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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(3-20-2001) OMB #0348-0057 EIN : 930903782 Part I: GENERAL INFORMATION2.Type of A-133 1. Fiscal year ending date for this submission (mm/dd/audityyyy)12/31/2003 Single auditCENSUS 4.Date received by clearinghouse 3. Audit period coveredUSE Annual ONLY5.Employer Identification Number (EIN) b.Are multiple EINS covered in this report? a.Auditee EIN No 930903782 6.AUDITEE INFORMATION 7.AUDITOR INFORMATIONa.Auditee name a.Auditor name CONFEDERATED TRIBES OF COOS, ISLER & CO., L.L.C.LOWER UMPQUA AND SIUSLAW INDIANS b.Auditor address (Number and street) b.Auditee address (Number and street) 1976 GARDEN AVE1245 FULTON AVECity City EUGENECOOS BAYState Zip Code State Zip Code OR 97403 - OR 97420 - c.Auditor contact c.Auditee contact Name Name PATTY BOYNTONCAROL BARNESTitle Title CPATRIBAL ACCOUNTANTd.Auditor contact telephone d.Auditee contact telephone ( 541 ) 342 - 5161 ( 541 ) 888 - 7525 e.Auditor contact FAX (Optional) e.Auditee contact FAX (Optional) ( 541 ) 342 - 3533 ( 541 ) 888 - 2853 f.Auditor contact E-mail (Optional) f.Auditee contact E-mail (Optional) [e-mail] [e-mail]:///C|/A-PACT/Background%20Docs/CoosTribe/FedFundingAudits/Coos-031231a.html (1 of ...

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• Publié par: Orro
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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(3-20-2001) OMB #0348-0057

EIN : 930903782

Part I: GENERAL INFORMATION

1.

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

yyyy)

12/31/2003

2.

Type

of A-133

audit

Single

audit

3.

Audit period covered

Annual

CENSUS

USE

ONLY

4.

Date received by clearinghouse

5.

Employer Identification Number (EIN)

a.

Auditee EIN

930903782

b.

Are multiple EINS covered in this report?

No

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 BARNES

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., L.L.C.

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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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 BARNES TRIBAL

ACCOUNTANT

10/20/2004

g.AUDITOR STATEMENT -

The data elements and

information included in this form are limited to those

prescribed by OMB Circular A-133.The information

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

III, Items 8, 9, and 10, 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 certifying official

Date

10/6/2004

FAC DETERMINED TYPE OF ENTITY:

Indian Tribe-Wide/Alaskan Native Village-Wide

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Form SF-SAC(3-20-2001)

OMB #0348-0057

EIN : 930903782

Part III: FEDERAL PROGRAMS Continued

10.

FEDERAL AWARDS EXPENDED DURING FISCAL YEAR

11.

AUDIT FINDINGS

Row

10a. CFDA Number

Federal

Agency

Prefix (1)

Extension

(2)

10b. Research

and

development

10c. Name of Federal

Program

10d. Amount

expended

in Whole Numbers

10e.

Direct

Award

10f.

Major

program

11a. Type of

compliance

requirement

(3)

11b. Audit

finding

reference #

(s) (4)

1

15.021

N

BUREAU OF INDIAN

AFFARIS

$ 1,001,785

Y

Y

O

N/A

2

15.031

N

BIA COMMUNITY

FIRE PROTECTION

$ 2,130

Y

N

O

N/A

3

15.033

N

BIA TRIBAL

TRANSPORTATION

$ 46,667

Y

N

O

N/A

4

15.904

N

NATIONAL PARK

SERVICE

$ 7,483

Y

N

O

N/A

5

93.575

N

HHS ADMIN FOR

CHILDREN &

FAMILIES

$ 49,923

Y

N

O

N/A

6

93.047

N

HHS NUTRITIONAL

SERVICES GRANT

$ 81,090

Y

N

O

N/A

7

93.612

N

HHS ANA

$ 177,692

Y

N

O

N/A

8

93.667

N

STATE OF OREGON

CHILDREN SERVICES

BLOCK GRANT

$ 119

N

N

O

N/A

9

93.919

N

STATE OF OREGON

BCC GRANT

$ 3,776

N

N

O

N/A

10

93.556

N

STATE OF OREGON

FAMILY

PRESERVATION

$ 869

N

N

O

N/A

11

93.441

N

INDIAN HEALTH

SERVICE

$ 2,821,460

Y

Y

O

N/A

12

93.237

N

HHS SPECIAL

DIABETES PROGRAM

$ 27,235

Y

N

O

N/A

13

93.210

N

HHS SELF

GOVERNANCE

PLANNING

$ 37,672

Y

N

O

N/A

14

93.228

N

HHS TRIBAL

MANAGEMENT

$ 50,819

Y

N

O

N/A

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15

10.769

N

DEPT OF

AGRICULTURE

$ 59,620

Y

N

O

N/A

16

11.307

N

DEPT OF COMMERCE

$ 5,377

Y

N

O

N/A

17

84.299A

N

DEPT OF EDUCATION

$ 47,641

Y

N

O

N/A

18

45.311

N

NATL FOUNDATION

ON ARTS &

HUMANITIES

$ 4,062

Y

N

O

N/A

19

81.042

N

DEPT OF ENERGY

$ 55,716

Y

N

O

N/A

20

66.926

N

DEPT OF EPA

RESERVATION PLAN

$ 133,290

Y

N

O

N/A

21

66.419

N

DEPT OF EPA CLEAN

WATER ACT II

$ 104,634

Y

N

O

N/A

22

16.608

N

DEPT OF JUSTICE -

TRIBAL COURT

IMPLEMENTATION

$ 24,367

Y

N

O

N/A

23

16.587

N

DEPT OF JUSTICE

STOP DOMESTIC

VOILENCE

$ 22,274

Y

N

O

N/A

24

16.731

N

DEPT OF JUSTICE

YOUTH PROGRAM

$ 95,853

Y

N

O

N/A

25

14.867

N

DEPT OF HOUSING &

URBAN

DEVELOPMENT

$ 906,715

Y

Y

O

N/A

26

14.862

N

DEPARTMENT OF

HOUSING & URBAN

DEVELOPMENT ROSS

GRANT

$ 6,935

Y

N

O

N/A

Computer Generated Total Federal

Awards Expended:

$ 5775204

TOTAL FEDERAL AWARDS EXPENDED

$5775204

*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.

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

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

reported for each Federal program.

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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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