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DocuSign Envelope ID: 74839431 - 9216- 429F- BFA4- 2AC6473BD9D3 <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br />PROGRAM NAME <br />PROGRAM REVENUE <br />Private Donations <br />Program Budget <br />Operating Budget for Program <br />Partner Abuse Intervention <br />Program Generated Revenue <br />Local Government Grants: <br />Human Services - Town of Carrboro <br />Other - Town of Garrboro <br />Human Services - Town of Chapel Full <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 (CDBGfHOMEIetc.) <br />Private Foundation Grants <br />Other Revenue fund bal. <br />Total Program Revenue <br />PROGRAM EXPENSES <br />Compensation <br />Rent & Utilities <br />Supplies & Equipment <br />Travel & Training <br />Other Expenses: (Contract facilitators) <br />Total Program Expenses <br />SURPLUSI(DEFICIT) FOR PERIOD: <br />FY 2018 -19 Program Budget <br />Is (0)1$ 1 is - I - 1007/. <br />Actual <br />Estimated <br />Projected <br />Percent <br />2016 -17 <br />2017 -18 <br />2018 -19 <br />Chan e <br />$ <br />- <br />$ <br />- <br />$ <br />- <br />0 <br />$ <br />500 <br />$ <br />13,140 <br />$ <br />6,760 <br />-49 %a <br />$ <br />1,250 <br />$ <br />1,750 <br />$ <br />3,500 <br />100% <br />$ <br />$ <br />- <br />$ <br />- <br />0 <br />3,750 <br />$ <br />1,750.-$ <br />6,000 <br />243% <br />$ <br />- <br />$ <br />- <br />$ <br />- <br />0 <br />$ <br />2,000 <br />$ <br />2,350 <br />$ <br />4,500 <br />91% <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 />S <br />- <br />$ <br />- <br />0 <br />$ <br />- <br />$ <br />- <br />$ <br />- <br />o <br />$ <br />- <br />$ <br />- <br />$ <br />- <br />0 <br />$ <br />3,383 <br />$ <br />- <br />$ <br />- <br />0 <br />$ <br />1 0,883 <br />$ <br />18,990 <br />$ <br />20,760 <br />9% <br />$ <br />6,811 <br />$ <br />6,854 <br />$ <br />9,585 <br />40% <br />$ <br />1,400 <br />S <br />2,575 <br />$ <br />2,575 <br />0% <br />$ <br />472 <br />$ <br />600 <br />$ <br />6o0 <br />0 % <br />$ <br />47 <br />$ <br />2,600 <br />$ <br />2,500 <br />0 % <br />$ <br />2,153 <br />$ <br />6,460 <br />$ <br />5,500 <br />-15% <br />$ <br />10,883--[—$ <br />18,930 <br />$ <br />20,760 <br />3 °�0 <br />Is (0)1$ 1 is - I - 1007/. <br />