Corrective Action Plans

Finding 574443 (2024-001)

Significant Deficiency 2024

WI

Internal Control / Segregation of Duties

The Authority is aware of the lack of segregation of duties caused by the limited size of its staff. Segregation of duties is enhanced whenever possible and the Board of Comissioners assumes an active roll through monthly review of receipt and disbursement transactions and monthly financial stateme...

The Authority is aware of the lack of segregation of duties caused by the limited size of its staff. Segregation of duties is enhanced whenever possible and the Board of Comissioners assumes an active roll through monthly review of receipt and disbursement transactions and monthly financial statements.

View Audit 364779

Finding 574438 (2024-002)

Material Weakness 2024

Central Columbia School District

PA

Questioned Costs Cash Management Reporting

Contact Person: Steven Dolak, Business Administrator. Recommendation: The District should revise procedures to ensure the data entered into the claim for reimbursement is reviewed for accuracy prior to the report being submitted. Evidence of the approval of submission should be documented in writi...

Contact Person: Steven Dolak, Business Administrator. Recommendation: The District should revise procedures to ensure the data entered into the claim for reimbursement is reviewed for accuracy prior to the report being submitted. Evidence of the approval of submission should be documented in writing, such as with an initial, to demonstrate the review of the information has been performed. Action: The Business Administrator will prepare the reports for submission. Prior to submitting the report through the reimbursement system, a second individual will review the information entered. Upon satisfactory completion of the review, the second individual will acknowledge review by initialing and dating the document(s). Date of Completion: This procedure will be implemented at the beginnign of the 2025-26 school year.

View Audit 364777

Finding 574408 (2024-001)

Material Weakness 2024

Family & Childcare Resources of Northeast Wisconsin, Inc.

WI

Internal Control / Segregation of Duties

This finding will not be completely resolved given the limited amount of financial staff and limited financial resources of the Organization. The Organization will rely on Board oversight and review of the financial records.

View Audit 364769

Finding 574383 (2024-002)

Significant Deficiency 2024

Childcaring, Inc.

WI

Internal Control / Segregation of Duties

This finding will not completely resolve itself given the cost/benefits basis the Organization continues to base this decision on.

View Audit 364767

Finding 574183 (2024-001)

Significant Deficiency 2024

Wisconsin Rural Water Association, Inc.

WI

Internal Control / Segregation of Duties

The Organization is aware of the lack of segregation of duties caused by the limited size of its staff, and will continue to use other controls, where practical to compensate for this limitation.

View Audit 364760

Finding 574175 (2024-001)

Significant Deficiency 2024

East Texas Crisis Center, Inc.

TX

Internal Control / Segregation of Duties Subrecipient Monitoring Procurement, Suspension & Debarment § 200.112 § 200.303 § 200.331 § 200.333 § 200.338

Management agrees with the finding. The Center is currently in the process of updating its fiscal policies and procedures to align with the requirements of 2 CFR Part 200. The Finance Committee is leading this effort and is reviewing each policy area identified, including conflict of interest, allow...

Management agrees with the finding. The Center is currently in the process of updating its fiscal policies and procedures to align with the requirements of 2 CFR Part 200. The Finance Committee is leading this effort and is reviewing each policy area identified, including conflict of interest, allowable costs, subrecipient monitoring, and record retention. Updated policies and procedures will be finalized and presented for Board approval by August 30, 2025. Once approved, the Center will ensure implementation across all departments and provide internal guidance to promote consistent application. Anticipated Completion Date: August 30, 2025 Responsible Party: Finance Committee, with support from Executive Director, Nichole Henry.

View Audit 364753

Finding 574174 (2024-001)

Significant Deficiency 2024

College of the Ozarks

MO

Reporting Internal Control / Segregation of Duties § 200.303 § 200.502 § 200.510

Views of responsible personnel and planned corrective actions: Management concurs with this finding. The College has implemented immediate corrective actions including development of a comprehensive grant tracking spreadsheet and establishment of regular meetings between program and finance staff. A...

Views of responsible personnel and planned corrective actions: Management concurs with this finding. The College has implemented immediate corrective actions including development of a comprehensive grant tracking spreadsheet and establishment of regular meetings between program and finance staff. Additionally, effective immediately, all grant applications must be reviewed and approved by the Controller prior to submission to ensure proper identification of funding sources and compliance requirements. The College will also implement cutoff procedures to ensure federal expenditures are reported in the correct period based on when eligible costs are incurred. The Controller will review all G5 drawdowns near year-end to verify proper period reporting. Formal written procedures for SEFA preparation will be implemented by October 15, 2025. The Controller will maintain the master grant listing and review all grant agreements to determine federal funding sources. Beginning with fiscal year 2026 SEFA preparation, the CFO will perform an independent review for completeness and accuracy, including verification of proper period reporting for all federal expenditures.

