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DocuSign Envelope ID:40C90B7F-D85F-4E1C-A5CA-4BC263526A8E t A - continued <br /> Provider's Outside Agency Application <br /> MAIN APPLICATION <br /> Program Budget <br /> Agency/Program: Orange Congregations in Mission Meals on Wheels <br /> Actual Estimated Projected Percent <br /> AGENCY REVENUE 2014-15 2015-16 2016-17 Change <br /> Private Donations $ 4,342 $ 5,000 $ 5,000 0% <br /> Agency Generated Revenue(fees) $ 9,523 $ 15,500 $ 15,500 0% <br /> Local Government Grants: <br /> Orange County $ 17,000 $ 17,000 $ 17,000 0% <br /> Town of Chapel Hill 0 <br /> Town of Carrboro 0 <br /> Other Local: 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 $ 19,623 $ 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 $ 4,462 $ 5,000 $ 5,000 0% <br /> Please list 3 largest Miscellanous sources: <br /> Other foundations&grants $ - <br /> $ - <br /> Total Agency Revenue $ 54 950 $ 57 000 $ 57 000 0% <br /> AGENCY EXPENSES <br /> Compensation $ 1,112 $ 1,300 $ 1,300 0% <br /> Rent&Utilities $ 7,213 $ 5,450 $ 5,450 0% <br /> Supplies&Equipment $ 2,923 $ 4,170 $ 4,170 0% <br /> Travel&Training $ 252 $ 250 $ 250 0% <br /> Other Expenses: $ 50,235 $ 49,927 $ 49,927 0% <br /> Please list 3 largest"Other Expenses": <br /> Client Assistance $ 26,586.00 <br /> Personnel Costs $ 23,639.00 <br /> Depreciation $ 10.00 <br /> Total Agency Expenses $ 61,735 $ 61,097 $ 61,097 0% <br /> SURPLUS/(DEFICIT) FOR PERIOD: 1 $ (6,785)1 $ (4,097)1 $ (4,097)1 0%I <br /> Main Application 5/25/2016 9:29:51 AM Pa 1 o of 22 <br />