Corrective Action Plans

None Reported Finding: 2024-001 Name of contact person: Corrective Action: Proposed Completion Date: Finding: 2024-002 Name of contact person: Corrective Action: Proposed Completion Date: Finding: 2024-003 Name of contact person: Corrective Action: Proposed Completion Date: Finding: 2024-004 Name of contact person: Corrective Action: Proposed Completion Date: Training will be provided by 1/31/2025 for all Medicaid caseworkers. Darren Phillips, Supervisor QA/PI We have built a training slideshow to provide to the caseworkers.This covers training for the use of OVS and the TWN and a reminder about the correct way to end-date income and add new income to NCFAST. Training will be provided by 1/31/2025 for all Medicaid caseworkers. Darren Phillips, Supervisor QA/PI We have built a training slideshow to provide to the caseworkers. A training slide shows that buildings are part of Real Property and must be added to a case. Corrective Action Plan Section III - Federal Award Findings and Question Costs Section II - Financial Statement Findings For the Year Ended June 30, 2024 Darren Phillips, Supervisor QA/PI We have built a training slideshow to provide to the caseworkers and a new system for tracking recertification cases has been implented in the three Recertification Units to alleviate worker errors when sending request for information to applicant/beneficiaries and completing recertifications in a timely manner. Training will be provided by 1/31/2025 for all Medicaid caseworkers. Darren Phillips, Supervisor QA/PI We have built a training slideshow to provide training to the caseworkers. Supervisors has been reminded to use the appropriate reports in NCFAST. Training will be provided by 1/31/2025 for all Medicaid caseworkers. 235

None Reported Finding: 2024-001 Name of contact person: Corrective Action: Proposed Completion Date: Finding: 2024-002 Name of contact person: Corrective Action: Proposed Completion Date: Finding: 2024-003 Name of contact person: Corrective Action: Proposed Completion Date: Finding: 2024-004 Name of contact person: Corrective Action: Proposed Completion Date: Training will be provided by 1/31/2025 for all Medicaid caseworkers. Darren Phillips, Supervisor QA/PI We have built a training slideshow to provide to the caseworkers.This covers training for the use of OVS and the TWN and a reminder about the correct way to end-date income and add new income to NCFAST. Training will be provided by 1/31/2025 for all Medicaid caseworkers. Darren Phillips, Supervisor QA/PI We have built a training slideshow to provide to the caseworkers. A training slide shows that buildings are part of Real Property and must be added to a case. Corrective Action Plan Section III - Federal Award Findings and Question Costs Section II - Financial Statement Findings For the Year Ended June 30, 2024 Darren Phillips, Supervisor QA/PI We have built a training slideshow to provide to the caseworkers and a new system for tracking recertification cases has been implented in the three Recertification Units to alleviate worker errors when sending request for information to applicant/beneficiaries and completing recertifications in a timely manner. Training will be provided by 1/31/2025 for all Medicaid caseworkers. Darren Phillips, Supervisor QA/PI We have built a training slideshow to provide training to the caseworkers. Supervisors has been reminded to use the appropriate reports in NCFAST. Training will be provided by 1/31/2025 for all Medicaid caseworkers. 235

None Reported Finding: 2024-001 Name of contact person: Corrective Action: Proposed Completion Date: Finding: 2024-002 Name of contact person: Corrective Action: Proposed Completion Date: Finding: 2024-003 Name of contact person: Corrective Action: Proposed Completion Date: Finding: 2024-004 Name of contact person: Corrective Action: Proposed Completion Date: Training will be provided by 1/31/2025 for all Medicaid caseworkers. Darren Phillips, Supervisor QA/PI We have built a training slideshow to provide to the caseworkers.This covers training for the use of OVS and the TWN and a reminder about the correct way to end-date income and add new income to NCFAST. Training will be provided by 1/31/2025 for all Medicaid caseworkers. Darren Phillips, Supervisor QA/PI We have built a training slideshow to provide to the caseworkers. A training slide shows that buildings are part of Real Property and must be added to a case. Corrective Action Plan Section III - Federal Award Findings and Question Costs Section II - Financial Statement Findings For the Year Ended June 30, 2024 Darren Phillips, Supervisor QA/PI We have built a training slideshow to provide to the caseworkers and a new system for tracking recertification cases has been implented in the three Recertification Units to alleviate worker errors when sending request for information to applicant/beneficiaries and completing recertifications in a timely manner. Training will be provided by 1/31/2025 for all Medicaid caseworkers. Darren Phillips, Supervisor QA/PI We have built a training slideshow to provide training to the caseworkers. Supervisors has been reminded to use the appropriate reports in NCFAST. Training will be provided by 1/31/2025 for all Medicaid caseworkers. 235

