Office of the State Comptroller PRESCHOOL SPECIAL EDUCATION
INTERNAL CONTROL QUESTIONNAIRE (Use Additional Pages, If Necessary) Select “View” “Edit
Document” to make edits.
SCHOOL YEAR(S): 2011 - 12, 2012 - 13, and 2013 - 14 SECTION I
Agency Name Principal Business Address
If different from above, the address at time of NYSED approval. NA
Name(s) of Executive Director(s)/Chief Executive Officer(s) or other title(s) responsible for the overall performance of the Agency.
Name(s) of Assistant Executive Director(s) or other title(s) that assists the above in the overall administration of the Agency and acts on that person’s behalf when necessary.
Name of Comptroller/Controller/Chief Financial Officer/Director of Finance or other title responsible for the overall fiscal management of the Agency.
SECTION II
1. Identify any of the items below that were prepared by a consultant/firm. Name of Consultant/Firm General Ledger (G/L)
Consolidated Fiscal Report (CFR) Financial Statement (F/S)
KAS, AOA
2. Provide the name(s) and title(s) of staff/firm who recorded entries in the G/L during the audited year(s). Name of staff
Title
Employee or Consultant
3. Provide the name(s) and title(s) of staff/firm who prepared Adjusting Entries during the audited year(s). Name of Staff
Title
Employee or Consultant
4. Provide the name(s) and title(s) of staff/firm who approved Adjusting Entries during the audited year(s). Name of Staff
Title
Employee or Consultant
5. Name of the firm(s) that audited the Agency’s CFRs and F/S.
6. Within the past three years did any other firm audit the Agency’s CFRs and F/S? Yes
No
If “Yes”, provide the following information:
Name of Firm
Address
Year
7. Does the Agency maintain subsidiary revenue and expenditure accounts (“sub-ledgers”) for each approved program and/or for IDEA and/or revenue source(s)? X
Yes No N/A - Agency has only one approved program and received no IDEA vendor funding.
8. Did any individual(s), identified in Section I, hold a position in or work for another entity as an employee or consultant? Yes
No
If “Yes”, provide the following information regarding the individual(s) and their other employment.
Employee
Employer
Title
Job Description
Dates
9. Did the CFR include allocated costs? Yes
No
If “Yes”:
A. Is written documentation for the allocation methodology maintained?
Yes
No
B. If “Yes”, indicate the last time the allocation methodology was reviewed for reasonableness and appropriateness.
10. Provide the name of the individual/firm who prepared the “Crosswalk” (i.e. the document that reconciles the CFR to the G/L).
11. Provide the name(s) and title(s) of the party(ies) that signs the Agency’s checks.
12. Are bank reconciliations performed?
Yes
No
If “Yes”, how often?
By whom?
Employee/Consultant Name
Title
13. Does the Agency have one or more vehicles which costs are charged to the program(s)?
Yes
No
If “Yes”, how many?
Vehicle Type and Year
Ownership (Personal, Leased, Owned by agency)
14. Does the Agency have a Board of Directors?
Yes No If “Yes”: A. How often did the Board of Directors meet during the audited school year(s)?
)
B. Did any Board member engage in related party/less-than-arm’s-length transactions
(as that term is defined in the applicable year(s)’ Reimbursable Cost Manual)?
Yes
No
If “Yes”, identify the Board member(s).
15. Are any of the agency’s administrators or any of their immediate relatives members of the Agency’s Board of Directors?
Yes
No
If “Yes”, identify by name and title?
16. Are any family members employed by the Agency?
Yes
No
If “Yes”, identify by name and title?
17. Has the Agency been subject to a program or fiscal review by any government agency during the past three years?
Yes
No
18. Identify by name and title the supervisor(s) responsible for approving employees’ time records?
19. Identify by name and title the employee(s) or consultant(s) who prepare payroll tax forms?
20.
Are payroll checks generated by the Agency?
Yes: Identify by name and title the responsible staff.
No: Identify the consultant/firm who generates these checks.
21. Does the Agency use consultants to provide programmatic services?
No
Yes
If “Yes”, provide the name and title of staff responsible for reviewing and approving the consultants’ invoices.
22. Does the Agency use consultants to provide administrative services?
No
Yes
If “Yes”, provide the name and title of staff responsible for reviewing and approving the consultants’ invoices.
