Corrective Action Plans

Finding 496688 (2023-002)

Significant Deficiency 2023

WI

Procurement, Suspension & Debarment Allowable Costs / Cost Principles Cash Management

Action Planned/taken in response to the finding: Kewaunee County agrees with the finding. An assessment of all grants, requirements, and related policy and procedures is in progress and will continue to: • Evaluate existing policy and procedures for needed revisions • Document revisions to policy an...

Action Planned/taken in response to the finding: Kewaunee County agrees with the finding. An assessment of all grants, requirements, and related policy and procedures is in progress and will continue to: • Evaluate existing policy and procedures for needed revisions • Document revisions to policy and procedures as necessary • Communicate any new policies to employees responsible for awards • Identify awards covered by the Uniform Guidance • Set and document a schedule for periodic review and revision Policy and procedures, as well as related documentation, are being revised as necessary to ensure compliance with the Uniform Guidance. Progress continues into 2024. The Finance Director will continue to coordinate and provide assistance and guidance to departments receiving grants subject to the Uniform Guidance. Names(s) of the contact person(s) responsible for corrective action: Paul Kunesh Planned completion date for corrective action: December 31, 2024

View Audit 319501

Finding 496664 (2023-003)

Material Weakness 2023

Fort Frye Local School District

OH

Subrecipient Monitoring Cash Management Material Weakness § 200.302 § 200.303

Finding Number: 2023-003 Planned Corrective Action: The accounts payable clerk will double check all claims submitted to the state for accuracy. Anticipated Completion Date: 08/30/2024 Responsible Contact Person: Stacy Bolden

View Audit 319478

Finding 496646 (2023-003)

Significant Deficiency 2023

Honor Ehg INC

NY

Cash Management

2023-003 TANF Voucher Controls The Administration of HONOR acknowledges the finding identified in our 2023 Financial Audit concerning the inadequacies regarding ''TANF Voucher Controls". The following response outlines the steps the HONOR Administration, Management and Direct Support Team will take...

2023-003 TANF Voucher Controls The Administration of HONOR acknowledges the finding identified in our 2023 Financial Audit concerning the inadequacies regarding ''TANF Voucher Controls". The following response outlines the steps the HONOR Administration, Management and Direct Support Team will take to address these issues and prevent recurrence. Corrective Actions Taken: -Create a Policy and Procedure by 9/30/2024. HONOR has identified verification forms and processes to ensure accurate data is recorded. -Staff Training: A comprehensive training program has been initiated for all relevant staff, focusing on verifications forms, admissions/discharges, and bed nights. Training requirements will ensure these policies are covered and understood. Staff will receive in-depth training on nightly bed sheets and data entry of client attendance in the EMR system, (NETSMART), to generate an accurate attendance roster. This in-service will take place by 10/15/2024. - Revamping Verification Procedures: HONOR has designated a position, Administrative Response Coordinator, to be responsible for verifying the nightly bed sheets and roster at the end of the month. Any discrepancies are reported to the Case Management Supervisor for verification. If changes are to be made, documentation will be made on the bed sheets and data entry will be corrected in NETSMART and roster reprinted. - HONOR will re-engage, when determined and or required, with designated team members of the Orange County Department of Social Services. Any possible disputes and or concerns regarding possible inaccuracies with TANF vouchers will be reviewed and documented by the Shelter Manager. -Periodic Reviews. The Quality Assurance/Compliance Mgr will conduct a regularly scheduled review process to monitor documentation, ensuring ongoing compliance and addressing any issues proactively. Monitoring and Follow-up: -To ensure the effectiveness of the corrective actions, HONOR administrative team will be conducting a quarterly review of internal audits, trends and data. HONOR's Executive Director along with the Administration and Management teams take this audit seriously and are committed to strengthening our internal controls to prevent future incidents. The steps outlined above will help us maintain compliance and ensure the proper use of resources. HONOR thanks RBT for their due diligence and bringing these matters to our attention.

