about the supported organization(s).
(i) Name of supported organization
(ii) EIN
(iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions))
(iv) Is the organization in col. (i) listed in your governing document?
(v) Did you notify the organization in col. (i) of your support?
(vi) Is the organization in col. (i) organized in the U.S.?
(vii) Amount of monetary support
Yes
No
Yes
No
Yes
No
Total
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 2
Part II
Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi) (Complete only if you checked the box on line 5, 7, or 8 of Part I or if the
organization failed to qualify under Part III. If the organization fails to
qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in)
(a) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....
2
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......
3
The value of services or facilities furnished by a governmental unit to the organization without charge..
4
Total. Add lines 1 through 3
5
The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included
on line 1 that exceeds 2% of the amount shown on line 11, column (f)..
6
Public support. Subtract line 5 from line 4.
Section B. Total Support
Calendar year
(or fiscal year beginning in)
(a) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(f) Total
7
Amounts from line 4..
8
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...
9
Net income from unrelated business activities, whether or not the business is regularly carried on..
10
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..
11
Total support (Add lines 7 through 10).
12
Gross receipts from related activities, etc. (see instructions)
..................
12
13
First five years.
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here........................................
Section C. Computation of Public Support Percentage
14
Public support percentage for 2012 (line 6, column (f) divided by line 11, column (f))
.........
14
15
Public support percentage for 2011 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2012.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
.......................
b
33 1/3% support test—2011.
If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2012.
If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization
.....................................................
b
10%-facts-and-circumstances test—2011.
If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported organization
................................................
18
Private foundation.
If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions
.....................................................
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 3
Part III
Support Schedule for Organizations Described in Section 509(a)(2) (Complete only if you checked the box on line 9 of Part I or if the organization
failed to qualify under Part II. If the organization fails to qualify under
the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year (or fiscal year beginning in)
(a) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(f) Total
1
Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .
2,083,281
1,793,621
963,894
5,836,721
3,432,756
14,110,273
2
Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......
17,828,084
19,147,142
19,258,848
20,479,617
20,457,952
97,171,643
3
Gross receipts from activities that are not an unrelated trade or business under section 513..
0
4
Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...
0
5
The value of services or facilities furnished by a governmental unit to the organization without charge..
0
6
Total. Add lines 1 through 5.
19,911,365
20,940,763
20,222,742
26,316,338
23,890,708
111,281,916
7a
Amounts included on lines 1, 2, and 3 received from disqualified persons...
0
b
Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.
0
c
Add lines 7a and 7b..
8
Public support (Subtract line 7c from line 6.)
111,281,916
Section B. Total Support
Calendar year (or fiscal year beginning in)
(a) 2008
(b) 2009
(c) 2010
(d) 2011
(e) 2012
(f) Total
9
Amounts from line 6...
19,911,365
20,940,763
20,222,742
26,316,338
23,890,708
111,281,916
10a
Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..
0
b
Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.
0
c
Add lines 10a and 10b.
11
Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.
0
12
Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)
..
26,407
181,221
148,720
109,610
99,555
565,513
13
Total support. (Add lines 9, 10c, 11, and 12.)..
19,937,772
21,121,984
20,371,462
26,425,948
23,990,263
111,847,429
14
First five years.
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public support percentage for 2012 (line 8, column (f) divided by line 13, column (f))
.........
15
99.490 %
16
Public support percentage from 2011 Schedule A, Part III, line 15
...............
16
99.530 %
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2012 (line 10c, column (f) divided by line 13, column (f))
......
17
0 %
18
Investment income percentage from 2011 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2012.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
........
b
33 1/3% support tests—2011.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
.....
20
Private foundation.
If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 4
Part IV
Supplemental Information.
Complete this part to provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
Explanation
Schedule A (Form 990 or 990-EZ) 2012
Additional Data
Software ID:
12000229
Software Version:
2012v2.0
-
TIN:
SCHEDULE O (Form 990 or 990-EZ)
Department of the Treasury Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ
Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
Penn Foundation Inc
Employer identification number
23-1496225
Identifier
Return Reference
Explanation
Schedule R, Part V, Line 2, (A) 4
This amount was reimbursed from Penn Foundation Trust for expenses that were capitalized as the expenses pertained to building projects.
Form 990, Page 8, Section B
Dr. Vernon Kratz formerly held positions as Penn Foundation's Medical Director and President. Dr. Vernon Kratz is a subcontracted psychiatrist and board member with Penn Foundation. Subsequent to his retirement on 12/31/03, Dr. Kratz now serves as an independent contractor who provides psychiatric services to many of the seriously and persistently mentally ill clients whom he has had a long-standing supportive relationship with as their psychiatrist. In this capacity, Dr. Kratz controls the scheduling of his time and appointments as well as the number of hours he works and clients he sees at Penn Foundation.
