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DocuSign Envelope ID:4D553CF7-2BBD-4F4E-B84E-E6B8B077A9AB
<br /> EXHIBIT A
<br /> PROVIDER'S OUTSIDE AGENCY APPLICATION
<br /> Program Budget
<br /> Operating Budget for Program
<br /> PROGRAM NAME Community Mental Health Programs(PBCN, Compeer, FAN)
<br /> Actual Estimated Projected Percent
<br /> PROGRAM REVENUE 2015-16 2016-17 2017-18 Change
<br /> Private Donations $ 2,547 $ 1,000 $ 20,000 1900%
<br /> Program Generated Revenue $ 1,157 $ 2,200 $ 3,000 36%
<br /> Local Government Grants:
<br /> Human Services-Town of Carrboro $ 5,700 $ '5,700 $ 5,700 0%
<br /> Other-Town of Carrboro - 0
<br /> Human Services-Town of Chapel Hill $ 5,500 $ 6,000 $ 6,000 0%
<br /> Other-Town of Chapel Hill - 0
<br /> Human Services-Orange County $ 59,719 $ 57,939 $ 58,000 0%
<br /> Other-Orange County
<br /> Durham County $ 22,000 $ 23,588 $ 23,588
<br /> Durham County JCPC $ 14,000 $ 15,166 $ 14,000 -8%
<br /> Other Government Grants
<br /> Triangle United Way 0
<br /> State Government 0
<br /> Federal Government(CDBG/HOME/etc.) 0
<br /> Private Foundation Grants $ 25,000.00 $ 1.00
<br /> Other Revenue: Cardinal Innovations $ 79,600 $ 66,508 $ 67,000 $ 0.01
<br /> Total Program Revenue $ 190,223 $ 203,101 $ 197,288 -3%
<br /> PROGRAM EXPENSES
<br /> Compensation $ 153,410 $ 190,164 $ 185,000 -3%
<br /> Rent&Utilities $ 6,967 $ 1,375 $ 1,400 2%
<br /> Supplies&Equipment $ 10,670 $ 1,875 $ 2,000 7%
<br /> Travel&Training $ 3,292 $ 1,500 $ 2,000 33%
<br /> Other Expenses:Contractual Services, $ 12,860 $ 7,362 $ 6,500 -12%
<br /> Insurance, Dues,Bank,Advertising IMOMINININIEMIMMINIMMEIMINE
<br /> Total Program Expenses $ 187,199 $ 202,276 $ 196,900, -3%
<br /> SURPLUS/(DEFICIT) FOR PERIOD: 1 $ 3,024 ( $ 825 1 $ 388 I -53%1
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