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Exhibit A - continued
<br /> Provider's Outside Agency Application
<br /> MAIN APPLICATION
<br /> Program Budget
<br /> Agency/Program Client Services
<br /> Aetual; Esimated ProJeCted ; Percent
<br /> AGENCY REVENUE 464-15 3015=16 ..i 201,6-17:. Ch0n e. .
<br /> Private Donations $ 25,000 $ 25,000 $ 25,000 0%
<br /> Agency Generated Revenue (fees) $ $ - $ - 0
<br /> Local Government Grants:
<br /> Orange County $ 15,000 $ 15,000 $ 17,500 17%
<br /> Town of Chapel Hill $ 4,000 $ 10,000 $ 13,500 35%
<br /> Town of Carrboro $ 2,000 $ 5,000 $ 6,000 20%
<br /> Other Local: Town of Hillsborough $ 2,500 $ 2,500 $ - -100%
<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 i6ift
<br /> Triangle United Way $ 21,412 $ 26,365 $ 22,500 -15%
<br /> State Government $ 43,784 $ 38,550 $ 35,500 -8%
<br /> Federal Government $ 134,932 $ 158,655 $ 193,655 22%
<br /> Other Grants: Contracts(LAV $ 14,103 $ 12,250 $ 4,000 -67%
<br /> Other Grants: 0
<br /> Miscellaneous/Other Revenue $ 25,975 $ 26,893 $ 31,917 19%
<br /> Please list 3 largest"scellanous sources:
<br /> Fundraiser(annual auction) $ $ 24,475 $ 24,893 $ 30,417
<br /> Miscellaneous $ $ 1,500 $ 2,000 $ 1,500
<br /> Total Agency Revenue $ 288,706 $ 320,213 $ 349,572 9%
<br /> AGENCY EXPENSES
<br /> Compensation $ 202,540 $ 235,650 $ 267,250 13%
<br /> Rent&Utilities $ 43,372 $ 45,411 $ 48,005 6%
<br /> Supplies BEquipment $ 14,1851 $ 18,150 $ 15,100 17%
<br /> Travel&Training $ 3,390 $ 3,000 $ 3,000 0%
<br /> Other Expenses: $ 26,679 $ 18,002 $ 16,217 -10%
<br /> Please list 3 largest"Other Expenses":
<br /> Financial:Audit,bank fees,etc. $ $ 6,010 $ 6,627 $ 6,952
<br /> Professional dues,marketing,mist. $ $ 10,711 $ 7,625 $ 8,515
<br /> Client Emergency Funds,contract fees $ $ 9,958 $ 3,750 $ 750
<br /> Total Agency Expenses $ 290,1661 $ 320 213 $ 349,572 9%
<br /> SURPLUS/(DEFICIT)FOR PERIOD: 1 $ (1,460) $ $ - 0
<br /> Main Application 1/25/2016 12:55:42 PM P J e, 2 6 o f 3 2
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