Corrective Action Plans

Finding 425612 (2022-004)

Material Weakness 2022

IL

Cash Management Material Weakness Matching / Level of Effort / Earmarking § 200.303

REFERENCE: 2022-004 ? Cash ManagementStudent Financial Assistance Cluster (Assistance listing No. 84.007, 84.063, 84.268)Federal Grantor: U.S. Department of EducationFacility: Good Samaritan College of Nursing and Health ScienceFinding: Per discussion with management, Good Samaritan College of Nursi...

REFERENCE: 2022-004 ? Cash ManagementStudent Financial Assistance Cluster (Assistance listing No. 84.007, 84.063, 84.268)Federal Grantor: U.S. Department of EducationFacility: Good Samaritan College of Nursing and Health ScienceFinding: Per discussion with management, Good Samaritan College of Nursing & Health Science has processes andinternal controls in place to ensure requests for funding are allowable under the terms of the grant agreement. Theseinternal controls included validating the draw agreed between the G5 system, COD, and Good Samaritan College ofNursing & Health Science?s internal records for student financial need. However, management did not consistentlyretain documentation evidencing the performance of these internal controls.Corrective Action Plan: Good Samaritan will implement a formal monthly reconciliation process, includingcomparison of all systems for the period, a final review of G5 funds prior to draw down, a cover sheet noting anyexplaining any differences, proper sign off for preparation and review and the date by GSC management and FASmanagement. A year end reconciliation will also be performed following the same process.Person Responsible: Judy Kronenberger ? President Good Samaritan College of Nursing and Health ScienceCompletion: June 2022

View Audit 312373

Finding 424941 (2022-205)

Significant Deficiency 2022

State of Idaho

ID

Questioned Costs Allowable Costs / Cost Principles Subrecipient Monitoring

Finding Number 2022-205: An expenditure was made by the Department for unallowable activities from the Elementary and Secondary School Emergency Relief (ESSER) program.Federal Program: 84.425U - Education Stabilization Fund - ARPA ESSER IIIRelated to Prior Finding: N/AAgency?s view: The Department a...

Finding Number 2022-205: An expenditure was made by the Department for unallowable activities from the Elementary and Secondary School Emergency Relief (ESSER) program.Federal Program: 84.425U - Education Stabilization Fund - ARPA ESSER IIIRelated to Prior Finding: N/AAgency?s view: The Department agrees with this finding.Corrective Action: When the Elementary and Secondary School Emergency Relief Funds {ESSER) were first awarded, it was not required that districts attach any documentation to their Grant Reimbursement Application {GRA) requests. Federal Programs will start requiring that all requests coming in through the GRA system have supporting documentation attached as of July 1, 2023, which is the beginning of our next fiscal cycle.Anticipated Corrective Action Date: We will announce this new procedure through emails and during our state-wide Consolidated Federal and State Grant Application training in April and May2023.Responsible for Corrective Action: Gideon Tolman, Chief Financial Officergtolman@sde.idaho.gov 208-332-6874

View Audit 312368 Questioned Costs: $1

Finding 422815 (2022-053)

Material Weakness 2022

State of Alaska

AK

Eligibility Subrecipient Monitoring Cash Management

Finding: 2022-053 - Thirty Medicaid and 20 CHIP recipients with paid medical claims during FY 22 were randomly selected for eligibility testing. Auditors found DPA staff did not process applications in a timely manner or redetermine eligibility when required for 87 percent of Medicaid cases and 90 p...

Finding: 2022-053 - Thirty Medicaid and 20 CHIP recipients with paid medical claims during FY 22 were randomly selected for eligibility testing. Auditors found DPA staff did not process applications in a timely manner or redetermine eligibility when required for 87 percent of Medicaid cases and 90 percent of CHIP cases tested.Questioned Costs: NoneAssistance Listing Number: 93.767; 93.775, 93.777, 93.778Assistance Listing Title: CHIP; Medicaid ClusterViews of Responsible Officials (state whether your agency agrees or disagrees with the finding; if you disagree, briefly explain why): DOH agrees with the finding.Corrective Action (corrective action planned): The Division of Public Assistance (DPA) continues to streamline internal processes, including staff training on the use of the electronic document management system (ILINX) and the Instant Eligibility Verification System (IEVS) to increase accurate and timely eligibility renewals. The department also completed a procurement during FY22 to secure a contractor, who is serving as the primary resource in implementing an automated renewal process. The contract became effective 03/01/2022.Completion Date (list anticipated completion date): DOH anticipates the finding will be resolved in FY2023.Agency Contact (name of person responsible for corrective action): Josephine Stern, Assistant Commissioner

