Corrective Action Plans

Finding 499732 (2023-002)

Significant Deficiency 2023

IL

HUD Housing Programs Reporting Significant Deficiency

Finding No. 2023-002 Significant Deficiency Personnel Responsible for Section 8 Director Corrective Action: Anticipated Completion Date: January 31, 2025 Corrective Action Plan: We take the proper review and documentation of review of our Housing Quality Standards (HQS) inspections prior ...

Finding No. 2023-002 Significant Deficiency Personnel Responsible for Section 8 Director Corrective Action: Anticipated Completion Date: January 31, 2025 Corrective Action Plan: We take the proper review and documentation of review of our Housing Quality Standards (HQS) inspections prior to their timely submission to the Public and Indian Housing Information Center (PIC) very seriously. We acknowledge the importance of this process and the need for consistent implementation. To address this finding, we will implement the following measures: 1. Documentation: A new documentation protocol will be established to provide clear proof that this process is occurring regularly. This will include date-stamped review logs and signatures from responsible staff members. We will institute a monthly review of 3 to 5 initial failed inspections. This review will: • Determine if repairs have occurred in a timely manner • Assess whether abatement letters should be sent • Be documented and included in our regular reporting 2. Training: We will conduct refresher training for all relevant staff to ensure they understand the importance of this process and their role in maintaining it. 3. Automated Reminders: We will implement an automated reminder system to alert staff when reviews and submissions are due. 4. Internal Review: Internal quarterly reviews will be conducted to ensure compliance with this process and to identify any potential issues early.

View Audit 322548

Finding 499727 (2023-001)

Material Weakness 2023

Village of Cassville

WI

Internal Control / Segregation of Duties HUD Housing Programs

Finding #2023-001- Limited 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 unintenti...

Finding #2023-001- Limited 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: Molly Roskams, Clerk/Treasurer Anticipated Completion: Not applicable

View Audit 322532

Finding 499684 (2023-006)

Material Weakness 2023

St. Vincent De Paul Village, Inc.

CA

Questioned Costs Subrecipient Monitoring Matching / Level of Effort / Earmarking § 200.303

Corrective Action: Management will enhance and enforce existing policies and procedures over monitoring of rental reasonableness in compliance with HUD-determined fair market rent requirements. Management and Tenant Services team will perform a thorough review of all tenant files, a task executed in...

Corrective Action: Management will enhance and enforce existing policies and procedures over monitoring of rental reasonableness in compliance with HUD-determined fair market rent requirements. Management and Tenant Services team will perform a thorough review of all tenant files, a task executed in partnership with landlords and property management companies. Perform internal compliance checks with sub-recipients by FJV compliance staff on a quarterly basis. Finally, develop additional oversight procedures for accounting and documentation of tenant rents to guarantee accuracy within our accounting general ledgers. Name of Responsible Individual(s): Jason Brenier, Maria Rafanan, Jesse Casement, Christina Madriles, Ann Wieczorek, and Judy Bokhari Anticipated Completion Date: December 2024

View Audit 322528 Questioned Costs: $1

Finding 499659 (2023-004)

Significant Deficiency 2023

St. Vincent De Paul Village, Inc.

CA

Subrecipient Monitoring Allowable Costs / Cost Principles Cash Management § 200.303 § 200.430

Corrective Action: Management will review all cost allocations and implement documented policies and procedures to ensure sufficient support of any allocations of costs is maintained as required by 2 CFR §200.403. In addition, Management has developed a cost allocation worksheet and framework and is...

Corrective Action: Management will review all cost allocations and implement documented policies and procedures to ensure sufficient support of any allocations of costs is maintained as required by 2 CFR §200.403. In addition, Management has developed a cost allocation worksheet and framework and is in the process of implementing a new procedure to ensure it is reviewed by accounting and grant managers to ensure accurate reporting. Name of Responsible Individual(s): Jason Brenier, Judy Bokhari, and Luz Gonzales-Toscano Anticipated Completion Date: December 2025

View Audit 322528

Finding 499643 (2023-005)

Material Weakness 2023

City of New Castle

IN

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

FINDING 2023-005 Finding Subject: COVID-19 STATE AND LOCAL FISCAL RECOVERY REPORTING Summary of Finding: There were deficiencies in the internal control system of the City over the grant’s reporting requirements. Contact Person Responsible for Corrective Action: Ashley Huffman Contact Phone Number a...