View Audit 364751

Finding 574172 (2024-001)

Significant Deficiency 2024

Barron County Housing Authority

WI

HUD Housing Programs Significant Deficiency Internal Control / Segregation of Duties

Rent Reasonableness Calculations Corrective Action Plan (CAP): Recommendation: We recommend, the entity develop a process to verify that rent reasonableness calculations are completed and maintained in the files. Explanation of disagreement with audit finding: There is no disagreement with the audit...

Rent Reasonableness Calculations Corrective Action Plan (CAP): Recommendation: We recommend, the entity develop a process to verify that rent reasonableness calculations are completed and maintained in the files. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action planned/taken in response to finding: The Authority will train individuals doing the calculations to ensure calculations are done and maintained in the files and implement processes to verify rent reasonableness calculations are done. Name of the contact person responsible for corrective action: Bob Kazmierski Planned completion date for corrective action plan: December 31, 2024

View Audit 364743

Finding 574147 (2024-005)

Significant Deficiency 2024

New Mexico Rural Water Association

NM

Internal Control / Segregation of Duties

It is management’s policy that all disbursements are documented and receipts and invoices retained. In an effort to ensure that receipts do not get misplaced or misfiled, management will look at employing scanning technology to make this process more secure.

View Audit 364720

Finding 574146 (2024-004)

Significant Deficiency 2024

New Mexico Rural Water Association

NM

Cash Management Internal Control / Segregation of Duties

It is management’s policy to update and distribute travel reimbursement forms with new mileage and per diem rates at the beginning of each year, and any other time the rates may change. Travel and per diem rates are reviewed periodically to ensure current rates are used. A staff person was utilized ...

It is management’s policy to update and distribute travel reimbursement forms with new mileage and per diem rates at the beginning of each year, and any other time the rates may change. Travel and per diem rates are reviewed periodically to ensure current rates are used. A staff person was utilized for a period of time over the past year, but that process was not continued through the full year. Utilization of a staff person to review vouchers prior to payment will begin again, and will be used continuously in the future.

View Audit 364720

Finding 574145 (2024-002)

Significant Deficiency 2024

Connected Lane County

OR

Questioned Costs Reporting Significant Deficiency § 200.212 § 200.512

Finding 2024-002: Significant deficiency in internal controls over compliance and immaterial non- compliance. Corrective Action Planned: Connected Lane County has updated internal control processes to ensure timely reporting and closing of the books and records are stored both electronically and in ...

Finding 2024-002: Significant deficiency in internal controls over compliance and immaterial non- compliance. Corrective Action Planned: Connected Lane County has updated internal control processes to ensure timely reporting and closing of the books and records are stored both electronically and in paper files in the finance department for easy access during the course of the audit. Person(s) Responsible: Mary Bell, Finance Manager Anticipated Completion Date: September 1, 2025

View Audit 364714

Finding 574144 (2024-004)

Significant Deficiency 2024

Christmas Valley Domestic Supply District

OR

Questioned Costs Procurement, Suspension & Debarment Subrecipient Monitoring § 200.328 § 200.329

Reports were not sent in a way that does not show proof that they were received and reviewed. In the future all reports will be sent and approved through a channel that can be proven and pulled upon request at any time.

View Audit 364712

Finding 574140 (2024-002)

Significant Deficiency 2024

Town of Babylon

NY

Reporting Internal Control / Segregation of Duties Questioned Costs § 200.328

The Town acknowledges the finding related to the delayed submission of the 4th Quarter 2024 ARPA report and concurs with the auditor’s recommendation. While the Town ultimately recognizes its responsibility to meet the filing deadlines for all federal reporting, the Town has instituted efforts to mi...