View Audit 312347

Finding 422814 (2022-051)

Significant Deficiency 2022

State of Alaska

AK

Allowable Costs / Cost Principles Eligibility Subrecipient Monitoring

Finding: 2022-051 - DHSS staff claimed inaccurate federal reimbursement for behavioral health costs.Questioned Costs: Assistance Listing 93.767: Indeterminate; Assistance Listing 93.778: IndeterminateAssistance Listing Number: 93.767; 93.775, 93.777, 93 .778Assistance Listing Title: CHIP; Medicaid C...

Finding: 2022-051 - DHSS staff claimed inaccurate federal reimbursement for behavioral health costs.Questioned Costs: Assistance Listing 93.767: Indeterminate; Assistance Listing 93.778: IndeterminateAssistance Listing Number: 93.767; 93.775, 93.777, 93 .778Assistance Listing Title: CHIP; Medicaid ClusterViews of Responsible Officials (state whether your agency agrees or disagrees with the finding; if you disagree, briefly explain why): DOH agrees with the finding.Corrective Action (corrective action planned): The Division of Behavioral Health (DBH) is working with the ASO to ensure accurate member eligibility file load and claims processing issues under a corrective action plan to resolve issues that led to inaccurate federal reimbursement.Completion Date (list anticipated completion date): DOH anticipates an interim resolution will be in place during FY2023 followed with a full system resolution in FY2024.Agency Contact (name of person responsible for corrective action): Josephine Stern, Assistant Commissioner

View Audit 312347

Finding 422782 (2022-083)

Significant Deficiency 2022

State of Alaska

AK

Student Financial Aid Matching / Level of Effort / Earmarking Internal Control / Segregation of Duties § 200.303

Finding: 2022-083 - During the testing of the outstanding Title IV student check listing we observed nine instances of stale checks at the University of Alaska Southeast (UAS) and three stale checks at UAF that were aged greater than 240 days and not returned to the Department of Education.Questione...

Finding: 2022-083 - During the testing of the outstanding Title IV student check listing we observed nine instances of stale checks at the University of Alaska Southeast (UAS) and three stale checks at UAF that were aged greater than 240 days and not returned to the Department of Education.Questioned Costs: NoneAssistance Listing Number: 84.007, 84.038, 84.063, 84.268, 84.379Assistance Listing Title: Student Financial Assistance ClusterViews of Responsible Officials (state whether your agency agrees or disagrees with the finding; if you disagree, briefly explain why): There is no disagreement with the audit finding.Corrective Action (corrective action planned): UAF and UAS Financial Aid Offices will work with the Statewide Office of Finance and Accounting to pull a regular report of uncashed checks and review for Title IV aid. The Financial Aid Offices or Bursars? Offices will contact students with uncashed checks to attempt to provide the refund. Checks still uncashed after attempts will be canceled and returned to Title IV aid programs within 240 days of payment.Completion Date (list anticipated completion date): June 30, 2023Agency Contact (name of person responsible for corrective action):Janelle Cook, UAS Financial Aid Director, 907-796-6257Jon Lasinski, UAS Business Office Director, 907-796-6497Ashley Munro, UAF Financial Aid Director, 907-474-1934Jennie Witter, UAF Bursar, 907-474-6196

View Audit 312347

Finding 422767 (2022-033)

Significant Deficiency 2022

State of Alaska

AK

Special Tests & Provisions Procurement, Suspension & Debarment Cash Management

Finding: 2022-033 - Testing of 25 daily SNAP Electronic Benefit Transfer reconciliations found that six (24 percent) lacked evidence of review and four (16 percent) included discrepancies that were not followed up on.Questioned Costs: NoneAssistance Listing Number: 10.55 1, 10.561Assistance Listing ...

