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DocuSign Envelope ID: 5D25D6E0-716B-4244-AEA3-02E6A45FD852
<br /> EXHIBIT A
<br /> PROVIDER'S OUTSIDE AGENCY APPLICATION
<br /> Summer Interns 17,500 17,500 17,500 0%
<br /> Additional Staffing Needs 1,056 5,707 5,707 0%
<br /> Employee Benefits 11,200 31,323 32,576 4%
<br /> Payroll Taxes 24,843 24,344 25,771 6%
<br /> Subtotal: Personnel 259,582 328,641 347,913 6%
<br /> Contracted Services
<br /> Accountant 539 4,200 4,200 0%
<br /> NC Campus Compact Americorps VISTA 6,050 700 0 -100%
<br /> NC IDA Collaborative Americorps VISTA 7,000 6,200 6,200 0%
<br /> Additional Americorps 0 5,400 5,400 0%
<br /> Subtotal: Contracted Services 13,589 16,500 15,800 -4%
<br /> Supplies and Materials
<br /> Printing and Copying 3,574 2,960 3,256 10%
<br /> Food and Drinks 2,778 3,404 3,506 3%
<br /> Office Supplies 1,544 2,270 2,338 3%
<br /> Program Supplies 1,554 3,058 3,149 3%
<br /> Credit Union Account Membership Fees 210 550 550 0%
<br /> Subtotal: Supplies and Materials 9,660 12,241 12,799 5%
<br /> Direct Member Support(Reimbursable) 0
<br /> HUD Supportive Services 6,080 5,000 0 -100%
<br /> Designated Direct Member Support 19,646 2,192 0 -100%
<br /> Subtotal: Direct Member Support 25,726 7,192 0 -100%
<br /> Operating Expenses
<br /> Rent, Utilities& Internet 35,481 44,917 44,917 0%
<br /> Online Services 2,939 2,173 2,239 3%
<br /> Staff&Volunteer Development 2,362 2,650 2,950 11%
<br /> Travel and Transportation 2,104 1,030 1,030 0%
<br /> Course Fees for Advocate Training 0 1,500 1,500 0%
<br /> Payroll Services 1,216 994 1,024 3%
<br /> Conferences & Memberships 789 1,100 1,100 0%
<br /> Postage 1,058 1,100 1,210 10%
<br /> Other: Bank Charges, Miscellaneous 1,022 488 503 3%
<br /> Insurance, licenses and permits 1,767 1,118 1,152 3%
<br /> Subtotal: Operating Expenses 48,738 57,071 57,624 1%
<br /> Professional Fees
<br /> Audit&Tax Preparation Fees 8,027 8,000 8,000 0%
<br /> Other Professional Fees 7,636 0 1,000 0
<br /> Subtotal: Professional Fees 15,663 8,000 9,000 13%
<br /> Operating Reserves 29,145 0 0 0
<br /> TOTAL EXPENSES 407,556 447,645 450,136 1%
<br /> NET INCOME 0 0 0
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