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DocuSign Envelope ID:7D246B6F-37D5-48F7-99D7-98C230BA1C70 it A continued <br /> Provider's Outside Agency Application <br /> MAIN APPLICATION <br /> Section VI.Financial Data <br /> Operating Budget for Entire Agency <br /> AGENCY NAME: Behavioral Insights,Inc. <br /> Actual Estimated Projected Percent <br /> AGENCY REVENUE 2014-15 2015-16 2016-17 Chan•e <br /> Private Donations 0 <br /> Agency Generated Revenue(fees) $ 4 000 0 <br /> Local Government Grants: <br /> Orange County -- $ 142 760 0 <br /> Town of Chapel Hill $ 7 500 $ 7 500 $ 15 000 100% <br /> Town of Carrboro $ 5 500 $ 5 600 $ 11 000 96% <br /> Other Local: --- 0 <br /> Other Local: $ 320 $ 320 -100% <br /> Other Local: $ 4 680 $ 4,580 -100% <br /> If more than 3 sources,please <br /> provide a separate list. <br /> Non-Local Government Grants <br /> Triangle United Way --- 0 <br /> State Government --- 0 <br /> Federal Government --- 0 <br /> Other Grants: --- 0 <br /> Other Grants: --- 0 <br /> Miscellaneous/Other Revenue 0 <br /> Please list 3 largest Miscellanous sources: <br /> $ - <br /> $ - <br /> $ <br /> Total Agency Revenue $ 18 000 $ 18 000 $ 172 760 860% <br /> AGENCY EXPENSES <br /> Compensation $ 16 800 $ 13 800 $ 160 060 1060% <br /> Rent&Utilities $ 4 200 in kind #VALUE! <br /> Supplies&Equipment $ 1 200 $ 2 900 0 <br /> Travel&Training $ 1 200 0 <br /> Other Expenses: $ 8 600 0 <br /> Please list 3 largest"Other Expenses": <br /> $ - <br /> $ - <br /> $ - <br /> Total Agency Expenses $ 18 000 $ 18 000 $ 172 760 860% <br /> SURPLUS/(DEFICIT)FOR PERIOD: $ - I$ - I$ - I 0 <br /> Main Application 1/20/2016 4:35:53 PM Page 21 of 21 <br />