View Audit 319438

Finding 496627 (2023-004)

Significant Deficiency 2023

City of Boston

MA

School Nutrition Programs Cash Management Significant Deficiency § 200.303

Boston Public Schools (BPS) Food and Nutrition Services (FNS) has implemented advanced policies including additional segregation of duties to ensure that all deposits made have clear and accurate cash receipt forms. Anticipated Completion Date: June 30, 2024 Responsible Contact Person: Colin Musto...

Boston Public Schools (BPS) Food and Nutrition Services (FNS) has implemented advanced policies including additional segregation of duties to ensure that all deposits made have clear and accurate cash receipt forms. Anticipated Completion Date: June 30, 2024 Responsible Contact Person: Colin Musto, Assistant City Auditor, Grants Monitoring Unit colin.musto@boston.gov

View Audit 319431

Finding 496626 (2023-003)

Material Weakness 2023

City of Boston

MA

Questioned Costs School Nutrition Programs Cash Management § 200.303

Boston Public Schools (BPS) Food and Nutrition Services (FNS) has implemented various procedures in order to accurately report meal counts and claims. Anticipated Completion Date: June 30, 2024 Responsible Contact Person: Colin Musto, Assistant City Auditor, Grants Monitoring Unit colin.musto@bos...

Boston Public Schools (BPS) Food and Nutrition Services (FNS) has implemented various procedures in order to accurately report meal counts and claims. Anticipated Completion Date: June 30, 2024 Responsible Contact Person: Colin Musto, Assistant City Auditor, Grants Monitoring Unit colin.musto@boston.gov

View Audit 319431 Questioned Costs: $1

Finding 496462 (2023-004)

Material Weakness 2023

Washington Parks Academy

MI

Cash Management Material Weakness

Management will ensure experienced staff is recruited, retained, and trained to support grant revenues. This includes recording the grants correctly in the G/L and also pulling the correct draws from the State website accurately and timely.

View Audit 319381

Finding 496442 (2023-001)

Material Weakness 2023

Del Norte Child Care Council

CA

Allowable Costs / Cost Principles Matching / Level of Effort / Earmarking Internal Control / Segregation of Duties

Management agrees that due to turnover in staff during 2022 and 2023, there were gaps in communication leading to the cost allocation formulas and leadsheet account reconciliations not being updated on a continuing basis as reimbursement requests were being to the California Department of Social Ser...

Management agrees that due to turnover in staff during 2022 and 2023, there were gaps in communication leading to the cost allocation formulas and leadsheet account reconciliations not being updated on a continuing basis as reimbursement requests were being to the California Department of Social Services. Management believes that all key accounting positions have since been filled by qualified personnel. A formal close process and reconciliation of all balance sheet accounts and indirect cost allocations each month will ensure reimbursement requests are complete and accurate. Process documentation is also being prepared to help personnel in the accounting department follow proper control procedures. Action: Develop and document process for drawdown calculation and year end reconciliation to accounting records. Due Date: 8/1/24 Staff: Don Reynolds, contracted CFO

View Audit 319367

Finding 496413 (2023-001)

Material Weakness 2023

Kosciusko County

IN

Internal Control / Segregation of Duties Cash Management Material Weakness § 200.302 § 200.303 § 200.328 § 200.329 § 200.344

FINDING 2023-001 Finding Subject: Coronavirus State and Local Fiscal Recovery Funds – Reporting Summary of Finding: The Kosciusko County Sheriff's Office applied for the Indiana Local Body Camera Grant (ILBC). The sheriff’s office was awarded this grant on January 1, 2023, with a grant cost amount o...