Finding: 2022-033 - Testing of 25 daily SNAP Electronic Benefit Transfer reconciliations found that six (24 percent) lacked evidence of review and four (16 percent) included discrepancies that were not followed up on.Questioned Costs: NoneAssistance Listing Number: 10.55 1, 10.561Assistance Listing Title: SNAP ClusterViews of Responsible Officials (state whether your agency agrees or disagrees with the finding; if you disagree, briefly explain why): DOH agrees with the finding.Corrective Action (corrective action planned): The Division will reestablish reconciliation processes that were affected by staff turnover. Newer staff will be trained on the reconciliation and discrepancy processes, to include reviewing and follow-up documentation.Completion Date (list anticipated completion date): DOH anticipates the finding will be resolved in FY2024. Agency Contact (name of person responsible for corrective action): Josephine Stern, Assistant Commissioner

View Audit 312347

Finding 421534 (2022-001)

Material Weakness 2022

Monroe County Community School Corporation

IN

School Nutrition Programs Cash Management Material Weakness § 200.303

FINDING 2022-001Contact Person Responsible for Corrective Action: Matt TomrellContact Phone Number: (812) 349-4762 ext 51598Views of Responsible Official: We concur with this finding. This finding has been remediated as of the completion dateshown below.Description of Corrective Action Plan:MCCSC hi...

FINDING 2022-001Contact Person Responsible for Corrective Action: Matt TomrellContact Phone Number: (812) 349-4762 ext 51598Views of Responsible Official: We concur with this finding. This finding has been remediated as of the completion dateshown below.Description of Corrective Action Plan:MCCSC hired a new Food Services Director in July of 2021 who was unaware of the existing internal control. The importanceof the internal control has been communicated to the Food Service Director who now prints and signs the state claimreimbursement requests and files with the rest of the monthly paperwork.Completion Date: March 8, 2023

View Audit 312306

Finding 421493 (2022-004)

Material Weakness 2022

Blackford County Schools

IN

School Nutrition Programs Cash Management Material Weakness § 200.303

FINDING 2022-004Subject: Child Nutrition Cluster - ReportingFederal Agency: Department of AgricultureFederal Programs: School Breakfast Program, COVID-19 School Breakfast Program, National School LunchProgram, COVID-19 National School Lunch Program, Summer Food Service Program for Children, COVID-19...

FINDING 2022-004Subject: Child Nutrition Cluster - ReportingFederal Agency: Department of AgricultureFederal Programs: School Breakfast Program, COVID-19 School Breakfast Program, National School LunchProgram, COVID-19 National School Lunch Program, Summer Food Service Program for Children, COVID-19Summer Food Service Program for ChildrenAssistance Listings Numbers: 10.553, 10.555, 10.559Federal Award Numbers and Years (or Other Identifying Numbers): FY21, FY22Pass-Through Entity: Indiana Department of EducationCompliance Requirement: ReportingAudit Findings: Material WeaknessContact Person Responsible for Corrective Action: Shelley Kemp, Food Service DirectorContact Phone Number: 765-348-7564Views of Responsible Official: We agree with this audit findingDescription of Corrective Action Plan:BCS had moved away from a daily point of sale system after qualifying for the Community EligibilityProvision Free meal program, and had utilized clickers to record the number of students eating daily. Wealso utilized meals claiming number sheets daily.BCS will revert to the point of sale system for the beginning of the 2023-2024 school year to better verifythe student count and to provide more detailed records. We will revise procedures for this process when point ofsale reports are reinstituted.Procedures:1. Daily, Cafeteria Managers at each BCS location will complete an Edit Check report to certify thenumber of meals served at that school for that day.2. Monthly, Cafeteria Managers compile the Edit Checks to determine monthly total meals served.This monthly report will be sent to the Food Service Director for review.3. The Food Service Director will verify the reports from each cafeteria manager, and then compile theinformation for the CNP website that lists the district totals for reimbursement.4. The BJSHS Cafeteria Manager will review and verify the totals compiled by the Food ServiceDirector prior to submission to the IDOE. The BJSHS will sign off prior to submission, verifying thetotals.Anticipated Completion Date: September 2023

View Audit 312304

Finding 421486 (2022-001)

Significant Deficiency 2022

Judson Independent School District

TX

Procurement, Suspension & Debarment Cash Management Reporting

Federal Award Findings and Questioned CostsFor the year ended June 30, 20222022-C-001 ? Expenditures not reported in proper periodType of Finding ? NoncomplianceCFDA No. 84.425U ESSER III GrantCriteria: The District should have adequate processes and controls established for recognition of expenditu...

