|
DocuSign Envelope ID: E8DFACF7 -45BE- 435E- 9B5A- BB177E968F07
<br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION
<br />Agency Budget
<br />Operating Budget for Entire Agency
<br />AGENCY NAME: Duke Hospice
<br />AGENCY REVENUE
<br />Private Donations
<br />Agency Generated Revenue (fees)
<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 - Granville County
<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 Agency Revenue
<br />AGENCY EXPENSES
<br />Compensation
<br />Rent & Utilities
<br />Supplies & Equipment
<br />Travel & Training
<br />Other Expenses:
<br />Total Agency Expenses
<br />SURPLUS /(DEFICIT) FOR PERIOD: 1 $ 24,1491$- 39,492 1 $ 24,000 -39%
<br />FY 2015 -16 Comparative Agency Budget
<br />Revised 9/2912014
<br />Actual
<br />2016 -17
<br />Estimated
<br />2017 -18
<br />Projected 2018
<br />19
<br />Percent
<br />Change
<br />$
<br />480,719
<br />$
<br />540,100
<br />$
<br />539,800
<br />0%
<br />$
<br />12,109,420
<br />$
<br />12,909,690
<br />$
<br />13,256,000
<br />3%
<br />$
<br />3,800
<br />$
<br />3,800
<br />$
<br />3,800
<br />00/0
<br />$
<br />-
<br />$
<br />-
<br />$
<br />-
<br />0
<br />$
<br />1,500
<br />$
<br />3,000
<br />$
<br />3,200
<br />7%
<br />$
<br />$
<br />$
<br />-
<br />0
<br />$
<br />1,000
<br />$
<br />1,100
<br />$
<br />1,200
<br />9%
<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 />$
<br />-
<br />$
<br />-
<br />$
<br />-
<br />0
<br />$
<br />-
<br />$
<br />-
<br />$
<br />-
<br />0
<br />$
<br />$
<br />12,596,439
<br />6,433,227
<br />$
<br />$
<br />13,457,690
<br />8,035,588
<br />$
<br />$
<br />13,804,000
<br />8,266,000
<br />3 %p
<br />3%
<br />$
<br />212,329
<br />$
<br />223,165
<br />$
<br />227,000
<br />2%
<br />$
<br />1,291,376
<br />$
<br />1,397,122
<br />$
<br />1,483,000
<br />6%
<br />$
<br />184,846
<br />$
<br />211,165
<br />$
<br />221,723
<br />5 %
<br />$
<br />4,450,512
<br />$
<br />3,551,158
<br />$
<br />3,582,277
<br />1%
<br />$
<br />12,572,290
<br />$
<br />13,418,198
<br />$
<br />13,780,000
<br />3 %Q
<br />SURPLUS /(DEFICIT) FOR PERIOD: 1 $ 24,1491$- 39,492 1 $ 24,000 -39%
<br />FY 2015 -16 Comparative Agency Budget
<br />Revised 9/2912014
<br />
|