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DocuSign Envelope ID:A3E0213B-1DCD-43A3-9C41-A2EC55A8CA94 t A - continued <br /> Provider's Outside Agency Application <br /> MAIN APPLICATION <br /> Program Budget <br /> Agency/Program: Orange Congregations in Mission:Samaritan Relief Ministry <br /> Actual Estimated Projected Percent <br /> AGENCY REVENUE 2014-15 2015-16 2016-17 Change <br /> Private Donations $ 440,680 $ 344,000 $ 344,000 0% <br /> Agency Generated Revenue(fees) $ 8,779 $ 11,000 $ 11,000 0% <br /> Local Government Grants: <br /> Orange County $ 33,415 $ 33,415 $ 33,415 0% <br /> Town of Chapel Hill 0 <br /> Town of Carrboro 0 <br /> Other Local: Town of Hillsborough Water Assistance $ 2,828 $ 5,600 $ 5,600 0% <br /> Other Local: 0 <br /> Other Local: 0 <br /> If more than 3 sources,please <br /> provide a separate list. <br /> Non-Local Government Grants <br /> Triangle United Way $ 19,752 $ 14,500 $ 14,500 0% <br /> State Government 0 <br /> Federal Government 0 <br /> Other Grants: 0 <br /> Other Grants: 0 <br /> Miscellaneous/Other Revenue $ 14,386 $ 18,585 $ 18,585 0% <br /> Please list 3 largest Miscellanous sources: <br /> Duke Energy $ 4,596.59 <br /> Other foundations/groups $ 9,789.00 <br /> Total Agency Revenue $ 519,840 $ 427,100 $ 427,100 0% <br /> AGENCY EXPENSES <br /> Compensation $ 14,241 $ 12,448 $ 12,448 0% <br /> Rent&Utilities $ 11,382 $ 10,300 $ 10,300 0% <br /> Supplies&Equipment $ 2,492 $ 3,180 $ 3,180 0% <br /> Travel&Training $ 201 $ 100 $ 100 0% <br /> Other Expenses: $ 541,383 $ 414,172 $ 414,172 0% <br /> Please list 3 largest"Other Expenses": <br /> Client Assistance $ 475,304.00 <br /> Personnel Costs $ 65,717.00 <br /> Depreciation $ 362.00 <br /> Total Agency Expenses $ 569,699 $ 440,200 $ 440,200 0% <br /> SURPLUS/(DEFICIT) FOR PERIOD: I $ (49,859)1 $ (13,100)1 $ (13,100)1 0%+ <br /> Main Application 5/25/2016 9:39:17 AM Pa 1 o of 22 <br />