FINDING 2023-005 Finding Subject: COVID-19 STATE AND LOCAL FISCAL RECOVERY REPORTING Summary of Finding: There were deficiencies in the internal control system of the City over the grant’s reporting requirements. Contact Person Responsible for Corrective Action: Ashley Huffman Contact Phone Number and Email Address: 765-521-6803 nccityclerk@gmail.com Views of Responsible Officials: We concur with the finding. Description of Corrective Action Plan: Beginning Sept. 1, 2024, procedures put in place include the Clerk Treasurer and Deputy Clerk Treasurer verifying each other with the reporting. Internal controls are the Clerk Treasurer will review and include the information to prepare the required reports. Monthly receipt detail and disbursement detail reports will be included, with the Deputy reviewing that. Both will sign off after reviews and communication. Additionally, the monthly detail reports will be provided to the City's Finance Committee and Council who oversees the ARP funds. Anticipated completion date: September 1, 2024

View Audit 322522

Finding 499635 (2023-005)

Material Weakness 2023

Floyd County

IN

Subrecipient Monitoring Internal Control / Segregation of Duties § 200.303 § 200.332

FINDING 2023-005 Finding Subject: COVID-19 - Coronavirus State and Local Fiscal Recovery Funds - Subrecipient Monitoring Summary of Finding: Both of the County’s subrecipients submitted quarterly reports for Quarter 2 of 2023, covering the time period from April 1st through June 30th. No other quart...

FINDING 2023-005 Finding Subject: COVID-19 - Coronavirus State and Local Fiscal Recovery Funds - Subrecipient Monitoring Summary of Finding: Both of the County’s subrecipients submitted quarterly reports for Quarter 2 of 2023, covering the time period from April 1st through June 30th. No other quarterly financial and performance reports were submitted to the County during the fiscal year. As part of the monitoring the County performed on the subrecipients in March 2023, they noted the subrecipients had been missing quarterly reports. Despite communications made by the County to obtain the missing quarterly reports, no other quarterly reports were submitted by the subrecipients. Contact Person Responsible for Corrective Action: Don Lopp, Director of Operations and County Planning Contact Phone Number and Email Address: 812-948-4110 and dlopp@floydcounty.in.gov Views of Responsible Officials: We concur with the finding Description of Corrective Action Plan: Staff will continue to work with Water companies regarding audit of projects and submission of all required quarterly reports. Anticipated Completion Date: Quarterly Reports will be collected until final December 2024 reporting. All subrecipient awards are required to be completed by December 2024.

View Audit 322513

Finding 499634 (2023-004)

Material Weakness 2023

Floyd County

IN

Internal Control / Segregation of Duties Allowable Costs / Cost Principles Material Weakness § 200.1 § 200.303

FINDING 2023-004 Finding Subject: COVID-19 - Coronavirus State and Local Fiscal Recovery Funds - Reporting Summary of Finding: The County submitted four P&E reports during the audit period; however, the errors as identified below were noted on all four reports.  Quarterly Report: October 1, 2022 to...

FINDING 2023-004 Finding Subject: COVID-19 - Coronavirus State and Local Fiscal Recovery Funds - Reporting Summary of Finding: The County submitted four P&E reports during the audit period; however, the errors as identified below were noted on all four reports.  Quarterly Report: October 1, 2022 to December 31, 2022 Current period expenditures reported 7 projects with errors totaling $77,234. Cumulative expenditures reported 22 projects with errors totaling $3,955,669.  Quarterly Report: January 1, 2023 to March 31, 2023 Current period expenditures reported 7 projects with errors totaling $173,169. Cumulative expenditures reported 25 projects with errors totaling $2,633,217.  Quarterly Report: April 1, 2023 to June 30, 2023 Current period expenditures reported 2 projects with errors totaling $0, since expenditures were posted to the incorrect project. Cumulative expenditures reported 24 projects with errors totaling $2,372,744.  Quarterly Report: July 1, 2023 to September 30, 2023 Current period expenditures reported 3 projects with errors totaling $13,412. Cumulative expenditures reported 26 projects with errors totaling $2,273,749. Contact Person Responsible for Corrective Action: Don Lopp, Director of Operations and County Planning Contact Phone Number and Email Address: 812-948-4110 and dlopp@floydcounty.in.gov Views of Responsible Officials: We concur with the finding Description of Corrective Action Plan: As Director of Operations and Planning, the American Rescue Plan quarterly reports are submitted through the office. During the last two audit, it appears data input errors have occurred with the reporting of total expenditures. The initial corrective action of review was not sufficient to correct the data input errors. During the recent July 2024 quarterly report, staff reviewed the items on line and believe that all reporting has been corrected. Starting with the September reporting, two staff members will review the data input Anticipated Completion Date: September 2024 – For the third quarter reporting period.

View Audit 322513

Finding 499621 (2023-001)

Significant Deficiency 2023

Cuyahoga Metropolitan Housing Authority

OH

HUD Housing Programs Significant Deficiency Internal Control / Segregation of Duties

CUYAHOGA METROPOLITAN HOUSING AUTHORITY CORRECTIVE ACTION PLAN YEAR ENDED DECEMBER 31, 2023 U.S. Department of Housing and Urban Development The Cuyahoga Metropolitan Housing Authority (the Authority) respectfully submits the following corrective action plan for the year ended December 31, 2023. ...

