Corrective Action Plans

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Finding 2024-002 – Procurement and Suspension and Debarment Contact Person Responsible for Corrective Action: Lisa Simmons, Auditor (765) 348-1620 lsimmons@blackfordcounty.in.gov Views of Responsible Officials and Corrective Action Planned: Blackford County acknowledges and agrees with the finding r...
Finding 2024-002 – Procurement and Suspension and Debarment Contact Person Responsible for Corrective Action: Lisa Simmons, Auditor (765) 348-1620 lsimmons@blackfordcounty.in.gov Views of Responsible Officials and Corrective Action Planned: Blackford County acknowledges and agrees with the finding related to Suspension and Debarment compliance and will implement additional procedures to ensure all covered transactions comply with federal requirements. To correct this finding, the County will implement the following actions: 1. A formal procurement and suspension and debarment procedure will be documented requiring verification of vendor eligibility for all covered transactions equal to or exceeding $25,000 involving federal funds. 2. Prior to each covered transaction, the County will verify vendor eligibility by one of the following methods: o Checking the System for Award Management (SAM.gov) exclusion records (formerly EPLS) o Obtaining a written certification from the vendor o Including the required suspension and debarment clause within the contract or agreement 3. Documentation supporting the verification process will be retained in the grant procurement file for audit purposes. 4. A standardized procurement checklist will be implemented to ensure all federal compliance requirements, including suspension and debarment, are completed prior to contract execution. 5. Management will perform periodic reviews of procurement files to verify compliance and consistency. 6. Staff involved in procurement and grant administration will receive additional training on federal procurement requirements and compliance expectations. These corrective actions will strengthen internal controls and ensure compliance with federal procurement and suspension and debarment requirements going forward. Anticipated Completion Date: December 31, 2026
Reporting Federal Agency: U.S. Department of Housing and Urban Development Federal Program: Economic Development Initiative, Community Project Funding, and Miscellaneous Grants, Assistance Listing Number 14.251 Award Period: March 9, 2022 through August 31, 2030 Recommendation: The Village should im...
Reporting Federal Agency: U.S. Department of Housing and Urban Development Federal Program: Economic Development Initiative, Community Project Funding, and Miscellaneous Grants, Assistance Listing Number 14.251 Award Period: March 9, 2022 through August 31, 2030 Recommendation: The Village should implement controls to report accurate information in Federal Reports. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action planned in response to finding: The Village continues to work at updating its policy and procedures manuals. The Village will amend policies as necessary. Name(s) of the contact person(s) responsible for corrective action: Teresa Taylor, Village Clerk-Treasurer. Planned completion date for corrective action plan: The Village will adopt reporting policies in accordance with Uniform Guidance by December 31, 2025.
Response and Corrective Action Plan: The District will review current processes to determine procedures to ensure federal reports are properly documented and reviewed.
Response and Corrective Action Plan: The District will review current processes to determine procedures to ensure federal reports are properly documented and reviewed.
Response and Corrective Action Plan: The District will review current processes to determine procedures to ensure documentation is properly maintained for District submissions.
Response and Corrective Action Plan: The District will review current processes to determine procedures to ensure documentation is properly maintained for District submissions.
Bill.com is the system being used to approve disbursements and maintain an audit trail.
Bill.com is the system being used to approve disbursements and maintain an audit trail.
Corrective Action: The Foundation acknowledges that the 2024 single audit reporting package was not submitted by the September 30, 2025 deadline under 2 CFR 200.512. This delay resulted directly from the challenges detailed in Finding 2024-001. Significant accounting turnover delayed year-end reconc...
Corrective Action: The Foundation acknowledges that the 2024 single audit reporting package was not submitted by the September 30, 2025 deadline under 2 CFR 200.512. This delay resulted directly from the challenges detailed in Finding 2024-001. Significant accounting turnover delayed year-end reconciliations and SEFA preparation. The Foundation has implemented substantial corrective actions to address root causes and ensure future timeliness. As outlined in the response to Finding 2024-001, comprehensive SOPs now govern financial close, revenue/deposit processing, reconciliations, payroll, fiscal sponsorship financial management, and fund setup. These promote consistent monthly GL reconciliations, accurate/timely transaction recording, strong documentation, and efficient inter-departmental coordination. Supporting improvements include standardized monthly reporting, system integrations reducing manual work, clear responsibilities and timelines in SOPs, and emphasis on procedural continuity to mitigate transition risks. The Foundation is completing remaining 2024 items and committed to submitting the package promptly. With the enhanced control environment, the 2025 close and audit will be completed well within required timelines. Ongoing training, procedure reviews, and oversight by the Finance Director and Fiscal Sponsorship Manager will sustain compliance. By these actions, the Foundation has remediated the conditions and is positioned to meet all future single audit deadlines while maintaining strong fund stewardship. Person Responsible: Justin O’Shea, Finance Director Completion Date: Corrective action was completed as of December 31, 2025
Finding 1220081 (2024-005)
Material Weakness 2024
FINDING 2024-005 Finding Subject: COVID-19 - Coronavirus State and Local Fiscal Recovery Funds - Reporting Contact Person Responsible for Corrective Action: Burzynski Thaddeus Contact Phone Number and Email Address: 219-755-3200, burzytx@lakecountyin.org Views of Responsible Officials: We concur wit...
