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DocuSign Envelope ID: CB0C1343-06EB-4BE7-9AF6-62EE77BD69FE t A - continued <br /> Provider's Outside Agency Application <br /> MAIN APPLICATION <br /> S€dtion'1A_Financial Data <br /> Ana BL It for B1ir e Arienogf <br /> AGEN2Yliattli Rained P,a 1So1,f>MMantic <br /> AIGEMYFENdEtiLE 21041.15 211315.1G 2IYI 17 Charge <br /> Pri a Cyan to $ 493 $ 6,554 744 $ E 6845 8M 111111111111M <br /> Agency 113enaralad xwp $ 5,D'1$888 $1 0,TM,OW $1Q945,647 <br /> Local G04.09111111311 Granter <br /> Orange Carty $ 1 Q 00 $ 20,CCD $ 2:,C M .. <br /> Tba^t cf awe Fill $ 1,2250 $ 2 500 $ 2 500 MR 1M <br /> Toon or C5rrlxra $ 500 $ 1,DOD $ 1,COJ <br /> ah c Local: larta-r1C arty $ 8,623 $ 17,245 $ 17,245 <br /> Other Local. --- 0 <br /> Otr'rerLOCat --- 0 <br /> r rrvrevra�asavcc,mama rrarerem <br /> separate I@t <br /> flan-Local Goilaninrarilt Grants.... <br /> TMaltgel_IYtetl Jam, --- 0 <br /> Mate Gwen-in/ft $ 55,074 $ 1.35,CCC $ 135,COO 11111111 1=. <br /> Fettral C,00rrr'ert $ 921,237 $ 1,955500 $ 2 602 COD <br /> °tlterGrarts --- 0 <br /> CII ter Carts --- 0 <br /> Iulrcell retrl lea 1e1 <br /> ROW811.118 $ 83 226 $ 65,145 $ 31,2010 <br /> Reese Lt3 largest F t oetznaz sauces: <br /> Ft-search $ 33, .00 <br /> F5rt 4 Irrcarr $ 31,Z1010 DJ <br /> - <br /> Total Aganast Fi xle $ 3W38410 $'16t4BLs42 a 43 t432 <br /> Conperwallon $ 5 360 3.7 $11,3M,864 $11,734,650 <br /> Hatt&Ittillttlea $ 602184 $ 704, $ 726 455 <br /> 4a FJles&E4p.IImrB1't $ 1,731,012 $ 4,478605 $ 4,61 2851 <br /> Towel&Training $ 209,C1743 $ '.551,72'^7 $ 565.279 <br /> attar Expenses $ 2 431,977 $ 2 532 973 $ 2 7543 462 <br /> Feaae tt 3Ia rgest"Other Ebr.parses°': <br /> A€tettleng $ /710 <br /> O rtracted Sent aes $Brad.era <br /> Total Amity Eventeas ) 104 5f13 I$186111336 /72114047W I 3561 <br /> SUIR LLIGICE Ic1T)F+t.1111:3 I$ (1354086132Et $ 34.723 111 <br /> Main Application 1/21/2016 18:35:26 a1/p1 II I:' c 241 of 2 <br />