Corrective Action Plans

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Federal Agency Name: Department of Health and Human Services Program Name: COVID-19 Provider Relief Fund (PRF) and American Rescue Plan (ARP) Rural Distribution Applicable Federal Award Number and Year - Period 4 TIN#421030129 Federal Financial Assistance Listing #93.498 Compliance Requirement: Acti...
Federal Agency Name: Department of Health and Human Services Program Name: COVID-19 Provider Relief Fund (PRF) and American Rescue Plan (ARP) Rural Distribution Applicable Federal Award Number and Year - Period 4 TIN#421030129 Federal Financial Assistance Listing #93.498 Compliance Requirement: Activities Allowed or Unallowed and Allowable Costs/Cost Principles and Reporting Finding Summary: The Hospital did not retain evidence of the review and approval of the expenditure listing and lost revenue calculation by a separate individual outside of the preparer. In addition, the Hospital's special report submitted to the Department of Health and Human Services for Period 4 TIN #421030129 did not have evidence that it was reviewed and approved by a separate individual outside of the preparer. Responsible Individuals: Michael Coyle, CEO Corrective Action Plan: Management agrees with the finding. Controls will be put into place to ensure review and approval by a separate individual outside of the preparer is retained. Anticipated Completion Date: November 30, 2023
Finding Number: 2023-005 Approval Of Expense Transactions Corrective Action Plan: A process was put in place in May 2023 to ensure that all principal approvals are documented in writing or electronic approval in the system which can be date stamped by the system. Payroll will not be run, nor grant...
Finding Number: 2023-005 Approval Of Expense Transactions Corrective Action Plan: A process was put in place in May 2023 to ensure that all principal approvals are documented in writing or electronic approval in the system which can be date stamped by the system. Payroll will not be run, nor grants submitted, until proper approval is received. Personnel Responsible for Corrective Action: Nachum Golodner, Academica Director of Accounting Anticipated Completion Date: June 30, 2024
1. Explanation of Disagreement with Audit Finding There is no disagreement with the audit finding. 2. Actions Planned in Response to Finding The District will evaluate and revise current practices to ensure proper documentation is retained supporting all salary and wage expenditures applied to the p...
1. Explanation of Disagreement with Audit Finding There is no disagreement with the audit finding. 2. Actions Planned in Response to Finding The District will evaluate and revise current practices to ensure proper documentation is retained supporting all salary and wage expenditures applied to the program, including time distribution records. 3. Official Responsible Dr. Jeff Ridlehoover, Superintendent, is the official responsible for ensuring corrective action. 4. Planned Completion Date June 30, 2024 5. Plan to Monitor Completion The Board of Education will be monitoring this Corrective Action Plan.
The Clinical Practice Director has put procedures in place to verify the accuracy of documentation and application of the correct slide. The procedures consist of a monthly review of the paperwork and sliding fee for completeness and accuracy and continued training of personnel.
The Clinical Practice Director has put procedures in place to verify the accuracy of documentation and application of the correct slide. The procedures consist of a monthly review of the paperwork and sliding fee for completeness and accuracy and continued training of personnel.
Name of Contact Person: Michael Gaddy Executive Director Corrective Action: Management has already developed and adopted a Cost Allocation Plan. Management will ensure that the Cost Allocation Plan is followed ...
Name of Contact Person: Michael Gaddy Executive Director Corrective Action: Management has already developed and adopted a Cost Allocation Plan. Management will ensure that the Cost Allocation Plan is followed to allocate shared costs properly. Proposed Completion Date: Immediately
For the 2022-23 School Year, the District failed to correctly allocate expenditures to the CACFP accounts. In order to correct this action for the 2023-24 school year, the Director of Fiscal services will work with the Director of Child nutrition to reconcile each program and complete the cost alloc...