2024.02 - Eligibility Recommendation We recommend that management provide training to those responsible for verifying eligibility to ensure that documentation and internal control over eligibility is maintained. Action Taken 1) To ensure patient eligibility is properly assigned to patients, the Director of Clinical Operations will perform random audits on a Monthly basis of patients that are assigned. 2) The Director of Clinical Operations will also ensure proper training to those that are assigning eligibility to ensure that proper documentation is obtained and properly stored. If the Cognizant or Oversight Agency for Audit has questions regarding this plan, please call: Eric Newman, CFO at (203) 756-8021 x 3015. Sincerely yours, Eric Newman Chief Financial Officer

SIGNIFICANT DEFICIENCY 2024.001 - Sliding Fee Scale Discount Recommendation The Center should implement a system of controls to ensure all sliding fee discounts are properly supported. Action Taken 1) To ensure Sliding Fee Discounts are properly supported, the Director of Program Management will assign random audits on a Monthly basis of patients that are assigned a sliding fee. 2) Director of Program Management as well as Program Managers will monitor Phreesia dashboard to identify self-pay patients on the schedule and work to ensure that accounts are updated accordingly. a. For any accounts that need to be updated, they will inform the PSA who checked in the patient to make the updates as necessary and provide additional training if needed. b. Provide trainings to PSAs to ensure that they are offering the Sliding Fee Discount to all patients that may need to apply, and appropriately applying those slides. 3) If a Pt has had a visit and left prior to getting sliding fee information, PSAs are to call the patient to let them know that they may have to apply for a sliding fee (or receive insurance information over the phone). 4) Practice Managers will identify Self-pay accounts via Phreesia each morning that may need attention and send a list of accounts to the PSAs at the beginning of each day. PSA will then contact the patients to remind them to bring in proof of income to apply for the sliding fee if eligilble.

2024-005 – Pell Grant Calculation. Auditor Description of Condition and Effect. One student out of the twenty five Pell grants tested was found to be under awarded based on the enrollment status and cost of attendance. As a result of this condition, the College was exposed to an increased risk that incorrect information would be used to determine students' Pell Grant award amounts. Auditor Recommendation. We recommend the College implement procedures to ensure the COA and EFC used to calculate each student's Pell Grant is updated for each academic year and reviewed by an independent official. Corrective Action. This is corrected on setup and noted to correct the COA. Responsible Party. Financial Aid Director, Jennifer Stimson. Anticipated Completion Date. March 2025 - next set up, it was corrected for 24/25 academic year in May 2024.

Finding Summary: U.S. Department of Education Student Financial Aid Cluster (FAL # 84.268, 84.063) Eligibility Significant Deficiency in Internal Control over Compliance Responsible Individuals: Alicia Smith, Director of Financial Aid Corrective Action Plan: The process has been adjusted to ensure manual calculations are done independently by two different people. Anticipated Completion Date: July 1, 2025

For the Year Ended June 30, 2024 Corrective Action Plan Proposed completion date: Finding 2024-006 Inadequate Request for Information Name of contact person: Corrective Action: Proposed completion date: Finding 2024-007 Inaccurate Information Entry Name of contact person: Refresher training will be held by December 31, 2024 on effective documentation and record keeping. “Vehicle Status Documentation” template will be created and implemented by December 31, 2024. Error Trends Data log was implemented October 1, 2024. Adult Medicaid Lead Workers will monitor this by conducting a random selection of second party reviews each month. Adult Income Maintenance Supervisor II (pending vacancy), Delta Elliott, Income Maintenance Lead Worker III, and Michelle Ogle, Income Maintenance Lead Worker III Error discovered where vehicle status was not clearly documented in the case record caused by ineffective record keeping and incomplete documentation. Refresher training will be held by 12/31/2024 to review appropriate documentation and record keeping in NC FAST and will be conducted by Adult Medicaid leadership. Adult Medicaid Supervisor will create a “Vehicle Status Documentation” template that will be utilized by all Adult Medicaid caseworkers at every application and recertification. Completion and uploading of this template will be required in NC FAST. Adult Medicaid Lead Caseworkers will monitor the use of the template during monthly second party reviews of each caseworker. Adult Medicaid Supervisor created and utilized an Error Trends Data log effective 10/1/2024. The Error Trends Data log captures monthly errors to identify trends among staff. This log also provides Adult Medicaid leadership with data regarding errors that are repetitive to help leadership conduct monthly or quarterly refresher training as well as individualized training for staff who continue to have repetitive errors. Staff who fail to utilize the “Vehicle Status Documentation” template and continue to have repetitive errors will be placed on a corrective action plan. Policy refresher training will be held before 12/31/2024 that will cover the IV-D Referral process with specific advisory that the policy is currently suspended until further notice per DHB (Admin Letter 13-23). The Recertification Documentation template was updated on 11/20/2024 and went into effect immediately to be used by all Family and Children’s Medicaid caseworkers. The Error Trends Data log was implemented on October 1, 2024. Family and Children’s Medicaid leadership will monitor this by conducting a random selection of second party reviews each month. Section III - Federal Award Findings and Questioned Costs (continued) Kim Grissom, Income Maintenance Supervisor II; Taylor White, Income Maintenance Supervisor II; Lisa Kornegay, Income Maintenance Lead Worker III; and Sherry Stainback, Income Maintenance Lead Worker III 176Corrective Action Plan For the Year Ended June 30, 2024 Proposed completion date: Corrective actions for Finding 2024-005, 2024-006, and 2024-007 also apply to State Award findings. Errors discovered were income and household composition was calculated incorrectly due to inaccurate information being entered into NCFAST. Family and Children’s Medicaid leadership updated the Recertification Documentation Template on 11/20/2024 to ensure that accurate income, specifically UIB, and household composition is captured and documented appropriately. All Family and Children’s Medicaid caseworkers have been advised to utilize the updated Recertification Documentation Template effective immediately. The Family and Children Medicaid Supervisors created and utilizes an Error Trends Data log effective 10/1/2024. The Error Trends Data log captures monthly errors to identify trends among staff. This log also provides Family and Children Medicaid leadership with data regarding errors that are repetitive to help leadership conduct monthly or quarterly refresher training as well as individualized trainings for staff who continue to have repetitive errors. Staff who fail to utilize the updated Recertification Documentation template and continue to have repetitive errors will be placed on a corrective action plan. Refresher policy training will be held to ensure caseworkers understand policy surrounding income, specifically UIB, and household composition before 12/31/2024. The Recertification Documentation template was updated on 11/20/2024 and went into effect immediately to be used by all Family and Children’s Medicaid caseworkers. The Error Trends Data log was implemented on October 1, 2024. Family and Children’s Medicaid leadership will monitor this by conducting a random selection of second party reviews each month. Section IV - State Award Findings and Questioned Costs Section III - Federal Award Findings and Questioned Costs (continued) 177

