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DocuSign Envelope ID:99BDCA4A-2934-455A-8D45-0C865AD016D0 it A continued <br /> Provider's Outside Agency Application <br /> MAIN APPLICATION <br /> Agency/Program Big Brothers Big Sisters of the Triangle <br /> Actual Estimated Projected Percent <br /> AGENCY REVENUE 2014-15 2015-16 2016-17 Change <br /> Private Donations $ 128,650 $ 128,500 $ 130,500 2% <br /> Agency Generated Revenue (fees) 0 <br /> Local Government Grants: <br /> Orange County $ 2,000 $ 2,000 $ 6,000 200% <br /> Town of Chapel Hill $ 2,000 $ 2,000 $ 6,000 200% <br /> Town of Carrboro $ 1,350 $ 1,500 $ 3,000 100% <br /> Other Local: 0 <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 <br /> Triangle United Way $ 10,000 $ 10,000 $ 10,000 0% <br /> State Government 0 <br /> Federal Government 0 <br /> Other Grants: 0 <br /> Other Grants: 0 <br /> Miscellaneous/Other Revenue $ 90,000 $ 90,000 $ 90,000 0% <br /> Please list 3 largest Mscellanous sources: <br /> ICAP Energy $ 30,000.00 <br /> Anonymous Foundation $ 60,000.00 <br /> Total Agency Revenue $ 234 000 $ 234 000 $ 245 500 5% <br /> AGENCY EXPENSES <br /> Compensation $ 213,500 $ 213,500 $ 225,000 5% <br /> Rent&Utilities 0 <br /> Supplies&Equipment $ 7,000 $ 7,000 $ 7,000 0% <br /> Travel&Training $ 6,000 $ 6,000 $ 6,000 0% <br /> Other Expenses: $ 7,500 $ 7,500 $ 7,500 0% <br /> Please list 3 largest"Other Expenses": <br /> Background Checks $ 3,000.00 <br /> Liability Insurance $ 4,500.00 <br /> Total Agency Expenses $ 234,000 $ 234,000 $ 245,500 5% <br /> SURPLUS/(DEFICIT)FOR PERIOD: <br /> Main Application 5/24/2016 8:51:19 AM Pag e 20 f 25 <br />