|
DocuSign Envelope ID: 112713E4-A11E-4CO3-B5A6-92020A894CD7 t A - continued
<br /> Provider's Outside Agency Application
<br /> MAIN APPLICATION
<br /> Actual Estimated Projected Percent
<br /> AGENCY REVENUE 2014-15 2015-16 2016-17 Change
<br /> Private Donations $ 2,064 $ 2,000 $ 2,000 0%
<br /> Agency Generated Revenue (fees) $ 1,181,022 $ 1,205,000 $ 1,205,000 0%
<br /> Local Government Grants:
<br /> Orange County $ 45,100 $ 45,100 $ 51,100 13%
<br /> Town of Chapel Hill $ 3,000 $ 6,000 $ 10,000 67%
<br /> Town of Carrboro $ 3,500 $ 3,600 $ 5,000 39%
<br /> Other Local: 0
<br /> Other Local: 0
<br /> Other Local: 0
<br /> If more than 3 sources,please provide a
<br /> 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 $ 200 $ 1,000 $ 1,000 0%
<br /> Please list 3 largest Miscellanous sources:
<br /> Total Agency Revenue $ 1 234 886 $ 1 262 700 $ 1 274 100 1%
<br /> AGENCY EXPENSES
<br /> Compensation $ 990,708 $ 1,003,661 $ 1,008,000 0%
<br /> Rent&Utilities $ 44,962 $ 48,655 $ 50,000 3%
<br /> $ 93,408 $ 95,100 $ 97,000 2%
<br /> Travel &Training $ 42,488 $ 45,000 $ 50,000 11%
<br /> Other Expenses: $ 90,475 $ 90,000 $ 90,000 0%
<br /> Please list 3 largest"Other Expenses":
<br /> Subcontractor& Professional Fee: $ 65,300.00
<br /> Workers Comp Ins $ 25,175.00
<br /> Total Agency Expenses $ 1,262,041 $ 1,282,416 $ 1,295,000 1%
<br /> SURPLUS/(DEFICIT) FOR PERIOD: $ 27,155 $ 19,716 $ 20,900 -6°/;
<br /> Main Application 2/1/2016 11:26:11 AM Page 16 of 1
<br />
|