For the Year Ended June 30, 2024 Corrective Action Plan Proposed completion date: Finding 2024-006 Inadequate Request for Information Name of contact person: Corrective Action: Proposed completion date: Finding 2024-007 Inaccurate Information Entry Name of contact person: Refresher training will be held by December 31, 2024 on effective documentation and record keeping. “Vehicle Status Documentation” template will be created and implemented by December 31, 2024. Error Trends Data log was implemented October 1, 2024. Adult Medicaid Lead Workers will monitor this by conducting a random selection of second party reviews each month. Adult Income Maintenance Supervisor II (pending vacancy), Delta Elliott, Income Maintenance Lead Worker III, and Michelle Ogle, Income Maintenance Lead Worker III Error discovered where vehicle status was not clearly documented in the case record caused by ineffective record keeping and incomplete documentation. Refresher training will be held by 12/31/2024 to review appropriate documentation and record keeping in NC FAST and will be conducted by Adult Medicaid leadership. Adult Medicaid Supervisor will create a “Vehicle Status Documentation” template that will be utilized by all Adult Medicaid caseworkers at every application and recertification. Completion and uploading of this template will be required in NC FAST. Adult Medicaid Lead Caseworkers will monitor the use of the template during monthly second party reviews of each caseworker. Adult Medicaid Supervisor created and utilized an Error Trends Data log effective 10/1/2024. The Error Trends Data log captures monthly errors to identify trends among staff. This log also provides Adult Medicaid leadership with data regarding errors that are repetitive to help leadership conduct monthly or quarterly refresher training as well as individualized training for staff who continue to have repetitive errors. Staff who fail to utilize the “Vehicle Status Documentation” template and continue to have repetitive errors will be placed on a corrective action plan. Policy refresher training will be held before 12/31/2024 that will cover the IV-D Referral process with specific advisory that the policy is currently suspended until further notice per DHB (Admin Letter 13-23). The Recertification Documentation template was updated on 11/20/2024 and went into effect immediately to be used by all Family and Children’s Medicaid caseworkers. The Error Trends Data log was implemented on October 1, 2024. Family and Children’s Medicaid leadership will monitor this by conducting a random selection of second party reviews each month. Section III - Federal Award Findings and Questioned Costs (continued) Kim Grissom, Income Maintenance Supervisor II; Taylor White, Income Maintenance Supervisor II; Lisa Kornegay, Income Maintenance Lead Worker III; and Sherry Stainback, Income Maintenance Lead Worker III 176

