Corrective Action Plans

Finding 1155511 (2024-004)

Material Weakness 2024

CT

Cash Management Subrecipient Monitoring Allowable Costs / Cost Principles § 200.303

Cash Management Block Grants for Prevention and Treatment of Substance Abuse – Assistance Listing No. 93.959 COVID-19 - Substance Abuse and Mental Health Services Projects of Regional and National Significance – Assistance Listing No. 93.243 Recommendation: We recommend Shatterproof implement contro...

Cash Management Block Grants for Prevention and Treatment of Substance Abuse – Assistance Listing No. 93.959 COVID-19 - Substance Abuse and Mental Health Services Projects of Regional and National Significance – Assistance Listing No. 93.243 Recommendation: We recommend Shatterproof implement controls to ensure anadequate review process is in place to review reimbursement requests to determine anddocument the request is properly supported and in compliance with the grant agreement. Explanation of disagreement with audit finding: There is no disagreement with the auditfinding. Action taken in response to finding: State Directors review and approve all invoices prior to submission to the state. Name of the contact person responsible for corrective action: Young Kim Planned completion date for corrective action plan: January 1st, 2025

View Audit 367790

Finding 1155494 (2024-001)

Material Weakness 2024

Homes for the Exceptional V, Inc.

NY

Cash Management HUD Housing Programs

Owner certified financials will be submitted in HUD Secure Systems within approximately 45 days from year end. This will allow for sufficient time to submit residual receipts within 60 days of year-end. Our current practice of submitting residual receipts has been aligned with the due date of Owner ...

Owner certified financials will be submitted in HUD Secure Systems within approximately 45 days from year end. This will allow for sufficient time to submit residual receipts within 60 days of year-end. Our current practice of submitting residual receipts has been aligned with the due date of Owner Certified Financials, 90 days after year-end close. We have not been made aware by HUD that this was a compliance issue.

View Audit 367787

Finding 1155492 (2024-001)

Material Weakness 2024

Homes for the Exceptional Iv, INC

NY

Cash Management HUD Housing Programs

Owner certified financials will be submitted in HUD Secure Systems within approximately 45 days from year end. This will allow for sufficient time to submit residual receipts within 60 days of year-end. Our current practice of submitting residual receipts has been aligned with the due date of Owner ...

Owner certified financials will be submitted in HUD Secure Systems within approximately 45 days from year end. This will allow for sufficient time to submit residual receipts within 60 days of year-end. Our current practice of submitting residual receipts has been aligned with the due date of Owner Certified Financials, 90 days after year-end close. We have not been made aware by HUD that this was a compliance issue.

View Audit 367785

Finding 1155491 (2024-001)

Material Weakness 2024

Homes for the Exceptional Iii, Inc.

NY

Cash Management HUD Housing Programs

Owner certified financials will be submitted in HUD Secure Systems within approximately 45 days from year end. This will allow for sufficient time to submit residual receipts within 60 days of year-end. Our current practice of submitting residual receipts has been aligned with the due date of Owner ...

Owner certified financials will be submitted in HUD Secure Systems within approximately 45 days from year end. This will allow for sufficient time to submit residual receipts within 60 days of year-end. Our current practice of submitting residual receipts has been aligned with the due date of Owner Certified Financials, 90 days after year-end close. We have not been made aware by HUD that this was a compliance issue.

View Audit 367784

Finding 1155490 (2024-001)

Material Weakness 2024

Homes for the Exceptional Ii, INC

NY

Cash Management HUD Housing Programs

Owner certified financials will be submitted in HUD Secure Systems within approximately 45 days from year end. This will allow for sufficient time to submit residual receipts within 60 days of year-end. Our current practice of submitting residual receipts has been aligned with the due date of Owner ...

Owner certified financials will be submitted in HUD Secure Systems within approximately 45 days from year end. This will allow for sufficient time to submit residual receipts within 60 days of year-end. Our current practice of submitting residual receipts has been aligned with the due date of Owner Certified Financials, 90 days after year-end close. We have not been made aware by HUD that this was a compliance issue.

View Audit 367783

Finding 1155461 (2024-002)

Material Weakness 2024

Aid Upstate

SC

Cash Management Significant Deficiency

Contact Person: Tracy Carr, Rajee Rao Management Response: We agree with the auditors’ comments and the following action plan will be taken to implement internal control procedures to allow for timely reporting: A schedule has been developed which has enabled the submission of the monthly grant reim...

