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DocuSign Envelope ID: CCFF6125- AA47- 438A- 98CA- B42519499D42
<br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION
<br />PROGRAM NAMI
<br />PROGRAM REVENUE
<br />Primate Donations
<br />Program Budget
<br />Operating Budget for Program
<br />Carrboro, Community Health Center
<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 />SURPLUSI(DEFICIT) FOR PERIOD
<br />$ 244,697 1 $ 257,543 1 $ 420,952 63/9,
<br />PROGRAM INFORMATION 1/23/2018 11:00:54 AM Page 21 of 23
<br />Actual
<br />FY1€
<br />Estimated
<br />FY17
<br />Projected FY18
<br />Percent
<br />Change
<br />$
<br />-
<br />$'
<br />262
<br />$
<br />-
<br />- 100%
<br />$
<br />3,636,939
<br />2,961,641
<br />$
<br />4,572.303
<br />54%
<br />$
<br />3,000
<br />$
<br />5.000
<br />$
<br />15.000
<br />200%
<br />$
<br />-
<br />$
<br />$
<br />-
<br />0
<br />$
<br />2,000
<br />$
<br />2.000
<br />$
<br />15,000
<br />650%
<br />$
<br />-
<br />$
<br />-
<br />$
<br />0
<br />$
<br />11,000
<br />$
<br />16.500
<br />$
<br />16.500
<br />0%
<br />$
<br />-
<br />$
<br />$
<br />0
<br />$
<br />-
<br />$
<br />$
<br />0
<br />$
<br />-
<br />$
<br />$
<br />0
<br />$
<br />61925
<br />$
<br />160,266
<br />$
<br />100.000.00
<br />$ 0.38
<br />$
<br />652,123
<br />$
<br />1,127,575
<br />1
<br />494,553.00
<br />$ "0.56
<br />$
<br />153.133
<br />5
<br />237,525
<br />$
<br />105,500.00
<br />$• 0.56
<br />$
<br />42,837
<br />$
<br />193.846
<br />$
<br />83,627
<br />$ 0.57
<br />$4,564,957
<br />$ 2,810,627
<br />$4,704,615
<br />$ 2,846,781
<br />$
<br />$
<br />5;402,483
<br />3,522,621
<br />15%
<br />24%
<br />$
<br />82,128
<br />$
<br />98,929
<br />$
<br />296,869
<br />200%
<br />$
<br />440,757
<br />$
<br />665,610
<br />$
<br />490,731
<br />-26 %6
<br />$
<br />34.931
<br />$
<br />28.207
<br />$
<br />39.322
<br />39%
<br />$ 951,818
<br />$4,320,260
<br />$ 807,545
<br />$
<br />631.988
<br />-22%
<br />$ 4,951,531
<br />120
<br />$4,447,072
<br />$ 244,697 1 $ 257,543 1 $ 420,952 63/9,
<br />PROGRAM INFORMATION 1/23/2018 11:00:54 AM Page 21 of 23
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