Finding 2024-005 Non-cooperation with IV-D Referrals Name of contact person: Corrective Action: July 1, 2024 Section II - Financial Statement Findings (continued) Kim Grissom, Family and Children's Medicaid Supervisor and Shelia Morton, Family and Children's Medicaid Supervisor Error discovered was that there was no IV-D Referral sent to Child Support Services. Family and Children’s Medicaid leadership updated the Recertification Documentation template on 11/20/2024 to ensure that workers are documenting the necessary IV-D Referral process (including when it is not required) on every case. The AP section of the template has been updated to allow caseworkers to provide detailed information on IV-D Referrals. All Family and Children’s Medicaid caseworkers have been advised to utilize the updated Recertification Documentation Template effective immediately. Currently, the Division of Health Benefits (DHB) have advised that during the Public Health Emergency and the Continuous Coverage Unwinding period, IV-D Referrals are not required and are only sent at the request of the client. This policy will be in effect until further notice from DHB (Admin Letter 13-23). Although IV-D Referrals are currently suspended per DHB, Family & Children’s Medicaid leadership will review this policy with staff by conducting a refresher training by 12/31/2024. The Family and Children Medicaid Supervisors created and utilizes an Error Trends Data log that went into effect on 10/1/2024. The Error Trends Data log will provide Family and Children’s Medicaid leadership with data regarding errors that are repetitive. This will help leadership conduct monthly or quarterly refresher training as well as individualized training for staff who continue to have repetitive errors. Staff who fail to utilize the updated Recertification Documentation Template and continue to have repetitive errors will be placed on a corrective action plan.For the Year Ended June 30, 2024 Corrective Action Plan Proposed completion date: Finding 2024-006 Inadequate Request for Information Name of contact person: Corrective Action: Proposed completion date: Finding 2024-007 Inaccurate Information Entry Name of contact person: Refresher training will be held by December 31, 2024 on effective documentation and record keeping. “Vehicle Status Documentation” template will be created and implemented by December 31, 2024. Error Trends Data log was implemented October 1, 2024. Adult Medicaid Lead Workers will monitor this by conducting a random selection of second party reviews each month. Adult Income Maintenance Supervisor II (pending vacancy), Delta Elliott, Income Maintenance Lead Worker III, and Michelle Ogle, Income Maintenance Lead Worker III Error discovered where vehicle status was not clearly documented in the case record caused by ineffective record keeping and incomplete documentation. Refresher training will be held by 12/31/2024 to review appropriate documentation and record keeping in NC FAST and will be conducted by Adult Medicaid leadership. Adult Medicaid Supervisor will create a “Vehicle Status Documentation” template that will be utilized by all Adult Medicaid caseworkers at every application and recertification. Completion and uploading of this template will be required in NC FAST. Adult Medicaid Lead Caseworkers will monitor the use of the template during monthly second party reviews of each caseworker. Adult Medicaid Supervisor created and utilized an Error Trends Data log effective 10/1/2024. The Error Trends Data log captures monthly errors to identify trends among staff. This log also provides Adult Medicaid leadership with data regarding errors that are repetitive to help leadership conduct monthly or quarterly refresher training as well as individualized training for staff who continue to have repetitive errors. Staff who fail to utilize the “Vehicle Status Documentation” template and continue to have repetitive errors will be placed on a corrective action plan. Policy refresher training will be held before 12/31/2024 that will cover the IV-D Referral process with specific advisory that the policy is currently suspended until further notice per DHB (Admin Letter 13-23). The Recertification Documentation template was updated on 11/20/2024 and went into effect immediately to be used by all Family and Children’s Medicaid caseworkers. The Error Trends Data log was implemented on October 1, 2024. Family and Children’s Medicaid leadership will monitor this by conducting a random selection of second party reviews each month. Section III - Federal Award Findings and Questioned Costs (continued) Kim Grissom, Income Maintenance Supervisor II; Taylor White, Income Maintenance Supervisor II; Lisa Kornegay, Income Maintenance Lead Worker III; and Sherry Stainback, Income Maintenance Lead Worker III 176

The Director of Financial aid will update the procedure to include a report to be reviewed of credits earned to verify the amounts to be disbursed to the student is in compliance standards of the correct grade level for Direct Loans. All financial aid staff will be updated on procedures to review the Direct Loan amounts to credits earned when packaging the student and a final approval from either the Assistant Director of Financial Aid or the Director of Financial Aid before the award letter is sent to the student. Completion date 2/15/2025. Responsible staff: Crystal Hamilton, Director of Financial Aid

The Director of Financial Aid will review and verify the funds that were disbursed to the students account match the disbursement dates in COD on the date the transfer batch report is sent to the College’s Business Office. Completion date: 2/15/2025. Responsible staff: Crystal Hamilton, Director of Financial Aid

The disbursement letter that we previously had notified they had the right to decline their loan. As with the recommendation of our auditor, the letter’s wording has already been changed from the right to decline their loan to the right to cancel their loan by the Director of Financial Aid. Letter also states that the request must be received by KWC within 14 days of the date on the notice. Completion date: 9/1/2024. Responsible staff: Crystal Hamilton, Director of Financial Aid

