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DocuSign Envelope ID: D068E7B0- D869- 43F4- B35C- 428F10E3BDC1 <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br />Program Budget <br />Operating Budget for Program <br />PROGRAM NAME <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 (CDBG /HOME /etc.) <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: <br />FY 2018 -19 Program Budget <br />MEDIATION <br />$ (8,488) $ (4,690) $ - 1 100% <br />Actual <br />2016 -17 <br />Estimated <br />2017 -18 <br />Projected <br />2018 -19 <br />Percent <br />Change <br />$ <br />20,000 <br />$ <br />20,000 <br />$ <br />37,500 <br />88% <br />$ <br />18,587 <br />$ <br />27,000 <br />$ <br />26,000 <br />-4% <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 />1 <br />80,000 <br />$ <br />81,500 <br />$ <br />85,000 <br />4% <br />$ <br />- <br />1 $ <br />- <br />1 $ <br />- <br />0 <br />6$ <br />$ <br />- <br />$ <br />- <br />0 <br />$ <br />=0l- <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 />25,000.00 <br />$ <br />20,000.00 <br />$ <br />10,000.00 <br />$ (0.50) <br />$ <br />- <br />$ <br />- <br />$ <br />- <br />0 <br />$ <br />$ <br />143,587 <br />129,500 <br />$ <br />$ <br />148,500 <br />132,090 <br />$ <br />$ <br />158,500 <br />134,750 <br />7% <br />2% <br />$ <br />2,650 <br />$ <br />2,900 <br />$ <br />3,400 <br />17% <br />$ <br />3,875 <br />$ <br />3,000 <br />$ <br />3,250 <br />8% <br />$ <br />3,175 <br />$ <br />2,800 <br />$ <br />3,200 <br />14% <br />$ <br />12,875 <br />$ <br />12,400 <br />$ <br />13,900 <br />12% <br />$ <br />152,075 <br />$ <br />153,190 <br />$ <br />158,500 <br />3% <br />$ (8,488) $ (4,690) $ - 1 100% <br />