Corrective Action Plans

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Finding 2022-004: Allowable Costs - Significant Deficiency in Internal Control over Allowable Costs/Cost principles Official's Response and Corrective Action Plan: Prior accounting staff was gone by December 2021. New financial staff was hired and in place in the 4th quarter of April 2022. We made...
Finding 2022-004: Allowable Costs - Significant Deficiency in Internal Control over Allowable Costs/Cost principles Official's Response and Corrective Action Plan: Prior accounting staff was gone by December 2021. New financial staff was hired and in place in the 4th quarter of April 2022. We made changes in the accounting department during the past year to improve the overall functionality. Since we tripled our amount of grants, it was necessary to increase the accounting staff to maintain them, as well as increase overall efficiencies. We now have a staff of 4 accountants, as well as a new CFO with nonprofit/grant experience. The late filling of vacant positions delayed some of our internal processes during their training. We added monthly meetings with internal staff to make sure we have a good communication flow and appropriate documentation for new and existing grants which are monitored monthly Anticipated Completion Date: June 30, 2023
View Audit 31455 Questioned Costs: $1
Finding 31259 (2022-001)
Significant Deficiency 2022
Finding Number: 2022-001 Planned Corrective Action: The correction of this issue has already been in place even prior to this audit. As I have research more on federal funding and ...
Finding Number: 2022-001 Planned Corrective Action: The correction of this issue has already been in place even prior to this audit. As I have research more on federal funding and the criteria for drawing funds and the time line of disbursing them. Vantage has not drawn funds in advance of spending them to date and will continue to follow that method. Anticipated Completion Date: Already in place Responsible Contact Person: Laura Peters, Treasurer/CFO
Finding 2022-003 ?Claims Payments Made Based on Incorrect Calculations of Amounts Reimbursed Status: Under completion. Planned Corrective Action: A review was made by the Foundation?s outside accounting firm engaged to process claims and the errors cited in Finding 2022-003 resulted in only one ...
Finding 2022-003 ?Claims Payments Made Based on Incorrect Calculations of Amounts Reimbursed Status: Under completion. Planned Corrective Action: A review was made by the Foundation?s outside accounting firm engaged to process claims and the errors cited in Finding 2022-003 resulted in only one overpayment to a nursing home. This was confined to a single nursing home that received more than that nursing home would have been entitled to receive under the adopted allocation regime. That nursing home was contacted and has promptly refunded the overage. The Foundation plans to redistribute this amount to other nursing facilities with unmet needs on a ratio and proportion basis. Person(s) Responsible: John Matson, Acting Executive Director Completion Date: October 31, 2023
View Audit 25745 Questioned Costs: $1
CORRECTIVE ACTION PLAN September 8, 2023 U.S. Department of Health and Human Services St. Claire Regional Medical Center, Inc. respectively submits the following corrective action plan for the year ended June 30, 2022. Name and address of independent public accounting firm: Blue & Co., LLC 2650 East...
CORRECTIVE ACTION PLAN September 8, 2023 U.S. Department of Health and Human Services St. Claire Regional Medical Center, Inc. respectively submits the following corrective action plan for the year ended June 30, 2022. Name and address of independent public accounting firm: Blue & Co., LLC 2650 Eastpoint Parkway, Suite 300 Louisville, Kentucky 40223 Audit Period: Year ended June 30, 2022 The findings from the Schedule of Findings and Questioned Costs for the year ended June 30, 2022, are discussed below. The findings are numbered consistently with the numbers assigned in the Schedule. FINDINGS ? FEDERAL AWARD PROGRAM AUDITS 2022-001 Condition: Untimely disbursement of federal grant funds received: When receiving federal grant funds for the HHS Rural Health Care Services Outreach, Rural Health Network Development, and Small Health Care Provider Quality Improvement Plan Program, the Hospital did not disburse federal grant funds received within 3 working days. Action: Management will implement internal control procedures by December 31, 2023 to ensure proper and timely disbursements of federal grant funds to ensure proper cash management of any future HHS Rural Health Care Services Outreach, Rural Health Network Development, and Small Health Care Provider Quality Improvement Plan Program funds. If the U.S. Department of Health and Human Services has questions regarding this plan, please call Chris McClurg, CFO, at (606) 783-6587. Sincerely, Chris McClurg Chief Financial Officer
2022-003 U.S. Department of Justice Federal Financial Assistance Listing/Federal CFDA #16.575 Victims of Crime Act (VOCA) Cash Management Significant Deficiency in Internal Control over Compliance Finding Summary: The Organization's internal control policy relating to the review over the preparati...