FINDING 2024-002 􀀃 􀀃 Finding Subject: Title I Grants to Local Education Agencies – Internal Controls Over Eligibility 􀀃 Summary of Finding: Material Weakness:􀀃 Though no errors were found in the Title I application, a documented internal control plan needs to be in place to ensure that the Enrollment ad Poverty numbers inputted into the Title I Application by the IDOE matches the School Corporation’s internal records (Real Time Reports). This checks and balances for monitoring the Enrollment and Poverty numbers on the Title I application could reduce the risk of errors. 􀀃 Contact Person Responsible for Corrective Action: Kari Dyer 􀀃 Contact Phone Number and Email Address: (574)825-9425, dyerk@mcsin-k12.org Views of Responsible Officials: We concur with the finding. Though no discrepancies were found between the LEA and the Enrollment and Poverty numbers populated by the IDOE in the Title I Application, a checks and balances needs to be in place to ensure accuracy in the Title I application, reducing the risk for error and ensuring the LEA allocates funds appropriately. Description of Corrective Action Plan: The School Corporation plans to take the following action: 􀁸 Develop a dual signature page requiring verification from Title I Program Director and MCS Data Manager that IDOE Enrollment and Poverty numbers populated in the Title I Application match the LEA internal records from the October 1 count day of the previous school year. This internal control document will be titled Enrollment and Poverty Verification. 􀁸 Utilize and maintain record of the Enrollment and Poverty Verification signature form during the Title I Application period to ensure the alignment of IDOE data and LEA enrollment and poverty numbers in the Title I application. Verification from both the Title I Program Director and the MCS Data Manager will be required. o Upon submission of Oct. 1 ADM, the MCS Data Manager will supply ADM information on the Enrollment and Poverty Verification form to the Title I Program Director. o During the creation of the Title I budget application, Title I Program Director will cross-reference and verify Oct. 1 ADM data with the Enrollment and Poverty numbers populated by the IDOE in the Title I application, addressing discrepancies with the IDOE Title Grant Specialist should they occur. Anticipated Completion Date: Winter 2025: Internal Control process written for Enrollment and Poverty Verification Winter 2025: Creation of Enrollment and Poverty Verification signature form. Annually: Utilization of the Enrollment and Poverty Verification process and signature form during the October ADM process and during the Title I Application process. The first use of the form will be in winter, 2025 to document Oct.1, 2024 enrollment and poverty numbers with the first verification occurring during the fall, 2025 Title I Budget Application process for SY25-26.

Corrective Action Plan January 24, 2025 The Housing Authority City of Kennewick is submitting the following Corrective Action Plan for the year ending June 30, 2024, related to the Housing Choice Voucher Payment Standards/Rent Reasonableness. Audit period: July 1, 2023-June 30, 2024 The finding from the June 30, 2024, and Housing Choice Voucher Payment Standards/Rent calculation: Finding: Finding No. 2024-001 Condition and Context: For FYE 2023, The Housing Authority City of Kennewick’s (KHA) was approved by HUD to use 120% FMRs for the calculation of the Housing Choice Voucher Payment Standards. The actual payment standard used was incorrectly calculated. KHA mistakenly multiplied the 120% FMR twice creating an overstated calculation of 144%. The 144% FMR was not the approval payment standard by HUD. During the audit, auditors selected 40 tenants to test for eligibility and special tests and 32 out of the 40 tenants on the 50058 used the 144% payment standard. Recommendation: The Auditors recommended multiple levels of review before approving the correct payment standard. The 8 tenants tested who did not have errors were from 2024. The 2024 FMR is correct, the Housing Authority is not using the correct payment standard. The issue appears to be a one time mathematical mistake. Plan for Corrective Action: Management will obtain multiple level of reviews on future payment standard calculation to ensure that the correct FMRs are used to calculate the payment standard.Actions Taken: KHA reached out to HUD to verify whether there are any further actions to be taken to correct the incorrect payment standard. HUD will confirm the necessary actions after reviewing the audit reports. There might be no further action taken as the current FMRs have increased and the agency is currently under the correct payment standard. Hermelinda Sierra_______________ Hermelinda Sierra CFO/Deputy Director Contact Persons: Hermelinda Sierra, CFO/Deputy Director 509-586-8576 ext. 111 Matt Truman, KHA Executive Director 509-586-8576 ext. 103

Recommendation: Procedures and forms should be updated per award requirements and eligibility determination should be reviewed and approved by an appropriate supervisor annually. The organization’s directors and grants compliance director should receive training on eligibility and be provided with written procedures for determining eligibility, completing the required documentation, and when and how reviews and approvals should be documented. Action Taken: Boys & Girls Clubs of Dane County is establishing a formal policy around TANF Eligibility and an SOP for Club Directors and staff to follow. TANF Eligibility Forms will be collected at each registration period to include the academic year and summer camp sessions. The collection of forms from families will be in MyClubHub and part of the registration process. A member cannot attend until the full registration process is complete with all respective paperwork. The individuals responsible are: Membership Services Associates, AVP of Operations, Sr. VP of Operations, Sr. Director of Grants & Compliance. The anticipated completion date is March 31, 2025.