Contact Person: Tracy Carr, Rajee Rao Management Response: We agree with the auditors’ comments and the following action plan will be taken to implement internal control procedures to allow for timely reporting: A schedule has been developed which has enabled the submission of the monthly grant reimbursement reports by the due date. It has required a group effort by the entire staff and the individual members of the finance team in the responsibilities to meet the deadline. The continued use of this schedule has proven to keep the process on track and allow the organization to adhere to the grant deadlines. Completion Date: Beginning June 1, 2024 and thereafter.

View Audit 367743

Finding 1155449 (2024-010)

Material Weakness 2024

County of Allegheny, Pennsylvania

PA

Cash Management HUD Housing Programs Reporting

The balance error was a result of human error. Specifically, the Program Income and Grant balances were combined erroneously. The staff person responsible for submitting the Cash on Hand report has since received additional training from HUD Pittsburgh Field Office’s Senior Financial Analyst, Cather...

The balance error was a result of human error. Specifically, the Program Income and Grant balances were combined erroneously. The staff person responsible for submitting the Cash on Hand report has since received additional training from HUD Pittsburgh Field Office’s Senior Financial Analyst, Catherine Byrne. ACED's Fiscal staff will follow the steps on the Cash on Hand checklist template, following all steps to complete the report. The Assistant Director of Finance or the Assistant Director of Operations will review and approve the report for accuracy and completion. This procedure is outlined in the attached policy and procedures manual. (p. 32)

View Audit 367739

Finding 1155426 (2024-003)

Material Weakness 2024

Forth Mobility Fund

OR

Cash Management Internal Control / Segregation of Duties Material Weakness § 200.303

2024-003. Conservation Research and Development Program – Assistance Listing #81.086 Recommendation: The Organization should establish written policies and procedures regarding invoicing for cost-reimbursement related to federal grants which include proper segregation of duties. Explanation of disag...

2024-003. Conservation Research and Development Program – Assistance Listing #81.086 Recommendation: The Organization should establish written policies and procedures regarding invoicing for cost-reimbursement related to federal grants which include proper segregation of duties. Explanation of disagreement with audit findings: There is no disagreement with the audit findings. Action Plan: Effective October 31, 2024, we implemented proper segregation of duties for preparing and submitting cost-reimbursement invoices related to federal grant awards. Under this procedure, the Grants Accountant prepares the invoice, and the Senior Finance Manager reviews and documents approval in writing. This segregation of duties has been incorporated into our written policies and procedures. In the event of any staffing changes or vacancies, responsibilities are reassigned among available finance staff and contracted accountants to ensure that preparation and review functions remain segregated at all times. Name(s) of the contact people responsible for correction action: Gina Avalos-Limardo, Director of Finance & Operations and Rachel Pippin, CMA, Senior Finance Manager Plan completion date for corrective action plan: September 30, 2025

View Audit 367713

Finding 1155416 (2024-005)

Material Weakness 2024

City of Wilton

ND

Cash Management Internal Control / Segregation of Duties

Contact Person – Pattie Solberg, City Auditor Corrective Action Plan – The City should follow their procedures for signing off on all requests for reimbursement reports before submitting the federal reimbursement. Completion Date – December 1, 2025

View Audit 367687

Finding 1155354 (2024-002)

Material Weakness 2024

Goodwill Industries of Michiana, Inc.

IN

Cash Management Significant Deficiency Internal Control / Segregation of Duties

2024-002 PAYROLL POPULATION The Organization uses general ledger detail to create draws to submit reimbursement claims. Some reimbursements are for payroll expenses that are paid through a separate system. The Organization could not reconcile the general ledger to the payroll software detail used to...

2024-002 PAYROLL POPULATION The Organization uses general ledger detail to create draws to submit reimbursement claims. Some reimbursements are for payroll expenses that are paid through a separate system. The Organization could not reconcile the general ledger to the payroll software detail used to submit reimbursements. Recommendation: The Organization should perform and maintain monthly reconciliations of the payroll software, general ledger, and draw detail that all agree. Action Taken: The Organization was billing the grantor for payroll fees, the additional fees for each employee or contract that participated in the grant. Originally, the funds were coded to payroll (compensation) expenses, which generated a discrepancy between the Payroll Register and the General Ledger. The unemployment expense was also coded to benefits, which created a variance between the payroll register (generated from payroll software) and the general ledger. Going forward, the trail balance and general ledger will be reconciled to the draw request. Additionally, the team has been trained in how to properly code these expenses. Contact Person: Shire Kuch Effective Date: 25 September 2025.