For the 2022-23 School Year, the District failed to correctly allocate expenditures to the CACFP accounts. In order to correct this action for the 2023-24 school year, the Director of Fiscal services will work with the Director of Child nutrition to reconcile each program and complete the cost allocation worksheet. The District utilizes a direct cost vending agreement, which will allocate the costs in an allowable manner. The Director of Fiscal Services will be responsible for making the transfer of expenditures from NSLP accounts to the CACFP accounts. The Director of Child Nutrition will verify the transfers have been completed correctly before the books are closed
View Audit 13071 Questioned Costs: $1
FINDINGS—FEDERAL AWARD PROGRAMS AUDITS Department of Education 2023-001 Special Education Cluster – Assistance Listing No. 84.017 and 84.173 Recommendation: We recommend the District review their controls and procedures surrounding time and effort certifications and reviewing individuals charged to...
FINDINGS—FEDERAL AWARD PROGRAMS AUDITS Department of Education 2023-001 Special Education Cluster – Assistance Listing No. 84.017 and 84.173 Recommendation: We recommend the District review their controls and procedures surrounding time and effort certifications and reviewing individuals charged to the grant to ensure allowability under the grant. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: The District will ensure time and effort certifications are performed as required and will ensure proper review of individuals charged to the grant to ensure allowability under the grant. Name of the contact person responsible for corrective action: Scott Smith, Chief of Operations and Finance Planned completion date for corrective action plan: January 1, 2024 If the Department of Education has questions regarding this plan, please call Scott Smith at 720-554-4344.
Finding Number: 2023-004 Approval Of Expense Transactions Corrective Action Plan: A process was put in place in May 2023 to ensure that all principal approvals are documented in writing or electronic approval in the system which can be date stamped by the system. Payroll will not be run, nor grant...
Finding Number: 2023-004 Approval Of Expense Transactions Corrective Action Plan: A process was put in place in May 2023 to ensure that all principal approvals are documented in writing or electronic approval in the system which can be date stamped by the system. Payroll will not be run, nor grants submitted, until proper approval is received. Personnel Responsible for Corrective Action: Nachum Golodner, Academica Director of Accounting Anticipated Completion Date: June 30, 2024
We will implement policies or procedures to establish an internal control system that will ensure strong financial accountability, including compliance with all federal grant requirements.
We will implement policies or procedures to establish an internal control system that will ensure strong financial accountability, including compliance with all federal grant requirements.
Finding 9335 (2023-007)
Significant Deficiency 2023
Management will ensure an effective review of reimbursement requests prior to submission to ensure all costs requested are legitimate and allowable. Contact Person: Mayor Leroy Sullivan and Sandra Williams. Anticipated Completion Date: Annual basis/as needed
Management will ensure an effective review of reimbursement requests prior to submission to ensure all costs requested are legitimate and allowable. Contact Person: Mayor Leroy Sullivan and Sandra Williams. Anticipated Completion Date: Annual basis/as needed
View Audit 12808 Questioned Costs: $1
Management will update written policies and procedures to ensure compliance with Uniform Guidance. Additionally, management will establish controls to ensure timely reporting of federal awreds as well as the monitoring of vendors for suspension and debarment. Contact Person: Mayor Leroy Sullivan and...
Management will update written policies and procedures to ensure compliance with Uniform Guidance. Additionally, management will establish controls to ensure timely reporting of federal awreds as well as the monitoring of vendors for suspension and debarment. Contact Person: Mayor Leroy Sullivan and Sandra Williams. Anticipated Completion Date: Monthly basis
Planned Corrective Action: Family First Health did update their internal policies around time and effort reporting as well as implemented an attestation form that is sent to employees through Paycom. Employee profiles have been updated to include the recognition of if/which grants their time is att...
Planned Corrective Action: Family First Health did update their internal policies around time and effort reporting as well as implemented an attestation form that is sent to employees through Paycom. Employee profiles have been updated to include the recognition of if/which grants their time is attributed to. Employees are required to attest to their time for every payroll prior to their supervisor’s approval. We have had success in obtaining signed attestation statement from employees in recognition of the connection between their work and respective grants. Completion Date 4/1/23 Accounting Name of Contact Person: Jenny Englerth, President/CEO; Brent Doores, CFO
The Chicago Lighthouse will implement processes to address material weakness for internal controls in relation to reviewing and approving time spent by personnel working on government funded programs. Staff dedicating time and effort to activities that are multi-grant funded will prepare Personnel ...
