2018-444-E Finance - Habitat for Humanity outside agency agreement

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Page 21 of 23 o Other Revenue x Expenditures o Compensation o Rent & Utilities o Supplies & Equipment o Travel & Training o Other Expenses 2. Program Budget Detail –Provide description of “other” budget items, not defined. Other Revenue: loan payments from homeowners. Other Expenses: materials and subcontracted labor. 3. This program budget represents what percent of the agency budget? Home Preservation represents 6.2% of Habitat’s FY17 budget, 5.5% of FY18, and 6.5% of FY19. 4. COST PER INDIVIDUAL This Cost per Individual must reflect the total program budget divided by the total number of program individuals in this application. Actual 2016-17 Estimated 2017-18 Projected 2018-19 Total Cost of Program $192,263 $246,660 $251,430 Total # of Individuals 31 30 30 Cost Per Individual $6,202 $8,222 $8,381 4.ATTACHMENTS Description of Required Attachments a) Financial Audit A recent financial audit that should cover CY 2016, for calendar year agencies, and FY 2016-17, for fiscal year agencies. For agencies with prior year revenues totaling $500,000 or more a financial audit, prepared by a certified public accountant is required. Agencies with prior year revenues of less than $500,000 may submit a completed Schedule of Receipts and Expenditures form (see application materials), in lieu of an audit/report. Agencies with a certified audit/report should not complete the form. b) IRS Federal Form 990 A copy of the agency’s 2016 Form 990 is required. The specific form depends upon the agency’s financial activity. Review the IRS’ table guide, for more details. For Form 990-N (e-postcard) filers, include a copy of the postcard, with the agency’s application materials. c) NC Solicitation License EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION DocuSign Envelope ID: 1263366F-0902-4D24-AE16-FC2EBB866669