Federal Award Findings and Questioned CostsFor the year ended June 30, 20222022-C-001 ? Expenditures not reported in proper periodType of Finding ? NoncomplianceCFDA No. 84.425U ESSER III GrantCriteria: The District should have adequate processes and controls established for recognition of expendituresfor the fiscal year.Condition: The District recorded expenditures totaling $9,999 from the ESSER grant funds as of June 30, 2022.Cause: The District initiated the purchase order in March 2022; however, the supplier did not perform the deliveryof goods until July 2022.Effect: Noncompliance with grants seeking reimbursement of expenditures that were not for the reporting periodrequested.Recommendation: The District should develop a process for establishing the recognition of expenditures for thereporting period.District?s Response: The District will monitor all purchase requests at the end of the fiscal year to ensure theyare recorded in the correct year.Responsible Person(s): Michelle Haese, Accounts Payable Coordinator

View Audit 312303

Finding 421348 (2022-003)

Material Weakness 2022

Southwest Dubois County School Corporation

IN

School Nutrition Programs Cash Management Material Weakness § 200.303

FINDING 2022-003Contact Person Responsible for Corrective Action: Allison Pund and Ora Lee CottonContact Phone Number: 812-683-3971Views of Responsible Official: We concur to the finding.Description of Corrective Action Plan: Southwest Dubois will develop a system of internal controls that will ensu...

FINDING 2022-003Contact Person Responsible for Corrective Action: Allison Pund and Ora Lee CottonContact Phone Number: 812-683-3971Views of Responsible Official: We concur to the finding.Description of Corrective Action Plan: Southwest Dubois will develop a system of internal controls that will ensurereporting compliance requirements are met. The corporation will assure one individual is completing the claims/reportsand another is verify the reports.Anticipated Completion Date: March 2023

View Audit 312295

Finding 421284 (2022-007)

Material Weakness 2022

Scotland County Board of Education

NC

Questioned Costs Allowable Costs / Cost Principles Procurement, Suspension & Debarment

Name of Contact Person: Victoria Blue, Interim Finance OfficerCorrective Action Plan: The Board will implement controls to ensure that management fully understands all program requirements pertaining to grant funding received by the district to ensure that available grant funding is maximized for th...

Name of Contact Person: Victoria Blue, Interim Finance OfficerCorrective Action Plan: The Board will implement controls to ensure that management fully understands all program requirements pertaining to grant funding received by the district to ensure that available grant funding is maximized for the benefit of the district.Proposed Completion Date: Immediately

View Audit 312291 Questioned Costs: $1

Finding 421250 (2022-005)

Material Weakness 2022

Scotland County Board of Education

NC

Subrecipient Monitoring Cash Management Material Weakness

Name of Contact Person: Victoria Blue, Interim Finance OfficerCorrective Action Plan: Monthly reconciliations will be completed by the 15th day of the following month. A report showing completion of the reconciliations will be provided to the Superintendent by the end of the following month. The res...

Name of Contact Person: Victoria Blue, Interim Finance OfficerCorrective Action Plan: Monthly reconciliations will be completed by the 15th day of the following month. A report showing completion of the reconciliations will be provided to the Superintendent by the end of the following month. The results of the reconciliations will be evident in the monthly Trial Balance.Proposed Completion Date: Immediately

View Audit 312291

Finding 421030 (2022-001)

Significant Deficiency 2022

Board of Education Baltimore County

MD

Subrecipient Monitoring Allowable Costs / Cost Principles Cash Management § 200.302 § 200.303

Finding Number: 2022-001Prior Year Finding: NoFederal Agency: U.S. Department of TreasuryU.S. Department of EducationFederal Program: COVID-19 -Coronavirus State and Local Fiscal Recovery FundsCOVID-19 - Education Stabilization FundSupporting Effective Instruction State Grants (formerlyImproving Tea...

Finding Number: 2022-001Prior Year Finding: NoFederal Agency: U.S. Department of TreasuryU.S. Department of EducationFederal Program: COVID-19 -Coronavirus State and Local Fiscal Recovery FundsCOVID-19 - Education Stabilization FundSupporting Effective Instruction State Grants (formerlyImproving Teacher Quality State Grants)Assistance Listing: 21.019, 84.425C and DPass-Through Entity: Maryland State Department of EducationPass-Through AwardNumber and Period:211838-01 (3/3/21 ? 12/31/24) 211815-01 (3/3/21 ? 12/31/24)211875-01 (3/3/21 ? 12/31/24) 201873-01 (3/13/20 ? 9/30/22)201787-01 (3/13/20 ? 9/30/22) 202233-01 (3/13/20 ? 9/30/22)191360-01 (7/1/18 ? 9/30/21) 201067-01 (7/1/19 ? 9/30/21)210781-01 (7/1/20 ? 6/30/22) 221052-01 (7/1/21 ? 6/30/23)Compliance Requirement: ReportingType of Finding Significant Deficiency in Internal Control over Compliance, OtherMattersRecommendation:We recommend that the Board review its policies and procedures to ensure that ReimbursementRequests and the detail & accompanying reconciliations used to prepare it are retained for auditpurposes.Explanation of disagreement with audit finding: There is no disagreement with the auditfinding. Action taken in response to finding: Procedures to ensure that the documentation to supportthe monthly submission of the Financial Status Report have been modified accordingly.Name(s) of the contact person(s) responsible for corrective action: BCPS grant accountants;Accounting Manager.Planned completion date for corrective action plan: For immediate implementation andongoing.