FINDING 2023-001 Finding Subject: Coronavirus State and Local Fiscal Recovery Funds – Reporting Summary of Finding: The Kosciusko County Sheriff's Office applied for the Indiana Local Body Camera Grant (ILBC). The sheriff’s office was awarded this grant on January 1, 2023, with a grant cost amount of up to $31,920. This grant is a reimbursable grant through the Indiana Department of Homeland Security. The period of performance was from January 1, 2023, to December 31, 2023. The Kosciusko County Sheriff's Office ordered body-worn cameras and equipment on April 26, 2023. The invoice for the cameras and the camera equipment was paid on July 14, 2023. The Kosciusko County Sheriff's Office then submitted a Reimbursement Claim Form on September 11, 2023. The Reimbursement Claim Form shows the Sheriff's Office incorrectly requested the full $31,920. They received $31,920 from the Indiana Department of Homeland Security on September 27, 2023. However, the county had only spent $9,581 of the grant money towards the body camera purchase. Therefore, there is a remaining balance in the fund of $22,339 as of December 31, 2023. Due to the period of performance, the county should have reimbursed the Indiana Department of Homeland Security $22,339. On May 9, 2023, the Sheriff's Office grant administrator submitted a Program Report for the ILBC grant. This report was filed without an implemented internal control or evidence of a review. The report was completed and submitted by the Sheriff's Office grant administrator. The report incorrectly indicated that all expenditures had been completed. As of the date of the submission, the county had not purchased the bodyworn cameras and all federal funds had not been expended. Contact Person Responsible for Corrective Action: Alyssa Schmucker Contact Phone Number and Email Address: 574-372-2325 aschmucker@kosciusko.in.gov View of Responsible Officials: We concur with the findings identified. Description of Corrective Action Plan: The Kosciusko Sheriff’s Office, grant coordinator will contact IDHS for instruction on how to return the $22,339.00 and prepare a claim to be processed by the Kosciusko County Auditor’s office. The grant balances are submitted each month by departments these are checked and confirmed by the Auditor’s Office this one was overlooked in the review process. The person who applied for the grant no longer works for the county. It is believed the new person handling the grants was not aware that this grant even existed. The Grant Administrator(s) will have someone sign off on the grant report submissions and forward all reports to the Auditor’s Office. Anticipated Completion Date: It is anticipated that this will be completed as soon as the information to return the funds is received from the state and the claim is submitted to the Auditor for payment. This claim will be paid as soon as it is received. On or before 12/31/2024.

View Audit 319325

Finding 496410 (2023-001)

Material Weakness 2023

Full Harvest Housing, Inc.

IA

Allowable Costs / Cost Principles Special Tests & Provisions Subrecipient Monitoring

CORRECTIVE ACTION PLAN FOR THE YEAR ENDED MARCH 31, 2023 Title 2, U.S. Code of Federal Regulations Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (Uniform Guidance), Subpart F, Section 511 – Audit Findings Follow-up requires the auditee t...

CORRECTIVE ACTION PLAN FOR THE YEAR ENDED MARCH 31, 2023 Title 2, U.S. Code of Federal Regulations Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (Uniform Guidance), Subpart F, Section 511 – Audit Findings Follow-up requires the auditee to prepare a corrective action plan to address each audit finding included in the current year auditor’s reports. The Corrective Action Plan for Current Year Findings present our corrective action plan for the Financial Statement and/or Federal Award Findings described in the accompanying Schedule of Findings and Questioned Costs for the period ended March 31, 2023. Finding 2023-001 Responsible Party Name: Tamara Wallace Position: Executive Director – Management Agent Telephone Number: 816-233-4250 Federal Agency Department of Housing and Urban Development Federal Program Supportive Housing for the Elderly (Section 202) Compliance Requirements A/B - Activities Allowed or Unallowed and Allowable Costs/Cost Principles, C – Cash Management, E – Eligibility, L – Reporting, and N – Special Tests and Provisions Finding Type Financial Statement and Federal Awards Auditee’s Comment on Finding We agree with the auditor’s finding. Corrective Action Management reported that the failure(s) involved records related to the period managed by the predecessor management company. We will request and keep all required documentation from HUD and establish processes and procedures to ensure compliance with the Regulatory Agreement. Anticipated Completion Date September 30, 2024

View Audit 319318

Finding 496401 (2023-003)

Significant Deficiency 2023

Esperanza Health Center, Inc.

PA

Allowable Costs / Cost Principles Cash Management Reporting

View of Responsible Officials: Based on the perspectives provided by management and officials, the finance department has initiated specific corrective measures to ensure strict adherence to reporting PRF and centralization of documentation. As our organization expands, we will evaluate our document...

