Corrective Action Plans

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Planned Corrective Action: The audited financial statements for FY2022 will be finalized before the end of the month, and shortly thereafter, the single audit reporting package will be transmitted to FAC. Name of Contact Person: Melby Albano, MHK HUD Housing Manager, and Greg Payton, CEO Projected C...
Planned Corrective Action: The audited financial statements for FY2022 will be finalized before the end of the month, and shortly thereafter, the single audit reporting package will be transmitted to FAC. Name of Contact Person: Melby Albano, MHK HUD Housing Manager, and Greg Payton, CEO Projected Completion Date: 12/31/2024
Planned Corrective Action: The audited financial statements for FY2022 will be finalized before the end of the month, and shortly thereafter, the single audit reporting package will be transmitted to FAC. Name of Contact Person: Melby Albano, MHK HUD Housing Manager, and Greg Payton, CEO Projected C...
Planned Corrective Action: The audited financial statements for FY2022 will be finalized before the end of the month, and shortly thereafter, the single audit reporting package will be transmitted to FAC. Name of Contact Person: Melby Albano, MHK HUD Housing Manager, and Greg Payton, CEO Projected Completion Date: 12/31/2024
Planned Corrective Action: The audited financial statements for FY2022 will be finalized before the end of the month, and shortly thereafter, the single audit reporting package will be transmitted to FAC. Name of Contact Person: Melby Albano, MHK HUD Housing Manager, and Greg Payton, CEO Projected C...
Planned Corrective Action: The audited financial statements for FY2022 will be finalized before the end of the month, and shortly thereafter, the single audit reporting package will be transmitted to FAC. Name of Contact Person: Melby Albano, MHK HUD Housing Manager, and Greg Payton, CEO Projected Completion Date: 12/31/2024
We will estalish a procedure by which review of invoices for grant-funded expenses will include compliance with allowable expenses and period of performance and note it on the invoice.
We will estalish a procedure by which review of invoices for grant-funded expenses will include compliance with allowable expenses and period of performance and note it on the invoice.
Audit Finding Reference: 2022-002 Corrective Action Taken or Planned: 1. Formalized Record Retention Policies: A formal record retention policy specific to federal grant programs will be implemented to ensure full compliance with 2 CFR 200.334. This policy will apply regardless of whether documentat...
Audit Finding Reference: 2022-002 Corrective Action Taken or Planned: 1. Formalized Record Retention Policies: A formal record retention policy specific to federal grant programs will be implemented to ensure full compliance with 2 CFR 200.334. This policy will apply regardless of whether documentation is stored internally or by third-party systems. Any documentation downloaded or transferred from third-party systems will be subject to a review process to verify completeness and accuracy before being finalized for County retention. The County shall also take steps to ensure that information downloads and exports from third-party systems represent omplete and accurate records. 2. Audit Timing Advocacy and Preparedness: The County will continue to maintain timely documentation and preparedness for audits and will also advocate for timely initiation and completion of future audits. Significant delays in the audit process, through no fault of the County, as observed during the FY2022 audit, substantially impacted the County's ability to access necessary documentation and demonstrate compliance. Although the County made every effort to retain records in accordance with federal requirements, the timing of the audit fieldwork occurred well after the program had concluded in May 2023. Had the audit been conducted in a timely manner, full access to the third-party platform used for program administration would have been available, along with all supporting documentation. However, by the time the audit took place, the program had been closed for over 18 months, and access to the external software system had lapsed in accordance with the expiration of the service agreement. 3. Internal Audit Readiness Reviews: Beginning with FY2025, the County will conduct internal audit readiness reviews shortly after fiscal year-end to ensure all documentation for closed federal programs is centralized, archived, and accessible for future audit purposes, even if conducted years later. Anticipated Completion Date: October 15, 2025 Contact Person Responsible for Corrective Action: Charles Nickerson, Senior Director of Finance
Finding 1227098 (2022-001)
Material Weakness 2022
Audit Finding Reference: 2022-001 Planned Corrective Action: The Town and School Department will strengthen internal controls over compliance for Federal programs by requiring documented approval of all payroll rate authorizations before employees are compensated from Federal awards, require evidenc...
