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DocuSign Envelope ID:38357F45-0FD1-474F-992F-A2DODA42A3E2 1 Fchtifitted
<br /> Provider's Outside Agency Application
<br /> AGENCY NAME: Duke Home Care &Hospice
<br /> AdtUal,,),,,I[',,,"'; );),,i,liFEstirhated'N',:0'"e,Projeeted Freitent,ho,4
<br /> 0001,„9,,,,0,,,,N,W44,%004'0,'{ 4 14401414444444'4,44,44,44,44$44,'VIC4444444,14,1,„410,r0441,i,lp 4044,4,4,44,4 4444414,U1IVINA:'44'
<br /> PROGRAM REVENUE 2131415K'', 01'1201516141'''''l'','"4,1'201617'''''''";',14'''''HiChange
<br /> Private Donations $ 344,833 $ 467,200 $ 467,200 0%
<br /> Program Generated Revenue (fees) $10,319,858 $11,008,000 $11,251,000 2%
<br /> ., ...
<br /> flAfp..,,,',IfigOolliplort: 1,„;,,Fro4tqo, ,Ttr:-01,,,,,i,"'"q14NIAiri1-4„"e"-,l',i,,,,$"1,11;Aor'il,,,,r,p,i,opri,,
<br /> A,r,..11r,, ,, 116p,i'dtkt'64k''S4,1,kt6''' '.64041,i'14",,,Ifp,,p,Ikk,,k40,4,k16;
<br /> Local Government Grants: ',ZiArfigNiWolli SilkteiNS,,,",,Olh"41011010111eitili Ne,N,,,ANiligirt
<br /> Orange County $ 1,000 $ 1,000 $ 1,000 0%
<br /> Town of Chapel Hill $ 3,000 $ 3,000 $ 3,000 0%
<br /> Town of Carrboro $ 3,800 $ 3,800 $ 3,800 0%.
<br /> Other Local: 0
<br /> .„
<br /> Other Local: 0
<br /> Other Local: 0
<br /> If more than 3 sources,please 'fl ''''''"'g,',J4jr i'1(i■I,f'6 ql. , i ,A'1,1,r. .,1 1,41 " 1, 1 A,,,,.0 ,H.1'„, i', ,
<br /> 4 1t-Op',,ll,/l44 444; 1 44 41 01 li, ,,, .p ri''1 .• 1 11,:;,,V,,4i k q/401114 lik 9'fi'l',,' k6t1,1,4,01 k'
<br /> provide a separate list. i .1,',','lig ip,.,1'•:,.411,4„!411,4 1 .!,■,b,,1 ,,,,,,,..,11,40 ,±,Ai;,0,,,,Ii.' 4.Vorviii,,,'11',tl,;',.■,,3 ,i
<br /> 1V4''14'4141114-1M tr '',',,6'6i'o PC■ I 4 If 1,1;,, 616'.6 li41 001)Y,0'j''$ .1.10("f,'.FT"'",1,7,,',ir,q''Ill
<br /> 4"fir,,F1)q',:'ll'ijifi;,l'[?P'',III!ihil'1,1110'114
<br /> Non-Local Government Grants r?,,: ,„g 1 1 1, vt„,5,$;,1',, ,,,,
<br /> 4,4,14i L,„,,f,,; ,,,„ ok k;,,,i,,[k ,i,;,r,,n■kg i,',„ ..4 ,''44'16, , '„,,,,'61,114''0 6'0' k",k,,[44$1,,gd''61'11,k1 Ii1144•
<br /> Triangle United Way 0
<br /> State Government 0
<br /> Federal Government 0
<br /> Other Grants: 0
<br /> Other Grants: 0
<br /> $11KIIMININSItIONNISINItt liNIVOMNSI OSIVIONOMNN
<br /> Miscellaneous/Other Revenue 0
<br /> Please list 3 largest Miscellanous sources: 1;,..4,tri%% ,,ifi,,,, :„w,;,1,IJ ,'Ii/'14,{1,1,/,I,',4,11I1
<br /> $ 1', 11.411/1.0i 11,,,I,,,,, ,i,,,,,,,, ,,,,,..,,) .