View of Responsible Officials: Based on the perspectives provided by management and officials, the finance department has initiated specific corrective measures to ensure strict adherence to reporting PRF and centralization of documentation. As our organization expands, we will evaluate our documentation processes to create clear standard operating procedures (SOPs). We have employed a grants analyst who will define distinct responsibilities for grants reporting, establish a central repository, and reconcile both FTE and non-FTE expenditures and receipts, including cash receipts, drawdowns and invoice allocation. Project codes will be crucial in driving this process within our financial system, Blackbaud. Management will report on progress of these actions to the Finance Committee of the Board of Directors at its monthly meetings.

View Audit 319296

Finding 496383 (2023-001)

Significant Deficiency 2023

Community Council of Greater Dallas

TX

Allowable Costs / Cost Principles Cash Management Reporting

Finding 2023-001: Allowable costs – significant deficiency in internal controls over compliance and compliance finding. Management Response CCGD was issued monitoring findings by HHSC for the monitoring period October 2021 (FY 21) -November 2022 (FY 22) in April 2023. As a result of that finding, CC...

Finding 2023-001: Allowable costs – significant deficiency in internal controls over compliance and compliance finding. Management Response CCGD was issued monitoring findings by HHSC for the monitoring period October 2021 (FY 21) -November 2022 (FY 22) in April 2023. As a result of that finding, CCGD received a finding in its 2022 audit. Because of the timing of the findings, as noted in the 2023 audit report, there was not time to resolve the issue before 2023. Therefore, even though the below described plan was implemented in 2023, immediately upon receipt of the initial finding, CCGD was still issued a finding in its FY2023 audit. The notification was received in the 7th month of fiscal year 2023, the following plan has been implemented. o Timesheet and GL mismatch i. Management Response: 1. Perform an audit of existing setup of HRIS-Paycom system to determinecause of mismatch 2. If needed, reimplement Paycom with required setup or change vendors 3. All departments along with respective service categories werereestablished in Paycom to only display employees applicable servicecategories based their respective grants. 4. Conduct quarterly audits of timesheets and GL to ensure there are nomismatches. 5. Time study was performed on quarterly basis to ensure individualperformance complies with funders mandate. ii. Progress Update - GL and Timesheet Mismatch: 1. Audit of existing setup to review the following: a. Department(s) - revised department names/descriptions i. Made changes to all applicable employees’ setup. b. Home Allocation(s) – revised home allocation(s)i. Revised/edited the default home allocation description ii. Assigned correct default home allocation to employees c. Service Categories i. Revised/edited service categories assigned to each department 2. Observations: a. Following Paycom updates, CCGD experienced technical challenges due to software glitches which continued to result in timesheet and GL mismatches. CCGD is continuing to work with Paycom to identify and eliminate the problem. b. CCGD subsequently sought assistance from Paycom in the troubleshooting process. 3. Departmental training of timekeeping process a. Personalized standard operating procedures used b. Real-time examples/instruction provided to staff in training session(s) 4. Post-training audits conducted to include: a. Timecard/sheet review b. GL review and comparison of timecards and sheetsiii. Future Steps and Anticipated Timeline: 1. Continuation of post-training audits to include: a. Timecard/sheet review b. GL review and comparison of timecards and sheets 2. With an anticipated deadline completion date of December 31, 2023, for adherence of full compliance, CCGD effectively implemented system updates prior to this deadline to ensure payroll processing is now based on the actual time and effort performed. iv. Progress Update – Performance Activity Report 1. To provide further back up to time and effort, an additional option in Paycom was enabled for staff to enter notes on day-to-day activity. 2. Departmental training on this goal was performed and completed as of March 31, 2024. 3. Continuation of post-training audits to include: a. Timecard/sheet review b. GL review and comparison of timecards and sheets v. Post implementation plan and observation: CCGD is fully committed to complying with funders and audit standards. Furthermore, CCGD will continue to monitor and identify any potential errors in its payroll reporting to bring a timely solution if required. Furthermore, minor reporting errors occur in payroll GL reports on a random basis. The errors appear to be technical, and as such, we are currently working with Paycom to resolve this issue. Additionally, CCGD will continue to perform time study to ensure that all salary expenses and allocations are adhered to the respective program budget. Parties Responsible: Chief Executive Officer, Chief Financial Officer, and Director - Human Resources

View Audit 319280

Finding 496219 (2023-001)

Significant Deficiency 2023

City of Orange, Texas

TX

Questioned Costs Subrecipient Monitoring Internal Control / Segregation of Duties

Finding 2023-001: Condition and Context: For the year ended September 30, 2023, we reviewed the current period grant expenditures and found the HUD monthly monitoring reports to be incomplete. In addition, several material grant expenditures were not submitted for reimbursement within 120 days foll...