23. Number of Checking Accounts maintained by the Agency
24. Number of Savings Accounts maintained by the Agency
25. Number of Credit Cards and /or Debit Cards maintained by the Agency # of Credit Cards
# of Debit Cards
To whom are they assigned? Name of Individual
Title
Type of Card
SECTION III RELATED PARTIES
Use the following definitions to respond to the questions in this section. NYSED Reimbursable Cost Manual section (1)(4)(E)(July 1, 2011—June 30, 2012) defines “related parties” as comprising all “affiliates of an entity, including but not limited to (1) its management and their immediate families; (2) its principal owners and their immediate families; and/or (3) any party transacting or dealing with the agency/entity of which that party has ownership of, control over, or significant influence upon the management or operating policies of a program(s)/entity(ies) to the extent that an arm’s‐length transaction may not be achieved.” For the purpose of this Questionnaire, “immediate family” means any person who is related to an individual in the following ways: (1) Spouse, and spouse’s brothers, sisters and/or parents; (2) sons, daughters, and/or their spouses; (3) parents, and/or their spouses; (4) brothers, sisters, including their spouses or their children; (5) grandparents, grandchildren, including their spouses; (6) domestic partner, and domestic partner’s brothers, sisters, and/or parents, including domestic partner of any individual in (1)‐(5); and (7) any individual related by blood or affinity (marriage or other legal relationship) whose close relationship with the employee is the equivalent of an immediate family relationship.
26. Related party transactions. A. Did the Agency purchase services (e.g. accounting, management, legal services, etc.) from a related party?
Yes
If “Yes”, provide the following information.
No
Identify the related party.
How are the parties related?
Identify the type of service(s) received, total hours for which compensation was made and total compensation paid.
B. Did the Agency furnish services (e.g. accounting, management, legal services, etc.) to a related party?
Yes
If “Yes”, provide the following information.
No
Identify the related party.
How are the parties related?
Identify the type of service(s) furnished, and total compensation received.
C. Did the Agency purchase personal property valued in excess of $5,000 and/or real property from a related party?
Yes
No
If “Yes”, provide the following information.
Type of real and/or personal property that was purchased. If real property, identify the location. If real property, include whether the property was bought outright or mortgaged. State the purchase price. State the purpose for which the real property was used.
Identify the related party seller(s).
How are the parties related?
D. Did the Agency sell and/or transfer property valued in excess of $5,000 and/or real property to a related party?
Yes
If “Yes”, provide the following information:
No
Type of real and/or personal property that was sold and/or transferred. If real property, identify the location.
If real property, include whether the property was sold outright or mortgaged. State the sale or transfer price.
Identify the related party buyer(s)
How are the parties related?
E. Did the Agency lease real property from a related party?
Yes
No
If “Yes”, provide the following information:
Identify the location of the leased property and the monthly cost of the lease.
Identify the related party lessor. How are the parties related?
F. Did the Agency lease real property to a related party?
Yes
No
If “Yes”, provide the following information:
Identify the location of the leased property and the monthly income. Identify the related party
How are the parties related?
G. Did a related party occupy space in any location in which the Agency provides direct or administrative services?
Yes
No
If “Yes”, provide the following information:
Address(es) of the co-located property.
The related party and the nature of that party’s business.
How are the parties related?
H. Were related services such as speech therapy, physical therapy, occupational therapy and psychological services purchased by the Agency from a related party?
Yes
No
If “Yes”, provide the following information:
Identify the related party.
How are the parties related?
Identify the type of service(s) purchased and the total compensation paid.
I. Were related services such as speech therapy, physical therapy, occupational therapy and psychological services provided by the Agency to a related party?
Yes
No
If “Yes”:
Identify the related party.
How are the parties related?
Identify the type of service(s) provided and the transaction(s) price. J. Did the Agency owe money to a related party?
Yes
No
If “Yes”:
Identify the related party.
How are the parties related?
Indicate the amount borrowed, terms of the loan/note, date of the loan/note and current balance.
K. Did the Agency lend money to a related party? Yes
No
If “Yes”, answer the questions below. If multiple loans were made, identify the ones with the highest outstanding balance as of the filing of the most recent CFR.
Multiple related party loans? Identify the related party.
How are the parties related?
Indicate the amount loaned, terms of the loan/note, date of loan/note and balance as of the filing of this form.
Yes
No
L. Even if no services or monies were exchanged, did any of the individuals identified in “Section I” have a related party interest in another entity that provided special education programs and/or services?
Yes
No
If “Yes”, provide the following information:
Name and business address of the related party.
Special Education Programs/Services provided by the related party.
How are the parties related?