View Audit 367596

Finding 1155337 (2024-001)

Material Weakness 2024

Belmont Housing Associates, Inc.

CO

Questioned Costs Cash Management HUD Housing Programs

Management should ensure surplus cash is calculated in a timely matter in order to make any required deposit to the residual receipts account.

View Audit 367572 Questioned Costs: $1

Finding 1155330 (2024-005)

Material Weakness 2024

City of Muskegon Heights

MI

Allowable Costs / Cost Principles Cash Management Reporting

2024-005 – Reporting (Repeat Finding) Auditor Description of Condition and Effect. While the City performed the required Coronavirus State and Local Fiscal Recovery Funds expenditure reporting for each quarter of 2024, the Project and Expenditure reports for the first three quarters of 2024 did not ...

2024-005 – Reporting (Repeat Finding) Auditor Description of Condition and Effect. While the City performed the required Coronavirus State and Local Fiscal Recovery Funds expenditure reporting for each quarter of 2024, the Project and Expenditure reports for the first three quarters of 2024 did not report any current period expenditures. Rather, the cumulative expenditures for the year were included in the fourth quarter Project and Expenditure report. In addition, the Project and Expenditure reports for the third and fourth quarters of 2024 were not filed within the required timeframe. As a result of this condition, the City did not comply completely with the reporting requirements of the Coronavirus State and Local Fiscal Recovery Funds grant. Auditor Recommendation. We recommend that the City review the reporting requirements for each grant and complete all required reporting as required under the terms of the grant agreement. Corrective Action. City staff has accessed these reports and attempted to submit all required reports. Ongoing reports have been submitted on time. Assistance will be sought with federal agencies as necessary. Responsible Person. Finance Director Anticipated Completion Date. December 31, 2025

View Audit 367568

Finding 1155282 (2024-002)

Material Weakness 2024

Housing Authority of Pikeville

KY

Cash Management HUD Housing Programs Matching / Level of Effort / Earmarking § 200.305

Management will review and retrain to insure that capital fund expenditures are drawn down prior to payment.

View Audit 367530

Finding 1155265 (2024-001)

Material Weakness 2024

Public Utility District No. 1 of Skamania County

WA

Questioned Costs Subrecipient Monitoring Allowable Costs / Cost Principles

CORRECTIVE ACTION PLAN FOR FINDINGS REPORTED UNDER UNIFORM GUIDANCE Public Utility District No. 1 of Skamania County January 1, 2024 through December 31, 2024 This schedule presents the corrective action the District is planning to take for findings included in this report in accordance with Title 2...

CORRECTIVE ACTION PLAN FOR FINDINGS REPORTED UNDER UNIFORM GUIDANCE Public Utility District No. 1 of Skamania County January 1, 2024 through December 31, 2024 This schedule presents the corrective action the District is planning to take for findings included in this report in accordance with Title 2 U.S. Code of Federal Regulations (CFR) Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (Uniform Guidance). Finding ref number: 2024-001 Finding caption: The District did not have adequate internal controls and did not comply with time-and-effort requirements. Name, address, and telephone of District contact person: Meagan Mikkonen, PO Box 500 – Carson, WA 98610, 509.219.0140 Corrective action the auditee plans to take in response to the finding: (If the auditee does not concur with the finding, the auditee must list the reasons for disagreement). The District will track all grant related employee time-and-effort through a timesheet. Timesheets will be submitted twice a month and approved by management. Anticipated date to complete the corrective action: Effective immediately (September 2025)

View Audit 367480 Questioned Costs: $1

Finding 1155264 (2024-003)

Material Weakness 2024

Disability Law Center of Virginia

VA

Allowable Costs / Cost Principles Cash Management Matching / Level of Effort / Earmarking § 200.430

dLCV has refined our policies regarding review of timesheets to ensure that all timesheets are timely submitted and are reviewed and approved by designated staff. The policy revisions will be effective as of October 1, 2025

View Audit 367479

Finding 1155263 (2024-002)

