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DocuSign Envelope ID: 717C8AE2- 4D6E- 4E46- A9A7- F4213973D039 <br />EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION <br />Program Budget <br />Operating Budget for Program <br />PROGRAM NAME: Club Nova Community, Inc. - O.C. Funding for Transportation <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 (CDBGIHOMEletc.) <br />Private Foundation Grants <br />Other Revenue <br />Total Program Revenge <br />PROGRAM EXPENSES <br />Compensation: Drivers, wage increase, and Transport Coordinator <br />Rent & Utilities <br />Supplies & Equipment: <br />Travel & Training <br />Other Expenses: <br />Total Program Exponses <br />Vehicles ExpenseslMaintenance <br />SURPL,USI(DEFICIT) FOR PERIOD: 1 $ (26,741) $ (31,080) $ (36,000) -16% <br />Actual <br />2016 -17 <br />Estimated <br />2017 -18 <br />Projected <br />2018 -19 <br />Percent <br />Change <br />$ <br />- <br />$ <br />$ <br />0 <br />$ <br />- <br />$ <br />$ <br />0 <br />$ <br />$ <br />$ <br />- <br />0 <br />$ <br />$ <br />- <br />$ <br />- <br />0 <br />$ <br />- <br />$ <br />- <br />$ <br />- <br />0 <br />$ <br />$ <br />- <br />$ <br />0 <br />$ <br />55,000 <br />$ <br />62,500 <br />$ <br />65,000 <br />4% <br />$ <br />- <br />$ <br />- <br />$ <br />- <br />Q <br />$ <br />0 <br />$ <br />$ <br />$ <br />- <br />0 <br />$ <br />- <br />$ <br />$ <br />Q <br />$ <br />- <br />$ <br />$ <br />0 <br />$ <br />- <br />$ <br />- <br />$ <br />Q <br />$ <br />- <br />$ <br />$ <br />- <br />0 <br />$ <br />55,000 <br />$ <br />62,500 <br />$ <br />65,000 <br />4% <br />$ <br />50,500 <br />$ <br />58,580 <br />$ <br />63,000 <br />8% <br />$ <br />- <br />$ <br />- <br />$ <br />- <br />0 <br />$ <br />31,241 <br />$ <br />35,000 <br />$ <br />38,000 <br />9% <br />$ <br />- <br />$ <br />- <br />$ <br />0 <br />$ <br />- <br />$ <br />- <br />$ <br />0 <br />$ <br />81,741 <br />$ <br />93,580 <br />$ 101,000 <br />8% <br />SURPL,USI(DEFICIT) FOR PERIOD: 1 $ (26,741) $ (31,080) $ (36,000) -16% <br />