2022-003 U.S. Department of Justice Federal Financial Assistance Listing/Federal CFDA #16.575 Victims of Crime Act (VOCA) Cash Management Significant Deficiency in Internal Control over Compliance Finding Summary: The Organization's internal control policy relating to the review over the preparation of cash draws of federal funds prior to submission was not consistently applied throughout the year. No reviews were noted surrounding the preparation and draws of federal funds prior to submission. Without proper implementation of internal controls over Organization's cash draws, errors could occur and result in the Organization drawing funds in inappropriate amounts or for unallowed costs. We recommend that a member of the Organization's staff who does not prepare the cash draw review the cash draw prior to submission and document that review on a more consistent basis. Status: The Finance Director reviews and approves the prepared cash draw materials prior to submission electronically via email on a consistent basis. Responsibility of: Andrea Lang, Director of Organization Advancement & Jennifer Babcock, Finance Director Estimated Completion Date: Completed. The Finance Director is now reviewing and approving prepared cash draw materials prior to submission.
The Business Administrator will ensure meals and snacks claimed for reimbursement be in agreement with the meals and snacks served per the daily sheets.
The Business Administrator will ensure meals and snacks claimed for reimbursement be in agreement with the meals and snacks served per the daily sheets.
Finding: The Emergency Rental Assistance program requires that non-Federal entities receiving Federal Awards establish and maintain internal control designed to reasonably ensure compliance with Federal Statutes, regulations, and the terms and conditions of the Federal award. The Organization was u...
Finding: The Emergency Rental Assistance program requires that non-Federal entities receiving Federal Awards establish and maintain internal control designed to reasonably ensure compliance with Federal Statutes, regulations, and the terms and conditions of the Federal award. The Organization was unable to replicate exact payroll expenses that were reported to the City of Huntsville for the program. This is due to the program being new and the expediated nature of the programs initiation. No fraud or over reimbursement is suspected related to payroll reporting issues for this program. Response: Adjustments were made to the payroll process to retain all supporting documentation and to replicate any prior period paperwork.
Finding: The Emergency Shelter Grant requires that non-Federal entities receiving Federal Awards establish and maintain internal control designed to reasonably ensure compliance with Federal Statutes, regulations, and the terms and conditions of the Federal award. The Organization was unable to rep...
Finding: The Emergency Shelter Grant requires that non-Federal entities receiving Federal Awards establish and maintain internal control designed to reasonably ensure compliance with Federal Statutes, regulations, and the terms and conditions of the Federal award. The Organization was unable to replicate exact payroll expenses that were reported to the City of Huntsville for this program. This is due to this program being new and the expediated nature of this program initiation. No fraud or over reimbursement is suspected related to payroll reporting issues for this program. Response: Adjustments were made to the payroll process to retain all supporting documentation and to replicate any prior period paperwork.
FINDING 2022-003 Contact Person Responsible for Corrective Action: Nicole Wolverton, CFO Contact Phone Number: 219-881-5536 Views of Responsible Official: We concur with the audit finding. Description of Corrective Action Plan: As it relates to reporting of meal claims, a policy and procedure will b...
FINDING 2022-003 Contact Person Responsible for Corrective Action: Nicole Wolverton, CFO Contact Phone Number: 219-881-5536 Views of Responsible Official: We concur with the audit finding. Description of Corrective Action Plan: As it relates to reporting of meal claims, a policy and procedure will be created and implemented to ensure that accurate meal counts are recorded and entered CNP web by Sodexo based off reports from Skyward recording daily meal counts, documentation and entry then reviewed by the GCSC Food Service Manager for accuracy prior to submission of claims and then reviewed by the CFO for completeness. Anticipated Completion Date: Gary Community School Corporation will implement this procedure by September 2023. INDIANA STATE
Formal finding #1: CNU Administrative finding- Monthly meals overreported on claims from August 2021 through April of 2022. Response: The overclaim was repaid in February of 2023 and the district has put into place steps to prevent this from happening in the future by making sure overclaim does not...