The Chicago Lighthouse will implement processes to address material weakness for internal controls in relation to reviewing and approving time spent by personnel working on government funded programs. Staff dedicating time and effort to activities that are multi-grant funded will prepare Personnel Activity Reports (PAR) monthly and submit them to the Accounting Department once approved by the manager over the program. Charges to awards for salaries, wages, and benefits will be based on documented PAR approved by a responsible official(s) of the organization. PAR submissions will contain the breakdown of time dedicated by staff to activities and awards across all programs they support. In the event a staff member is dedicated to only one program or cost objective, the recurrence of the PAR will be at least twice a year. Each Program Director must ensure that all grant-funded employees are familiar with time documentation guidelines and are complying with these requirements. The Director of Grants and Contracts will review the time and effort report (PAR) and confirm appropriate verification. As part of the recurring vouchering process, the Director of Grants and Contracts will reconcile actual hours worked and percentage of hours worked per program as reported on the time reporting forms to actual charges within the accounting system. The Director of Grants and Contracts will work with the Program Director/Administrator to resolve any discrepancies. The Program Director/Administrator must initial any corrections that are made to the forms. Name of the contact person responsible for corrective action: Rosa Carrillo, CFO Anticipated completion date for corrective action: 07/01/2023
Corrective Action Plan Inaccurate Vendor Invoice Calculations Communication was made by USA Health Director of Accounting to the USA Health Accounting Department on 11/4/23 and sent via email to all USA Health Department Managers on 11/6/2023 reiterating the procedures for submission, review, and ap...
Corrective Action Plan Inaccurate Vendor Invoice Calculations Communication was made by USA Health Director of Accounting to the USA Health Accounting Department on 11/4/23 and sent via email to all USA Health Department Managers on 11/6/2023 reiterating the procedures for submission, review, and approval of contract labor invoices. Specific instructions to recalculate each contract employees’ timesheet(s) and agree the totals to the related invoice prior to approval were included and outlined for department managers, accountants, and accounts payable staff. Duplicate Grant Expenditures and Proper Approvals The manager charged with approval of grant related transactions and transfers in 2022/2023 has since left USA. The process for reviewing and approving grant expenditures has since been enhanced. Specifically, employees responsible for processing grant transfer documentation will ensure documents contain management approval(s), grants and contracts accounting approval, and appropriate documentation prior to keying and uploading documentation into the general ledger (Banner system). The new practice will help compensate for employee turnover as documentation of historical review will be available to successors. Additional process enhancements will include the following: • Expenses cannot be transferred to a grant until payment has been processed. • Entries must contain a transaction line item for each invoice transferred to the Grant (not subtotals). • Accounting records will be reviewed prior to approval to ensure expenditures have not been previously transferred to a grant. • Expense transfer supporting documentation must contain a detailed schedule of all invoices, include a reference to the foapal and document number originally charged, name of vendor, date of initial payment, and amount. USA Health Accounting is currently working with Grants & Contracts Accounting and the USA Campus Business Office to document the process and effectively communicate this process with all responsible parties. Anticipated Completion Date 01/31/2024 Name of Contact Person for Corrective Action Becky Schaffer, USA Health Director of Accounting
View Audit 12556 Questioned Costs: $1
The District will work to collect federal certifications for all employees paid from grants. By Dawn Mead, Treasurer by 6/30/2024.
The District will work to collect federal certifications for all employees paid from grants. By Dawn Mead, Treasurer by 6/30/2024.
Finding 9151 (2023-001)
Significant Deficiency 2023
United States Department of Commerce 2023-001 Connecticut State Technology Extension Program – Assistance Listing No. 11.611 Recommendation: We recommend that if employees are being allocated to multiple programs throughout the year, personnel activity reports must be prepared at minimum, on a mo...
United States Department of Commerce 2023-001 Connecticut State Technology Extension Program – Assistance Listing No. 11.611 Recommendation: We recommend that if employees are being allocated to multiple programs throughout the year, personnel activity reports must be prepared at minimum, on a monthly basis and be reviewed and signed off on by both the employee and their immediate supervisor. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: Management will implement a policy to require employees to prepare activity reports on a least a monthly basis that are signed by the employee and the supervisor. Name of the contact person responsible for corrective action: Robert Blakey, Controller Planned completion date for corrective action plan: December 2023.