Material Weakness 2024

Disability Law Center of Virginia

VA

Allowable Costs / Cost Principles Cash Management Reporting § 200.430

dLCV will implement a weighted direct bill process beginning October 1, 2025. Throughout the audit review, and as recently as one month before the final report, the auditors consistently reported to us that this was likely not a compliance issue. Additionally, the auditors were not able to provide a...

dLCV will implement a weighted direct bill process beginning October 1, 2025. Throughout the audit review, and as recently as one month before the final report, the auditors consistently reported to us that this was likely not a compliance issue. Additionally, the auditors were not able to provide any sample for any time period in 2024 showing the potential impact of changing from an hours allocation to a dollars allocation. The auditors did not inform us of their changed opinion until late August, 2025, making it impossible to make any adjustments in the current fiscal year.

View Audit 367479

Finding 1155261 (2024-002)

Material Weakness 2024

Barnesville Housing Authority

GA

Cash Management HUD Housing Programs § 200.305

Noncompliance with Cash Management (Public Housing Capital Fund ALN 14.872) We will implement controls and procedures to ensure CFP draws are made within 3 business days from date of expenditure. Date of completion: Ongoing

View Audit 367476

Finding 1155257 (2024-004)

Material Weakness 2024

Boys & Girls Club of Brazoria County

TX

Cash Management Allowable Costs / Cost Principles Significant Deficiency

Finding #2024-004 – Significant Deficiency and Other Noncompliance. Condition and context: In a sample of 30 vendor payments, we found one instance of reimbursement by the grantor approximately five months before payment was made to the vendor. Recommendation: Strengthen controls to ensure that invo...

Finding #2024-004 – Significant Deficiency and Other Noncompliance. Condition and context: In a sample of 30 vendor payments, we found one instance of reimbursement by the grantor approximately five months before payment was made to the vendor. Recommendation: Strengthen controls to ensure that invoices are paid in a timely manner to ensure federal reimbursements are not being held for an excess period of time. Planned corrective action: As part of our enhanced review of government transactions, we will be mindful that federal reimbursement requests should only include expenses that have been disbursed or have been accrued with expectation of disbursement in a timely manner. Responsible officer: Amber Newman, CEO. Estimated completion date: October 1, 2025.

View Audit 367470

Finding 1155255 (2024-002)

Material Weakness 2024

Boys & Girls Club of Brazoria County

TX

Cash Management Reporting Significant Deficiency

Finding #2024-002 – Significant Deficiency and Other Noncompliance. Condition and context: Same as finding reported as #2024-001. Recommendation: Same as finding reported as #2024-001. Planned corrective action: Year-end closing policies and procedures will be modified to ensure grant transactions a...

Finding #2024-002 – Significant Deficiency and Other Noncompliance. Condition and context: Same as finding reported as #2024-001. Recommendation: Same as finding reported as #2024-001. Planned corrective action: Year-end closing policies and procedures will be modified to ensure grant transactions are reviewed, reconciled, and include applicable accruals. Management will review grant reports monthly to ensure transactions are properly recorded. Responsible officer: Amber Newman, CEO. Estimated completion date: October 1, 2025.

View Audit 367470

Finding 1155204 (2024-003)

Material Weakness 2024

Wilkes-Barre/scranton International Airport

PA

Subrecipient Monitoring Procurement, Suspension & Debarment Cash Management

Finding 2024-003 Condition: As part of our audit of the Federal Aviation Administration Program, it was noted that the Airport did not adopt written policies/procedures surrounding certain areas to comply with the requirements of the Uniform Guidance Corrective Action Plan: Corrective Action Planned...

Finding 2024-003 Condition: As part of our audit of the Federal Aviation Administration Program, it was noted that the Airport did not adopt written policies/procedures surrounding certain areas to comply with the requirements of the Uniform Guidance Corrective Action Plan: Corrective Action Planned: Airport Finance department has adopted written policies and procedures to satisfy Uniform Guidance Name(s) of Contact Person(s) Responsible for Corrective Action: Director of Finance Anticipated Completion Date: August 1, 2025

View Audit 367446

Finding 1155191 (2024-002)

Material Weakness 2024

Village of Genoa

OH

Cash Management Reporting Matching / Level of Effort / Earmarking § 200.302 § 200.328 § 200.329

The Administrator and Fiscal Officer will work to ensure all reports for grant funding are completed.

