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DocuSign Envelope ID: DBF0775B-3A75-4D97-9EA7-5AC7933304BF 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 $ 36,502 $ 29,400 $ 31,500 7%,
<br /> Agency Generated Revenue(fees) $ 7,827 $ 7,125 $ 8,500 19%
<br /> Local Government Grants:
<br /> Orange County $ - 5 - $ 15,000 0
<br /> Town of Chapel Hill 0'
<br /> Town of Carrboro 0
<br /> Other Local: Town of Hillsborough 5 4,500 $ 4,500 $ 4,500 0%
<br /> Other Local: Hillsborough Tourism Board $ 21,000 $ 24,380 $ 16,000 -34%
<br /> Other Local: Orange Co Arts Commission $ 9,000 $ 6,000 $ 6,000 0%
<br /> more than 3 sources,please
<br /> provide a separate list.
<br /> Non-Local Government Grants
<br /> Triangle United Way 0.
<br /> State Government 0
<br /> Federal Government 0,
<br /> Other Grants:NC Humanities Council $ 1,200 $ - $ - 0
<br /> Other Grants: 0,
<br /> Miscellaneous/Other Revenue $ 18,560 $ 25,185 $ 25,000 -1%
<br /> Please list 3 largest Miscellanous sources:
<br /> Net Sale of Goods $ 8,428.00
<br /> Event Ticket Sales 5 10,400.00
<br /> Total Agency Revenue $ 98 589 $ 96 590 $ 106 500 10%'
<br /> AGENCY EXPENSES
<br /> Compensation $ 6,634 5 31,000 $ 36,486 18%
<br /> Rent&Utilities $ 15,054 $ 15,290 $ 16,100 5%
<br /> Supplies&Equipment $ 6,075 $ 4,960 $ 7,000 41%
<br /> Travel&Training $ 55 $ 50 $ - -100%
<br /> Other Expenses: $ 49,647 $ 66,965 $ 57,830 -14%,
<br /> Please list 3 largest"Other Expenses":
<br /> Performance Services $ 21,183.00
<br /> Advertising $ 7,035.00
<br /> Other Contracted Services $ 3,705.00
<br /> Total Agency Expenses $ 77,465 $ 118,265 $ 117,416
<br /> SURPLUS/(DEFICIT)FOR PERIOD: 1 $ 21,124 1 $ (21,675)1 $ (10,916)1 50%
<br /> Main Application 1/22/2016 8:56:04 AM P a e 2 1 c f 2 1
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