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DocuSign Envelope ID:8E4BA2A0-F8F0-406A-A380-E6C66CCD78B4 <br /> EXHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> Program Budget <br /> Operating Budget for Program <br /> PROGRAM NAME: CHARLES HOUSE: Daytime Eldercare Program <br /> *based on Jan-Dec Fiscal Years <br /> Actual Estimated Projected Percent <br /> PROGRAM REVENUE 2015-16* 2016-17 201748 Change <br /> Private Donations $ $ - $ 0 <br /> Program Generated Revenue $ 375,725 $ 545,000 $ 590,000 8% <br /> Local Government Grants: <br /> Human Services-Town of Carrboro $ 3,500 $ 3,500 $ 4,000 14% <br /> Other-Town of Carrboro $ - $ $ - 0 <br /> Human Services-Town of Chapel Hill $ 9,000 $ 9,000 $ 10,000 11% <br /> Other-Town of Chapel Hill $ $ $ - 0 <br /> Human Services - Orange County $ 15,000 $ 20,000 $ 25,000 25% <br /> Other- Orange County $ $ - $ - 0 <br /> Other-Town of Hillsborough $ $ $ - 0 <br /> Other Government Grants <br /> Triangle United Way $ $ $ - 0 <br /> State Government $ $ $ 0 <br /> Federal Government (CDBG/HOME/etc) $ $ - $ 0 <br /> Private Foundation Grants $ $ - $ 0 <br /> Other Revenue $ $ - $ - 0 <br /> Total Program Revenue $ 403,225 $ 577,500 $ 629,000 9% <br /> PROGRAM EXPENSES <br /> Compensation $ 350,000 $ 365,000 $ 448,500 23% <br /> Rent& Utilities $ 53,500 $ 73,000 $ 89,000 22% <br /> Supplies, Equipment, Program $ 32,725 $ 32,000 $ 34,000 6% <br /> Travel & Training $ $ $ 0 <br /> Other Expenses: Administrative Exp. $ 5,500 $ 7,000 $ 6,500 -7% <br /> Other Expenses: Depreciation Exp. $ 17,300 $ 23,000 $ 23,000 0% <br /> $ 459,025 $ 500,000 $ 601,000 20%, <br /> SURPLUSI(DEFICIT) FOR PERIOD: $ (55,800)1 $ 77,500 1 $ 28,000 1 -64% <br />