Finding 2023-001: Condition and Context: For the year ended September 30, 2023, we reviewed the current period grant expenditures and found the HUD monthly monitoring reports to be incomplete. In addition, several material grant expenditures were not submitted for reimbursement within 120 days following the date of expenditure. Corrective action planned: Management of the City will implement additional control activities over the review of draw requests and monthly reports by reconciling them to the detail grant expenditures contained in the City’s financial accounting system. Contact person: Cheryl Zeto, Finance Director (409) 883-1041 Anticipated completion date: August 2024

View Audit 319159 Questioned Costs: $1

Finding 486131 (2023-001)

Material Weakness 2023

City of Independence

OH

Subrecipient Monitoring Cash Management Matching / Level of Effort / Earmarking § 200.305

The HIDTA Financial Manager, in conjunction with the City's Finance Assistant, will request smaller dollar amounts with new advances in order to liquidate the prescribed HIDTA guideline of 21 days.

View Audit 318767

Finding 485982 (2023-001)

Material Weakness 2023

City of Quincy, Illinois

IL

Cash Management Reporting Internal Control / Segregation of Duties

Finding 2023-001: Restatement to Fund Balance Condition: During audit fieldwork, our testing resulted in a restatement of fund balance to correct prior year accruals and deferrals related to property taxes, accounts payable, grant receivables, etc. that were not included on the unadjusted trial bala...

Finding 2023-001: Restatement to Fund Balance Condition: During audit fieldwork, our testing resulted in a restatement of fund balance to correct prior year accruals and deferrals related to property taxes, accounts payable, grant receivables, etc. that were not included on the unadjusted trial balances Plan: The City will implement internal controls to properly record necessary accruals and deferrals on a timely basis prior to audit fieldwork. Additionally, the City Comptroller should provide monthly reviews of the financial statements Anticipated Date of Completion: Fiscal Year Ending April 30, 2024

View Audit 318702

Finding 485981 (2023-002)

Significant Deficiency 2023

Northwest Compass

IL

Cash Management § 200.305

DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT 2023-002 (repeat finding of 2022-001) Continuum of Care Program, ALN #14.267 Auditor’s Recommendation: We recommend that when a check is paid, the expense is allocated through the accounting system. At the time a grant voucher is prepared, only actual expe...

DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT 2023-002 (repeat finding of 2022-001) Continuum of Care Program, ALN #14.267 Auditor’s Recommendation: We recommend that when a check is paid, the expense is allocated through the accounting system. At the time a grant voucher is prepared, only actual expenses should be requested. We recommend that each reimbursement request agrees to what is allocated through the accounting system by grant or program for actual expenses. This will help support the request and, if needed, a method to provide the actual invoice for the expense being requested. Action Taken: Supportive Strategies has set up cost centers so all Grant vouchers/expenses are allocated to the proper Grant.

View Audit 318700

Finding 485962 (2023-004)

None 2023

Illinois Academy of Family Physicians

IL

Cash Management § 200.308

DEPARTMENT OF HEALTH AND HUMAN SERVICES 2023-004 Immunization Cooperative Agreements, ALN #93.268 Criteria: According to 2 CFR Section 200.308, all budget revisions over 10% must receive a budget revision from the grantee. Condition: Following a budget revision of over 10%, an approval was not rece...