View Audit 312282

Finding 420981 (2022-004)

Material Weakness 2022

Sheridan Community Schools

IN

School Nutrition Programs Cash Management Material Weakness § 200.303

FINDING 2022-004Contact Person Responsible for Corrective Action: Robin PopejoyContact Phone Number: 317.758.4172Views of Responsible Official: We concur with the finding.Description of Corrective Action Plan: Those procedures and errors were discussed and adjustments have beenmade. To cover oversig...

FINDING 2022-004Contact Person Responsible for Corrective Action: Robin PopejoyContact Phone Number: 317.758.4172Views of Responsible Official: We concur with the finding.Description of Corrective Action Plan: Those procedures and errors were discussed and adjustments have beenmade. To cover oversight of the School Food Service Accounts, at the close of the month the Director of Business willsend Director of Food Service reports to approve all activity of School Food Service Accounts.Anticipated Completion Date: February 2023

View Audit 312279

Finding 420648 (2022-003)

Material Weakness 2022

Hope Community Services, Inc.

OK

Questioned Costs Cash Management Allowable Costs / Cost Principles § 200.303 § 200.403

Finding 2022-003 - Allowable Activities or Unallowed, Allowable Costs/Cost Principles and CashManagementMaterial Weakness in Internal Control over Compliance and Material Noncompliancefinding Summary: During the audit, the appropriate documentation for grant expenditures to supportthe drawdown from ...

Finding 2022-003 - Allowable Activities or Unallowed, Allowable Costs/Cost Principles and CashManagementMaterial Weakness in Internal Control over Compliance and Material Noncompliancefinding Summary: During the audit, the appropriate documentation for grant expenditures to supportthe drawdown from grant funding was not readily provided. In addition, the process to ensure thatgrant expenditures are allowable and reconciled was not clearly communicated to appropriate partiescausing expenditures to be inappropriately claimed in the wrong fiscal year.Responsible Individual: Chief Financial OfficerCorrective Action Plan; We have designated a member of management to participate in monthly,quarterly, or annual reconciliations as proposed by the auditors. The existing controls will be clearlycommunicated to ensure that program expenditures are made prior to requesting reimbursement offunds.Anticipated Completion Date: Ongoing

View Audit 312271 Questioned Costs: $1

Finding 419333 (2022-003)

None 2022

Urban League of Metropolitan Seattle

WA

Cash Management Matching / Level of Effort / Earmarking § 200.305

ULMS Corrective Action Plan for FY 21-22 Audit FindingsULMS faced significant challenges with the departure of its longtime CFO two months post fiscal year 2021. In addition, the third-party management company who had been responsible for the Partnership accounting, ceased the relationship abruptly...

ULMS Corrective Action Plan for FY 21-22 Audit FindingsULMS faced significant challenges with the departure of its longtime CFO two months post fiscal year 2021. In addition, the third-party management company who had been responsible for the Partnership accounting, ceased the relationship abruptly without opportunity to smoothly transition the responsibility in-house to ULMS. Our external auditor does not prepare a Management Letter typically used to communicate with the Board of Directors and Governance issues that may not elevate to a finding. As such, significant findings are reflected in Section III ? Federal Award Findings and Questioned Costs.FY 2021 was the organization?s first single audit reporting requirement. ULMS engaged a third-party CPA to review past audit and current documents needed to commence the FY 2022 audit. However, due to an emergency there was limited independent review of documents prior to being submitted to the auditor due to time constraints. ULMS continues to strengthen its accounting team and has hired a new Controller in July 2023. The new Controller is a licensed CPA with over 30 years accounting experience and over 10 years? experience as an independent auditor for a range of organizations including non-profits. The Controller will collaborate with the CFO to ensure there is accuracy in reporting, especially for major federal programs. Finding #: 2022-003Contact Person: Mansour Camara? During the FY 2021 audit, the auditor recommended that ULMS formalize written federal payment procedures in compliance with required standards. ULMS developed procedures for advance federal payment which was sent to the auditor for feedback. There was no feedback proposing ULMS update its advance federal payment procedure until the issuance of this finding. The finding states a lack of written policy that complies with the federal payment standard per CFR 200.305. However, the recommendation instructs ULMS to formalize written procedures. Such procedures were in place during FY 2022.Actions to be taken: Notwithstanding the inconsistency between the finding and the recommendation provided by the auditor, ULMS prepared written procedures consistent with CFR 200.305 and recorded transactions consistent with that procedure for FY 2022. ULMS will update its accounting policy and procedures manual to create a written policy in addition to the procedures that have already been in place consistent with CFR 200.305.