Formal finding #1: CNU Administrative finding- Monthly meals overreported on claims from August 2021 through April of 2022. Response: The overclaim was repaid in February of 2023 and the district has put into place steps to prevent this from happening in the future by making sure overclaim does not occur again.
View Audit 33017 Questioned Costs: $1
Corrective Action Plan Federal Award Findings and Questioned Costs For the Year Ended December 31, 2022 Finding 2022-001 ? A. Activities Allowed or Unallowed, B. Allowable Costs/Cost Principles, E. Eligibility Federal program information: Federal Program: HRSA COVID-19 Claims Reimbursement for...
Corrective Action Plan Federal Award Findings and Questioned Costs For the Year Ended December 31, 2022 Finding 2022-001 ? A. Activities Allowed or Unallowed, B. Allowable Costs/Cost Principles, E. Eligibility Federal program information: Federal Program: HRSA COVID-19 Claims Reimbursement for the Uninsured Program and the COVID-19 Coverage Assistance Fund (93.461) Federal Agency: U.S. Department of Health and Human Services (HHS), Health Resources and Services Administration (HRSA) Locations: Various Award Numbers: Various Award Period: January 1, 2022, through December 31, 2022 Summary of finding: Premier Health Partners and Subsidiaries (the Company) did not appropriately design and execute internal control procedures to review for retroactive insurance that subsequently became effective for the date(s) of service on patient accounts previously billed to and reimbursed by the COVID-19 Uninsured Program. Corrective Action Plan: Premier Health will submit all claims paid by the HRSA COVID-19 Uninsured Program to a third-party vendor to perform a search for any retroactive insurance coverage for these patients for the service dates submitted and paid by this program. Any accounts found to have retroactive insurance coverage for dates submitted will be paid back to the HRSA Uninsured Program by December 31, 2023. Expected Completion Date: December 31, 2023 Responsible Contact Persons: Amanda Ricci-Adkins ? System VP Revenue Cycle, Mike Sims ? System VP & Corporate Controller
MATERIAL WEAKNESS IN INTERNAL CONTROL OVER FINANCIAL REPORTING: Finding 2022-001 Account Reconciliations and Financial Close and Reporting - Organization's Response 2021: The Organization will improve their efforts to ensure an efficient and accurate closing process before the January 31, 2022 audit...
MATERIAL WEAKNESS IN INTERNAL CONTROL OVER FINANCIAL REPORTING: Finding 2022-001 Account Reconciliations and Financial Close and Reporting - Organization's Response 2021: The Organization will improve their efforts to ensure an efficient and accurate closing process before the January 31, 2022 audit. Organization's Response 2022 and Corrective Action Plan: The Organization concurs with the recommendation and had already released updated financial policies and procedures as of September 2022. Further revisions will be made in 2023 and include specific instructions for particular grants including federal and state. Additional training is needed for all levels of the fiscal team as well as for program managers to better understand the fiscal requirements of each grant. It is acknowledged that the fiscal team must be expanded and restructured and we have already started the process of recruiting a new CFO. The new CFO will be expected to consistently maintain a comprehensive matrix including all grant requirements. During this time we are seeking a consultant to help us establish better processes, controls and systems and assist until a permanent CFO is established. Other consultants may be obtained for supportive services as needed/recommended in the future. All applicable staff (fiscal and management) will be trained regarding procedures to review grant expenditures for compliance with terms of the grant, and to maintain sufficient records that reconcile to amounts reported as grant expenditures. Further, a new accounting system, Blackbaud, with enhanced cost recording, reporting and budgeting capabilities, has been approved by our Board of Directors to be implemented at the start of the next fiscal year. This implementation includes extensive training for fiscal and program staff. The fiscal committee and the Board will receive monthly updates on the progress being made in these areas. (Current responsible party: Renee Hungerford, Executive Director/CEO) Auditor's Response to Organization's Response 2022 and Corrective Plan: We have noted the Organization's response which appears sufficient and appropriate in the circumstances, and we further note the certain referenced steps already taken in discussion with management.
