|
DocuSign Envelope ID:636AFD33-DA5C-4B55-88DC-03C0863BAFE3 t A - continued
<br /> Provider's Outside Agency Application
<br /> MAIN APPLICATION
<br /> Section Vt.Financial Data
<br /> Operating Budget for Entire Agency
<br /> Agency Name: Mental Health America of the Triangle
<br /> Actual Estim ated Projected Percent
<br /> Agency Revenue 2014-15 2015-16 2016-17 Change
<br /> Private Donations $ 84,877 $ 87,185 $ 70,892 -19%
<br /> Agency Generated Revenue(fees) 0%
<br /> Local Government Grants:
<br /> Orange County $ 17,000 0%
<br /> Town of Chapel Hill $ 5,500 $ 5,500 $ 6,000 9%
<br /> Town of Carrboro $ 5,500 $ 5,700 $ 6,000 5%
<br /> Other Local: JCPC Local Match $ 15,605 $ 15,605 $ 15,605 0%
<br /> Other Local: Durham County $ 23,588 $ 23,588 $ 23,588 0%
<br /> Other Local: Family Success Alliance $ 38,817 $ 53,000 37%
<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: JCPC Funds-Orange $ 52,024 $ 52,024 $ 52,024 0%
<br /> Federal Government $ 106,227 $ 125,753 $ 125,753 0%
<br /> Other Grants: JCPC Funds-Durham $ 14,000 $ 14,000 0%
<br /> Other Grants: ABC/PUD Funds $ 20,000 $ 20,000 $ 20,000 0%
<br /> Other Grants: Cardin al Innovations $ 79,000 $ 79,000 $ 79,000 0%
<br /> Miscellaneous/Other Revenue $ 953 $ 1,000 $ 1,000 0%
<br /> Please list 3 largest Miscellanous sources:
<br /> Training Revenue $ 953.00
<br /> Total Agency Revenue $ 393,274 $ 468,172 $ 483,862 3%
<br /> AGENCY EXPENSES
<br /> Compensation $ 245,364 $ 281,105 $ 337,844 20%
<br /> Rent&Utilities $ 18,663 $ 20,100 $ 20,100 0%
<br /> Supplies&Equipment $ 38,766 $ 15,344 $ 14,337 -7%
<br /> Travel&Training $ 12,212 $ 18,509 $ 13,400 -28%
<br /> Other Expenses: $ 106,675 $ 123,622 $ 92,166 -25%
<br /> Please list 3 largest'Other Expenses':
<br /> Contractual Services $ 91,155.00
<br /> Insurance $ 6,261.00
<br /> Sues,Bank,Adv,FR Exp $ 9,259.00
<br /> Total Agency Expenses $ 421,680 $ 458,680 $ 477,847 4%
<br /> SURPLUS/(DEFICIT)FOR PERIOD: $ (28,406)1 $ 9,492 J $ 6,015 J -37%
<br /> Main Application 5/25/2016 9:20:28 AM F a g 20 of 20
<br />
|