View Audit 312222

Finding 417685 (2022-006)

Significant Deficiency 2022

The Center for Victims of Torture

MN

Cash Management Internal Control / Segregation of Duties Significant Deficiency § 200.305

Federal Agency Name: Department of State ? Bureau of Population, Refugees, and MigrationProgram Name: Oversees Refugee Assistance Programs for AfricaCFDA #19.517Federal Agency Name: Agency for International DevelopmentDepartment of StateProgram Name: USAID Foreign Assistance for Programs OverseasCFD...

Federal Agency Name: Department of State ? Bureau of Population, Refugees, and MigrationProgram Name: Oversees Refugee Assistance Programs for AfricaCFDA #19.517Federal Agency Name: Agency for International DevelopmentDepartment of StateProgram Name: USAID Foreign Assistance for Programs OverseasCFDA #98.001Finding Summary: CVT does not have an internal control designed to ensure advance payments are placed in an interest-bearing account.Responsible Individuals: James Behnke, CFO and Mary Kinder, ControllerCorrective Action Plan: Management will complete an extensive review over cash management policies to make sure requirements under the CFR section are met.Anticipated Completion Date: June 2023

View Audit 312164

Finding 417677 (2022-004)

Significant Deficiency 2022

The Center for Victims of Torture

MN

Allowable Costs / Cost Principles Cash Management Significant Deficiency

Federal Agency Name: Department of State ? Bureau of Population, Refugees, and MigrationProgram Name: Oversees Refugee Assistance Programs for AfricaCFDA #19.517Federal Agency Name: Agency for International DevelopmentDepartment of StateProgram Name: USAID Foreign Assistance for Programs OverseasCFD...

Federal Agency Name: Department of State ? Bureau of Population, Refugees, and MigrationProgram Name: Oversees Refugee Assistance Programs for AfricaCFDA #19.517Federal Agency Name: Agency for International DevelopmentDepartment of StateProgram Name: USAID Foreign Assistance for Programs OverseasCFDA #98.001Finding Summary: CVT has an internal control process designed to approve the payrates, but the controls did not operate as designed for one month tested under both programs.Responsible Individuals: James Behnke, CFO and Mary Kinder, ControllerCorrective Action Plan: During the period audited, CVT Ethiopian staff provided professional services and administrative functions on both sides of the Ethiopian armed conflict. This was a difficult work environment to carry out program objectives. CVT Management will complete an extensive review over all internal controls that were affected by managing processes under this environment. Specifically, Management will revise their internal controls to make sure the employees contracted rates agree to the rate paid and submitted for reimbursement. In addition, CVT has hired a new Ethiopia Country Director who has an extensive financial management background and two additional Senior Accountants. Management also plans to send a U.S. Finance staff person to conduct an in-person internal control review for our Ethiopia programs.Anticipated Completion Date: September 2023

View Audit 312164

Finding 417481 (2022-003)

Material Weakness 2022

Big Springs Medical Association D/b/a Missouri Highlands Health Care

MO

Allowable Costs / Cost Principles Cash Management Reporting

2022-003 Lost revenues attributable to coronavirus, as reported in the Period 1 PRF report, were overstated.Responsible Person: Julie O?Neal, Chief Financial OfficerCompletion Date: February 2023Management?s Views:The Provider Relief Reporting for Period 1 was completed in September of 2021. Our a...

2022-003 Lost revenues attributable to coronavirus, as reported in the Period 1 PRF report, were overstated.Responsible Person: Julie O?Neal, Chief Financial OfficerCompletion Date: February 2023Management?s Views:The Provider Relief Reporting for Period 1 was completed in September of 2021. Our audit for FY21 was not finalized until May 2022, at which point we found that our cost report settlement amount ended up swinging due to an error in our interim payment requests from Missouri Medicaid. Going forward, I do not expect this to be a problem as we have remedied our interim wrap payments to be more effective. We will correct the lost revenues calculation on a cumulative basis in your Period 3 and 4 PRF reports.

