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DocuSign Envelope ID:AB039DC1-8309-4D41-B525-6E84F973FAA6 <br /> EXHIBIT A - PROVIDER'S OUTSIDE AGENCY APPLICATION CONTINUED <br /> MAIN APPLICATION <br /> Section Vi.Financial Data <br /> Operating Budget for Entire Agency <br /> AGENCY NAME: The Exchange Club's Family Center in Alarnance <br /> Actual Estimated Projected Percent <br /> AGENCY REVENUE '201445 2015-16 2016-17 Chan e <br /> Private Donations $ 5,189 $ 4,118 $ 5,000 21% <br /> Agency Generated Revenue(fees) 0 <br /> Local Government Grants: <br /> Orange County $ 2,000 $ 2,000 $ 10,350 418% <br /> Town of Chapel Hill $ 4,000 $ 6,000 $ 10,350 73% <br /> Town of Carrbnro - $ 1,000 $ 3,000 200% <br /> Other Local: Alornonco United Way $ 18,000 $ 18,000 5 25,000 39% <br /> Other Local: 0 <br /> Other Local: 0 <br /> t rrore than 3 souroes,please <br /> provide a separate Int <br /> Non-Local Government Grants <br /> Triangle United Way EMMM $ $ 0 <br /> State Government $ 353,014 $ 414 861 $ 373,379 -10% <br /> Federal Government - $ - $ <br /> Olher Grants:Duke Endowment - $ 42,250 $ 85,000 101% <br /> Other(in-ants: 0 <br /> Miscellaneous/Other Revenue $ 2,400 $ 10,500 MI <br /> Reese list 0 largest Macs lariats so.irces: <br /> Special Ewalts 5 2,400 00 <br /> Total Agency Revenue $ 490 629 522 579 MEP <br /> AGENCY EXPENSES <br /> Compensation $ 305,335 $ 369,724 $ 407,724 10%, <br /> Rent&Utilities $ 22,361 $ 27,258 $ 28,218 <br /> Supplies&Equipment $ 6,291 $ 9,151 $ 9,252 <br /> 1% <br /> Travel&Training $ 30,033 $ 30,960 $ 35,000 13% <br /> Other Expenses: S 33,461 $ 53,546 $ 42,385 -21% <br /> Reese list 3 Largest'aier Expenses". <br /> Grants&Assistance $ 12,625..00 <br /> Contractual $ 17,640.00 <br /> Fees&Depreciation Expense: $ 11,441 33 <br /> Total Agency Expenses 490 629 S 522 579 <br /> SURPLUMDEFICIT)FOR PERIOD: I$ (14,1394$ 01 S - [ -10074 <br /> Main Application 1/24/2016 4:55:46 PM Page 2 1 of 2 1 <br />