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DocuSign Envelope ID:71415AD7-DCDD-4CF6-89A9-F93F72D8DC62 XHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <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? deficit <br /> Is there a significant change? Yes/No no <br /> Please provide a brief explanation for Surplus or Deficit, and significant changes. <br /> As of the 1/31/17 deadline, OCIM has not received the audited December 2016 financial <br /> report from the accountants. Until the report is available, it will be unclear as to whether <br /> there is a deficit or how much it may be. OCIM always operates with a very narrow <br /> margin. <br /> The shown budget for 2018 is only a mirror of the 2017 budget, with the addition of <br /> additional funds OCIM is seeking for Meals on Wheels. The OCIM Board of Directors will <br /> begin working on the 2018 budget later this year. <br /> iv. What is your agency's fiscal year? January 1, 2017 through December 31, 2017 <br /> (Example: July 1, 2016 through June 30, 2017) <br /> Anpnrit InfnrmAtinn 1m/21117 4.dR-17 PM P 4 n 1 9 n F 2 ",1 <br />