MATERIAL WEAKNESS IN INTERNAL CONTROL OVER FINANCIAL REPORTING: Finding 2022-002 - Schedule of Expenditures of Federal - Awards CFDA Title and Number: 93.600 - Head Start and Early Head Start - Federal Agency: Department of Health and Human Services - Internal Control over Financial Reporting and C...
MATERIAL WEAKNESS IN INTERNAL CONTROL OVER FINANCIAL REPORTING: Finding 2022-002 - Schedule of Expenditures of Federal - Awards CFDA Title and Number: 93.600 - Head Start and Early Head Start - Federal Agency: Department of Health and Human Services - Internal Control over Financial Reporting and Compliance: Auditee Responsibilities - Organization's Response 2022 and Corrective Action Plan: The Organization concurs with the recommendation and had already released updated financial policies and procedures as of September 2022. Further revisions will be made in 2023 and include specific instructions for particular grants including federal and state. Additional training is needed for all levels of the fiscal team as well as for program managers to better understand the fiscal requirements of each grant. It is acknowledged that the fiscal team must be expanded and restructured and we have already started the process of recruiting a new CFO. The new CFO will be expected to consistently maintain a comprehensive matrix including all grant requirements. During this time we are seeking a consultant to help us establish better processes, controls and systems and assist until a permanent CFO is established. Other consultants may be obtained for supportive services as needed/recommended in the future. All applicable staff (fiscal and management) will be trained regarding procedures to review grant expenditures for compliance with terms of the grant, and to maintain sufficient records that reconcile to amounts reported as grant expenditures. Further, a new accounting system, Blackbaud, with enhanced cost recording, reporting and budgeting capabilities, has been approved by our Board of Directors to be implemented at the start of the next fiscal year. This implementation includes extensive training for fiscal and program staff. The fiscal committee and the Board will receive monthly updates on the progress being made in these areas. (Current responsible party: Renee Hungerford, Executive Director/CEO) Auditor's Response to Organization's Response 2022 and Corrective Plan: We have noted the Organization's response which appears sufficient and appropriate in the circumstances, and we further note the certain referenced steps already taken in discussion with management.
Corrective Action Plan Additional processes will be implemented to audit billings to the HRSA uninsured program. The System is not aware of claims incorrectly reimbursed by HRSA but will implement an audit of claims without COVID as the primary diagnosis and will review these claims with HRSA if any...
Corrective Action Plan Additional processes will be implemented to audit billings to the HRSA uninsured program. The System is not aware of claims incorrectly reimbursed by HRSA but will implement an audit of claims without COVID as the primary diagnosis and will review these claims with HRSA if any do not appear to be in compliance with Federal guidelines. Any claims HRSA has already identified as overpayment based on their formulary have already been refunded at their request. Anticipated Completion Date June 30, 2023 Name of Contact Person for Corrective Action Ramona Fryer, VP Revenue Cycle
View Audit 27020 Questioned Costs: $1
2022-003: Controls over Cash Management (Drawdowns) Program Title: National Organizations of State and Local Officials - Local Community Based Workforce to Increase COVID-19 Vaccine Access AL #: 93.011 Contract Grant Numbers: 6G32HS42695-01-03, 9U3SHS42189-01-01 Federal Award Years: July 31, 20...
2022-003: Controls over Cash Management (Drawdowns) Program Title: National Organizations of State and Local Officials - Local Community Based Workforce to Increase COVID-19 Vaccine Access AL #: 93.011 Contract Grant Numbers: 6G32HS42695-01-03, 9U3SHS42189-01-01 Federal Award Years: July 31, 2021 through January 31, 2023 and pass-through grant through April 29, 2022 Federal Agency: Department of Health and Human Services Recommendation: We recommend that all requests for reimbursements be reviewed by either the Grant Coordinator or Executive Director to ensure that the program is in compliance with cash management requirements, and ensure the accuracy of the information supporting the request. Corrective Action Plan: We have already implemented a process to submit initial reimbursement report to CEO or designated person, have them review and signed for final approval of cash drawdown prior to drawing down funds. Corrective Action owner: Laura Garza, COO Completion Date 11/01/2022
The Emergency Rental Assistance Program was developed in response to the pandemic and was implemented swiftly to meet the needs of low-income tenants affected by Covid-19. The program design involves fourteen partner agencies and their varying accounting systems. In March 2021, UWMC began this eme...