View Audit 312152

Finding 412032 (2022-001)

Significant Deficiency 2022

University Prep Public Charter Schools

NY

Allowable Costs / Cost Principles Cash Management Eligibility

The school has implemented an electronic timecard system for tutors that will automatically generate timesheets and eliminate or significantly reduce the possibility for human error. All tutors for the school are required to use this computer-based clock in/out system for all shifts.

View Audit 312127

Finding 411335 (2022-002)

None 2022

Humboldt County School District

NV

Subrecipient Monitoring Allowable Costs / Cost Principles Cash Management § 200.308 § 200.309

AUDIT FINDING REFERENCE: 2022-002FINDING SUMMARY:The District?s expenditures charged to grant award number 21-340-07000 occurred prior to the date of the sub-grantaward provided by the State of Nevada Department of Education.RESPONSIBLE PERSON:Dr. David Jensen, SuperintendentPLANNED CORRECTIVE ACTIO...

AUDIT FINDING REFERENCE: 2022-002FINDING SUMMARY:The District?s expenditures charged to grant award number 21-340-07000 occurred prior to the date of the sub-grantaward provided by the State of Nevada Department of Education.RESPONSIBLE PERSON:Dr. David Jensen, SuperintendentPLANNED CORRECTIVE ACTION:This finding was in relation to a pass-through grant of Supplemental Corona Virus Relief Funding provided to theDistrict in lieu of an error found in the PCFP funding formula for the bi-ennium. While the District?s expenditures forthe program are consistent with the March 1, 2020 through December 31, 2021 Period of Performance for thisfederal funding, the Period of Performance on the sub-grant Award was listed as December 10 through December 31,2021. Prior to acceptance, the District informed the pass-through entity that the funds would be used to reimbursecosts incurred during July through October, 2021, and the pass-through entity personnel verbally assured Districtmanagement that this would be acceptable. However, the pass-through entity did not amend the sub-grant awardperiod of performance, resulting in non-compliance with the sub-grant award.Humboldt County School District agrees with the audit finding that this was an isolated instance resulting from aunique situation that arose and was out of the District?s control, and is not the result of a systematic problem.However, the District will follow the recommendation and make every effort to obtain written documentation of anypromised revisions to sub-grant awards prior to expending funds from the pass-through entity in the future.ANTICIPATED COMPLETION DATE:January 31, 2023

View Audit 312061

Finding 411119 (2022-002)

Significant Deficiency 2022

Baltimore City Public School System

MD

Cash Management Reporting Internal Control / Segregation of Duties

Recommendation: We recommend that the schools develop internal controls andprocedures to ensure the reports are reviewed in a timely manner to identify errorsand/or irregularities.Explanation of disagreement with audit finding: There is no disagreement with the auditfinding.Action planned/taken in r...

Recommendation: We recommend that the schools develop internal controls andprocedures to ensure the reports are reviewed in a timely manner to identify errorsand/or irregularities.Explanation of disagreement with audit finding: There is no disagreement with the auditfinding.Action planned/taken in response to finding:Baltimore City Schools had worked for many years with success, maintaining reportingand ensuring compliance, as evident in prior audit reviews. Specifically, with the FSRmonthly reporting (cash reimbursement request to grantor), prior to COVID-19,processes had been in place for completion of reporting, followed by review andapproval to include signature certification. Although reports completed, distribution ofdocuments in the process had been altered in our virtual world and unfortunately did notcontain the entire review/approval/submission process to be completely visible foroutside viewers. A more formal process will be instituted immediately with the nextreporting cycle to clearly display evidence of full reporting process for audit compliance.Reporting process will reflect report announcement, due date, identified preparer,reviewer/approver and report submission to funding agency. Full reporting process willbe documented via controlled, stamped signatory and date via electronic approvalprocess such as DocuSign and email correspondences for grantor submissions.Name(s) of the contact person(s) responsible for corrective action: Renee Calvi,Accounting ManagerPlanned completion date for corrective action plan: January 2023 (next round ofreporting)

View Audit 312027

Finding 410380 (2022-004)

Material Weakness 2022

Madelia Health

MN

Allowable Costs / Cost Principles Cash Management Eligibility

Finding 2022-004Federal Agency Name: Department of Health and Human ServicesProgram Name: COVID-19 Provider Relief Fund and American Rescue Plan (ARP) Rural DistributionFederal Financial Assistance Listing #93.498Compliance Requirement: Activities Allowed or Unallowed and Allowable Costs/Cost Princi...

