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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. - Chapel Hill Funding for CNCI 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 EXPENSES <br />Compensation <br />Rent & Utilities <br />Supplies & Equipment <br />Travel & Training <br />Other Expenses: <br />Total Program Expenses <br />SURPLUS/(DEFICIT) FOR PERIOD: 1 $ (397,852) $ (823,792) $ (411,000) 50% <br />Actual:' <br />2015-16 <br />Estimated <br />2016 -17 <br />Projected <br />2017 -18 <br />Percent <br />Change <br />$ <br />- <br />$ <br />- <br />$ <br />- <br />0 <br />$ <br />- <br />$ <br />- <br />$ <br />- <br />0 <br />$ <br />- <br />$ <br />- <br />$ <br />0 <br />$ <br />- <br />$ <br />- <br />$ <br />0 <br />$ <br />9,500 <br />$ <br />16,000 <br />$ <br />20,000 <br />25% <br />$ <br />- <br />$ <br />- <br />$ <br />0 <br />$ <br />- <br />$ <br />- <br />$ <br />0 <br />$ <br />- <br />$ <br />- <br />$ <br />0 <br />$ <br />- <br />$ <br />- <br />$ <br />- <br />0 <br />$ <br />- <br />$ <br />- <br />$ <br />- <br />0 <br />$ <br />- <br />$ <br />- <br />$ <br />- <br />0 <br />$ <br />- <br />$ <br />- <br />$ <br />- <br />0 <br />$ <br />- <br />$ <br />- <br />$ <br />- <br />0 <br />Is <br />- <br />I $ <br />- <br />$ <br />- <br />0 <br />$ <br />$ <br />9,500 <br />42,949 <br />$ <br />$ <br />16,000 <br />468,792 <br />$ <br />$ <br />20,000 <br />50,000 <br />25% <br />-89% <br />$ <br />34,008 <br />$ <br />36,000 <br />$ <br />37,000 <br />3% <br />$ <br />62,091 <br />$ <br />65,000 <br />$ <br />67,000 <br />3% <br />$ <br />49,576 <br />$ <br />50,000 <br />$ <br />52,000 <br />4% <br />$ <br />218,728 <br />$ <br />220,000 <br />$ <br />225,000 <br />2 % <br />$ <br />407,352 <br />$ <br />839,792 <br />$ <br />431,000 <br />-49% <br />SURPLUS/(DEFICIT) FOR PERIOD: 1 $ (397,852) $ (823,792) $ (411,000) 50% <br />