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DocuSign Envelope ID: 535BB656- 53CF- 457A- 98B2- D73B9641501D XHIBIT A <br />PROVIDER'S OUTSIDE AGENCY APPLICATION <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 />• Other Government Grants <br />• Triangle United Way <br />• State Government <br />• Federal Government (CDBGIHOMEIetc.) <br />IN Private Foundation Grants <br />• Other Revenue <br />Expenditures <br />• Compensation <br />• Rent & Utilities <br />• Supplies & Equipment <br />• Travel & Training <br />• Other Expenses <br />iii. Does your agency budget show a Surplus or Deficit? Deficit <br />Is there a significant change? Yes /No Yes <br />A significant change for Senior Care of Orange County has been a challenge over the past <br />fiscal year. The Florence Gray Soltys Adult Day Health Program has various third party <br />payer sources and due one; the Veterans Administration is currently providing limited <br />funding days of service for approved Veterans. In the past; Veterans would qualify for <br />attendance in the program for up to five days per week, where now its three days. The <br />increase in the cost of living wage, where the program cost per day of service has <br />remained the same. The staffing changes due to limited wages and employees needing <br />benefits. (Staffing Turnover) <br />iv. What is your agency's fiscal year? July 1, 2016 —June 30, 2017 <br />13 of 26 <br />