2018-507-E Finance - Club Nova outside agency agreement

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DocuSign Envelope ID: 717C8AE2- 4D6E- 4E46- A9A7- F4213973D039 EXHIBIT A: PROVIDER'S OUTSIDE AGENCY APPLICATION Program Budget Operating Budget for Program PROGRAM NAME Club Nova Community, Inc. - Orange County Funding - PSR Services -ACTT Members PROGRAM REVENUE Private Donations Program Generated Revenue Local Government Grants: Human Services - Town of Carrboro Other - Town of Carrboro Human Services - Town of Chapel Hill Other - Town of Chapel Hill Human Services - Orange County Other - Orange County Other - Town of Hillsborough Other Government Grants Triangle United Way State Government Federal Government (CDBG /HOME /etc.) Private Foundation Grants Revenue: MCO County Allocations i Total Program Revenue PROGRAM EXPENSES Compensation: Rent & Utilities Supplies & Equipment Travel & Training Other Expenses: # of hours at PSR Reim. Rate Total Program Expenses SURPLUS /(DEFICIT) FOR PERIOD: 1 $ (21,596) $ (44,500) $ (49,500) -11 90 Actual 2016 -17 Estimated 2017 -18 Projected 2018 -19 Percent Change $ - $ - $ - 0 $ - $ - $ - 0. $ - $ - $ 0 $ - $ - $ - 0 $ - $ - $ - 0 $ - $ - $ - 0 $ 15,000 $ 15,000 $ 17,500 17% $ - $ - $ - 0 $ - $ - $ - 0 - $ - $ - 0 $ - $ - $ _ 0 $ - $ - $ - 0 $ - $ $ - 0 $ 68,000 $ 68,000 $ 68,000 $ - $ $ 83,000 - $ $ 83,000 - $ $ 85,500 3% 0 $ - $ - $ - 0 $ - $ - $ 0 $ - $ - $ - 0 $ 104,596 $ 127,500 $ 135,000 6% $ 104,596 1 $ 127,504 $ 135,000 6% SURPLUS /(DEFICIT) FOR PERIOD: 1 $ (21,596) $ (44,500) $ (49,500) -11 90