HomeMy WebLinkAbout2010 HA Exemption from AuditF A PPLICATION FOR EXEMPTION FROM AUDIT - LONG FORM - FOR GOVERNMENTS WITH
EVENUES OR EXPENDITURES GREATER THAN $100 0 00 BUT NOT MORE THAN $500,000
Name of Government:
Wheat Ridge Housing Authority
For the Fiscal Year
Ended December 31, 2010
or fiscal year ended:
Address:
7500 West 29th Avenue
Wheat Ridge, CO 80033
Contact Person:
Sally Payne
Telephone:
(303) 235 -2852
E -Mail:
spayne@ci.wheatridge.co.us
Fax:
(303) 235 -2857
Return to: Office of the State Auditor
Local Government Audit Division
225 E. 16th Ave., Suite 555
Denver, CO 80203
Fax: (303) 866 -4062
Email: OSA.LG@state.co.us
Call (303) 866 -3338 if you need help completing this form.
Section 29 -1 -604, C.R.S. outlines the provisions for an exemption from audit. Generally, any local government where
neither revenues nor expenditures exceed $500,000 in any fiscal year may qualify for an exemption.
If either revenues or expenditures are $100,000 or greater, but not more than $500,000, you may use this
form. If both revenues and expenditures are less than $100,000 individually, use the short form application
for exemption from audit.
-,
e ALL,mstrwutl9ns priortot#+'e completion of- ttiis'forri:.
Instructions' (See "Instructions" tab for additional information)
1. Prepare this form completely and accurately. Pleae note that there are eleven parts to this form and all questions
must be answered for the application to be considered complete.
2. File this form with the Office of the State Auditor within 3 months after the end of the fiscal year.
For years ended December 31, the form must be received by the Office of the State Auditor by March 31.
3. The form must be completed by an independent accountant (separate from the entity) with knowledge of
governmental accounting.
4. The application must be personally reviewed and approved by a majority of the governing body as evidenced by one of
the following methods:
a. Resolution of the governing board - application may be e- mailed, faxed, or mailed.
b. Original signatures - application must be mailed. E -mail or fax will NOT be accepted.
5. The preparer must sign the application that is submitted in order for it to be accepted.
6. Additional information may be attached to the exemption at the re arer's discretion.
CERTIFICATION OF PREPARER
I certify that I am an independent accountant with knowledge of governmental accounting and that the information in the Application is tv
complete and accurate to the best of m knowledge. Independent means someone who is separate from the enti
Name: Wendy Swanhorst
Title: Partner
Firm Name (if ap licable): Swanhorst & Compan LLC
Address: 8400 East Crescent Parkway, Suite 600, Greenwood Villa e, CO 80111
Telephone Number: (720) 528 -4306
Date Prepared: Februa 14, 2011
Pre parer signature (Required): G�
The Audit Law requires that a person independent of the entity complete the Application if revenues or expenditure are at least
$100,000 but not more than $500,000. Independent means someone who is separate from the entity. Please describe what your
relationship is with the entity.
None
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Page 5
PART 4 - DEBT OUTSTANDING, ISSUED AND RETIRED
rv..
nsWe" #iotl #by= i1'I;e7k Wn;flle.appYOp`nate3�9xes _' ._ . 's - ,°-
aeas: KthefolfowtPl44ufes
X
4 -1
Does the entity have debt?
If yes:
Is the debt repayment schedule attached? If no, please explain:
Outstanding at
Total issued
Total retired
Total
Governmental
Please complete the following debt
beginning of
during fiscal year
during fiscal year
outstanding at
Proprietary
Pro P eta ry ( P )
sched if applicable
fiscal year
(add)
(less)
Y
General Obligation Bonds
$ -
$ -
$ -
$
Revenue Bonds $ - $ - $ -
$ _
Notes /Loans $ $ - $ -
$ _
Leases $ $ $ -
$ _
Develo erAdvances $ - $ - $ -
_
$ _
Other (specify): $ - $
Total $
.
p new'er;tfiefall4.wch` ' 'e3fiorts:3t' rtiarliifa itrfne a 'roptate bok a -
_...Y a `,._.,,.` ."`�
,;...plea
4 -2
Does the entity have authorized, but unissued debt?
x
If yes:
How much? $
Date debt was authorized:
X
4-3
Does the entity intend to issue debt within the next calendar year (2011)?