Form 990, Page 1, Part I, Line 1 and Page 2, Part III, Line 1
OUR VISION:We believe in the resilience of the human spirit.We dedicate ourselves to the provision of superior behavioral, developmental, and physical healthcare that is individual and family centered, accessible and equitable.We compassionately support the ability of every individual to fully realize their emotional, physical, and spiritual potential.We aspire to better serve our community through an integrated model of coordinated and cost-efficient care.We seek to innovate and collaborate with organizations that share our mission and values.We promote the development of our staff by creating opportunities for achievement and advancement.We dedicate ourselves to these values:Integrity--Quality--Responsiveness--Respectfulness--Our Professional Heritage
Form 990, Part VI, Line 19
Form 990, Part VI, Line 19: Other Organization Documents Publicly Available
Governing documents, policies, and financial statements are available upon request.
Form 990, Part VI, Line 15b
Form 990, Part VI, Line 15b: Compensation Review and Approval Process for Officers and Key Employees
Each year in December, at the request of the Board Chair, the CEO performs a salary survey based on CEO compensation data gathered from 990 information posted on the Guidestar website for organizations similar in terms of line of business, annual revenues, and other demographics. This information is provided to the Board Chair to assist the Board in determining appropriate CEO compensation. Also, the Executive Committee performs an annual CEO performance evaluation that is tied to the decision on salary. Documentation of the survey, evaluation and the Board's approval of the annual CEO compensation is kept on file with Penn Foundation's Human Resources Director.For other officers or key employees, the CEO periodically requests the Human Resource Director to perform salary surveys for like positions in similar organizations. Information may be gathered from trade associations, affiliates and published salary guides. HR summarizes the findings and reviews with the CEO for making a determination of appropriate compensation levels for these employees.
Form 990, Part VI, Line 12c
Form 990, Part VI, Line 12c: Explanation of Monitoring and Enforcement of Conflicts
The Board reviews expenses and if there was a conflict of interest it would be disclosed in the Minutes and the Board member would abstain from the discussion and voting on any issues where a conflict of interest arises. The conflict of interest statements are reviewed and signed off on by each of the Board members annually.
Form 990, Part VI, Line 11b
Form 990, Part VI, Line 11b: Form 990 Review Process
A full copy of Form 990, along with a narrative summary of the return, is distributed to each of the Penn Foundation Incs Board of Directors for individual review. Questions, comments or concerns are addressed with the CFO and/or CEO. Board members approve the tax return for filing based upon their review and resolution of any outstanding issues or questions.
Form 990, Part III, Line 4d
Form 990, Part III, Line 4d: Other Program Services Description
OTHER PROGRAM SERVICES 4: Case Management ServicesMental Health Navigation Peer Support Services partners trained professionals who self-identify as a current or past participant in behavioral health services with individuals currently participating in behavioral health services who desire such mentoring as a key intervention in their recovery. In 2012-2013, nearly 70 clients received 2,760 Peer Support Services. Peer Support facilitates empowerment and self-determination in a variety of ways, including but not limited to, individuals advocacy, psychoeducation, exposure to/development of natural supports, community integration opportunities, and skill acquisition as it pertains to the recovery of meaningful daily activity and community roles.Mental Health Case Management helps individuals and families in choosing, locating, and accessing community resources such as housing, financial benefits, employment, and educational opportunities, etc. to further their recovery. In 2012-2013, 950 clients received over 22,000 Mental Health Case Management hours of service. There are two levels of assistance - Administrative Case Management and Blended Case Management. Administrative Case Management provides short-term assistance to adults and children in accessing community resources such as low-income housing, financial entitlements, vocational rehabilitation services, and support groups. This program also monitors and assists with the implementation of aftercare planning with people receiving inpatient care at area state and community hospitals and residential treatment facilities.Blended Case Management/Recovery Coaching provides longer term assistance to children, young adults, and adults with serious mental health or co-occurring substance use disorders in maximizing their potential for independent community living, improved educational/vocational status, increased social support networks, and reduced psychiatric hospitalizations. Individuals registered with Blended Case Management have contact with their Case Manager/Recovery Coach based on their level of need. The minimum level of contact is once every 30 days but may be more frequent depending on the individuals needs/wishes for assistance. Blended Case Management also offers a 24-hour, 7 days-a-week coverage on-call schedule to support individuals who are in crisis.Health Connections (HCHC) helps individuals improve their physical and behavioral health care by working as a team with their primary care practitioner (PCP), their other physical and behavioral health care providers, and their physical and behavioral health care plans. Participants receive nursing and behavioral health assessments and participate in the development and implementation of their holistic wellness plan. Professional navigators conduct or facilitate these assessments, coordinate communication across providers, and work with participants in the community to access