Audit Finding Reference: 2022-001 Planned Corrective Action: The Town and School Department will strengthen internal controls over compliance for Federal programs by requiring documented approval of all payroll rate authorizations before employees are compensated from Federal awards, require evidence of review and approval on all invoices prior to payment, and maintain complete supporting documentation, including invoices and warrants, in accordance with Federal record retention requirements. The School Department will have the School Finance Director approve all payroll rate authorizations and all invoices before payment. The School Department currently keeps all invoices, warrants, and approvals digitally so that they can be provided for all future audits. The School Department will continue to monitor these procedures to ensure that expenditures are properly authorized, adequately supported, and available for audit. Planned Implementation Date of Corrective Action: Partially implemented already and full implemented in Fall 2026 Person Responsible for Corrective Action: Daniel Gale
Condition/Context: For 3 of the 3 samples selected for testing, the School did not provide support for review and approval of the monthly bank reconciliations Corrective action taken: Quileute Tribal School will establish effective internal controls for the monthly bank reconciliations and adhere to...
Condition/Context: For 3 of the 3 samples selected for testing, the School did not provide support for review and approval of the monthly bank reconciliations Corrective action taken: Quileute Tribal School will establish effective internal controls for the monthly bank reconciliations and adhere to the internal controls. Person responsible for corrective action: Bob Harmon, Superintendent NOTE: In addition, Quileute Tribal School has engaged an independent CPA firm to assist with account reconciliations and audit readiness to help ensure that financial information is complete, accurate, and properly reported. Implementation Date: July 30, 2026
Condition/Context: For 1 of the 3 samples selected for testing, the school did not provide support for review and approval of the Character Investigations. Corrective action taken: Quileute Tribal School will establish effective internal controls for the Character Investigations compliance requireme...
Condition/Context: For 1 of the 3 samples selected for testing, the school did not provide support for review and approval of the Character Investigations. Corrective action taken: Quileute Tribal School will establish effective internal controls for the Character Investigations compliance requirement and adhere to the internal controls. Person responsible for corrective action: Bob Harmon, Superintendent Implementation Date: July 30, 2026
2022-004 – Deficiencies Noted in Documentation of Controls - Housing Choice Voucher Participant Files - Significant Deficiency Auditor Recommendations: The Authority should establish a checklist for the Housing Choice Voucher Coordinator to use during the recertification process to document the proc...
2022-004 – Deficiencies Noted in Documentation of Controls - Housing Choice Voucher Participant Files - Significant Deficiency Auditor Recommendations: The Authority should establish a checklist for the Housing Choice Voucher Coordinator to use during the recertification process to document the procedures performed to ensure all compliance requirements are met. We recommend a complete review of all Housing Choice Voucher Program tenant file regulations to ensure compliance with these policies. Response: The Executive Director will actively oversee all financial aspects of the agency. Additionally, the director will ensure that finances are current and accurate monthly. A complete review of all Housing Choice Voucher Program tenant file regulations will be performed to ensure compliance with these policies. Timeframe: By completion of the 2027 FYE audit Individual responsible for correction: Mr. Marc Starling, Executive Director
The hospital will work with an outside consultant with more in-depth understanding of the reporting requirements prior to additional submissions. We are also catching up on the audit submissions and will remain on task with timely submission. Anticipated completion date: 09/30/2026
The hospital will work with an outside consultant with more in-depth understanding of the reporting requirements prior to additional submissions. We are also catching up on the audit submissions and will remain on task with timely submission. Anticipated completion date: 09/30/2026
Condition: During our testwork, we noted three employees were missing time and effort certifications. Plan: The Organization is implementing written policies and procedures over time and effort reporting to ensure proper documentation is always maintained or complete in all instances to properly dis...
