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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 Agency Budget <br /> Agency. A Helping Hared I Senior Companion Care <br /> Actual Estimated Protected 1 Percent <br /> AGENCY REVENUE 2014-15 2015.16 2016-17 Change <br /> Private Donations $ 38,GO0 $ 40,000 $ 45,000 13% <br /> Agency Generated Revenue(fees) *$ 442,105 $ 450,000 $ 455,000 1Local Government Grants:Change County 3,10D $ 3,100 $ 3,100 0°/0 <br /> Town of Chapel Hill $ 4.000 $ 4.000 $ 4,000 00/9 <br /> Town of Carrhoro $ 2,0001$ 2,000 $ 2,000 t7% <br /> Other Local: Durham County $ 12,000 1$ 12,000 $ 12,000 00/4 <br /> Other Local: 0 <br /> Other Local: ,p D <br /> le ase If more Iharr 3 sources <br /> provide a separate list. <br /> Non-Local Government Grants <br /> Triangle United Way $ 160 $ 160 $ 160 0% <br /> State Government 0 <br /> Federal Government 0 <br /> Other Grants: 0 <br /> Other Grants: 0 <br /> Miscellaneous/Other Revenue $ 22,000 $ 24,00D $ 30A0a 25% <br /> Please list 3 largest bAscellanous sources: <br /> Mary Goddard Pickens $ 12,000M <br /> Faile Foundation $ 10,000.00 <br /> $ <br /> Total Agency Revenue 23365 535 260 551 260 3°% <br /> AGENCY EXPENSES <br /> Compensation $ 419,201 $ 429,202 $ 440202 3% <br /> Rent&Utilities $ 25„058 $ 25,058 $ 25,058 0% <br /> Supplies&Equipment $ 12,083 $ 12,000 $ 15.000 25% <br /> Travel&Training $ 883 $ 1,000 $ 1.000 0°k <br /> Other Expenses: $ 68,140 $ 68,000 $ 70.000 3°k <br /> Please list 3 largest-Cxher Expenses-: <br /> Insurance $ 20,000.00 <br /> Mileage Reimbursement $ 16.000.0a <br /> Payroll Taxes $ 37.195-00 <br /> Total Agency Expenses 52336.5 535.260 551 260 3% <br /> SURPLUSI(DEFICIT)FOR PERIOD: 5 - s - - a <br /> Main Application 1/25/2016 1:23:46 PM Page 25 of 26 <br />