Single Audit Page 1

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Single Audit Page 1Data Collection Form for Reporting onAUDITS OF STATES, LOCAL GOVERNMENTS, AND NON-PROFIT ORGANIZATIONSRETURN TO: Federal Audit Clearinghouse, 1201 E. 10th Street, Jeffersonville, IN 47132Form SF-SAC(1-15-2004) OMB #0348-0057 EIN : 930903782Part I: GENERAL INFORMATION1. Fiscal year ending date for this submission (mm/dd/2. Type of Circular A-133 yyyy) Single auditaudit12/31/2004FEDERAL 3. Audit period coveredGOVERNMENT 4. Date received by clearinghouse Annual USE ONLY5. Auditee Identification Numbers b. Are multiple EINS covered in this report? Noa. Primary Employer Identification Number (EIN) c. If Part I, Item 5b = "Yes," complete Part I, 930903782 Item 5c on the continuation sheet on Page4.b. Are multiple DUNS covered in this report? Nod. Data Universal Numbering System (DUNS) c. If Part I, Item 5e = "Yes," complete Part I, Number 161160445Item 5f on the continuation sheet on Page4.6.AUDITEE INFORMATION 7.AUDITOR INFORMATIONa.Auditee name CONFEDERATED TRIBES OF COOS, a.Auditor name LOWER UMPQUA AND SIUSLAW ISLER & CO., LLCINDIANS b.Auditor address (Number and street) b.Auditee address (Number and street) 1976 GARDEN AVE1245 FULTON AVE City EUGENECity State Zip Code COOS BAYOR 97403 - State Zip Code OR 97420 - c.Auditor contact Name c.Auditee contact PATTY BOYNTONName Title CAROL JACOBSCPATitle TRIBAL ACCOUNTANT d.Auditor contact telephone ( 541 ) 342 - 5161 d.Auditee contact telephone ( 541 ) ...

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• Publié par: Shied
• Nombre de lectures: 47
• Langue: English

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Single Audit Page 1

Data Collection Form for Reporting on

AUDITS OF STATES, LOCAL GOVERNMENTS, AND NON-PROFIT ORGANIZATIONS

RETURN TO: Federal Audit Clearinghouse, 1201 E. 10th Street, Jeffersonville, IN 47132

Form SF-SAC(1-15-2004)

OMB #0348-0057

EIN : 930903782

Part I: GENERAL INFORMATION

1.

Fiscal year ending date for this submission (mm/dd/

yyyy)

12/31/2004

2.

Type of Circular A-133

audit

Single audit

3.

Audit period covered

Annual

FEDERAL

GOVERNMENT

USE ONLY

4.

Date received by clearinghouse

5. Auditee Identification Numbers

a.

Primary Employer Identification Number (EIN)

930903782

b.

Are multiple EINS covered in this report?

No

c.

If Part I, Item 5b = "Yes," complete Part I,

Item 5c on the continuation sheet on Page4.

d.

Data Universal Numbering System (DUNS)

Number

161160445

b.

Are multiple DUNS covered in this report?

No

c.

If Part I, Item 5e = "Yes," complete Part I,

Item 5f on the continuation sheet on Page4.

6.

AUDITEE INFORMATION

7.

AUDITOR INFORMATION

a.

Auditee name

CONFEDERATED TRIBES OF COOS,

LOWER UMPQUA AND SIUSLAW

INDIANS

b.

Auditee address

(Number and street)

1245 FULTON AVE

City

COOS BAY

State

OR

Zip Code

97420 -

c.

Auditee contact

Name

CAROL JACOBS

Title

TRIBAL ACCOUNTANT

d.

Auditee contact telephone

( 541 ) 888 - 7525

e.

Auditee contact FAX

(Optional)

( 541 ) 888 - 2853

f.

Auditee contact E-mail

(Optional)

[e-mail]

a.

Auditor name

ISLER & CO., LLC

b.

Auditor address

(Number and street)

1976 GARDEN AVE

City

EUGENE

State

OR

Zip Code

97403 -

c.

Auditor contact

Name

PATTY BOYNTON

Title

CPA

d.

Auditor contact telephone

( 541 ) 342 - 5161

e.

Auditor contact FAX

(Optional)

( 541 ) 342 - 3533

f.

Auditor contact E-mail

(Optional)

[e-mail]

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Single Audit Page 1

g.AUDITEE CERTIFICATION STATEMENT -

This is to certify that, to the best of my knowledge and

belief, the auditee has:(1)engaged an auditor to perform

an audit in accordance with the provisions of OMB

Circular A-133 for the period described in Part I, Items

1 and 3; (2)the auditor has completed such audit and

presented a signed audit report which states that the

audit was conducted in accordance with the provisions

of the Circular; and,(3)the information included in

Parts I,II,and III

of this data collection form is

accurate and complete.I declare that the foregoing is

true and correct.

Signature of certifying official

Date

Name/Title of certifying official

CAROL JACOBS TRIBAL

ACCOUNTANT

9/28/2005

g.AUDITOR STATEMENT -

The data elements and

information included in this form are limited to those

prescribed by OMB Circlular A-133.The information

included in Parts II and III of the form, except for Part

III, Items 7, 8, and 9a-9f, was transferred from the

auditor's report(s) for the period described in Part I,

Items 1 and 3, and

is not a substitute

for such reports.

The auditor has not performed any auditing procedures

since the date of the auditor's report(s). A copy of the

reporting package required by OMB Circular A-133,

which includes the complete auditor's report(s), is

available in its entirety from the auditee at the address

provided in Part I of this form. As required by OMB

Circular A-133, the information in

Parts II

and

III

of

this form was entered in this form by the auditor based

on information included in the reporting package. The

auditor has not performed any additional auditing

procedures in connection with the completion of this

form.