DEPARTMENT OF HEALTH AND HUMAN SERVICES 2023-004 Immunization Cooperative Agreements, ALN #93.268 Criteria: According to 2 CFR Section 200.308, all budget revisions over 10% must receive a budget revision from the grantee. Condition: Following a budget revision of over 10%, an approval was not received from the grantee. Cause: At direction from the pass-through agency, the Organization charged salary expenses to the contract services line items on its request reimbursement instead of getting budget revisions to reflect the change in the work performed. Effect: The costs billed on the vouchers for reimbursement, did not match the natural classification of the actual expenses incurred on the grant resulting in expenses reported being over budget on certain line items and under budget on others Auditor recommendation: We recommend that when there is a budget revision over 10%, the Organization works with the grantor to get formal documentation to support the revision to ensure amounts charged to the grants are in line with budget line items. Management response: Management will ensure a budget revision be done for any increase over 10% and submit that to the grantor to receive formal approval from the grantor.

View Audit 318675

Finding 485960 (2023-002)

Material Weakness 2023

Illinois Academy of Family Physicians

IL

Cash Management § 200.305

DEPARTMENT OF HEALTH AND HUMAN SERVICES 2023-002 Immunization Cooperative Agreements, ALN #93.268 Criteria: According to 2 CFR Section 200.305(b)(3), all reimbursement requests should be based on supporting documentation that shows the cost was incurred before the request for payment and that the p...

DEPARTMENT OF HEALTH AND HUMAN SERVICES 2023-002 Immunization Cooperative Agreements, ALN #93.268 Criteria: According to 2 CFR Section 200.305(b)(3), all reimbursement requests should be based on supporting documentation that shows the cost was incurred before the request for payment and that the payment to vendor was made. Condition: 4 of the 7 cash drawdown reports tested contained expense reimbursements requested for which there was missing supporting documentation for some of the expenses requested for reimbursements. Total questioned costs were $115,617. Cause: The extra expenses that were missing in the test were because IAFP used staff instead of consultants and the Organization did not update our policies and procedures to include time sheets to show how staff was allocated to the grant to support the charges. Effect: The effect is that the Organization requested funds but did not have back up to support that the actual expenses were incurred and was therefore not in compliance with the cash management requirements under Uniform Grant Guidance in relation reimbursement requests. Auditor recommendation: We recommend that the accounting department verify that the expense has been incurred and paid to the vendor before requesting reimbursement from the grantor and ensure that the backup documentation is filed where it can be located. We recommend hiring or training staff in relation to cash management and documentation of allowable cost. Management response: Management will follow the advice and undergo training in cash management and documentation of allowable costs.

View Audit 318675

Finding 485941 (2023-003)

Significant Deficiency 2023

Elkhorn Rural Public Power District

NE

Allowable Costs / Cost Principles Cash Management Period of Performance § 200.303

Federal Agency Name: Department of Homeland Security Pass-Through Entity: State of Nebraska Emergency Management Agency Federal Financial Assistance Listing #97.039 Program Name: Hazard Mitigation Grant Program Finding Summary: There was one instance of an employee’s timesheet which was reviewed an...

Federal Agency Name: Department of Homeland Security Pass-Through Entity: State of Nebraska Emergency Management Agency Federal Financial Assistance Listing #97.039 Program Name: Hazard Mitigation Grant Program Finding Summary: There was one instance of an employee’s timesheet which was reviewed and approved by the same employee and did not have an independent review performed. Responsible Individuals: Carmen Christensen, CFO/Office Manager Corrective Action Plan: The employee who reviews the timesheet is the general foreman. Action has been taken and all general foreman time will be approved electronically by the Operations Manager once training has been completed on entering time in the software system. Anticipated Completion Date: October 1, 2024

View Audit 318668

Finding 485752 (2023-001)

Significant Deficiency 2023

Pilgrim Towers, Inc.

CT

HUD Housing Programs Cash Management Reporting

Finding Reference Number: 2023-001 Description of Finding: During our audit for the year ended December 31, 2023, we inquired and requested documentation regarding the repayment status of the Flexible Subsidy Loan from the Agency's officers and from its management company. The Agency did not have do...