FINDING 2024-005 Finding Subject: COVID-19 - Coronavirus State and Local Fiscal Recovery Funds - Reporting Contact Person Responsible for Corrective Action: Burzynski Thaddeus Contact Phone Number and Email Address: 219-755-3200, burzytx@lakecountyin.org Views of Responsible Officials: We concur with the finding Description of Corrective Action Plan: The County will develop and implement a proper system of internal controls and segregation of duties. This will ensure accuracy and correctness of all quarterly P & E Reports in the future. Anticipated Completion Date: December 2026
Recommendations: Management should implement compensating controls to address the lack of segregation of duties, such as enhanced and documented review of disbursements and financial activity by an independent member of the Board of Directors, including periodic review of detailed financial reports,...
Recommendations: Management should implement compensating controls to address the lack of segregation of duties, such as enhanced and documented review of disbursements and financial activity by an independent member of the Board of Directors, including periodic review of detailed financial reports, bank reconciliations, and supporting documentation. Views of responsible officials and planned corrective actions: Management agrees with the finding and indicates that, due to limited staffing, complete segregation of duties is not feasible; however, it will strengthen compensating controls by increasing the level of Board oversight and implementing more formalized review and approval procedures over financial activity. Anticipated Completion Date: December 31, 2026
Recommendations: Management should implement a financial reporting process that includes maintaining a complete general ledger and trial balance, recording all balance sheet accounts, and preparing complete financial statements and disclosures on a periodic basis. Management should establish review ...
Recommendations: Management should implement a financial reporting process that includes maintaining a complete general ledger and trial balance, recording all balance sheet accounts, and preparing complete financial statements and disclosures on a periodic basis. Management should establish review procedures to ensure the accuracy and completeness of financial reporting, whether performed internally or with the assistance of external accountants. In addition, management should implement formal policies and procedures requiring the preparation, approval, and retention of complete Board meeting minutes for all meetings, as well as the retention of supporting documentation for significant estimates and transactions, including compensation decisions and bonus determinations, to ensure that all amounts recorded in the financial statements are adequately supported. Views of responsible officials and planned corrective actions: Management agrees with the finding and acknowledges the limitations of its current financial reporting and documentation practices. Management indicates it will evaluate options to improve its accounting system and financial reporting capabilities, strengthen review procedures over financial statements prepared by external accountants, and implement policies to ensure that Board meeting minutes and supporting documentation for compensation decisions are properly maintained going forward. Anticipated Completion Date: September 30, 2026
To address the finding, the Authority has implemented corrective actions that include establishing a formal year-end SEFA preparation and review process involving Accounting and Grant Program Mangers; reconciling federal expenditures reported on the SEFA to the general ledger and year end accruals, ...
To address the finding, the Authority has implemented corrective actions that include establishing a formal year-end SEFA preparation and review process involving Accounting and Grant Program Mangers; reconciling federal expenditures reported on the SEFA to the general ledger and year end accruals, reviewing active federal awards at fiscal year-end to identify eligible expenditures that may not have been reported; Revising the Grants Management Procedures Manual to formalize year-end cutoff, review, reconciliation, and approval procedures prior to SEFA issuance. These procedures will be incorporated into the FY26 year-end close and reporting process.
The Department is working with Human Resources to strengthen procedures for initiating, completing, and maintaining documentation for required background investigations in accordance with tribal policy. Person Responsible: Kayla Tallbear, Acting Treasurer Estimated Completion Date: December 31, 2026
The Department is working with Human Resources to strengthen procedures for initiating, completing, and maintaining documentation for required background investigations in accordance with tribal policy. Person Responsible: Kayla Tallbear, Acting Treasurer Estimated Completion Date: December 31, 2026
The Treasury Department will continue strengthening year-end close, reconciliation, and financial reporting processes to support timely completion of future audits and Single Audit submissions. Management is working to improve the accuracy and timeliness of accounting records, implement a more struc...
