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DocuSign Envelope ID: 134C4810- 3CA5- 4008- 9E74- 2A07D3AECED8 <br />EXHIBIT A - PROVIDER'S OUTSIDE AGENCY APPLICATION <br />Program Budget <br />Operating Budget for Program <br />PROGRAM NAME Club Nova Community, Inc. - Orange County Funding for Critical Safety Net <br />PROGRAM REVENUE <br />Private Donations <br />Program Generated Revenue <br />Local Government Grants: <br />Human Services - Town of Carrboro <br />Other - Town of Carrboro <br />Human Services - Town of Chapel Hill <br />Other - Town of Chapel Hill <br />Human Services - Orange County <br />Other - Orange County <br />Other - Town of Hillsborough <br />Other Government Grants <br />Triangle United Way <br />State Government <br />Federal Government (CDBGIHOMEIetc.) <br />Private Foundation Grants <br />Other Revenue <br />Total Program Revenue <br />PROGRAM E=XPENSES <br />$ - $ - $ - 0 <br />Is - $ - $ - 0 <br />$ 10,000 <br />$ 13,500 <br />$ 20,000 <br />48% <br />$ - <br />$ - <br />$ - <br />0 <br />$ 9,500 <br />$ 16,000 <br />$ 20,000 <br />25% <br />$ - <br />$ - <br />$ - <br />0 <br />$ - <br />$ 10,000 <br />$ 20,000 <br />100% <br />$ - <br />$ - <br />$ - <br />0 <br />_ <br />d. _ <br />It _ <br />n <br />$ 19,500 I `$ 39,500 I $ 60,000 52 <br />Compensation: include Living Wage Increase <br />Rent & Utilities <br />Supplies & Equipment: Food and Provisions <br />Travel & Training <br />Other Expenses: <br />Total Program. Expenses <br />$ 412,949 <br />$ 468,792 <br />$ 500,000 <br />7% <br />$ - <br />$ - <br />$ - <br />0 <br />$ 30,207 <br />$ 32,000 <br />$ 35,000 <br />9% <br />$ - <br />$ - <br />$ - <br />0 <br />$ - <br />$ - <br />$ - <br />0 <br />$ 443,156 <br />$ .500,792 <br />$ 535,000- <br />7% <br />SURPI_USI(DEFICIT) FOR PERIOD; 1 $ (423,656) $ (461,292) $ (475,000) -3% <br />