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DocuSign Envelope ID: A2273A84- 8827 - 4141- A87E- C8CFF83C3936 <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br />Agency Budget <br />Operating Budget for Entire Agency <br />AGENCY NAME: <br />AGENCY REVENUE <br />Private Donations <br />Agency Generated Revenue (fees) <br />Local Government Grants: <br />Refugee Community Partnership <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 Events <br />Corporate <br />Total Agency Revenue <br />AGENCY EXPENSES <br />Compensation <br />Rent & Utilities <br />Supplies & Equipment <br />Travel & Training <br />Other Expenses: Interpreters <br />Other Expenses: Insurance <br />Other Expenses: Consulting Fees <br />Total Agency Expenses <br />SURPLUS /(DEFICIT) FOR PERIOD: <br />Actual <br />2016 -17 <br />Estimated <br />2017 -18 <br />Projected <br />2018 -19 <br />Percent <br />Change <br />$ <br />20,000 <br />$ <br />22,486 <br />$ <br />32,000 <br />42% <br />$ <br />$ <br />- <br />3,500 <br />$ <br />$ <br />- <br />6,000 <br />$ <br />$ <br />- <br />9,000 <br />0 <br />50% <br />$ <br />- <br />$ <br />- <br />$ <br />- <br />0 <br />$ <br />1,750 <br />$ <br />2,000 <br />$ <br />8,200 <br />310% <br />$ <br />- <br />$ <br />- <br />$ <br />- <br />0 <br />$ <br />2,000 <br />$ <br />8,750 <br />$ <br />15,500 <br />77% <br />$ <br />14,120 <br />$ <br />- <br />$ <br />- <br />0 <br />$ <br />$ <br />- <br />- <br />$ <br />$ <br />- <br />- <br />$ <br />$ <br />- <br />- <br />0 <br />0 <br />$ <br />- <br />$ <br />- <br />$ <br />- <br />0 <br />$ <br />- <br />$ <br />- <br />$ <br />- <br />0 <br />$ 25,000.00 <br />$ - <br />$ 45,000.00 <br />$ 2,460 <br />$ 63,300.00 <br />$ 3,350 <br />41% <br />36% <br />$ <br />$ <br />1,000 <br />67,370 <br />$ 25,300 <br />$ 111,996 <br />$ - <br />$ 131,350 <br />- 100% <br />17% <br />$ <br />39,348 <br />$ <br />87,612 <br />$ <br />110,600 <br />26% <br />$ <br />7,200 <br />$ <br />2,796 <br />$ <br />2,796 <br />0% <br />$ <br />2,798 <br />$ <br />3,984 <br />$ <br />3,700 <br />-7% <br />$ <br />275 <br />$ <br />1,750 <br />$ <br />2,400 <br />37% <br />$ <br />1,829 <br />$ <br />3,000 <br />$ <br />5,500 <br />83% <br />$ <br />1,200 <br />$ <br />3,854 <br />$ <br />3,854 <br />0% <br />$ <br />$ <br />14,720 <br />67,370 1 <br />$ 9,000 <br />$ 111,996 1 <br />$ 2,500 <br />$ 131,350 <br />-72% <br />1 17% <br />$ - 1 $ - 1 $ - 1 0 <br />