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DocuSign Envelope ID: A0992361- 7662- 4FD7- 9DB3- 9D760E06A5D2
<br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION
<br />p) Program Budget
<br />1. Submit your program budget. You may complete the provided template (separate As
<br />file) or you may submit your own budget file (as long as it contains the same information,
<br />in the same format, as requested in the provided template).
<br />Program 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 />Program Budget
<br />Operating Budget for Program
<br />PROGRAM NAMI Transitions to Employment
<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 (CDBG /HOME /etc.)
<br />Private Foundation Grants
<br />Other Revenue
<br />Total Program Revenue
<br />PROGRAM EXPENSES
<br />Compensation
<br />Rent & Utilities
<br />Supplies & Equipment
<br />Travel & Training
<br />Other Expenses:
<br />Total Program Expenses
<br />SURPLUS /(DEFICIT) FOR PERIOD: 1 $ (107,716)1 $ 4,992 1 $ 7,265 1 46%
<br />2. Program Budget Detail — Provide description of "other" budget items, not defined.
<br />No other budget items noted.
<br />PROGRAM INFORMATION 1/22/2018 1:53:42 PM
<br />Actual
<br />2016 -17
<br />Estimated
<br />2017 -18
<br />Projected
<br />2018 -19
<br />Percent
<br />Change
<br />$
<br />7,733
<br />$
<br />7,500
<br />$
<br />7,500
<br />0%
<br />$
<br />979,853
<br />$
<br />1,150, 682
<br />$
<br />1,155, 000
<br />0%
<br />$
<br />3,800
<br />$
<br />4,000
<br />$
<br />4,000
<br />0%
<br />$
<br />-
<br />$
<br />-
<br />$
<br />-
<br />0
<br />$
<br />6,000
<br />$
<br />10,000
<br />$
<br />10,000
<br />0%
<br />$
<br />-
<br />$
<br />-
<br />$
<br />0
<br />$
<br />51,000
<br />$
<br />54,550
<br />$
<br />54,550
<br />0%
<br />$
<br />-
<br />1 $
<br />-
<br />1 $
<br />-
<br />0
<br />$
<br />-
<br />$
<br />-
<br />$
<br />-
<br />0
<br />$
<br />-
<br />$
<br />-
<br />$
<br />-
<br />0
<br />$
<br />101,117.64
<br />$
<br />108,148.64
<br />$
<br />108,148.64
<br />$ -
<br />$
<br />-
<br />$
<br />-
<br />$
<br />0
<br />$
<br />-
<br />$
<br />-
<br />$
<br />-
<br />0
<br />$
<br />-
<br />$
<br />-
<br />$
<br />0
<br />$1,149,504
<br />$ 1,003,287
<br />$1,334,881
<br />$ 1,070,387
<br />$1,339,199
<br />$ 1,070,387
<br />0%
<br />0%
<br />$
<br />50,917
<br />$
<br />51,170
<br />$
<br />51,886
<br />1%
<br />$
<br />73,093
<br />$
<br />76,703
<br />$
<br />75,807
<br />-1%
<br />$
<br />44,689
<br />$
<br />46,629
<br />$
<br />46,854
<br />0%
<br />$
<br />85,234
<br />$
<br />85,000
<br />$
<br />87,000
<br />2%
<br />1$1,257,2210
<br />$1,329,889
<br />$1,331,933
<br />0%
<br />SURPLUS /(DEFICIT) FOR PERIOD: 1 $ (107,716)1 $ 4,992 1 $ 7,265 1 46%
<br />2. Program Budget Detail — Provide description of "other" budget items, not defined.
<br />No other budget items noted.
<br />PROGRAM INFORMATION 1/22/2018 1:53:42 PM
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