By bringing the payroll back into the District from FEH BOCES, allows better oversight of the payroll functions. The District continues to work on improving and developing systems to enhance the payroll disbursements which are supported by documentation and approvals. It is the goal of the District ...
By bringing the payroll back into the District from FEH BOCES, allows better oversight of the payroll functions. The District continues to work on improving and developing systems to enhance the payroll disbursements which are supported by documentation and approvals. It is the goal of the District to continue to improve on systems by which timesheets are obtained promptly and maintained. The District purchased a timesheet enhancement software that works in conjunction with WINCAP software through FEH BOCES that is waiting to be implemented by the FEH BOCES Shared Business. Brandon Pelkey, superintendent ofschools is responsible for implementing this corrective action plan. We plan to rectrify all action by June 30, 2024.
Condition: Payments for expenditures associated with debt service obligations were expensed to the program but not disbursed to the debt holder. Cause: Internal controls in place did not ensure expenditures recorded met the federal compliance requirements for Allowable Costs/Cost Principles as defi...
Condition: Payments for expenditures associated with debt service obligations were expensed to the program but not disbursed to the debt holder. Cause: Internal controls in place did not ensure expenditures recorded met the federal compliance requirements for Allowable Costs/Cost Principles as defined in 2 CFR Part 200. Auditor Recommendation: We recommend the District enhance internal controls to ensure that eligible expenditures have been incurred prior to recording the expense. Plan of Action: The District has hired a Finance Director who has committed to increased financial monitoring to ensure federal compliance principles are met. In addition, the district has hired a new Operations Manager and District Accountant. The new team is committed to enhancing and adhering to internal controls to ensure proper monitoring of policies and procedures. In the event that there are questions about compliance for grants in general, the District will continue to rely on timely guidance from external governmental accounting consultants, the Oregon Department of Revenue, and the Oregon Department of Education. Date of implementation: Immediately and ongoing. If there are any questions regarding this plan, please contact Sam Stegemiller by email at sstegemill@grantspass.k12.or.us or by phone at 541-474-5703.
View Audit 12366 Questioned Costs: $1
Pennsylvania Department of Environmental Protection, CFDA #15.252 #2023-002 – Material Weakness – Activities Allowed or Unallowed Recommendation We recommend that the Commission approve all invoices in accordance with the Commission’s internal control procedures. We also recommend that the Commi...
Pennsylvania Department of Environmental Protection, CFDA #15.252 #2023-002 – Material Weakness – Activities Allowed or Unallowed Recommendation We recommend that the Commission approve all invoices in accordance with the Commission’s internal control procedures. We also recommend that the Commission review invoices for mathematical accuracy prior to payment. View of responsible officials and planned corrective action The Commission has contacted the vendor to resolve the billing errors and will implement procedures internally to oversee the verification of the accuracy of invoices going forward.
Recommendations: It is recommended that management update the internal calculation of lost revenues for 2020 and 2021 to deduct the unallowable costs to demonstrate and support that there are no reimbursements for the same expenses or lost revenue. In the event the Medical Center receives a reques...
Recommendations: It is recommended that management update the internal calculation of lost revenues for 2020 and 2021 to deduct the unallowable costs to demonstrate and support that there are no reimbursements for the same expenses or lost revenue. In the event the Medical Center receives a request from the federal agency or another party to audit the use of the funds, the most accurate and up-to-date information should be available. Actions: Henry County Medical Center claimed as COVID expenses for HRSA reporting the cost of additional drugs used in treating COVID patients for reporting periods 1-3. This was based on information received by management at the beginning of the COVID pandemic. It was later learned that Medicare provided additional payments on claims related to patients being treated for COVID. This additional reimbursement was to help offset some of the additional costs incurred by providers. Internal worksheets calculating lost revenue and COVID 19 expenses have been updated to accurately reflect lost revenue and expenses related to COVID 19 patient care. This change had no impact on the accounting for all funds received during the reporting periods.
SIGNIFICANT DEFICIENCIES 2023-001 - Child Nutrition Cluster - Allowable Activities and Costs/Cost Principles and Reporting Condition During testing of the sponsor claim reimbursement reports, it was found that the District submitted inaccurate meal counts on two monthly reports. Recommendation We re...