The Town acknowledges the finding related to the delayed submission of the 4th Quarter 2024 ARPA report and concurs with the auditor’s recommendation. While the Town ultimately recognizes its responsibility to meet the filing deadlines for all federal reporting, the Town has instituted efforts to mitigate the reporting lapse since the oversight. To prevent recurrence, the Town has implemented the following corrective actions: 1. Formal Reporting Calendar: A centralized ARPA reporting calendar has been created. This calendar will include internal deadlines at least 14 days in advance of federally mandated submission dates. 2. Assigned Reporting Officer: A designated ARPA Reporting Officer has been appointed, responsible for coordinating all necessary documentation and submissions related to ARPA funding. 3. Pre-Submission Review Process: A new protocol has been established requiring internal review and sign-off from both the Comptroller and the Town Supervisor’s designee no less than one week prior to each deadline. 4. Ongoing Training and Coordination: The Town will continue to work closely with its auditors and legal counsel to remain current on federal guidance, ensure continued compliance with Uniform Guidance standards, and maintain internal staff awareness of applicable obligations under ARPA. We believe these measures will ensure timely and accurate reporting for all future quarters and strengthen our internal compliance infrastructure.

View Audit 364708

Finding 574131 (2024-004)

Material Weakness 2024

Legacy Medical Care Inc.

IL

Questioned Costs Allowable Costs / Cost Principles Material Weakness

Action taken in response to finding: A new process has been put in place documenting the review and approval of payroll. Name(s) of the contact person(s) responsible for corrective action: Melissa D’Onorio, CEO, and Donna Landy, CFO. Planned completion date for corrective action plan: 07/14/2025

View Audit 364705

Finding 574129 (2024-002)

Material Weakness 2024

Legacy Medical Care Inc.

IL

Questioned Costs Material Weakness Internal Control / Segregation of Duties

Action taken in response to finding: •LMC will increase the frequency and sample size of its review of patient encounters. •LMC will be providing additional training for front desk staff regarding the collection and verification of patient information. Name(s) of the contact person(s) responsible fo...

Action taken in response to finding: •LMC will increase the frequency and sample size of its review of patient encounters. •LMC will be providing additional training for front desk staff regarding the collection and verification of patient information. Name(s) of the contact person(s) responsible for corrective action: Melissa D’Onorio, CEO, and Donna Landy, CFO. Planned completion date for corrective action plan: 08/15/2025

View Audit 364705

Finding 574121 (2024-001)

Material Weakness 2024

Wessington Springs School District No. 36-2

SD

Internal Control / Segregation of Duties Material Weakness

For this finding, Dr. Michael Ormsmith is the contact person responsible for the corrective action plan. This finding is due to having only two employees in the Business Office, both who have separate duties to cover the workload. Staffing in the office is at an efficient and financially feasible ...

For this finding, Dr. Michael Ormsmith is the contact person responsible for the corrective action plan. This finding is due to having only two employees in the Business Office, both who have separate duties to cover the workload. Staffing in the office is at an efficient and financially feasible level and precludes the hiring of additional personnel to provide an ideal environment for internal controls. The Wessinton Springs School Districted adopted Policy DA-R(1) Fiscal Management Internal Controls and Procedures on January 9, 2023. The district is aware of the weakness in internal controls and will adhere to the policy we have in place while providing compensating controls to reduce the risk. This is an ongoing process.

View Audit 364703

Finding 574119 (2024-001)

Significant Deficiency 2024

Brockton Housing Authority

MA

Questioned Costs HUD Housing Programs Eligibility

The Brockton Housing Authority {The Authority) has reviewed and agrees with finding 2024-01. The Authority has experienced a large turnover in staff who are responsible for the calculations of rents and Housing Assistance Payments. Through promotions, retirements, and resignations 7 of the 10 staff ...

The Brockton Housing Authority {The Authority) has reviewed and agrees with finding 2024-01. The Authority has experienced a large turnover in staff who are responsible for the calculations of rents and Housing Assistance Payments. Through promotions, retirements, and resignations 7 of the 10 staff primarily responsible for this function have left their positions in the last two years and have been replaced by staff new to the position. The Authority did increase quality control reviews due to the transition period. The finding does not identify a systemic issue rather it found various instances of noncompliance. Prior to the Audit the Authority scheduled a three-day onsite rent calculation training for all staff with Nan McKay inc that occurred the week of May 20, 2025. Finding 2024-001- Moving To Work Demonstration Tenant Files - Eligibility - Internal Control over Tenant Files - Noncompliance and Significant Deficiency Corrective Action Plan: The Authority will continue and enhance its training regimen for staff responsible for rent determination. Furthermore, the Authority has engaged the services of Edgemere Consulting. As part of this engagement Edgemere will conduct an independent quality control review of public housing and rental assistance files. From the information gathered from the file review Edgemere Consulting will develop specific training initiatives for the staff including enhanced quality control measures. Person Responsible: Bruna Campbell, Compliance officer Anticipated Completion Date: December 31, 2025 - Ongoing

View Audit 364699 Questioned Costs: $1

Finding 574117 (2024-002)

Material Weakness 2024

Paint Valley Local School District

OH

Internal Control / Segregation of Duties

Management will ensure District maintains all documentation to meet wage rate requirements of Federal programs.