The Treasury Department will continue strengthening year-end close, reconciliation, and financial reporting processes to support timely completion of future audits and Single Audit submissions. Management is working to improve the accuracy and timeliness of accounting records, implement a more structured closing process, and enhance audit preparation procedures to help ensure future reporting packages are submitted by required deadlines. Person Responsible: Kayla Tallbear, Acting Treasurer Estimated Completion Date: September 30, 2027
Finding 1218369 (2024-004)
Material Weakness 2024
Coronavirus State and Local Fiscal Recovery Funds – Assistance Listing No. 21.027 Recommendation: We recommend the Organization develop and implement formal policies and procedures or workflow restrictions that prevent employees from self‑approving their own timecards. Explanation of disagreement wi...
Coronavirus State and Local Fiscal Recovery Funds – Assistance Listing No. 21.027 Recommendation: We recommend the Organization develop and implement formal policies and procedures or workflow restrictions that prevent employees from self‑approving their own timecards. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. During 2024, the Organization implemented BanbooHR to replace manual timekeeping and strengthen payroll controls. The self-approval issue occurred during initial system implementation and was identified through audit procedures. A corrective control has since been established whereby the Human Resources Manager reviews and approves the Executive Director's timecards, eliminating the ability for self-approval. In addition, payroll continues to be independently processed and reviewed by the Senior Director of Finanice, providing an additional layer of oversight. These control enhancements ensure proper segregation of duties and prevent self-approval of timecards going forward. Name(s) of the contact person(s) responsible for corrective action: Monique Valenzuela, Executive Director and Theo Everheart, Senior Director of Finance. Planned completion date for corrective action plan: May 2026
Finding 1218367 (2024-003)
Material Weakness 2024
Coronavirus State and Local Fiscal Recovery Funds – Assistance Listing No. 21.027 Recommendation: We recommend the Organization develop and implement formal policies and procedures to ensure required performance reports are prepared, reviewed, and submitted in a timely manner. Such procedures should...
Coronavirus State and Local Fiscal Recovery Funds – Assistance Listing No. 21.027 Recommendation: We recommend the Organization develop and implement formal policies and procedures to ensure required performance reports are prepared, reviewed, and submitted in a timely manner. Such procedures should include clearly defined roles and responsibilities, tracking of reporting deadlines, and documented evidence of supervisory review and approval prior to submission. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: The finding was related to a one-time ARPA grant during a period of staff transition, where performance reports were not consistently documented as reviewed and approved prior to submission. Since then, management has implemented formalized procedures for grant reporting. All performance reports are now prepared by designated program staff, tracked against reporting deadlines, and subject to supervisory review and approval by the Executive Director prior to submission. These procedures establish clear roles and responsibilities and ensure timely, documented review and submission of required reports. Name(s) of the contact person(s) responsible for corrective action: Monique Valenzuela, Executive Director and Theo Everhearts, Senior Director of Finance. Planned completion date for corrective action plan: June 2024
CRT will initiate an outreach plan for low-income representation to fill the open positions on the Board. The President and Chief Executive Officer or designee will solicit Low-Income Director nominations from organizations and groups within the agency or the community that are recognized as serving...
CRT will initiate an outreach plan for low-income representation to fill the open positions on the Board. The President and Chief Executive Officer or designee will solicit Low-Income Director nominations from organizations and groups within the agency or the community that are recognized as serving or representing low-income residents following federal regulations, State statutes, CRT By-Laws and agency approved Democratic Selection Procedures. Upon review of the qualifications of the nominated candidates by the CRT Nominating Subcomittee, they will vote to select the best qualified candidate(s) for appointment to the Board. After the candidate(s) have been determined by the Nominating Subcommitee to meet the qualifications, the Board will vote whether to elect the proposed individual to the Board.
Management has implemented a formal procedure to ensure that future Single Audits are completed and submitted within the required timeframe. This procedure includes the following actions: First Quarter (January – March): The Purchasing Unit will initiate the procurement process for the independent a...