Condition: During our testwork, we noted three employees were missing time and effort certifications. Plan: The Organization is implementing written policies and procedures over time and effort reporting to ensure proper documentation is always maintained or complete in all instances to properly distribute salary and benefit costs for employees who work in whole or in part on grant program activity in accordance with the Uniform Guidance. This includes having the documentation reviewed and formally approved by a supervisor. Anticipated Date of Completion: December 31, 2026 Name of Contact Person: Matt Buckman, Executive Director
Finding 2022-002 Significant Deficiency in Internal Controls Over Compliance – HOME Investment Partnerships Program Finding: The audit identified a tenant file in which a HOME-assisted unit was not properly identified on the Household Eligibility Certification form, resulting in rental charges that ...
Finding 2022-002 Significant Deficiency in Internal Controls Over Compliance – HOME Investment Partnerships Program Finding: The audit identified a tenant file in which a HOME-assisted unit was not properly identified on the Household Eligibility Certification form, resulting in rental charges that exceeded allowable limits under HOME program requirements. Corrective Action Plan: DNDA agrees with the finding and has implemented procedures to strengthen compliance monitoring and tenant file review processes. To address this finding, management has taken the following actions: o Corrected the identified tenant file and reviewed the circumstances that led to the error. o Implemented additional review procedures for Household Eligibility Certification forms to verify unit designation, household income calculations, and applicable rent restrictions. o Established a secondary review process for HOME-assisted units to ensure compliance requirements are accurately reflected in tenant records. o Provided additional training and guidance to staff responsible for tenant certifications and compliance monitoring. o Incorporated periodic compliance reviews into ongoing property management oversight activities. Responsible Party: Shannon Woodard – Interim Executive Director, Danielle Clark-Burfening – Housing Director, Misty Wilson – Area Supervisor (3rd Party Property Management – United Marketing, Inc.), Bonita Salyers – Regional Portfolio Assistant (3rd Party Property Management – United Marketing, Inc.) Implementation Date: Corrective actions began upon identification of the finding. Expected Completion Date: Implemented December 18, 2025, Quarterly Verification of Compliance by Danielle Clark-Burfening Monitoring: Management will conduct periodic reviews of HOME-assisted tenant files and certification documents to verify continued compliance with HUD and HOME program requirements.
View of Responsible Officials: Management response and corrective action Personnel responsible for corrective action: Evan Heath, CFO Anticipated completion date for corrective action: April 30, 2026 In response to Finding No. 2022-SA5, management agrees with the finding. Corrective actions will be ...
View of Responsible Officials: Management response and corrective action Personnel responsible for corrective action: Evan Heath, CFO Anticipated completion date for corrective action: April 30, 2026 In response to Finding No. 2022-SA5, management agrees with the finding. Corrective actions will be implemented in subsequent fiscal years, including the establishment of policies and procedures to ensure that program income is tracked by contract and expended in accordance with applicable federal requirements.
View of Responsible Officials: Management response and corrective action Personnel responsible for corrective action: Evan Heath, CFO Anticipated completion date for corrective action: April 30, 2026 In response to Finding No. 2022-SA3, management agrees with the finding. Corrective actions will be ...
View of Responsible Officials: Management response and corrective action Personnel responsible for corrective action: Evan Heath, CFO Anticipated completion date for corrective action: April 30, 2026 In response to Finding No. 2022-SA3, management agrees with the finding. Corrective actions will be implemented in subsequent fiscal years. Unallowable costs will be identified and documented in the Accounting Policies and Procedures Manual and communicated to the Finance Department and the Organization’s employees. The CFO will regularly communicate these requirements to directors and staff through weekly and monthly meetings to ensure a clear understanding of allowable versus unallowable costs. In addition, quarterly budget-to-actual analyses will be prepared and reviewed to monitor expenditure and ensure costs remain within approved budget limitations.
