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DocuSign Envelope ID: E7F88FC1-7C61-4E68-8AF9-5870F711DEBC it A continued <br /> Provider's Outside Agency Application <br /> MAIN APPLICATION <br /> Program Budget <br /> AgencytProgram, A Helping Hand/Senior Companion Care <br /> Actual Estimated Projected Percent <br /> AGENCY REVENUE 2014-15 2015-16 2016-17 Change <br /> Private Donations $ 38,711 $ 40,600 $ 45,000 11% <br /> Agency Generated Revenue(fees) *$ 3, <br /> $ - $ - *0% <br /> Local Government Grants: <br /> Orange County 0 $ 3, 000 $ 3,100 <br /> Town of Chapel Hill $ 4,000 $ 4,0001 $ 4,000 0% <br /> Town of Carrboro $ 2,000 $ 2,000 1 $ 2,000 0% <br /> Other Local•. Durham County $ 12,000 $ 12.000 1 $ 12,000 0%® <br /> Other Local: 1 0 <br /> Other Local: 0 <br /> If more than 3 sources,please <br /> provide a separate list. <br /> Non-Local Government Grants <br /> Triangle united Way $ 160 $ 160 $ 160 0°l0 <br /> State Government 0 <br /> Federal Government 0' <br /> Other Grants: 0' <br /> Other Grants: 0 <br /> MiscellaneoustOther Revenue $ 22,000 $ 24,000 $ 30,000 25% <br /> Please list 3 largest Miscellanous sources: <br /> Mary Goddard Pickens $ 12,000.00 <br /> Faile Foundation $ 10,000M <br /> Total Agency Revenue S 81 971 85 860 96 260 12%' <br /> AGENCY EXPENSES <br /> Compensation $ 52,371 $ 56,260 $ 66,660 18% <br /> Rent&Utilities $ 8,000 $ 8,000 $ 8,000 0% <br /> Supplies&Equipment $ 1,200 $ 1,200 $ 1,200 0% <br /> Travel&Training $ 400 $ 400 $ 400 0% <br /> Other Expenses: $ 20,000 $ 20,000 $ 20,000 0% <br /> Please list 3 largest"Other Expenses": <br /> Insurance $ 15,000.00 <br /> Mileage Reimbursement $ 3,000.00 <br /> Payroll Taxes $ 2,000.00 <br /> Total Agency Expenses 81 9771 $ 85 860 96,2601 12%m <br /> SURPLUS1(DEFICIT)FOR PERIOD: $ - 1 $ - if - 1 0 <br /> Main Application 1/25/2016 1:23:46 PM Page 22 of 26 <br />