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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 auditaudit12/31/2005FEDERAL 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 CPA, L.L.C.INDIANS b.Auditor address (Number and street) b.Auditee address (Number and street) 1976 GARDEN AVENUE1245 FULTON AVENUE City EUGENECity State Zip Code COOS BAYOR 97403 - State Zip Code OR 97420 - c.Auditor contact Name c.Auditee contact PATTY BOYNTONName Title CAROL JACOBS-KOSHTCPATitle TRIBAL ACCOUNTANT d.Auditor contact telephone ( 541 ) 342 - 5161 d.Auditee contact ...
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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)
12/31/2005
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 AVENUE
City
COOS BAY
State
OR
Zip Code
97420 -
c.
Auditee contact
Name
CAROL JACOBS-KOSHT
Title
TRIBAL ACCOUNTANT
d.
Auditee contact telephone
( 541 ) 888 - 7525
e.
Auditee contact FAX
(Optional)
( 541 ) 888 - 2853
f.
Auditee contact E-mail
(Optional)
CJACOBS@CSB.PORTLAND.IHS.GOV
a.
Auditor name
ISLER CPA, L.L.C.
b.
Auditor address
(Number and street)
1976 GARDEN AVENUE
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)
PBOYNTON@ISLERCPA.COM
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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-KOSHT TRIBAL
ACCOUNTANT
8/24/2006
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
8/9/2006
FAC DETERMINED TYPE OF ENTITY:
Indian Tribe-Wide/Alaskan Native Village-Wide
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Page 4 - EIN continuation
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
$ 957,725
Y
Y
U
O
N/A
2
15
.033
N
BIA TRIBAL
TRANSPORTATION
$ 10,493
Y
N
O
N/A
3
15
.904
N
NATIONAL PARK
SERVICE
$ 8,171
Y
N
O
N/A
4
93
.575
N
HHS ADMIN FOR
CHILDREN &
FAMILIES
$ 62,205
Y
N
O
N/A
5
93
.047
N
HHS ADMIN ON
AGING
$ 102,271
Y
N
O
N/A
6
93
.612
N
HHS AMERICAN
NATIVE ASSOC -
TRIBAL COURT
$ 171,359
Y
Y
U
H
2005-1
7
93
.581
N
HHS AMERICAN
NATIVE ASSOC -
PROTECTING
RESTORED LANDS
$ 141,610
Y
Y
U
O
N/A
8
93
.667
N
STATE OF
OREGON
CHILDREN
SERVICES BLOCK
GRANT
$ 6,034
N
N
O
N/A
9
93
.919
N
STATE OF
OREGON BCC/
TOBACCO GRANT
$ 8,379
N
N
O
N/A
10
93
.556
N
STATE OF
OREGON FAMILY
PRESERVATION
$ 7,118
N
N
O
N/A
11
93
.441
N
INDIAN HEALTH
SERVICES
$ 558,498
Y
Y
U
O
N/A
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Single Audit Page 3
12
93
.237
N
HHS SPECIAL
DIABETES
$ 45,023
Y
N
O
N/A
13
93
.210
N
IHS SELF
GOVERNANCE
$ 1,981,395
Y
Y
U
O
N/A
14
11
.307
N
DEPARTMENT OF
COMMERCE
$ 8,251
Y
N
O
N/A
15
84
.299A
N
DEPARTMENT OF
EDUCATION
$ 60,133
Y
N
O
N/A
16
45
.311
N
NATL
FOUNDATION ON
ARTS &
HUMANITIES
$ 56
Y
N
O
N/A
17
81
.042
N
DEPARTMENT OF
ENERGY
$ 128,555
Y
N
O
N/A
18
66
.926
N
DEPARTMENT OF
ENVIRONMENTAL
PROTECTION
$ 77,201
Y
N
O
N/A
19
66
.419
N
DEPARTMENT OF
ENVIRONMENTAL
PROTECTION
AGENCY
$ 137,828
Y
N
O
N/A
20
97
.
UNKNOWN
N
US COAST GUARD
$ 32,910
Y
N
O
N/A
21
16
.608
N
DEPARTMENT OF
JUSTICE - COURT
$ 10,042
Y
N
O
N/A
22
16
.587
N
DEPT OF JUSTICE
- STOP DOMESTIC
VIOLENCE
$ 11,774
Y
N
O
N/A
23
16
.731
N
DEPT OF JUSTICE
YOUTH PROGRAM
$ 27,364
Y
N
O
N/A
24
16
.712
N
DEPT OF JUSTICE
COPS GRANTS
$ 222,368
Y
N
O
N/A
25
14
.867
N
DEPT OF
HOUSING &
URBAN
DEVELOPMENT
$ 464,428
Y
Y
U
O
N/A
26
14
.862
N
HUD RURAL
HOUSING
ECONOMIC
DEVELOPMENT
GRANTS
$ 26,611
Y
N
O
N/A
Computer Generated Total Federal Awards Expended:
$ 5267802
TOTAL FEDERAL AWARDS EXPENDED
$5267802
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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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Page 4 - EIN continuation
Page 4 - DUNS continuation
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