View Audit 364686

Finding 574104 (2024-001)

Significant Deficiency 2024

Search for Common Ground

DC

Questioned Costs Subrecipient Monitoring Reporting § 200.328

We are fully committed to meet our reporting obligations for all of our donors. During 2024, the federal government had changed its login process to Payment Management System (PMS) and that resulted in access problems for our users at that time. Replacement account activation was gradual and took so...

We are fully committed to meet our reporting obligations for all of our donors. During 2024, the federal government had changed its login process to Payment Management System (PMS) and that resulted in access problems for our users at that time. Replacement account activation was gradual and took some time before we got the access to all the projects on PMS. We are already tracking both financial and narrative reports from the signing stage of projects, and most of the reports are prepared on time. Going forward, we will further strengthen our backup plans for submission of reports, both online and through email. We will develop a backup plan and strengthen delegation plans for each region during the times when the primary contact is not available

View Audit 364670

Finding 574080 (2024-002)

Significant Deficiency 2024

Chippewa County

MN

Questioned Costs Eligibility Significant Deficiency § 200.303

Finding Number: 2024-002 Finding Title: Eligibility Program: 93.778 Medical Assistance Program Name of Contact Person Responsible for Corrective Action: Michelle Trulock, Financial Assistance Supervisor Corrective Action Planned: Cases where there was an income discrepancy have been reviewed and upd...

Finding Number: 2024-002 Finding Title: Eligibility Program: 93.778 Medical Assistance Program Name of Contact Person Responsible for Corrective Action: Michelle Trulock, Financial Assistance Supervisor Corrective Action Planned: Cases where there was an income discrepancy have been reviewed and updated. Peacetime instructions used during COVID are no longer in place. MAXIS cases have reverted to pre-pandemic processing and will be reviewed and updated. Specific income calculations were reviewed with staff. Supervisor will promote annotation on documents for clarification, as well as clear and concise case noting. Desk reviews are completed periodically for review of income, assets and citizenship and all transfer in cases are reviewed for the like. Supervisor will request that each worker review citizenship (STAT/ MEMB/MEMI and imaging) at healthcare renewal month to ensure accuracy. Policy and procedure review for staff on reviewing forms for asset information. This also relates to the self-attestation of cash on the review forms. Anticipated Completion Date: On 06/03/2025, Supervisor met with staff to discuss the results of the audit and train and review policy and procedure on best practices for processing and maintenance of healthcare cases. This will be an ongoing agenda item at monthly unit meetings.

View Audit 364657

Finding 574079 (2024-001)

Material Weakness 2024

Chippewa County

MN

Allowable Costs / Cost Principles Reporting Internal Control / Segregation of Duties § 200.303

Finding Number: 2024-001 Finding Title: Activities Allowed or Unallowed and Allowable Costs/Cost Principles Program: 93.778 Medical Assistance Program Name of Contact Person Responsible for Corrective Action: Jennifer Bakkelund, Fiscal & Support Services Supervisor Corrective Action Planned: Due to ...

Finding Number: 2024-001 Finding Title: Activities Allowed or Unallowed and Allowable Costs/Cost Principles Program: 93.778 Medical Assistance Program Name of Contact Person Responsible for Corrective Action: Jennifer Bakkelund, Fiscal & Support Services Supervisor Corrective Action Planned: Due to overlap of when we found the errors from 2023 and the corrections of those in 2024, this triggered other areas we knew would have to change in 2024. This included more movement in personnel expenses for programs not considered under federal financial participation. These programs were all removed from the Family Services budget by January 1, 2025. The corrections to our internal systems were corrected in 2025. Chippewa County staff will connect with DHS to review the corrections made in our system as it pertains to the quarterly reports and will adjust as they instruct. For the Administrative split being used each year, we will use the A87 Report to determine the rate. It will be shared with the Payroll department, the County Auditor/Treasurer’s department and Family Services accounting staff prior to the start of the year or prior to any mid-year change. More oversight will be given to placement of “Other” charges that are paid in County systems and to make sure placement of those are correct in the quarterly reports. Anticipated Completion Date: December 2025

View Audit 364657

Finding 574078 (2024-002)

Material Weakness 2024

Village of Blanchardville

WI

Material Weakness Reporting Internal Control / Segregation of Duties

Finding #2024-002- Material Adjustments Condition: Johnson Block and Company, Inc. proposed adjusting journal entries during the audit process. We deem these entries to be material in relation to the financial statements. Since the Village did not make these adjustments in its accounting system pri...