Finding Reference Number: 2023-001 Description of Finding: During our audit for the year ended December 31, 2023, we inquired and requested documentation regarding the repayment status of the Flexible Subsidy Loan from the Agency's officers and from its management company. The Agency did not have documentation regarding the mortgage status of the Flexible Subsidy Loan available since the HUD Section 202 mortgage was paid off in November 2016. Statement of Concurrence or Nonconcurrence: We are in agreement with this finding. Corrective Action: King's Daughters and Sons Management Company, Pilgrim Towers' new management agent as of 4/1/2024, has engaged with HUD's Northeast Multifamily Asset Resolution Specialist Branch to explore any statutory or regulatory options for loan deferral as part of a preservation transaction. These conversations are ongoing and a DRAFT proposal for loan deferral under HUD Notice 2011-05 has been submitted to that division. Name of Contact Person: Pat Thatcher, Board Treasurer patthatcher1@gmail.com 203-451-1090 Projected Completion Date: Anticipated to be competed in 2024.

View Audit 318591

Finding 485725 (2023-001)

Material Weakness 2023

Victory Heights, Inc.

MD

HUD Housing Programs Special Tests & Provisions Cash Management

We have processes in place to account for these requirements, but in this case the year end changed, and a stub period audit was conducted. We could not make a deposit by 10/31/23 since we did not have the final audit by then and there were not sufficient funds in the operating account to cover the ...

We have processes in place to account for these requirements, but in this case the year end changed, and a stub period audit was conducted. We could not make a deposit by 10/31/23 since we did not have the final audit by then and there were not sufficient funds in the operating account to cover the funding. Going forward, management will ensure that any shortage is funded on time even if operating funds are short and we have to request funds from ownership.

View Audit 318546

Finding 485719 (2023-001)

Significant Deficiency 2023

Cheval Court, Inc.

MD

HUD Housing Programs Special Tests & Provisions Cash Management

We have processes in place to account for these requirements, but in this case the year end changed, and a stub period audit was conducted. We could not make a deposit by 10/31/23 since we did not have the final audit by then and there were not sufficient funds in the operating account to cover the ...

We have processes in place to account for these requirements, but in this case the year end changed, and a stub period audit was conducted. We could not make a deposit by 10/31/23 since we did not have the final audit by then and there were not sufficient funds in the operating account to cover the funding. Going forward, management will ensure that any shortage is funded on time even if operating funds are short and we have to request funds from ownership.

View Audit 318541

Finding 485705 (2023-002)

Significant Deficiency 2023

Camillus Health Concern, Inc.

FL

Questioned Costs Cash Management § 200.305

Ineffective Controls Over the Cash Management Requirement Condition Community Health Concern, Inc. (“CHC”) did not minimize the times between drawdowns and disbursements of Federal funds in accordance with Federal regulations. There were three cash drawdowns made by management that were at least tw...

Ineffective Controls Over the Cash Management Requirement Condition Community Health Concern, Inc. (“CHC”) did not minimize the times between drawdowns and disbursements of Federal funds in accordance with Federal regulations. There were three cash drawdowns made by management that were at least two months (60 days) in advance of actual expenditures or immediate requirement needed for payment. Management’s Views: Management concurs with the audit findings and will implement various steps that will strengthen our internal control processes to mitigate any potential cash drawdown noncompliance in the future. Corrective Action Plan: In response to the Cash Management finding, the following actions will be implemented to ensure compliance with federal grant guidelines and to maintain transparency and accountability, CHC will: 1. Seek HRSA Guidance • In situations that are out of the ordinary or not explicitly covered by existing grant guidelines, the Director of Finance or his/her designee will seek guidance from the Health Resources and Services Administration (HRSA). • This step ensures that all actions taken are compliant with HRSA’s grant guidelines, 2. Consult the External Auditor • For additional guidance and to ensure proper procedure, the Director of Finance or his/her designee will consult with the external auditor. • If HRSA guidance is available, it will be shared with the external auditor to confirm that all steps align with federal requirements and best practices. 3. Continually Communicate and Engage with the Finance Committee and the Board of Directors • Ongoing communication and engagement with the Finance Committee and the Board of Directors will be maintained. • Regular updates will be provided on the status of grant fund requests, drawdowns, and any guidance received from HRSA or the external auditor. • This practice ensures that the Finance Committee and the Board of Directors are fully informed and can provide oversight and support as needed. Anticipated Date of Completion: Management has implemented approximately 85% of the strategies described in the Plan above. Management believes by implementing these actions, the compliance with federal grant guidelines will be enhanced to ensure transparency to the financial operations as well as maintain robust oversight by involving key stakeholders in the process. Management anticipates the successful completion date for the entire Plan to be no later than August 31st, 2024. Contact Person: For inquiries regarding this finding, please contact Benjo Reyes at BenjoR@CamillusHealth.org who is responsible for the corrective actions.