Oversight Agency for Audit, Edward Romero Terrace respectfully submits the following corrective action plan for the year ended September 30, 2024. Name and address of independent public accounting firm: Bellows Associates, P.A., 5401 N University Drive, Suite 201, Coral Springs, Florida 33067. Audit period: October 1, 2023 through September 30, 2024 The finding from the September 30, 2024 schedule of findings and questioned costs is discussed below. The finding is numbered consistently with the number in the schedule. SECTION III - FINDINGS AND QUESTIONED COSTS – MAJOR FEDERAL AWARD PROGRAMS AUDIT FINDING No. 2024-001: Section 202 Supportive Housing for the Elderly, ALN 14.157 Recommendation: The Project should implement procedures to ensure all documentation related to tenants are properly executed and maintained for move-in inspection reports, lease addendum items and tenant recertification. Action Taken: Monthly reminders are being sent to all managers to run their EIV reports for the month. In addition, random files are being reviewed by compliance to ensure EIV reports are pulled, unit inspections performed, and required documentation is complete and accurate. If the Oversight Agency for Audit has questions regarding the plan, please call Irene Phillips at 954-835-9200. Sincerely yours, Irene Phillips Irene Phillips CFO

Management agrees with this finding and the Auditor's recommendation. We will review and expand our internal control procedures with respect to the federal eligibility compliance requirement of annual reexaminations and document maintenance. Management will implement the expanded procedures necessary to clear this finding in FY 2025, and all Section 8 Housing Choice Voucher tenant files will be reviewed and corrected before June 30, 2025.

Information on the federal program: Subject: Child Nutrition Cluster - Internal Controls Federal Agency: Department of Agriculture Federal Program: School Breakfast Program, National School Lunch Program, Summer Food Program, School Summer Food Service Program, Fresh Fruit and Vegetable Program Assistance Listing Number: 10.553, 10.555, 10.559, 10.582 Federal Award Numbers and Years (or Other Identifying Numbers): FY2023, FY2024 Pass-Through Entity: Indiana Department of Education Compliance Requirement: Eligibility Audit Finding: Material Weakness Context: During testing over controls for eligibility, we noted there was no formal, secondary review for the applications entered in the food service software determining eligibility. Additionally, there was no documented annual review by School Corporation personnel of the FY23 income eligibility guidelines used by the food service software. The School Corporation did formally review the FY24 income eligibility guidelines used in the food service software. Contact Persons Responsible for Corrective Action: Andrew J Nicodemus, Business Manager Amber Reed, Director of Food Services Contact Phone Number: 765-362-2342 Views of Responsible Official: We concur with the finding. Description of Corrective Action Plan: Crawfordsville Community School Corporation plans to review all internal control procedures, including the controls over Eligibility for the Child Nutrition Cluster. After this review, we will implement a system to ensure that the Eligibility and Application review procedures are appropriate and fully integrated into our internal control structure. We will implement additional training for all staff involved and will have a designated place where this support is kept. Anticipated Completion Date: We expect this Corrective Action to be implemented by July 31, 2025.

The Clinic will review all patient files to ensure all applicable documentation is located within each file. Any applicable documentation that is missing from the file will be requested from the patient to verify continued eligibility or services will be terminated. The Clinic will also implement an approval process for new patients to ensure patient eligibility is reviewed and approved prior to providing services. The anticipated completion date is 09/30/2025.

Finding 2024-003 INADEQUATE REQUEST FOR INFORMATION Name of contact person: Corrective Action: Proposed Completion Date: Finding 2024-004 INTERNAL CONTROLS RELATED TO FNS ELIGIBILITY DETERMINATIONS Name of contact person: Corrective Action: Proposed Completion Date: Corrective Actions for Findings 2024-001, 2024-002, and 2024-003 also apply to State requirements and State Awards. Korey Fisher-Wellman, Department of Social Services Director and Amanda Grady, Assistant Department of Social Services Director Medicaid staff will be required to attend training sessions to address the negative findings found. The following MA policies will be discussed during training to address the areas that need improvement: MA-3200 APPLICATION XII. Requesting Information and MA-3421 MAGI RECERTIFICATION VIII. Recertification Procedures. Medicaid Supervisors will continue to conduct 2nd Party Reviews. As cases are reviewed, supervisors will provide any additional training as needed, either on an individual or group basis. The results from these 2nd party reviews will be shared with the Assistant Director and DSS Director. Corrections will be made to the cases in error, and documentation to support the corrections will be updated in NCFAST. Section IV - State Award Findings and Question Costs The initial training will be completed by 12/06/2024. Our success will be measured by the results of the 2nd party reviews. We will continue to review the results of all 2nd party reviews, conduct group or individual training, and address issues through the disciplinary process if necessary. Korey Fisher-Wellman, Department of Social Services Director and Amanda Grady, Assistant Department of Social Services Director All FNS staff will be required to attend training sessions to address the negative findings found. The following FNS policies will be discussed during training to address the areas that need improvement: Food and Nutrition Services Policy 300 Sources of Income; Food and Nutrition Services Policy 305 Rules for Budgeting Income; Food and Nutrition Services Policy 310 Budgeting New, Changed, and Terminated Income FNS Supervisors will continue to conduct 2nd Party Reviews. As cases are reviewed, supervisors will provide any additional training as needed, either on an individual or group basis. The results from these 2nd party reviews will be shared with the Assistant Director and DSS Director. Corrections will be made to the cases in error, and documentation to support the corrections will be updated in NCFAST. The initial training will be completed by 11/30/2024. Our success will be measured by the results of the 2nd party reviews. We will continue to review the results of all 2nd party reviews, conduct group or individual training, and address issues through the disciplinary process if necessary. Section III - Federal Award Findings and Question Costs (continued) BRIAN EPLEY, COUNTY MANAGER KAY H. DRAUGHN, CLERK TO THE BOARD J. R. SIMPSON, II, COUNTY ATTORNEY KANIA LAW FIRM, P.A., TAX ATTORNEY JEFFREY C. BRITTAIN, CHAIR SCOTT MULWEE, VICE CHAIR RANDY BURNS, COMMISSIONER JOHNNIE W. CARSWELL, COMMISSIONER PHIL SMITH, COMMISSIONER 137

