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DocuSign Envelope ID:78F84828-4CC5-4A5B-B256-33C571A84687 t A- continued
<br /> Provider's Outside Agency Application
<br /> MAIN APPLICATION
<br /> AGENCY NAME: Charles House Association
<br /> Actual Estimated Projected Percent
<br /> AGENCY REVENUE 2014-15 2016-16 2016-17 Change
<br /> Private Donations $ 115,000 $ 110,000 $ 80,000 -27%
<br /> Agency Generated Revenue(fees) $ 916,500 $ 1,187,000 $ 1,360,000 ME!
<br /> Local Government Grants:
<br /> Orange County $ 15 000 $ 16,000 $ 20,000 33%
<br /> Town of Chapel Hill $ 9,000 $ 9 000 $ 11,000 22%
<br /> Town of Carrboro $ 4,000 $ 3,500 $ 4,000 14%
<br /> Other Local: 0
<br /> Other Local: Mill1111111MI 1■1111111111111 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 I=.11111101111111 0
<br /> State Government 1.111.111111111. 1111111111111111 0
<br /> Federal Government 11111111. MIIIIM 0
<br /> Other Grants:Triangle Comm.Fndtn, $ 15,000 $ 14,000 $ 15,000 7%
<br /> Other Grants: $ 20,000 $ 20,000 $ 15,000 -25%
<br /> Miscellaneous/Other Revenue $ 10,000 II= 0
<br /> Please list 3 largest Miscellanaus sources:
<br /> Cottage Rental $ -
<br /> $ -
<br /> $ -
<br /> Total Agency Revenue 1,104500 $ 1 358 500 1 606 000 11%
<br /> AGENCY EXPENSES
<br /> Compensation,Personnel $ 750,000 $ 980,000 $ 1,100,000 12%
<br /> Rent,Utilities,Insurance,Property $ 90,000 $ 145,000 $ 157,000 MI
<br /> Supplies,Equipment,Program,Food Srvs $ 65,000 $ 80,000 $ 73,000 111=11
<br /> Admin.Expenses(Development,Outreach) $ 113,000 $ 54,000 $ 40 000 -26%
<br /> Other Expenses: $ 43 000 $ 55,300 $ 61 200 11/o
<br /> Please list 3 largest"Other Expenses":
<br /> Depreciation/Amortization $ -
<br /> $ -
<br /> $ -
<br /> Total Agency Expenses 1 061 000 $ 1 314 300 1 431 200 9%
<br /> SURPLUS/(DEFICIT)FOR PERIOD: is 43,500j$ 44,200 1$ 73,800 67%1
<br /> Main Application 1/25/2016 3:18:06 PM Page 21 of 21
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