If es:
How much? $
afSS!(vet the= ;"Alfow,ltf z .. G+ stionrb markfn -Sn fhe a pro iris boxes. :.-. ,. _ .Y .s.. .._ _..:r.� �.. n=...
4-4
Does the entit have debt that has been refinanced that it is still responsible for?
X
If es:
lWhat is the amount outstanding ? $ -
";;'
AieaseianswelrxtFre follo�ltiri . q teSfiof}s =6 mark ':itt
. _�
4 -5
Does the entity have any lease agreements?
X
If yes:
What is being leased?
What is the original date of the lease?
Number of ears of lease?
Is the lease subject to annual ap ro riation?
What are the annual lease a ments? $ -
Page 5
PART 6 - CAPITAL ASSETS
Beginning of the
End of Year
Year
Additions
Deletions
Balance
6 -1
For Governmental Funds
Land
$
$
Buildings
$ -
$ -
$ -
$ -
$ _
$
Machinery and Equipment
$
$
$ -
$ _
Furniture and Fixtures
$
$ -
$ -
$ _
Infrastructure
$
$ -
$ -
$ _
Accumulated Depreciation
$
$ -
$ _
Other
$
$
$
$ -
$
Total for Governmental Funds
$
$ -
Beginning of the
End of Year
Year
Additions
Deletions
Balance
6 -2
For Proprietary Funds
Land
$ -
$ -
$
$
Buildings
$ -
$ -
$ -
_
$ _
$
Machinery and Equipment
$ -
$
$ -
$ _
Furniture and Fixtures
$
$ -
$
$ -
$ _
Infrastructure
$
$ -
$ -
$ -
$ _
Accumulated Depreciation
$ -
$ -
$ _
Other
$ -
$ -
$ -
$
_
Total for Proprietary Funds
Please;b stitrerthg fiillgwin 6stion;b naMod "T" e�a .ro nate.box
�-- R.�:. - -
: ,
6 -3 Has the entity performed an annual inventory of property and equipment (capital assets) in
X
accordance with Section 29 -1 -506 C.R.S.,? If no, please explain: NA
Page 6
PART 10 - GENERAL INFORMATION
.;..; ^- r Aiease nswer the folidwirr" yiue Foi ri�b" tr iarkin d i lim the ap ropriate
10 -1 Is this entity a newly formed governmental entity? X
If es: Date of formation:
10 -2 Is this a metropolitan district? X
10 -3
Please indicate what services are provided: affordable housing
We, the undersigned, certify that this Application for Exemption from Audit has been:
10-4
Does the entity have an agreement with another government entit to provide services?
X
If yes:
List the name of the other government entity and the services provided:
governmental accounting.
City of Wheat Ridge, administrative services
10 -5
Has the district filed a Title 32, Article 1 Special District Notice of Inactive Status during the year?
Note: Please list all current members of the governing body. Original signatures must be
(Applicable to Title 32 Special Districts only, pursuant to Section 32 -1 -103 (9.3); 32 -1 -104 (3),
NA
orgimal signatures. (Please sign using blue ink.)
C.R.S.)
Name (print names of all current
If es:
Date Filed:
Page 7
PART 11 - GOVERNING BODY APPROVAL
We, the undersigned, certify that this Application for Exemption from Audit has been:
Prepared consistent with Section 29 -1 -604, C.R.S., which states that an application with revenues and expenditures
at least $100,000 but not more than $500,000 must be prepared by an independent accountant with knowledge of
governmental accounting.
Completed to the best of our knowledge and is accurate and true.
Personally reviewed and approved by a majority of the governing body.
Note: Please list all current members of the governing body. Original signatures must be
provided for a majority of the governing body or a resolution may be provided in lieu of
orgimal signatures. (Please sign using blue ink.)
Name (print names of all current
Date Term
members of the governing body)
Expires
Ori ' ignature (unless resolution is attached
1
Joseph DeMott
3/2/2011
2
Cheryl Brun ardt
3/2/2013
3
Katie Vanderveen
3/2/2014
4
Kathy Nuanes
3/2/2012
5
Janice Thompson
3/2/2015
6
7
Page 7