View Audit 318513 Questioned Costs: $1

Finding 485683 (2023-007)

Significant Deficiency 2023

Canoncito Band of Navajos Health Center, Inc.

NM

Questioned Costs Allowable Costs / Cost Principles Cash Management

Corrective Action: CBNHC will implement the following corrective actions: • The CBNHC Board of Directors will consult with both the CEO and the Finance Director to ensure that board actions for premium payroll disbursements are allowable and comply with 2 CFR Part 200. • CBNHC will immediately init...

Corrective Action: CBNHC will implement the following corrective actions: • The CBNHC Board of Directors will consult with both the CEO and the Finance Director to ensure that board actions for premium payroll disbursements are allowable and comply with 2 CFR Part 200. • CBNHC will immediately initiate a collection notice to the Board of Directors who received the “essential worker” payments in fiscal year 2023. Person Responsible: The following individuals will be responsible for the above corrective action plan: • Board of Directors (Kimberly Bruce, Lester Secatero, Harrison Platero) – Are responsible for CBNHC’s governance and will monitor compliance with 2 CFR Part 200. • Interim Finance Director/Chief Operations Officer (Volelle Zamora) through the Chief Executive Officer (Derrick Watchman) – Are responsible for issuing a notice of collections to the Board of Directors who received the premium payments in fiscal year 2023. Completion Date: CBNHC will immediately issue collection notices and will coordinate the accounting for the repayment of the unallowable costs.

View Audit 318493 Questioned Costs: $1

Finding 485624 (2023-008)

None 2023

Dolton West School District 148

IL

Questioned Costs Reporting Procurement, Suspension & Debarment

Condition: The District did not claim expenditures in conformity with the approved detail budget. Plan: Management will review its policies and procedures and implement changes to strengthen internal control over federal reporting. Anticipated Date of Completion: June 30, 2024. Name of Contact Perso...

Condition: The District did not claim expenditures in conformity with the approved detail budget. Plan: Management will review its policies and procedures and implement changes to strengthen internal control over federal reporting. Anticipated Date of Completion: June 30, 2024. Name of Contact Person: Dr. Kevin J. Nohelty, Superintendent. Management Response: Management will work together with staff to ensure that grant budgets are periodically reviewed and amended as necessary.

View Audit 318405 Questioned Costs: $1

Finding 485564 (2023-004)

Significant Deficiency 2023

Southern Fulton School District

PA

Subrecipient Monitoring Allowable Costs / Cost Principles Cash Management

The finding from Section III – Activities Allowed or Unallowed Finding 2023-004 – General Ledger System Condition: Federal expenditures should be posted to the federal funding source accounts in the general ledger as they are incurred, and significant adjusting entries reclassing expenditures shoul...

The finding from Section III – Activities Allowed or Unallowed Finding 2023-004 – General Ledger System Condition: Federal expenditures should be posted to the federal funding source accounts in the general ledger as they are incurred, and significant adjusting entries reclassing expenditures should be at a minimum. This will allow for the proper reporting of the eligible amounts to claim for reimbursement. Views of Responsible Officials and Planned Corrective Actions: The District Business Manager is aware and responsible for appropriate reporting of expenditures related to federal funding. During the course of the 2022-2023 school year, appropriate processes and classifying of expenditures were not completed as they should have been, resulting in numerous after-closing journal entries to correct the issues. Moving forward, with the assistance and guidance of federal and state guidelines, all expenditures will be budgeted for within the grant application and reconciled with the district’s general ledger, to ensure proper allocations. Additionally, reporting that is to be done quarterly will also verify the placement of expenditures accurately. The person responsible for the corrective action plan will be the Business Manager and the anticipated completion date will be June 30, 2024, but no later than June 30, 2025 due to the delays that occurred in the completion of the audit ending June 30, 2023.

View Audit 318339

Corrective Action Plans

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