Management response and corrective action Personnel responsible for corrective action: Evan Heath, CFO Anticipated completion date for corrective action: April 30, 2026 In response to Finding No. 2022-SA2, management agrees with the finding. Corrective actions will be implemented in subsequent fisca...
Management response and corrective action Personnel responsible for corrective action: Evan Heath, CFO Anticipated completion date for corrective action: April 30, 2026 In response to Finding No. 2022-SA2, management agrees with the finding. Corrective actions will be implemented in subsequent fiscal years. CFDA numbers for new federal awards will be identified, along with the applicable compliance requirements in accordance with the OMB Compliance Supplement (Matrix of Federal Compliance Requirements). Policies and procedures will be established for each applicable compliance requirement and will be communicated to employees responsible for monitoring and ensuring compliance.
Management of the Organization will restructure all classes in the functional classing system, as well as utilize the project function, and consistently apply expenditures such that system reports accurately reflect income and expenditures by program / grant.
Management of the Organization will restructure all classes in the functional classing system, as well as utilize the project function, and consistently apply expenditures such that system reports accurately reflect income and expenditures by program / grant.
Mental Health Kokua will ensure compliance with the FAC requirement of submitting the Single Audit Package and data collection report no later than 30 days after receipt of the audit. The CFO of Mental Health Kokua will be responsible for ensuring this compliance is met.
Mental Health Kokua will ensure compliance with the FAC requirement of submitting the Single Audit Package and data collection report no later than 30 days after receipt of the audit. The CFO of Mental Health Kokua will be responsible for ensuring this compliance is met.
Finding 2022-004 Federal Agency: U.S. Department of Housing and Urban Development Federal Program Titles: Housing Voucher Cluster, Public and Indian Housing Program, Public Housing Capital Fund Program, and Coronavirus Relief Fund Assistance Listing Numbers: 14.871, 14.879, 14.850, 14.872, and 21.01...
Finding 2022-004 Federal Agency: U.S. Department of Housing and Urban Development Federal Program Titles: Housing Voucher Cluster, Public and Indian Housing Program, Public Housing Capital Fund Program, and Coronavirus Relief Fund Assistance Listing Numbers: 14.871, 14.879, 14.850, 14.872, and 21.019 Material Noncompliance Non Compliance Material to the Financial Statements: Yes Material Weakness in Internal Control over Compliance Criteria: The Authority must maintain complete and accurate accounts and other records for the program in accordance with HUD compliance requirements. Condition: The Authority did not maintain complete and accurate accounts and other records in accordance with HUD compliance requirements regarding Activities Allowed or Unallowed, Allowable Costs/Cost Principles, Eligibility, Reporting, and Special Tests and Provisions. Context: The Authority was unable to provide requested documentation at the time of audit to properly test the HUD compliance requirements. Known Questioned Costs: Unknown Cause: There is a material weakness in internal controls over compliance related to the maintenance of tenant files, wait lists, inspection reports and other records. The Authority has not properly considered, designed, implemented, maintained and monitored a system of internal controls that reasonably assures the program is in compliance. Effect: The Housing Voucher Cluster, Public and Indian Housing Program and Public Housing Capital fund Program are in material non- compliance with the compliance requirements of the program. Recommendation: We recommend that the Authority implement a process whereby Authority documents are stored and safeguarded to ensure compliance with the Uniform Guidance and the compliance supplement. View of Responsible Officials and Corrective Actions: The Authority experienced significant turnover in employees during the year and as a result certain source documents were misplaced or destroyed. Management agrees with the Auditors' finding and has hired a new Executive Director who will implement the required safeguards and ensure that the Authority follows its internal control over compliance processes and procedures related to the Housing Voucher Cluster, Public and Indian Housing Program and Public Housing Capital fund Program to remedy the aforementioned deficiencies. Byran McClellan, CFO, will be responsible to implement this corrective action by December 31, 2023.