The Emergency Rental Assistance Program was developed in response to the pandemic and was implemented swiftly to meet the needs of low-income tenants affected by Covid-19. The program design involves fourteen partner agencies and their varying accounting systems. In March 2021, UWMC began this emergency program with an existing system, the Smart Referral Network (SRN) software, which was adapted in order to quickly launch the program. In March of 2022, the SRN tool was replaced with a software system (Neighborly) more specifically designed to administer and report on ERAP. The new data system facilitates reconciliation to the detailed payment data. Management agrees that the expenditures for the reporting period were overstated and accepts the recommendation along with implementing the following corrective action. UWMC conducted a comprehensive reconciliation of program data to financial expenditure records of its partnering agencies through June 30, 2022. In the current fiscal year, all partnering agencies are required to submit program data through the online Neighborly software along with providing a general ledger report that supports and is reconciled to the data submitted prior to receiving reimbursement. This new procedure was put in place for reimbursements effective January 1, 2023 forward. For reimbursements from July 1, 2022 ? December 31, 2022, we are going to reconcile past reimbursement requests to the partner agency general ledger report retroactively. The UWMC staff member overseeing these reconciliations with support from the UWMC Finance Department is: Kelly DeWolfe, Community Impact Director, Financial Stability kelly.dewolfe@unitedwaymcca.org (831)318-1997
The Organization has hired a new executive director and chief financial officer; the management team has implemented new accounting and financial policies within the accounting department to oversee and maintain federal expenditures are incompliance with grant agreements.
The Organization has hired a new executive director and chief financial officer; the management team has implemented new accounting and financial policies within the accounting department to oversee and maintain federal expenditures are incompliance with grant agreements.
View Audit 33518 Questioned Costs: $1
The Organization has hired a new executive director and chief financial officer; the management team has implemented new accounting and financial policies within the accounting department to oversee and maintain federal expenditures are incompliance with grant agreements.
The Organization has hired a new executive director and chief financial officer; the management team has implemented new accounting and financial policies within the accounting department to oversee and maintain federal expenditures are incompliance with grant agreements.
Finding Reference Number: 2022-001 Concur or Do Not Concur: Concur Agree or Disagree with Auditor Recommendations: Agree Actions Taken or Planned on the Finding: Management agrees with the finding. The residual receipts account deficiency was funded on May 20, 2022 in the amount of $90,804. Manage...
Finding Reference Number: 2022-001 Concur or Do Not Concur: Concur Agree or Disagree with Auditor Recommendations: Agree Actions Taken or Planned on the Finding: Management agrees with the finding. The residual receipts account deficiency was funded on May 20, 2022 in the amount of $90,804. Management will ensure that the residual receipts account is properly funded in the future. Completion Date: May 20, 2022
Finding 30840 (2022-002)
Significant Deficiency 2022
Management's Response: CORRECTIVE ACTION PLAN (CAP): 1. Explanation of Disagreement with Audit Finding There is no disagreement with the audit finding. 2. Actions Planned in Response to Finding Administration now has access to Skyward reports year round and won?t need access to purged files for audi...
Management's Response: CORRECTIVE ACTION PLAN (CAP): 1. Explanation of Disagreement with Audit Finding There is no disagreement with the audit finding. 2. Actions Planned in Response to Finding Administration now has access to Skyward reports year round and won?t need access to purged files for auditing purposes to make sure these are readily available. 3. Official Responsible for Ensuring CAP Scott Marine is the official responsible for ensuring corrective action of the deficiency. 4. Planned Completion Date for CAP The planned completion date for the CAP is ongoing. 5. Plan to Monitor Completion of CAP Scott Marine will be monitoring this CAP.
Identifying Number: 2022-002 (Significant Deficiency) Audit Finding: Management Review and Approval of Monthly Grant Revenue Reports. Corrective Action Planned: PILC has implement internal controls for management?s review and approval of monthly grant revenue reports, including an officer of P...
Identifying Number: 2022-002 (Significant Deficiency) Audit Finding: Management Review and Approval of Monthly Grant Revenue Reports. Corrective Action Planned: PILC has implement internal controls for management?s review and approval of monthly grant revenue reports, including an officer of PILC (CFO and/or Chief Operating Officer) will review, approve and sign/initial all monthly grant reports prior to submission. The name of the contact person responsible for the corrective action: Joe Rogers, Chief Executive Officer The anticipated completion date: To be completed by September 30, 2023.