SIGNIFICANT DEFICIENCIES 2023-001 - Child Nutrition Cluster - Allowable Activities and Costs/Cost Principles and Reporting Condition During testing of the sponsor claim reimbursement reports, it was found that the District submitted inaccurate meal counts on two monthly reports. Recommendation We recommend that the District review its controls related to monthly reimbursement requests for the Child Nutrition Cluster in order to ensure that accurate meal counts are submitted. Comment on the Finding Recommendation The District is aware of the errors and will continue to strive to improve its processes and controls related to meal counts. Action Taken As of the date of this notice, staff members involved in recording manual meal counts for the Summer Food Service Program and Afterschool Snack Program have undergone training regarding the importance of submitting accurate numbers. In addition, meal counts are now required to be summed twice, in order to ensure that there are no calculation errors.
2023-04 Material Weakness: Unallowable costs for the EDA CARES Planning Grant and EDA CARES Revolving Loan Fund, Assistance Listing Number 11.307, were not identified in a timely or accurate manner. This resulted in a material weakness in internal control over compliance pertaining to Activities All...
2023-04 Material Weakness: Unallowable costs for the EDA CARES Planning Grant and EDA CARES Revolving Loan Fund, Assistance Listing Number 11.307, were not identified in a timely or accurate manner. This resulted in a material weakness in internal control over compliance pertaining to Activities Allowed/Allowable Costs being reported in the audit reporting package. Recommendation: It was recommended GEODC improve controls over compliance with Activities Allowed/Allowable Costs by accepting federal funding only when staff have or can obtain adequate knowledge of program requirements that will enable them to spend funding in accordance with all federal compliance requirements. Action Taken: GEODC staff are in agreement with the recommendation and will improve internal controls over compliance with Activities Allowed/Allowable Costs by accepting federal funding only when staff have or can obtain adequate knowledge of program requirements that will enable them to spend funding in accordance with all federal compliance requirements.
View Audit 12088 Questioned Costs: $1
2023-03 Material Weakness: Questioned const were identified within the EDA CARES Planning grant and EDA CARES RLF, Assistance Listing 11.307, $131,986 and $30,865, respectively. $131,986 and $30,865 of federal funds remained unspent at the end of the grant periods and were transferred to the general...
2023-03 Material Weakness: Questioned const were identified within the EDA CARES Planning grant and EDA CARES RLF, Assistance Listing 11.307, $131,986 and $30,865, respectively. $131,986 and $30,865 of federal funds remained unspent at the end of the grant periods and were transferred to the general fund under the assumption unspent funds could be spent in any manner. The result was a questioned cost of $162,851 and a compliance violation of requirements pertaining to Activities Allowed/Allowable Costs being reported in the audit reporting package. Recommendation: It was recommended $131,986 of federal funding be returned to the US Department of Commerce and $30,865 returned to the EDA CARES revolving loan fund cash balance. Action Taken: GEODC staff agreed with the finding and completed the recommended steps after the issue was identified in the annual audit but before the date of the audit report.
View Audit 12088 Questioned Costs: $1
The finding is correct in the fact that money was charged to the wrong grant award. However, as a whole with the grant awards from all of the American Rescue Plan Act, Vantage Career Center gave more money to students then the grants required. Moving forward the Treasurer will be more involved wit...
The finding is correct in the fact that money was charged to the wrong grant award. However, as a whole with the grant awards from all of the American Rescue Plan Act, Vantage Career Center gave more money to students then the grants required. Moving forward the Treasurer will be more involved with the requirements of administering the grants from the beginning.
Condition: The amount claimed on the June 30, 2023 expenditure report included an expense that had been claimed in the prior year. Recommendation: We recommend to review the general ledger for duplicate or unallowable expenses before entering into the expenditure report and submitting. Managemen...
Condition: The amount claimed on the June 30, 2023 expenditure report included an expense that had been claimed in the prior year. Recommendation: We recommend to review the general ledger for duplicate or unallowable expenses before entering into the expenditure report and submitting. Management's response The District will review the general ledger for duplicate or unallowable expenses before submitting quarterly reports.
View Audit 12028 Questioned Costs: $1
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