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DocuSign Envelope ID:6D821DA0-CO6F-4D38-BB4F-DB28CB54AD8E XHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> ii. Does your agency budget show a Surplus or Deficit? Surplus <br /> Is there a significant change? Yes/No No <br /> Please provide a brief explanation for Surplus or Deficit, and significant changes. <br /> Our agency budget shows a surplus. It is our goal and mission to serve the targeted <br /> population within our capabilities and funding. We are able to do this with the various <br /> segments of our business. Surplus agency funds are used to supplement various <br /> program service deficits. <br /> iii. What is your agency's fiscal year? July 1, 2017 — June 30, 2018 <br /> Agency Information 1/31/2017 8:24:51 AM II ' ago 10 of 20 <br />