Finding 2022-004Federal Agency Name: Department of Health and Human ServicesProgram Name: COVID-19 Provider Relief Fund and American Rescue Plan (ARP) Rural DistributionFederal Financial Assistance Listing #93.498Compliance Requirement: Activities Allowed or Unallowed and Allowable Costs/Cost Principles and ReportingFinding Summary: During testing, we identified the following:- No formal documentation of review and approval of the Hospital's final expenditures listing identified as eligible and claimed under the Provider Relief Fund and American Rescue Plan (ARP} Rural Distribution program (the program) was retained.- Payroll reports to support the COVID-related bonuses based on hours worked were not retained and were not able to be recreated.- Some expenses claimed under the program were incurred before the Hospital started preparing, preventing, and responding to COVID. Net costs of $36,540.- Equipment and information technology expenses claimed under other sources of funding were claimed under the program. Net actual costs of $6,080.- Utility expenses and personnel expenses were overclaimed under the program based on a review of supporting documentation. Net costs of $2,985 with projected net costs of $3,827.- No formal documentation of review and approval of the Hospital's lost revenue calculation and the Hospital's special report submitted to HHS for Period 1 TIN #410758512 was retained.- The lost revenue narrative to describe the option iii calculation did not agree with the supporting calculation performed for January and February 2021. The narrative indicated a comparison to January and February of 2019, but the calculation was done based on January and February 2020 trended revenue.- Expenses claimed under the program and included within the Hospital's special report submitted to the Department of Health and Human Services (HHS} for Period 1 TIN #410758512 were reported at gross cost and did not consider the Hospital's Medicare Cost Reimbursement percentage. Net costs of $880,880.Responsible Individuals: Bruce Craven, CFOCorrective Action Plan: Management has formally documented the review and approval process for expense data and federal agency reporting for funds received by federal agencies. This review process ensures compliance of allowable expense data federal agency reporting. Full implementation of this documented process is expected to be completed within the next month.Anticipated Completion Date: March 2023

View Audit 311963

Finding 410368 (2022-003)

Material Weakness 2022

Jenkins Living Center, Inc.

SD

Allowable Costs / Cost Principles Cash Management Material Weakness § 200.303

Finding 2022-003Federal Agency Name: Department of Health and Human ServicesProgram Name: COVID 19 Provider Relief Fund and American Rescue Plan (ARP) Rural DistributionFederal Financial Assistance Listing #93.498Compliance Requirement: Activities Allowed or Unallowed and Allowable Costs/Costs Princ...

Finding 2022-003Federal Agency Name: Department of Health and Human ServicesProgram Name: COVID 19 Provider Relief Fund and American Rescue Plan (ARP) Rural DistributionFederal Financial Assistance Listing #93.498Compliance Requirement: Activities Allowed or Unallowed and Allowable Costs/Costs PrinciplesFinding Summary: Our special report submitted to the Department of Health and Human Services for Period 1 and 2 for TIN #460242831 did not have the formal documentation of a secondary review or approval. Our lost revenue calculation was based on actual revenue billed and reported within our financial software. It was found that we had immaterial unexplained variances in the Period 1 report. In addition, we did not consider the impact of the retroactive Medicaid reimbursement adjustment applicable to quarter 3 and 4 of 2021 on the Period 2 report.Responsible Individuals: Loren Diekman, Interim President/CEOCorrective Action Plan: We will enhance the review process over special reports and ensure the lost revenue calculation when applicable will include any retro Medicaid reimbursement adjustments.Anticipated Completion Date: March 31, 2023

View Audit 311960

Finding 409860 (2022-001)

None 2022

Holiday Drive Housing Corporation

MO

Cash Management HUD Housing Programs

Finding No 2022-001Name of Responsible PartyFred GibbsFKGibbs Company, LLCPO Box 410312Kansas City, MO 64141Fred@fkgibbs.comM: 913.709.1811Views of Responsible Official and Corrective ActionManagement will fund residual receipts within the required timeframe going forward.Expected Date of Completion...

Finding No 2022-001Name of Responsible PartyFred GibbsFKGibbs Company, LLCPO Box 410312Kansas City, MO 64141Fred@fkgibbs.comM: 913.709.1811Views of Responsible Official and Corrective ActionManagement will fund residual receipts within the required timeframe going forward.Expected Date of Completion: 06/30/2023

View Audit 311952

Corrective Action Plans

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