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DocuSign Envelope ID:24839407-DB2D-47A2-B399-3BEA061662C1 t A - continued
<br /> Provider's Outside Agency Application
<br /> MAIN APPLICATION
<br /> Program Budget
<br /> Agency/Prograrr CHC MOW Meals for the Homebound
<br /> Actual Estimated Projected Percent
<br /> AGENCY REVENUE 2014-15 2015-16 2016-17 Change
<br /> Private Donations $ 71,350 $ 83,528 $ 77,000 -8%
<br /> Agency Generated Revenue (fees) $ 54,000 $ 39,424 $ 38,000 -4%
<br /> Local Government Grants:
<br /> Orange County $ 10,000 $ 10,000 $ 15,000 50%
<br /> Town of Chapel Hill $ 9,000 $ 9,000 $ 15,000 67%
<br /> Town of Carrboro $ 10,000 $ 10,500 $ 15,000 43%
<br /> Other Local: 0
<br /> Other Local: 0
<br /> Other Local: 0
<br /> If more than 3 sources,
<br /> please provide a separate list.
<br /> Non-Local Government Grants
<br /> Triangle United Way $ 28,280 $ 27,893 $ 28,400 2%
<br /> State Government 0
<br /> Federal Government 0
<br /> Other Grants:Walmart or GSK $ 25,000 $ 25,000 $ 25,000 0%
<br /> Other Grants:Other $ 10,100 $ 12,650 $ 10,000 -21%
<br /> Miscellaneous/Other Revenue $ 92,207 $ 92,878 $ 86,500 -7%
<br /> Please list 3 largest Miscellanous sources:
<br /> events/fundraisers $ 42,000.00
<br /> :orporations/congregation: $ 27,500.00
<br /> in-kind $ 12,000.00
<br /> Total Agency Revenue $ 309 937 $ 310 873 $ 309 900 0%
<br /> AGENCY EXPENSES
<br /> Compensation $ 29,626 $ 35,806 $ 46,487 30%
<br /> Rent&Utilities $ 1,960 $ 2,040 $ 2,200 8%
<br /> Supplies&Equipment $ 4,911 $ 2,167 $ 4,800 122%
<br /> Travel&Training $ 494 $ 1,500 0
<br /> Other Expenses: $ 220,080 $ 237,017 $ 238,430 1%
<br /> Please list 3 largest"Other Expenses":
<br /> Food Costs $204,830.00
<br /> Professional $ 9,500.00
<br /> Events $ 8,000.00
<br /> Total Agency Expenses $ 257,071 $ 277,030 $ 293,417 6%
<br /> SURPLUS/(DEFICIT)FOR PERIOD: I $ 52,866 I $ 33,843] $ 16,483 I _ -51%
<br /> Main Application 5/24/2016 9:18:54 AM Pa 1 o of 2 4
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