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DocuSign Envelope ID:C70973D3-D989-4F31-A95E-3BCC099C95E7 XHIBIT A <br /> PROVIDER'S OUTSIDE AGENCY APPLICATION <br /> Agency Budget <br /> Operating Budget for Entire Agency <br /> AGENCY NAME: The Art Therapy Institute <br /> Actual Estimated Projected Percent <br /> AGENCY REVENUE 2015-16 2016-17 2017-18 Change <br /> Private Donations $ 26,000 $ 28,000 $ 28,000 0% <br /> Agency Generated Revenue (fees) $ 135,000 $ 158,000 $ 165,000 4% <br /> Local Government Grants: <br /> Human Services -Town of Carrboro $ 3,500 $ 4,000 $ 5,000 25% <br /> Other- Town of Carrboro $ - $ - $ - 0 <br /> Human Services -Town of Chapel Hill $ 2,000 $ 3,000 $ 5,000 67% <br /> Other-Town of Chapel Hill $ - $ - $ - 0 <br /> Human Services - Orange County $ 1,000 $ 1,000 $ 5,000 400% <br /> Other- Orange County $ - $ - $ - 0 <br /> Other- Town of Hillsborough $ - $ - $ - 0 <br /> Other Government Grants <br /> Triangle United Way $ - $ - $ - 0 <br /> State Government $ - $ - $ - 0 <br /> Federal Government (CDBG/HOME/etc.) $ - $ - $ - 0 <br /> Private Foundation Grants $ 5,000.00 $ 13,000.00 $ 13,000.00 $ - <br /> Other Revenue $ 3,000 $ 1,000 $ 3,000 $ 2.00 <br /> Total Agency Revenue $ 175,500 $ 208,000 $ 224,000 8% <br /> AGENCY EXPENSES <br /> Compensation $ 145,000 $ 177,000 $ 190,000 7% <br /> Rent & Utilities $ 10,500 $ 10,500 $ 10,500 0% <br /> Supplies & Equipment $ 4,500 $ 5,500 $ 6,500 18% <br /> Travel &Training $ 2,000 $ 2,500 $ 3,500 40% <br /> Other Expenses: $ 7,000 1 $ 7,500 1 $ 8,000 1 7% <br /> Total Agency Expenses $ 169,000 $ 203,000 1 $ 218,500 1 8% <br /> SURPLUS/(DEFICIT) FOR PERIOD: $ 6,500 $ 5,000 $ 5,500 10% <br /> FY 2015-16 Comparative Agency Budget <br /> Revised 9/29/2014 <br />