<br /> 1,!1.4,1.,404:11,,,,,Ali‘riktg,/, ):,,,, twoi,!,',
<br /> $ - liii,41!'°,,41:;0 ii.'',) ',P01.41,-'',, I .0,0 1,1'1 01 filli iii,i il,„1,4'.f1.1.1
<br /> $ ,I. 0. lc,,°J.1,, .,,g..;d,4 kl,',k 4, vi kdlotti '0.1 ' lik r '4,6, A
<br /> hl'• 1 1.. i'w,'141 4 ill 4,I ,1'164t
<br /> 16 1,p Y,i.44.',,U1,■,11!,,,,,',,,,f:;!,"y,''VI,j„I','■, t I4''''' 44'■ 411 k..,Y',BE',,o'4;.,'
<br /> , ..
<br /> Total Program Revenue $10,672,491 $11,483,000 $11,726,000 _ 2%
<br /> ,,t4,1114191;41,,11'1141 'Ili 1131',11 1,:i 114 lo,q..,4,K li gr/iVii itty"P)Ilvotti
<br /> 11,41,11$1
<br /> PROGRAM EXPENSES 1.4!14) 1,1„,.,,t,,,),i,,:. 4,4,•'1 i 41: 4,"1'4r11p1 f'I,fl 4 Pla'SP 44 ,1,444 t44.'p'4fr'"ii A.,
<br /> N Iv fri.0 o(400.74.0441A A,1144. IY .1.,,,,.'.1',',',',,61,:1.1,,.,14,1.40.,tr,A11411441 0, 44414,A,.,,'.4 6R04,
<br /> Compensation $ 5,344,986 $ 5,723,000 $ 5,927,000 4%
<br /> Rent& Utilities $ 233,663 $ 243,009 $ 252,730 4%
<br /> Supplies & Equipment $ 1,184,951 $ 1,208,000 $ 1,284,000 6%
<br /> Travel &Training $ 166,535 $ 173,196 $ 180,124 4%
<br /> Other Expenses: $ 4,090,343 $ 4,170,794 $ 4,237,146 2%
<br /> Please list 3 largest"Other Expenses":
<br /> ,,„,,,,%,113,„%%%,1%,,•01%1%, 'f64,4664 y 44:k 11.44444444414'q 444444,A4441,44,Nif41'444, 4y444P4N4,444/44444.044,44'4141 44,,4
<br /> $ _ Y.'0"I'd,,q,021','Y''.:14 NI.■'.:/'NI L'.i','4°4 41'lfAr4,1;,.:",,Or•.;`,',01: ',',4,',V1k6,141'4'6-teolii'"'",iwor', "4","1"'40,,,,',"■Phr(try'01f1,1',
<br /> (4;4',F',1i116k1f1A6'1',1144:. kktY,14,4',#114.140/6Cr ''I'f,A6fkii,IMP,V161'''W6110.0 40'14c,k1'"?6416'616A?,1 ,
<br /> $ - 464'444.0i40114 6,1,60k.1114p1414114111/11144,411411111 11114/1"0.44411011404r11°10 11I44111411.414111114'41111
<br /> '11111"04144N114,1j1411f11 ;111141111111414414141/1141141 1441131011410,4440440 4141141,1444114444414414141
<br /> $ - 1144:41,111111154:1;04414414441 41411,141114:11'114154104141141 0141140641$110.4.01110 P1111410'1114'':11.14ti1C°41'
<br /> 1141":1'11T't1!1•141111114135,144 V11111111117411111P1111111111144 (M110n14,4114;0$14111111 11411144111Vri114.154'1114411111
<br /> Total Program Expenses $11,020,478 $11,518,000 $11,881,000 _ 3%
<br /> \ $ (347,987)1 $ (35,000)1 $ (155,000)1 -343(Yol
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