Finding 2024-003 INADEQUATE REQUEST FOR INFORMATION Name of contact person: Corrective Action: Proposed Completion Date: Finding 2024-004 INTERNAL CONTROLS RELATED TO FNS ELIGIBILITY DETERMINATIONS Name of contact person: Corrective Action: Proposed Completion Date: Corrective Actions for Findings 2024-001, 2024-002, and 2024-003 also apply to State requirements and State Awards. Korey Fisher-Wellman, Department of Social Services Director and Amanda Grady, Assistant Department of Social Services Director Medicaid staff will be required to attend training sessions to address the negative findings found. The following MA policies will be discussed during training to address the areas that need improvement: MA-3200 APPLICATION XII. Requesting Information and MA-3421 MAGI RECERTIFICATION VIII. Recertification Procedures. Medicaid Supervisors will continue to conduct 2nd Party Reviews. As cases are reviewed, supervisors will provide any additional training as needed, either on an individual or group basis. The results from these 2nd party reviews will be shared with the Assistant Director and DSS Director. Corrections will be made to the cases in error, and documentation to support the corrections will be updated in NCFAST. Section IV - State Award Findings and Question Costs The initial training will be completed by 12/06/2024. Our success will be measured by the results of the 2nd party reviews. We will continue to review the results of all 2nd party reviews, conduct group or individual training, and address issues through the disciplinary process if necessary. Korey Fisher-Wellman, Department of Social Services Director and Amanda Grady, Assistant Department of Social Services Director All FNS staff will be required to attend training sessions to address the negative findings found. The following FNS policies will be discussed during training to address the areas that need improvement: Food and Nutrition Services Policy 300 Sources of Income; Food and Nutrition Services Policy 305 Rules for Budgeting Income; Food and Nutrition Services Policy 310 Budgeting New, Changed, and Terminated Income FNS Supervisors will continue to conduct 2nd Party Reviews. As cases are reviewed, supervisors will provide any additional training as needed, either on an individual or group basis. The results from these 2nd party reviews will be shared with the Assistant Director and DSS Director. Corrections will be made to the cases in error, and documentation to support the corrections will be updated in NCFAST. The initial training will be completed by 11/30/2024. Our success will be measured by the results of the 2nd party reviews. We will continue to review the results of all 2nd party reviews, conduct group or individual training, and address issues through the disciplinary process if necessary. Section III - Federal Award Findings and Question Costs (continued) BRIAN EPLEY, COUNTY MANAGER KAY H. DRAUGHN, CLERK TO THE BOARD J. R. SIMPSON, II, COUNTY ATTORNEY KANIA LAW FIRM, P.A., TAX ATTORNEY JEFFREY C. BRITTAIN, CHAIR SCOTT MULWEE, VICE CHAIR RANDY BURNS, COMMISSIONER JOHNNIE W. CARSWELL, COMMISSIONER PHIL SMITH, COMMISSIONER 137