Management has implemented a formal procedure to ensure that future Single Audits are completed and submitted within the required timeframe. This procedure includes the following actions: First Quarter (January – March): The Purchasing Unit will initiate the procurement process for the independent auditors, in coordination with the Fiscal Manager, while year-end closing activities are being completed, to ensure timely engagement of audit services. Second Quarter (April – June): Once the auditor is engaged, the program will initiate the audit engagement and provide the required documentation in accordance with the established audit schedule.
Management concurs with the findings. During the fiscal year, turnover in key finance leadership positions impacted on the continuity of accounting operations and reduced the effectiveness of established financial close and reconciliation processes. • Strengthened financial leadership and oversight ...
Management concurs with the findings. During the fiscal year, turnover in key finance leadership positions impacted on the continuity of accounting operations and reduced the effectiveness of established financial close and reconciliation processes. • Strengthened financial leadership and oversight by elevating the lead finance position to a Chief Financial Officer role and recruiting a highly qualified finance executive. • Filled critical finance and accounting positions to enhance internal controls, improve accountability, and ensure adequate operational oversight. • Documenting and formalizing month-end and year-end close procedures, including detailed reconciliation requirements and review responsibilities. • Implementing standardized account reconciliation templates and review sign-off procedures for all significant balance sheet accounts. • Cross-training accounting personnel and maintaining written process documentation to reduce operational risks associated with staff turnover.
Finding #2024-005 – Lack of Written Grant Procedures over Federal Programs Criteria: Under Federal Uniform Guidance, all non-Federal subrecipient entities must establish and maintain written policies and procedures over Federal programs. Written grant procedures are required in the areas of verifyin...
Finding #2024-005 – Lack of Written Grant Procedures over Federal Programs Criteria: Under Federal Uniform Guidance, all non-Federal subrecipient entities must establish and maintain written policies and procedures over Federal programs. Written grant procedures are required in the areas of verifying allowable costs, cash management, and conflicts of interest, while procurement, subrecipient monitoring, and reporting procedures should also be included. Condition: During their audit procedures, the auditors noted that the City did not have comprehensive written grant procedures governing key compliance areas. Cause: The City’s management has relied on informal practices and institutional knowledge rather than formulating a grant procedures manual. Effect: Without written procedures, there is an increased risk of noncompliance with Uniform Guidance, including improper cost charging, non-compliant procurement, untimely drawdowns or cash on hand, inadequate subrecipient oversight, and ineffective internal controls. This exposes the City to the risk of questioned costs, potential repayment of federal funds, audit findings, and other possible impacts. Recommendation: The auditors recommend that the City develop, approve, and implement a consolidated Federal grant procedures manual. The procedures should not be a replication of the Federal requirements but instead step-by-step processes that are necessary to be in compliance with the Federal guidelines. Response: The City will begin the process of drafting and approving a Federal grant procedures manual in order to be in compliance with Federal requirements going forward.
Finding #2024-001 – Material Audit Adjustments Criteria: Proper financial closing and year-end reconciliation procedures should be in place to identify and adjust the financial records to ensure the financial statements are fairly stated. Condition: The auditors proposed audit adjustments that, if n...
Finding #2024-001 – Material Audit Adjustments Criteria: Proper financial closing and year-end reconciliation procedures should be in place to identify and adjust the financial records to ensure the financial statements are fairly stated. Condition: The auditors proposed audit adjustments that, if not made, would have resulted in the financial statements being materially misstated. Cause: Financial information was not recorded in a timely manner and material adjustments were needed in order to correct various transactions. Effect: The City’s system of internal control may not prevent, detect, or correct misstatements in the financial statements. Financial reports generated by the accounting system may not provide an accurate reflection of the City’s financial position or activities. Not reconciling accounts on a timely basis could lead to errors or other problems not being recognized and resolved. Recommendation: The auditors recommend that policies and procedures should be implemented to ensure account balances are properly recorded and reconciled in a timely manner. Response: The City acknowledges their responsibility for the financial statements and recording of the current year activity. Going forward, the City will work toward verifying that all activity is completely and accurately recorded in the financial records and reflected on the financial statements.
Type: Material Weakness in Internal Control Over Compliance Corrective Actions: - Ensure complete documentation is obtained and retained. - Implement monitoring and periodic reviews. - Provide staff training. Responsible Parties: Chief Executive Officer and Chief Financial Officer
Type: Material Weakness in Internal Control Over Compliance Corrective Actions: - Ensure complete documentation is obtained and retained. - Implement monitoring and periodic reviews. - Provide staff training. Responsible Parties: Chief Executive Officer and Chief Financial Officer
Type: Material Weakness in Internal Control Over Compliance Corrective Actions: - Implement reconciliation of each drawdown to actual expenditures. - Require detailed supporting documentation. - Establish supervisory approval process. Responsible Parties: Chief Executive Officer and Chief Financial ...
