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DocuSign Envelope ID: C5305795- 2DF5- 4A04- B090- 9F458AA520CB
<br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION
<br />AGENCY NAME:
<br />AGENCY REVENUE
<br />Private Donations
<br />Agency Budget
<br />Operating Budget for Entire Agency
<br />CHARLES HOUSE ASSOCIATION
<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 - Town of Hillsborough
<br />Other Government Grants
<br />Triangle United Way
<br />State Government
<br />Federal Government (CDBGIHOMEIetc.)
<br />Private Foundation Grants
<br />Other: Capital & Program Development
<br />Total Agency Revenue
<br />AGENCY EXPENSES
<br />Compensation
<br />Rent, Mortgage, Utilities, Maintenance
<br />Program, Food Service
<br />Administrative
<br />Outreach, Development
<br />Other Expenses: Depreciation
<br />Total Agency Expenses
<br />CAPITAL & PROGRAM DEVELOPMENT RESERVE
<br />OPERATING SURPLUS /(DEFICIT):
<br />FY 2018 -19 Agency Budget
<br />$ 1,000 1 $ 75,400 1 $ 14,000 1
<br />Actual
<br />2016 -17
<br />Estimated
<br />2017 -18
<br />Projected
<br />2018 -19
<br />Percent
<br />Change
<br />$
<br />45,000
<br />$
<br />33,000
<br />$
<br />26,500
<br />-20%
<br />$
<br />1,370,000
<br />$
<br />1,475,000
<br />$
<br />1,510,000
<br />2 %
<br />$
<br />3,500
<br />$
<br />1,500
<br />$
<br />3,500
<br />133%
<br />$
<br />-
<br />$
<br />-
<br />$
<br />-
<br />0
<br />$
<br />9,000
<br />$
<br />7,000
<br />$
<br />10,000
<br />43%
<br />$
<br />-
<br />$
<br />-
<br />$
<br />-
<br />0
<br />$
<br />20,000
<br />$
<br />22,500
<br />$
<br />25,000
<br />11%
<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 />0
<br />$
<br />_
<br />$
<br />-
<br />$
<br />-
<br />0
<br />$
<br />6t1,000
<br />$
<br />40,000.00
<br />$
<br />20,000.00
<br />$
<br />$
<br />140,000
<br />$
<br />295,000
<br />$
<br />30,000
<br />$ {0.90}
<br />$1,648,500
<br />$ 1,133,000
<br />$1,874,000
<br />$ 1,140,004
<br />$1,625,000
<br />$ 1,220,000
<br />-13%
<br />7 %°
<br />$
<br />157,000
<br />$
<br />156,500
<br />$
<br />155,000
<br />-1%
<br />$
<br />82,850
<br />$
<br />89,500
<br />$
<br />91,000
<br />2 %©
<br />$
<br />39,500
<br />$
<br />35,100
<br />$
<br />33,500
<br />-5%
<br />$
<br />27,500
<br />$
<br />12,500
<br />$
<br />16,500
<br />32%
<br />$
<br />67,650
<br />$
<br />70,000
<br />$
<br />65,000
<br />-7 %fl
<br />$1,507,500
<br />$1,503,600
<br />$1,581,000
<br />5%
<br />$
<br />140,000
<br />$
<br />295,000
<br />$
<br />30,000
<br />-907.
<br />$ 1,000 1 $ 75,400 1 $ 14,000 1
<br />
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