View Audit 367439

Finding 1155031 (2024-001)

Material Weakness 2024

Watts Healthcare Corporation

CA

Questioned Costs Subrecipient Monitoring Cash Management

Management will implement the following corrective actions to address the root causes and prevent recurrence: • Policy Clarification – Categories A–D of the sliding fee schedule apply only to patients at or below 200% FPG. Category E is designated as a deposit/minimum payment category for patients a...

Management will implement the following corrective actions to address the root causes and prevent recurrence: • Policy Clarification – Categories A–D of the sliding fee schedule apply only to patients at or below 200% FPG. Category E is designated as a deposit/minimum payment category for patients above 200% FPG, with no discount applied. • Patient Reclassification – All previously misclassified patients are being reclassified to full-pay status. Prior balances will be reconciled in accordance with HRSA requirements and organizational policy. • Staff Training – Front office, billing, and eligibility staff will undergo mandatory refresher training on the Sliding Fee Discount Program, income verification, and proper application of the fee schedule. Additional refresher training on Self-Pay procedures will be led by the Director of Member Services. • Ongoing Monitoring – A quarterly compliance audit of the sliding fee program has been implemented. Results will be reviewed by management, with corrective actions taken as necessary. • Transparency & Communication – Patients will be notified in writing of their payment category. Appeals or questions will be addressed per organizational policy and HRSA guidelines. • Financial Remediation – Refunds will be issued to patients who were overcharged. For cases involving undercharges, the outstanding balance will be applied to the patient’s next visit. Personnel responsible for implementation: Jose Juarez, Director of Member Services Date of implementation: August 31, 2025

View Audit 367364 Questioned Costs: $1

Finding 1154981 (2024-009)

Material Weakness 2024

Silver Key Senior Services, Inc.

CO

Subrecipient Monitoring Cash Management Internal Control / Segregation of Duties § 200.516

Corrective Plan of Action: Silver Key Senior Services has had review and approval processes in place since early 2024; however, gaps arose in consistent documentation. Going forward, all compliance procedures will be followed and documented, including documenting verbal communications. All Controlle...

Corrective Plan of Action: Silver Key Senior Services has had review and approval processes in place since early 2024; however, gaps arose in consistent documentation. Going forward, all compliance procedures will be followed and documented, including documenting verbal communications. All Controller (new role in lieu of CFO) approvals will be maintained in writing, and transactions by the Controller will continue to be reviewed by the CEO. Quarterly spot checks will be conducted to confirm compliance. Anticipated Completion Date: Corrections were made as soon as the issue was identified; procedures are now in place to ensure consistent documentation

View Audit 367331

Finding 1154975 (2024-001)

Material Weakness 2024

Vhh - Jg Commons

WA

Cash Management HUD Housing Programs Reporting

Corrective Action: Management made a deposit for a total of $8,582 to cover the underfunded residual receipts. Management will maintain tracking record every year to ensure that the residual receipts account is appropriately funded. The bookkeeper will maintain the record and ensure that deposits ar...

Corrective Action: Management made a deposit for a total of $8,582 to cover the underfunded residual receipts. Management will maintain tracking record every year to ensure that the residual receipts account is appropriately funded. The bookkeeper will maintain the record and ensure that deposits are made as required.

View Audit 367316

Finding 1154952 (2024-002)

Material Weakness 2024

Southwestern Area Health Education Center, Inc.

CT

Questioned Costs Cash Management Period of Performance § 200.302 § 200.305

Condition: The Organization’s expenditure reports filed with the grantor for the cost reimbursement-based grant were overstated, and the Organization was overpaid by $182,167, of which $26,730 was received after yearend. The overpayment has not yet been refunded back to the grantor, over a year afte...

Condition: The Organization’s expenditure reports filed with the grantor for the cost reimbursement-based grant were overstated, and the Organization was overpaid by $182,167, of which $26,730 was received after yearend. The overpayment has not yet been refunded back to the grantor, over a year after the performance period of the grant had ended. Recommendation: The Organization should coordinate with the grantor the return of the unspent funds. The Organization should reevaluate its grant expenditure reporting procedures to better mitigate the risk of inaccurate filing and improper reimbursement. Views of Responsible Officials and Planned Corrective Actions: The Organization agrees with the finding and recommendation. The anticipated completion date for the corrective action is October 30, 2025.

View Audit 367273 Questioned Costs: $1

Corrective Action Plans

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