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13 <br /> SECTION 4: AGENCY DESCRIPTION <br /> Agency Information <br /> Mission statement: <br /> Estimated total agency budget for this fiscal year: $ <br /> Does your agency budget show a surplus or deficit? Please explain: <br /> Is there a significant change in your budget from the previous year? Please explain: <br /> Number of FTE full-time paid positions: <br /> Number of FTE part-time paid positions: <br /> Number of volunteers: Number of FTE volunteers: <br /> Does the agency pay permanent employees a minimum living wage (yes/no)? <br /> If yes, is the agency an Orange County Living Wage Certified Employer? <br /> If no, please explain. <br /> Please include the following attachments: <br /> Nonprofit Organizations <br /> ❑ Current list of Board of Directors, including addresses, phone numbers, terms of service, <br /> and relevant affiliations <br /> ❑ Current Bylaws and Articles of Incorporation <br /> ❑ Last 2 years' operating budgets <br /> ❑ Most recent independent audit <br /> ❑ IRS Form 990 <br /> ❑ IRS tax determination letter <br /> ❑ NC Solicitation License <br /> ❑ Certificate of Liability Insurance <br /> For-profit Organizations <br /> ❑ Current list of Board of Directors, including addresses, phone numbers, terms of service, <br /> and relevant affiliations <br /> ❑ Current Bylaws and Articles of Incorporation <br /> ❑ Last 2 years' operating budgets <br /> ❑ YTD profit and loss statement and balance sheet <br /> ❑ Most recent independent audit <br /> ❑ Last 2 years' corporate tax returns <br /> ❑ Last 2 years' personal tax returns and financial statements for all persons who have more <br /> than 19.9%ownership interest in the organization <br />