Signature of auditor

Date

9/27/2005

FAC DETERMINED TYPE OF ENTITY:

Indian Tribe-Wide/Alaskan Native Village-Wide

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Page 4 - DUNS continuation

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Single Audit Page 3

Form SF-SAC(1-15-2004)

OMB #0348-0057

EIN : 930903782

Part III: FEDERAL PROGRAMS Continued

9.

FEDERAL AWARDS EXPENDED DURING FISCAL YEAR

10.

AUDIT

FINDINGS

Row

CFDA Number

Research

and

development

(c)

Name of Federal

program

(d)

Amount

expended

(e)

Direct

award

(f)

Major program

Type(s) of

compliance

requirement

(s)

(a)

Audit

finding

reference

number

(s)

(b)

Federal

Agency

Prefix

(a)

Extension

(b)

Major

program

(g)

If

yes,

type

of

audit

report

(h)

1

15

.021

N

BUREAU OF

INDIAN AFFAIRS

$ 1,089,358

Y

Y

U

O

N/A

2

15

.031

N

BIA COMMUNITY

FIRE PROTECTION

$ 1,409

Y

N

O

N/A

3

15

.033

N

BIA TRIBAL

TRANSPORTATION

$ 22,027

Y

N

O

N/A

4

15

.904

N

NATIONAL PARK

SERVICE

$ 10,599

Y

N

O

N/A

5

93

.575

N

HHS ADMIN FOR

CHILDREN &

FAMILIES

$ 74,852

Y

N

O

N/A

6

93

.047

N

HHS

NUTRITIONAL

SERVICES

$ 92,749

Y

N

O

N/A

7

93

.612

N

HHS ANA

$ 43,045

Y

N

O

N/A

8

93

.667

N

STATE OF

OREGON

CHILDREN

SERVICES BLOCK

GRANT

$ 9,540

N

N

O

N/A

9

93

.919

N

STATE OF

OREGON BCC/

TOBACCO GRANT`

$ 7,460

N

N

O

N/A

10

93

.556

N

STATE OF

OREGON FAMILY

PRESERVATION

$ 1,482

N

N

O

N/A

11

93

.441

N

INDIAN HEALTH

SERVICES

$ 2,720,517

Y

Y

U

O

N/A

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Single Audit Page 3

12

93

.237

N

HHS SPECIAL

DIABETES

$ 14,727

Y

N

O

N/A

13

93

.210

N

HHS SELF

GOVERNANCE

$ 14,677

Y

N

O

N/A

14

10

.769

N

DEPT OF

AGRICULTURE

$ 554

Y

N

O

N/A

15

11

.307

N

DEPT OF

COMMERCE

$ 7,038

Y

N

O

N/A

16

84

.299A

N

DEPT OF

EDUCATION

$ 69,225

Y

N

O

N/A

17

45

.311

N

NATL

FOUNDATION ON

ARTS &

HUMANITIES

$ 3,911

Y

N

O

N/A

18

81

.042

N

DEPT OF ENERGY

$ 86,774

Y

N

O

N/A

19

66

.926

N

DEPARTMENT OF

ENVIRONMENTAL

PROTECTION

$ 109,127

Y

N

O

N/A

20

66

.419

N

EPA CLEAN

WATER ACT

$ 67,549

Y

N

O

N/A

21

97

.

UNKNOWN

N

U S COAST

GUARD

$ 1,598

Y

N

O

N/A

22

16

.608

N

DEPT OF JUSTICE

TRIBAL COURT

IMPLEMENTATION

$ 65,501

Y

N

O

N/A

23

16

.587

N

DEPT OF JUSTICE

STOP DOMESTIC

VIOLENCE

$ 11,013

Y

N

O

N/A

24

16

.731

N

DEPT OF JUSTICE

YOUTH PROGRAM

$ 39,145

Y

N

O

N/A

25

16

.712

N

DEPT OF JUSTICE

COPS GRANTS

$ 193,336

Y

N

O

N/A

26

14

.867

N

DEPT OF

HOUSING &

URBAN

DEVELOPMENT

$ 600,450

Y

Y

U

O

N/A

27

14

.862

N

DEPT OF HUD

GRANTS

$ 30,080

Y

N

O

N/A

Computer Generated Total Federal Awards Expended:

$ 5387743

TOTAL FEDERAL AWARDS EXPENDED

$5387743

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Single Audit Page 3

*Footnotes for Part 3 - Item 10 and Item 11

1. See Appendix 1 of instructions for valid Federal Agency two-digit prefixes.

2. Or other identifying number when the Catalog of Federal Domestic Assistance (CFDA) number is not available.

(See

Instructions)

3. If major program is marked "Yes," enter only one letter (

U

= Unqualified opinion,

Q

= Qualified opinion,

A

= Adverse

opinion,

D

= Disclaimer of opinion) corresponding to the type of audit report in the adjacent box. If major program is

marked "No," leave the type of audit report box blank.

4. Enter the letter(s) of all type(s) of compliance requirement(s) that apply to audit findings (i.e., noncompliance,

reportable conditions (including material weaknesses), questioned costs, fraud, and other items reported under §_.510(a))

reported for each Federal program.

A. Activities allowed or

unallowed

B. Allowable costs/cost

principles

C. Cash management

D. Davis-Bacon Act

E. Eligibility

F. Equipment and real

property management

G. Matching, level of effort,

earmarking

H. Period of availability of

funds

I. Procurement and

suspension and debarment

J. Program income

K. Real property acquisition

and relocation assistance

L. Reporting

M. Subrecipient monitoring

N. Special tests and

provisions

O. None

P. Other

4. N/A for None.

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