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Agency Information2/9/2017 4:13:51 PM Page 12 of 22 <br />Chapel Hill Human Services <br />Chapel Hill Other (DO NOT include CDBGfunding here) <br />Orange County Human Services <br />Orange County Other (DO NOT Include HOME funding here) <br />o Other Government Grants <br />Triangle United Way <br />State Government <br />Federal Government (CDBG/HOME/etc.) <br />Private Foundation Grants <br />o Other Revenue <br />x Expenditures <br />o Compensation <br />o Rent & Utilities <br />o Supplies & Equipment <br />o Travel & Training <br />o Other Expenses <br /> <br />iii.Does your agency budget show a Surplus or Deficit? Surplus <br />Is there a significant change? Yes/No Yes <br />Please provide a brief explanationfor Surplus or Deficit, and significant changes. <br />Board of Directors thought it important to carry a reserve to ensure organization is able to <br />weather any future tough times. <br />iv.What is your agency’s fiscal year? (Example: July 1, 2016 <br />through June 30,2017) <br />January 1, 2017 through December 31, 2017 <br />EXHIBIT A <br />PROVIDER'S OUTSIDE AGENCY APPLICATION <br />DocuSign Envelope ID: 0D59222E-5A4E-4094-9D22-7F342E2FD1A3