needed health services. In 2012-2013, 130 clients received 3,430 HCHC Services. OTHER PROGRAM SERVICES 5: Residential ServicesResidential Services offers housing support for adults (18 years of age and older) with serious mental illnesses and co-occurring mental health and substance use disorders. Within a caring community of current residents, alumni, and staff, residents experience independence, personal growth, and holistic recovery. Residential Services are provided within Penn Villa, an integrated community including one group home and fifteen townhomes. Housing supports are provided by Penn Foundation staff within the group home and within five of the townhomes. The remaining ten townhomes were purchased by Habitat for Humanity. Several of the townhomes are completed, and construction continues on the remaining homes. Maximum Community Residential Rehabilitation operates within the group home and is a transitional program offering residents 24/7 on-site staff support and supervision. During 2012-2013 over 2,900 bed days were provided to 8 individuals.Supported Housing operates within the townhomes and offers daily support and supervision to residents, including 24/7 staff availability within the group home. During 2012-2013 over 5,200 bed days were provided to 16 individuals. Provided to former tenants, Alumni Services include individual contact from staff for social support, assistance with resource linkages, and support when moving. Alumni are also able to participate in recreational activities available to current residents. During 2012-2013 over 600 hours of Alumni services were provided to 51 individuals.The Co-Occurring MH/AOD residential program, known as the Village of Hope, is a transitional (up to two years) supported housing program specifically for homeless adults who have been diagnosed with both a mental health and substance use disorder. It is designed to provide assistance in gaining skills necessary for the successful re-entry into the mainstream of life. Two houses one for men and one for women each serve up to eight individuals and offer 24/7 staff support. During fiscal year 2012-2013, Village of Hope provided over 5,200 bed days to 23 individuals. OTHER PROGRAM SERVICES 6: Psychiatric Rehabilitation ServicesReach IPR (Intensive Psychiatric Rehabilitation) assists individuals with mental health or co-occurring mental health and substance use issues in setting and achieving personal goals in their living, learning, working, and social environments. By working through the five phases Readiness Assessment, Readiness Development, Goal Choosing, Goal Achievement, and Goal Keeping individuals in this program develop skills that they can transfer to real life. During fiscal year 2012-2013 52 clients received 2,640 hours of service.Wellspring Clubhouse is a voluntary social, educational, and vocational rehabilitation program that promotes recovery and instills hope among members with mental health and/or co-occurring substance use challenges. The Clubhouse Model features member leadership and involvement in all aspects of the program. Members work side-by-side with staff as colleagues in three work units Health & Wellness, Member Services, and Career Development - to learn or teach skills and to offer support and resources needed to achieve a satisfying and improved quality of life in the community. During fiscal year 2012-2013, 148 Clubhouse members received nearly 11,000 hours of service. OTHER PROGRAM SERVICES 7: ID Supports Coordination ServicesIntellectual Disabilities Supports Coordination locates, coordinates, and monitors services and resources for adults and children with intellectual disabilities. This service aims to educate clients and their families about available resources and empower them to make decisions regarding their care and everyday lives in the community. During 2012-2013, 410 clients received 18,339 services. OTHER PROGRAM SERVICES 8: Hospital ServicesEmergency Services offers assessments, supportive problem solving strategies, and direct linkages to all levels of treatment for mental health and substance use emergencies. Trained professionals are available 24-hours-a-day, 7-days-a-week.Consultation Services provides psychiatric evaluations and support to medical service inpatients in a hospital setting. Chaplaincy Services offers spiritual support and guidance to patients at Grand View Hospital and their families. The chaplains make daily rounds in the intensive care, oncology, and telemetry units.During the 2012-2013 fiscal year, 5,052 individuals received 8,860 hospital services. OTHER PROGRAM SERVICES 9: Employee Assistance ProgramThe Employee Assistance Program (EAP) supports the unique needs of area business owners. EAP helps managers, supervisors, and employees to better manage the emotional, psychological, and addiction issues they may experience personally or at work. Additionally, through coaching, training, policy and procedure development, and management consultation, EAP has given leaders and managers the skills they need to deal with troubled employees. In 2012-2013, EAP had contracts with 73 companies, covering 15,792 households and provided approximately 3,318 service hours to 948 individuals. OTHER PROGRAM SERVICES 10: Christian/Pastoral ServicesDayspring Counseling offers individuals, couples, and families faith-based counseling services from a Christian perspective. Based on the biblical principles of hope, healing, compassion, and humility, Dayspring is meant to complement and enhance the ministry of pastoral care already offered by churches in the community. A Membership Assistance Program, in which churches share the cost of counseling for their members, is available. Dayspring Counseling services volumes are incorporated with Mental Health Outpatient.Pastoral Services provides direct pastoral services to all clients and residents requesting spiritual care. It is non-denominational in nature and offered to persons of all faiths. Pastoral Services also provides community education and co
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.