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<br />PROGRAM INFORMATION 1/23/2018 11:00:54 AM Page 20 of 23 <br />p) Program Budget <br /> <br />1. Submit your program budget. You may complete the provided template (separate xls <br />file) or you may submit your own budget file (as long as it contains the same information, <br />in the same format, as requested in the provided template). <br /> <br />Program Budgets are required to define budget amounts for the previous program <br />year, current program year, and next program year for the following categories: <br /> <br />• Revenues <br />o Private Donations <br />o Program Generated Revenue <br />o Local Government Grants <br /> Carrboro Human Services <br /> Carrboro Other <br /> Chapel Hill Human Services <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 />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 /> <br />2. Program Budget Detail – Provide description of “other” budget items, not defined. <br /> <br />3. This program budget represents what percent of the agency budget? 8.1% <br /> <br />4. COST PER INDIVIDUAL <br /> <br />PHS budgets using a cost per visit framework as provided below. Once a year, HRSA estimates <br />the cost per patient for the agency by service. In CY 2016, the total medical cost per PHS medical <br />patient served was $440.81, while the total dental cost per dental patient served was $568.37. <br />CY2017 total cost per individual figures by service will be available from HRSA in summer 2018. <br /> <br /> Actual 2016 Estimated 2017 Projected 2018 <br />Total Cost of Program $4,320,260 $4,447,072 $4,981,531 <br />Total # of Encounters <br />24,913 <br />(19,823 medical <br />+ 5,090 dental) <br />21,071 <br />(15,663 medical + <br />5,408 dental) <br />32,569 <br />(21,769 medical + <br />10,800 dental) <br />Cost Per Encounter $173.41 $211.05 $152.95 <br /> <br />