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DocuSign Envelope ID:6BDD2794-5ECO-4DFF-B4F6-F496A1C3AB13 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 $ 17,168 $ 20,300 $ 20,625 2%
<br /> Agency Generated Revenue(fees) $ 149,374 $ 234,656 $ 234,656 0%
<br /> Local Government Grants:
<br /> Orange County $ 15,000 $ 20,000 $ 20,000 0%
<br /> Town of Chapel Hill $ 6,500 $ 15,000 $ 15,000 0%
<br /> Town of Carrboro $ 14,000 $ 9,500 $ 15,000 58%
<br /> Town of Carrboro-Outreach $ 36,970 $ 36,970 $ 36,970
<br /> Other Local: Orange Co ABC Board $ 6,651 $ 15,000 $ 15,000 0%
<br /> Other Local: Durham County $ 29,421 $ 29,421 $ 29,421 0%
<br /> Other Local: Durham ABC $ 20,000 $ 20,000 $ 20,000 0%
<br /> If more than 3 sources,please provide
<br /> a separate list.
<br /> Non-Local Government Grants
<br /> Triangle United Way 0
<br /> State Government $ 72,456 $ 40,000 $ 40,000 0%
<br /> Federal Government 0
<br /> Other Grants:Foundations $ 99,960 $ 107,502 $ 107,502 0%
<br /> Other Grants:Non-Profit Grants $ 188,689 $ 202,772 $ 197,272 -3%
<br /> Miscellaneous/Other Revenue $ 66,352 $ 160,325 $ 160,000 0%
<br /> Please list 3 largest Miscellanous sources:
<br /> Revenue from Programs $ 44,135.00
<br /> Other Income $ 22,217.00
<br /> Total Agency Revenue $ 722 541 $ 911 446 $ 911 446 0%
<br /> AGENCY EXPENSES
<br /> Compensation $ 353,738 $ 474,807 $ 474,807 0%
<br /> Rent&Utilities $ 124,791 $ 117,762 $ 117,762 0%
<br /> Supplies&Equipment $ 6,860 $ 10,020 $ 10,020 0%
<br /> Travel&Training $ 15,850 $ 15,850 $ 15,850 0%
<br /> Other Expenses: $ 316,785 $ 293,007 $ 293,007 0%
<br /> Please list 3 largest"Other Expenses":
<br /> Contracted Services $ 190,225.00
<br /> Program Expenses $ 115,495.00
<br /> Dues,fees,etc $ 11,065.00
<br /> Total Agency Expenses $ 818,024 $ 911,446 $ 911,446 0%
<br /> SURPLUS/(DEFICIT)FOR PERIOD: $ (95,483)1$ - I $ - I 0
<br /> Main Application 5/24/2016 4:41:37 PM .. 5 o of 5
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