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DocuSign Envelope ID: C5305795- 2DF5- 4A04- B090- 9F458AA520CB <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br />Program Budget <br />Operating Budget for Program <br />PROGRAM NAME: CHARLES HOUSE DAYTIME ELDERCARE PROGRAM <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 (CDBGIHOMEIetc.) <br />Private Foundation Grants <br />Other Revenue <br />Total Program Revenue <br />PROGRAM EXPENSES <br />Compensation <br />Rent, Utilities, Maintenance <br />Program, Food Service <br />Administrative <br />Other Expenses: Depreciation <br />Total Program Expenses <br />SURPLUSI(DEFICIT) FOR PERIOD: 1 $ 29,000 26,900 1 $ 27,500 1 2% <br />FY 2018 -19 Program Budget <br />Actual <br />2016 -17 <br />Estimated <br />2017 -18 <br />Projected <br />2018 -19 <br />Percent <br />Change <br />$ <br />12,000 <br />$ <br />- <br />$ <br />- <br />0 <br />$ <br />540,000 <br />$ <br />575,000 <br />$ <br />610,000 <br />6% <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 />- <br />D <br />$ <br />_ <br />$ <br />_ <br />$ <br />_ <br />0 <br />$ <br />10,000 <br />$ <br />12,000 <br />$ <br />8,000.00 <br />$ <br />(0.33) <br />$ <br />_ <br />$ <br />_ <br />$ <br />- <br />0 <br />$ <br />$ <br />594,500 <br />415,000 <br />$ <br />$ <br />618,000 <br />435,500 <br />$ <br />$ <br />656,500 <br />471,000 <br />60 <br />8% <br />$ <br />87,000 <br />$ <br />87,000 <br />$ <br />89,000 <br />20 <br />$ <br />33,500 <br />$ <br />39,500 <br />$ <br />40,000 <br />1% <br />$ <br />7,000 <br />$ <br />6,100 <br />$ <br />6,000 <br />-2% <br />$ <br />23,000 <br />$ <br />23,000 <br />$ <br />23,000 <br />$ <br />565,500 <br />$ <br />591,100 <br />$ <br />629,000 <br />tO <br />SURPLUSI(DEFICIT) FOR PERIOD: 1 $ 29,000 26,900 1 $ 27,500 1 2% <br />FY 2018 -19 Program Budget <br />