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DocuSign Envelope ID:88AEE9BF-924A-442D-BD41-DC640F1 E1 BAC <br /> EXHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> • Chapel Hill Human Services <br /> • Chapel Hill Other (DO NOT include CDBG funding here) <br /> • Orange County Human Services <br /> • Orange County Other (DO NOT Include HOME funding here) <br /> o Other Government Grants <br /> • Triangle United Way <br /> • State Government <br /> • Federal Government (CDBG/HOME/etc.) <br /> • Private Foundation Grants <br /> o Other Revenue <br /> • Expenditures <br /> o Compensation <br /> o Rent & Utilities <br /> o Supplies & Equipment <br /> o Travel &Training <br /> o Other Expenses <br /> iii. Does your agency budget show a Surplus or Deficit? <br /> We had a slight deficit in FY16 of 2%. We don't know yet how FY17 will come <br /> out. We attempt to maintain several months operating expenses to be able to <br /> absorb this. In the overall budget, it is difficult to project the amount of fee for <br /> service projects that come our way that we can complete in a fiscal year. <br /> Is there a significant change? Yes/No NO <br /> Please provide a brief explanation for Surplus or Deficit, and significant changes. <br /> This year we used some reserve funds to invest in staff and our infrastructure. At <br /> the same time, one of our foundation supporters told us they were moving, and <br /> would stepping down the support to us in the next two years, which has been a <br /> loss of$5,000 and next year, $10,000. We also no longer have United Way <br /> support. This has meant pressure to raise fees for service and also more <br /> contributions, which we have been marginally successful with. <br /> iv. What is your agency's fiscal year? July 1 — June 30 <br /> (Example: July 1, 2016 through June 30, 2017) <br /> Agency Information 2/8/2017 11:26:12 AM P '11 • .f 22 <br />