CP-1011 CORRECTIVE ACTION PLAN Project Legal Name: Saint Elizabeth Manor HUD Project No.: 017?EH120 Audit Firm: CohnReznick Period covered by the audit: year ended 6/30/2022 Corrective Action Plan prepared by: Name:Jonathan Ramsay Position: Chief Financial Officer Telephone Number: 860...
CP-1011 CORRECTIVE ACTION PLAN Project Legal Name: Saint Elizabeth Manor HUD Project No.: 017?EH120 Audit Firm: CohnReznick Period covered by the audit: year ended 6/30/2022 Corrective Action Plan prepared by: Name:Jonathan Ramsay Position: Chief Financial Officer Telephone Number: 860-342-2224 The following is a recommended format to be followed by the auditee for preparing a corrective action plan: A. Current Findings on the Schedule of Findings, Questioned Costs and Recommendations 1. Finding 2022-001 a. Comments on the Finding and Each Recommendation Management agrees with the finding and the recommendations by the auditors. b. Action(s) Taken or Planned on the Finding Management will review the properties Surplus Calculation closer to year end to determine if there is Surplus Cash. If it is determined that there is Surplus Cash, management will deposit funds into the Residual Receipts account in a timely manner.
The Superintendent, Director of Finance and Food Service Director have met with the Board of Education to seek approval for kitchen remodeling projects. The district Architect is working on a remodeling plan that should be completed during the 2022-2023 school year with major construction starting i...
The Superintendent, Director of Finance and Food Service Director have met with the Board of Education to seek approval for kitchen remodeling projects. The district Architect is working on a remodeling plan that should be completed during the 2022-2023 school year with major construction starting in the 2023/2024 continuing through 2024/2025 school year with completion set for the start of the 2025/2026 school year.
Finding 2022-002: Internal Control Deficiency Cash Management Federal Grantor: United States Department of Health and Human Services Assistance Listing No.: 93.048, Special Programs for the Aging, Title IV, and Title II, Discretionary Projects Summary of Finding: There is no evidence of inte...
Finding 2022-002: Internal Control Deficiency Cash Management Federal Grantor: United States Department of Health and Human Services Assistance Listing No.: 93.048, Special Programs for the Aging, Title IV, and Title II, Discretionary Projects Summary of Finding: There is no evidence of internal controls in place to ensure that requests for reimbursement are based on expenses paid for by AdviseWell. Corrective Action Plan: Internal controls will be implemented to ensure drawdowns are made on expenses paid for by AdviseWell and not on unpaid obligated funds before proceeding by having a secondary review by appropriate staff. Documentation will be maintained to support those payments preceded drawdowns and secondary review has been completed. Management will ensure all duties are appropriately segregated. Responsible Party: Sonja Landry, Executive Director Anticipated Completion Date: December 31, 2023
Condition: Quarterly expenditure reports for the projects expenditures were not timely filed for ESSER DE (4 of 4 quarters required), ESSER PL (2 of 4 quarters required), ESSER E2 (1 of 4 quarters required), ESSER CP (1 of 1 quarter required), and ESSER D2 (1 of 3 quarters required). Plan: To avoid ...
Condition: Quarterly expenditure reports for the projects expenditures were not timely filed for ESSER DE (4 of 4 quarters required), ESSER PL (2 of 4 quarters required), ESSER E2 (1 of 4 quarters required), ESSER CP (1 of 1 quarter required), and ESSER D2 (1 of 3 quarters required). Plan: To avoid this reporting and internal control issue, the District should schedule the due dates of all expenditure reports in order to avoid late filings. Anticipated Date of Completion: June 30, 2023 Name of Contact Person: Lisa Schuenke, Assistant Superintendent of Finance and Human Resources Management Response: This District is aware of the issue and has determined that the majority of the problem occurs when a grant is first approved, and the first reporting period is missed or if a grant continues into subsequent project years. Management has found a dashboard within IWAS that has a listing of all grants by project year and dates that the grants and budgets are approved that will help determine when the first expenditure reports are due. Additionally, management will work on a process to ensure that expenditure reports are no longer missed or filed late.
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