Finding #2024-002- Material Adjustments Condition: Johnson Block and Company, Inc. proposed adjusting journal entries during the audit process. We deem these entries to be material in relation to the financial statements. Since the Village did not make these adjustments in its accounting system prior to the audit, a material weakness exists in the Village’s internal controls. Criteria: Material adjusting journal entries not prepared by the Village before the audit are considered an internal control weakness. Cause: The Village does not have policies and procedures in place to ensure that all transactions are properly recorded on the general ledger prior to the audit. Effect: This means that the proper recording and reporting of financial information may not occur within a timely manner. Recommendation: Policies and procedures should be implemented to ensure account balances are properly recorded in a timely manner. Response: The Village will work to establish policies and procedures to reduce the number of adjusting journal entries proposed by the auditor. Contact Person: Amy Barnes, Village Clerk/Treasurer, 608-523-4521, Email: clerk@blanchardvillewi.gov Anticipated Completion: December 31, 2025

View Audit 364647

Finding 574077 (2024-001)

Material Weakness 2024

Village of Blanchardville

WI

Internal Control / Segregation of Duties HUD Housing Programs

Finding #2024-001- Segregation of Duties Condition: The available office staff precludes a proper segregation of duties in the control areas reviewed. Criteria: Segregation of duties is an aspect of internal control intended to prevent or decrease opportunities of intentional and unintentional err...

Finding #2024-001- Segregation of Duties Condition: The available office staff precludes a proper segregation of duties in the control areas reviewed. Criteria: Segregation of duties is an aspect of internal control intended to prevent or decrease opportunities of intentional and unintentional errors and fraud. Duties and responsibilities are properly segregated if no single individual either has control over all phases of a transaction or can both make and conceal an error, whether such error is intentional or unintentional. Cause: Limited number of personnel. Effect: Errors or intentional fraud could occur and not be detected timely by other employees in the normal course of their responsibilities because of the lack of segregation of duties. Recommendation: We recommend that the Village consider the benefits of implementing additional policies and procedures to address key controls related to its significant transaction cycles as noted. Response: We agree with the finding but do not believe it is cost-effective to increase the office staff in an attempt to bring about a more effective segregation of duties. Contact Person: Amy Barnes, Village Clerk/Treasurer, 608-523-4521, Email: clerk@blanchardvillewi.gov Anticipated Completion: Not Applicable

View Audit 364647

Finding 574071 (2024-003)

Significant Deficiency 2024

Housing and Redevelopment Authority of the City of Worthington

MN

HUD Housing Programs Internal Control / Segregation of Duties

Explanation of Disagreement with Audit Finding: There is no disagreement with the audit finding. Actions Planned in Response to Finding: The HRA will monitor claims approvals going forward. Official Responsible for Ensuring CAP: Tanner Rogers, Executive Director, is the official responsible for ensu...

Explanation of Disagreement with Audit Finding: There is no disagreement with the audit finding. Actions Planned in Response to Finding: The HRA will monitor claims approvals going forward. Official Responsible for Ensuring CAP: Tanner Rogers, Executive Director, is the official responsible for ensuring corrective action. Planned Completion Date for CAP: The planned completion date is December 31, 2025. Plan to Monitor Completion of CAP: The Board will be monitoring this corrective action plan and believes the Executive Director will remedy this finding.

View Audit 364640

Finding 574054 (2024-005)

Significant Deficiency 2024

Easter Seals Serving Dc/md/va

MD

Allowable Costs / Cost Principles Questioned Costs Internal Control / Segregation of Duties § 200.403 § 200.412

• CFO will examine feasibility of adding flags to journal entries to ensure unallowable costs are flagged at the point of entry Will conduct training on allowable vs. unallowable costs Grants Accountant will conduct quarterly review of costs to ensure no unallowable costs included – will review firs...

• CFO will examine feasibility of adding flags to journal entries to ensure unallowable costs are flagged at the point of entry Will conduct training on allowable vs. unallowable costs Grants Accountant will conduct quarterly review of costs to ensure no unallowable costs included – will review first three months of FY26 by 12/31/25

View Audit 364634

Corrective Action Plans

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