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DocuSign Envelope ID: COBB49A6 -D1 E9- 42DE- 8E8D- 7583E683E1E2 <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br />A S C D E i G ! I } K L <br />_ Agency Budget <br />Qperaung Budget for Entire Agency <br />i <br />AGENCY NAME: Orange County Livie9ll: age ._ . <br />AGENCY REVENUE <br />Private Donations <br />�.... Agency Generffied Revenue (fees) <br />1 Local Government Grants; <br />1 _ Human Services - Town of Carrborc <br />12 Other - Town of Carrboro <br />13 Human Services -Town of Chapel Hill <br />_. —._.__ ma Other -Town of Chapel Hill <br />15 Hun Services - Orange County <br />16 Other - Orange County <br />17 <br />Other -Tpwn of HNlsborough <br />18 Other Government Grants —`� <br />19 Triangle United Way <br />23 ; State Govemment <br />2 ;Federal Govemment [CDBGIHOMElete.) <br />22 <br />lPrlvste Foundation Grants._ <br />23 <br />24 - .....��.._. Other Revenue <br />25 <br />26 Total Agency Revenue <br />27 <br />23 AGENCY EYLPENSES <br />29 ' Compensatlon <br />30 Rent & Utilities <br />31 Supplies & Equipment <br />'2 Travel & Training <br />Other Expenses: <br />Total Agency Expenses <br />SURPLUSHDEFICIT) FOR PERIOD: <br />Agency 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 />Revenues <br />Private Donations <br />Program Generated Revenue <br />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 />0 Other Government Grants <br />■ Triangle United Way <br />• State Government <br />■ Federal Government (CDBG /HOMEletc.) <br />■ Private Foundation Grants <br />0 Other Revenue <br />• Expenditures <br />Agency information 112112018 12:07:58 PM Page 6 of 17 <br />Actual <br />2016.17 <br />Estimated <br />2017 -18 <br />Projected <br />2Di8_18 <br />Pere-ant <br />Change <br />$ <br />2,023 <br />$ 2,461 <br />$ <br />3,000 <br />22% <br />S <br />o <br />S <br />5 <br />$ <br />6,000 <br />0 <br />S <br />$ <br />$ <br />0 <br />5 <br />$ <br />$ <br />9,000 <br />0 <br />$ <br />$ <br />S <br />0 <br />$ <br />16,750 <br />$ 17,725 <br />$ <br />20,000 <br />13% <br />$ <br />$ <br />$ <br />0 <br />$ <br />$ <br />0 <br />$ <br />$ <br />$ <br />0 <br />$ <br />$ <br />$ <br />0 <br />$ <br />$ <br />$ <br />0 <br />_ <br />$ 1,000.00 <br />$ <br />5,000.00 <br />$ <br />3673 <br />$ <br />0 <br />$ <br />22,446 <br />$ 21,106 <br />$ <br />43,000 <br />103% <br />$ <br />8,059 <br />$ 12,004 <br />S <br />24,750 <br />106% <br />$ <br />$ <br />$ <br />D <br />$ <br />2,853 <br />$ 6,030 <br />$ <br />7,500 <br />24% <br />$ <br />1,500 <br />$ <br />$ <br />0 <br />S <br />4,982 <br />S 2,894 <br />S <br />10,500 <br />263% <br />$ <br />17..394 <br />$ 20,924 <br />$ <br />42,750 <br />104% <br />Agency 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 />Revenues <br />Private Donations <br />Program Generated Revenue <br />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 />0 Other Government Grants <br />■ Triangle United Way <br />• State Government <br />■ Federal Government (CDBG /HOMEletc.) <br />■ Private Foundation Grants <br />0 Other Revenue <br />• Expenditures <br />Agency information 112112018 12:07:58 PM Page 6 of 17 <br />