Type: Material Weakness in Internal Control Over Compliance Corrective Actions: - Implement reconciliation of each drawdown to actual expenditures. - Require detailed supporting documentation. - Establish supervisory approval process. Responsible Parties: Chief Executive Officer and Chief Financial Officer
Views of Responsible Officials and Planned Corrective Action The Organization concurred with the prior year (2023-004) and current year renumbered recommendation (2024-004), acknowledging that the unexpected resignation of the former independent auditor (January 2023), and the domino effect of a del...
Views of Responsible Officials and Planned Corrective Action The Organization concurred with the prior year (2023-004) and current year renumbered recommendation (2024-004), acknowledging that the unexpected resignation of the former independent auditor (January 2023), and the domino effect of a delay in securing a new independent auditor (April 2023) continue to challenge the Organization, however, the Organization notes the status and progress of the following single audits: • June 30, 2022, filed in the Federal Audit Clearinghouse (FAC) in February 2025. • June 30, 2023, filed in the FAC in March 2026. • June 30, 2024, final review by Board in progress, projected filing in the FAC in June 2026. • June 30, 2025, engagement field work in progress with projected filing date no later than September 2026. • June 30, 2026, engagement letter signed with scheduled field work to commence after the June 30, 2025, audit FAC filing; projected to be completed with related FAC filing, no later than March 2027. The Organization notes the corrective actions that have been implemented, regarding internal controls to ensure compliance with the Uniform Guidance with respect to the submission deadline of single audit reports and the Data Collection Form: A. Internal Controls in Practice Since Inception of New Auditor Engagement – April 2023. As noted in the prior year corrective action response, the Organization established internal compliance controls related to the timely submission of single audit reports. Such process and review controls are implemented by the director of administrative operations, chief of staff (since December 2024), and chief executive officer; and subsequently communicated to the Board finance sub-committee and full Board, including the documented Board action(s) taken (e.g., Board agenda, minutes). B. Financial Policies and Procedures – May 2025. By May 2025, the Organization completed financial policies related to: implementation of significant accounting policies, internal control environment, cash and banking, cash disbursements and check issuance, payroll processes, procure to pay and revenue recognition policies, processes and procedures. Note the internal control policy of the Organization documents process and review controls, which were already in practice, applying to the timely filing of single audit reports. The current practices of the Organization, to the present period of the report dated June 17, 2026 is consistent with established process and review controls for timely submission of single audit reports.
Federal Agency Name: Department of Agriculture Assistance Listing Number: 10.766 Program Name: Community Facilities Loans and Grants Finding Summary: The Hospital did not have an adequate internal control policy in place to ensure the proper disbursement and funding of the reserve account. Although ...
Federal Agency Name: Department of Agriculture Assistance Listing Number: 10.766 Program Name: Community Facilities Loans and Grants Finding Summary: The Hospital did not have an adequate internal control policy in place to ensure the proper disbursement and funding of the reserve account. Although management obtained a waiver for the noncompliance, the lack of adequate policies governing proper funding of reserve increases the risk that employees participating in the federal award administration may not be able to detect and correct noncompliance in a timely manner. Corrective Action Plan: Management will review and enhance internal control policies to ensure that there is proper funding of the reserve accounts. Responsible Individuals: Jody Nelson, CEO and Megan Peterson, CFO
Person(s) Responsible for the Corrective Action: April Samuels, VP of Finance Corrective Action Plan: Implement monthly reconciliation between PHDC and DHCD to identify and resolve any discrepancies in real time. Anticipated Completion Date: June 30, 2026
Person(s) Responsible for the Corrective Action: April Samuels, VP of Finance Corrective Action Plan: Implement monthly reconciliation between PHDC and DHCD to identify and resolve any discrepancies in real time. Anticipated Completion Date: June 30, 2026
Person(s) Responsible for the Corrective Action: April Samuels, VP of Finance Corrective Action Plan: Implement monthly reconciliation between PHDC and DHCD to identify and resolve any discrepancies in real time. Anticipated Completion Date: June 30, 2026
Person(s) Responsible for the Corrective Action: April Samuels, VP of Finance Corrective Action Plan: Implement monthly reconciliation between PHDC and DHCD to identify and resolve any discrepancies in real time. Anticipated Completion Date: June 30, 2026
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