None reported Finding 2024-001 INACCURATE INFORMATION ENTRY Name of contact person: Corrective Action: Proposed Completion Date: Finding 2024-002 INACCURATE RESOURCE ENTRY Name of contact person: Corrective Action: Proposed Completion Date: Burke County, North Carolina Section III - Federal Award Findings and Question Costs Corrective Action Plan For the Year Ended June 30, 2024 Section II - Financial Statement Findings Korey Fisher-Wellman, Department of Social Services Director and Amanda Grady, Assistant Department of Social Services Director Medicaid staff will be required to attend training sessions to address the negative findings found. The following MA policy will be discussed during training to address the areas that need improvement: MA 3306, and the importance of ensuring that the tax filer is correct and documented in NCFAST. Medicaid Supervisors will continue to conduct 2nd Party Reviews. As cases are reviewed, supervisors will provide any additional training as needed, either on an individual or group basis. The results from these 2nd party reviews will be shared with the Assistant Director and DSS Director. Corrections will be made to the cases in error, and documentation to support the corrections will be updated in NCFAST. Korey Fisher-Wellman, Department of Social Services Director and Amanda Grady, Assistant Department of Social Services Director For all findings listed, Medicaid staff will be required to attend training sessions to address the negative findings found. The following MA policy will be discussed during training to address the areas that need improvement: MA-2230 Financial Resources and importance to update the evidence in NCFAST to ensure the case is accurate. Medicaid Supervisors will continue to conduct 2nd Party Reviews. As cases are reviewed, supervisors will provide any additional training as needed, either on an individual or group basis. The results from these 2nd party reviews will be shared with the Assistant Director and DSS Director. Corrections will be made to the cases in error, and documentation to support the corrections will be updated in NCFAST. The initial training will be completed by 12/06/2024. Our success will be measured by the results of the 2nd party reviews. We will continue to review the results of all 2nd party reviews, conduct group or individual training, and address issues through the disciplinary process if necessary. The initial training will be completed by 12/06/2024. Our success will be measured by the results of the 2nd party reviews. We will continue to review the results of all 2nd party reviews, conduct group or individual training, and address issues through the disciplinary process if necessary. JEFFREY C. BRITTAIN, CHAIR SCOTT MULWEE, VICE CHAIR RANDY BURNS, COMMISSIONER JOHNNIE W. CARSWELL, COMMISSIONER PHIL SMITH, COMMISSIONER BRIAN EPLEY, COUNTY MANAGER KAY H. DRAUGHN, CLERK TO THE BOARD J. R. SIMPSON, II, COUNTY ATTORNEY KANIA LAW FIRM, P.A., TAX ATTORNEY 136

None reported Finding 2024-001 INACCURATE INFORMATION ENTRY Name of contact person: Corrective Action: Proposed Completion Date: Finding 2024-002 INACCURATE RESOURCE ENTRY Name of contact person: Corrective Action: Proposed Completion Date: Burke County, North Carolina Section III - Federal Award Findings and Question Costs Corrective Action Plan For the Year Ended June 30, 2024 Section II - Financial Statement Findings Korey Fisher-Wellman, Department of Social Services Director and Amanda Grady, Assistant Department of Social Services Director Medicaid staff will be required to attend training sessions to address the negative findings found. The following MA policy will be discussed during training to address the areas that need improvement: MA 3306, and the importance of ensuring that the tax filer is correct and documented in NCFAST. Medicaid Supervisors will continue to conduct 2nd Party Reviews. As cases are reviewed, supervisors will provide any additional training as needed, either on an individual or group basis. The results from these 2nd party reviews will be shared with the Assistant Director and DSS Director. Corrections will be made to the cases in error, and documentation to support the corrections will be updated in NCFAST. Korey Fisher-Wellman, Department of Social Services Director and Amanda Grady, Assistant Department of Social Services Director For all findings listed, Medicaid staff will be required to attend training sessions to address the negative findings found. The following MA policy will be discussed during training to address the areas that need improvement: MA-2230 Financial Resources and importance to update the evidence in NCFAST to ensure the case is accurate. Medicaid Supervisors will continue to conduct 2nd Party Reviews. As cases are reviewed, supervisors will provide any additional training as needed, either on an individual or group basis. The results from these 2nd party reviews will be shared with the Assistant Director and DSS Director. Corrections will be made to the cases in error, and documentation to support the corrections will be updated in NCFAST. The initial training will be completed by 12/06/2024. Our success will be measured by the results of the 2nd party reviews. We will continue to review the results of all 2nd party reviews, conduct group or individual training, and address issues through the disciplinary process if necessary. The initial training will be completed by 12/06/2024. Our success will be measured by the results of the 2nd party reviews. We will continue to review the results of all 2nd party reviews, conduct group or individual training, and address issues through the disciplinary process if necessary. JEFFREY C. BRITTAIN, CHAIR SCOTT MULWEE, VICE CHAIR RANDY BURNS, COMMISSIONER JOHNNIE W. CARSWELL, COMMISSIONER PHIL SMITH, COMMISSIONER BRIAN EPLEY, COUNTY MANAGER KAY H. DRAUGHN, CLERK TO THE BOARD J. R. SIMPSON, II, COUNTY ATTORNEY KANIA LAW FIRM, P.A., TAX ATTORNEY 136

U.S. Department of Agriculture CFDA # 10.568, 10.569 Food Distribution Cluster Finding Summary:As part of the audit done by Eide Bailly LLP, a lack of internal controls were identified in eligibility determinations and reviews for The Emergency Food Assistance Programs. Responsible Individuals: Melissa Sobolik, CEO David Stachon, CFO Corrective Action Plan: The GPFB will ensure all documents for TEFAP programs have proper signatures by necessary parties going forward . An electronic signature process has been implemented to make the dissemination, review and storage of this process easier. Also, additional staffing has been hired to manage this process in the form of a Partner Network Manager with substantial compliance experience. Anticipated Completion Date: Immediate