Department of Housing and Urban Development and Department of Veterans Affairs 2022-008 Federal Program Name: Emergency Solutions Grant Program and VA Homeless Providers Grant and Per Diem Program Assistance Listing Number: 14.231 and 64.024 Recommendation: We recommend the Organization develop a sy...
Department of Housing and Urban Development and Department of Veterans Affairs 2022-008 Federal Program Name: Emergency Solutions Grant Program and VA Homeless Providers Grant and Per Diem Program Assistance Listing Number: 14.231 and 64.024 Recommendation: We recommend the Organization develop a system of internal controls to ensure that salaries and related payroll expenses are tracked to reasonably reflect the actual time spent working on the programs. In addition we recommend that management retain all documents including evidence of review and approval for all expenditures of federal funds until the latter of the legally required retention period or completion of required audits. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: Management has implemented internal control procedures to strengthen payroll allocation practices and documentation retention for federally funded expenditures. The Organization has established a process to ensure that salaries and payroll-related costs charged to federal programs are supported by appropriate time tracking and allocation documentation that reasonably reflects actual time worked on each program. Supervisory review and approval requirements have been implemented to validate payroll allocations and supporting documentation. Additionally, the Organization has reinforced documentation retention standards by requiring retention of all federal expenditure support, including invoices, approvals, reconciliations, and evidence of review, in accordance with federal retention requirements and audit availability standards. Name(s) of the contact person(s) responsible for corrective action: Ryan Ross, Executive Director Planned completion date for corrective action plan: March 31, 2026
Recommendations: Management should enhance its internal control procedures to ensure all disbursements and payroll transactions charged to the federal program are supported by complete and properly approved documentation consistent with 2 CFR Part 200 and the operating contract. This includes retain...
Recommendations: Management should enhance its internal control procedures to ensure all disbursements and payroll transactions charged to the federal program are supported by complete and properly approved documentation consistent with 2 CFR Part 200 and the operating contract. This includes retaining invoices, approvals, check copies, personnel files, and pay-rate authorizations. Management should assign clear responsibility for recordkeeping, implement periodic reviews for completeness, and provide staff training on documentation and retention expectations. Views of responsible officials and planned corrective actions: Management agrees with the findings and will ensure that all original supporting documents are maintained at the organization’s office in a secure location for a minimum of three years after an independent audit, and that every transaction is properly authorized and documented before expending monetary resources. Anticipated Completion Date: May 1, 2024
Recommendations: Management should prepare an Annual Cost Allocation Plan in accordance with the program’s operating contract and federal regulations and ensure it is consistently retained and made available for audit. Management should also establish internal controls over the preparation, approval...
Recommendations: Management should prepare an Annual Cost Allocation Plan in accordance with the program’s operating contract and federal regulations and ensure it is consistently retained and made available for audit. Management should also establish internal controls over the preparation, approval, and retention of the plan. Views of responsible officials and planned corrective actions: Management agrees with the finding and will ensure that the Annual Cost Allocation Plan is completed in a timely manner in accordance with the operating contract and the indirect cost rate submitted for reimbursement matches the Annual Cost Allocation Plan. Training on the proper Annual Cost Allocation Plan process is anticipated through the WV Transit Authority. Anticipated Completion Date: May 1, 2024
CORRECTIVE ACTION PLAN (Concerning Finding 2022-005) Contact Person Responsible for Corrective Action: Carrie Castonguay, Town Manager Corrective Action: The Treasurer, Town Manager and Select Board will take the following actions to address finding 2022-005 The current Town Manager was appointed by...
CORRECTIVE ACTION PLAN (Concerning Finding 2022-005) Contact Person Responsible for Corrective Action: Carrie Castonguay, Town Manager Corrective Action: The Treasurer, Town Manager and Select Board will take the following actions to address finding 2022-005 The current Town Manager was appointed by the Select Board on August 14, 2023, and had no knowledge of this material weakness. She is an experienced Manager and has drafted a new Procurement Policy that addresses this deficiency. The Select Board will review this draft at their meeting in January 2024, edits will be made and then it will be sent to legal for final review before adoption. Additionally, Department Heads are required to turn in no later than Thursday by noon, invoices to be paid on that week’s warrant. The Treasurer has been given authority by the Town Manager to contact Department Heads and request that they come to the office weekly to turn in invoices. All invoices must have the appropriate expense code and be signed by the Department Head. Anticipated Completion Date: The processing of invoices for the warrant has been corrected as of December 2023. The Procurement Policy was approved and implemented by the Select Board on January 23, 204.
CORRECTIVE ACTION PLAN (Concerning Finding 2022-006) Contact Person Responsible for Corrective Action: Carrie Castonguay, Town Manager Corrective Action: The Town Manager and Select Board will take the following actions to address finding 2022-006 The current Town Manager was appointed by the Select...
CORRECTIVE ACTION PLAN (Concerning Finding 2022-006) Contact Person Responsible for Corrective Action: Carrie Castonguay, Town Manager Corrective Action: The Town Manager and Select Board will take the following actions to address finding 2022-006 The current Town Manager was appointed by the Select Board on August 14, 2023, and had no knowledge of this material weakness. She is an experienced Manager and is drafting a new Internal Controls Policy that will address this deficiency. The Select Board will review this draft at their meeting in February or March 2024, edits will be made and then it will be sent to legal for final review before adoption. This policy will include sections on risk assessment and management, annual audit, chart of account, general ledger, reconciliation and verification, reserve funds and reserve accounts, investments, financial reporting, fraud, accounting software, online transactions and banking, documentation daily cash-ups, grants and projects, AR process, AP process, and payroll. Anticipated Completion Date: It is anticipated that the Internal Controls Policies and Procedures will be approved and adopted by June 2024 by the Select Board. Implementation will be July 1, 2025 with the new chart of accounts.
CORRECTIVE ACTION PLAN (Concerning Finding 2022-003) Contact Person Responsible for Corrective Action: Carrie Castonguay, Town Manager Corrective Action: The Treasurer, Town Manager and Select Board will take the following actions to address finding 2022-003 The current Town Manager was appointed by...
CORRECTIVE ACTION PLAN (Concerning Finding 2022-003) Contact Person Responsible for Corrective Action: Carrie Castonguay, Town Manager Corrective Action: The Treasurer, Town Manager and Select Board will take the following actions to address finding 2022-003 The current Town Manager was appointed by the Select Board on August 14, 2023, and had no knowledge of this material weakness. She is an experienced Manager that has implemented training for the Treasurer and the Select Board. She has implemented a process of having the Treasurer complete a warrant each week. The Select Board meets bi-monthly and the Town Manager has the Select Board review and approve all warrants as a regular action item in their meeting. Additionally, Department Heads are required to turn in no later than Thursday by noon, invoices to be paid on that week’s warrant. The Treasurer has been given authority by the Town Manager to contact Department Heads and request that they come to the office weekly to turn in invoices. All invoices must have the appropriate expense code and be signed by the Department Head. Anticipated Completion Date: This corrective action has been implemented as of October 2023.
Recommendation We recommend that management: ▪ Implement procedures requiring complete supporting documentation for all costs charged to federal awards ▪ Ensure costs are reviewed for allowability, reasonableness, and allocability prior to recording ▪ Establish and document formal cost allocation me...
Recommendation We recommend that management: ▪ Implement procedures requiring complete supporting documentation for all costs charged to federal awards ▪ Ensure costs are reviewed for allowability, reasonableness, and allocability prior to recording ▪ Establish and document formal cost allocation methodologies ▪ Require approval and documentation of all journal entries affecting federal programs ▪ Provide training to staff on Uniform Guidance cost principles (2 CFR 200 Subpart E) ▪ Conduct periodic internal reviews to ensure compliance
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