CUYAHOGA METROPOLITAN HOUSING AUTHORITY CORRECTIVE ACTION PLAN YEAR ENDED DECEMBER 31, 2023 U.S. Department of Housing and Urban Development The Cuyahoga Metropolitan Housing Authority (the Authority) respectfully submits the following corrective action plan for the year ended December 31, 2023. Audit period: January 1, 2023 through December 31, 2023 The finding from the schedule of findings and questioned costs is discussed below. The finding is numbered consistently with the numbers assigned in the schedule. FINDINGS—FEDERAL AWARD PROGRAMS AUDITS U.S. Department of Housing and Urban Development 2023-001 Section 8 Project Based Cluster – Assistance Listing No. 14.856/14.182 Recommendation: We recommend the Authority review their process for scheduling inspections to ensure they are performed timely. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: The Authority will review the inspection policies and procedures to ensure compliance with HQS guidelines and requirements. Name of the contact person responsible for corrective action: Claire Russ, Chief of Agency Analytics, Inspections and Technology Planned completion date for corrective action plan: December 31, 2024 If the U.S. Department of Housing and Urban Development has questions regarding this plan, please call Bo Truett at 216-348-5000.

View Audit 322505

Finding 499617 (2023-001)

Material Weakness 2023

County of Jefferson

PA

Subrecipient Monitoring Internal Control / Segregation of Duties

Subrecipient Monitoring AL 93.778 Medical Assistance Program and DHS Medical Assistance Criteria: PA DHS compliance require the County to perform subrecipient monitoring procedures over MATP funding disbursed to the Program’s vendor. Condition: During the audit, it was noted that the County was no...

Subrecipient Monitoring AL 93.778 Medical Assistance Program and DHS Medical Assistance Criteria: PA DHS compliance require the County to perform subrecipient monitoring procedures over MATP funding disbursed to the Program’s vendor. Condition: During the audit, it was noted that the County was not performing subrecipient monitoring over the Program’s vendor. Cause: The County does not have adequate controls in place or the expertise to ensure proper subrecipient monitoring procedures. Effect: The Program’s vendor may be using grant funding inappropriately. This is a repeat finding from the prior year – Finding 2022-001. Questioned Costs: The amount of questioned costs, if any, is undeterminable Recommendation: The County should implement internal control procedures that ensure the vendor is being properly monitored. Management Response: Management maintains that they do not have adequate controls or proper expertise to monitor the vendor. Management will contract a firm to provide oversight over the vendor. Anticipate Completion Date: Immediate

View Audit 322490

Finding 499616 (2023-002)

Material Weakness 2023

County of Jefferson

PA

Subrecipient Monitoring Internal Control / Segregation of Duties

Subrecipient Monitoring AL 21.023 Emergency Rental Assistance Program Criteria: Internal control procedures require the County to perform subrecipient monitoring procedures over the funding disbursed to the Program’s vendor. Condition: During the audit, it was noted that the County was not perfor...

Subrecipient Monitoring AL 21.023 Emergency Rental Assistance Program Criteria: Internal control procedures require the County to perform subrecipient monitoring procedures over the funding disbursed to the Program’s vendor. Condition: During the audit, it was noted that the County was not performing subrecipient monitoring over the Program’s vendor. Cause: The County does not have adequate controls in place or the expertise to ensure proper subrecipient monitoring procedures. Effect: The Program’s vendor may be using grant funding inappropriately. This is a repeat finding from the prior year – Finding 2022-002. Questioned Costs: The amount of questioned costs, if any, is undeterminable Recommendation: The County should implement internal control procedures that ensure the vendor is being properly monitored. Management Response: Management maintains that they do not have adequate controls or proper expertise to monitor the vendor. Management will contract a firm to provide oversight over the vendor. Anticipate Completion Date: Immediate

View Audit 322490

Finding 499587 (2023-003)

Material Weakness 2023

Anson-Madison Sanitary District

ME

Reporting Internal Control / Segregation of Duties

The District’s acknowledges that the size of the accounting staff limits the District’s ability to prepare the financial statements in accordance with U.S. generally accepted accounting principles, implement the proper segregation of duties among who performs the billing, receives cash receipts, pos...

The District’s acknowledges that the size of the accounting staff limits the District’s ability to prepare the financial statements in accordance with U.S. generally accepted accounting principles, implement the proper segregation of duties among who performs the billing, receives cash receipts, posts receipts to customer accounts, and makes deposits at the bank from occurring. The District’s acknowledges that the size of the accounting staff limits the District’s ability to prepare the Schedule of Expenditures and Federal Awards in accordance with the audit requirements of Title 2 U.S. Code of Federal Regulations Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (Uniform Guidance). While there is an outsourced bookkeeper, the Office Manager performs three of these functions in the normal course of performing her duties. The Board of Trustees plans to remain involved in the financial activities of the District to provide oversight by performing a monthly review of the financial information of the District to provide mitigating controls over the lack of segregation of duties over these functions. Responsible party: Dale Clark, Superintendent, (207) 696-5211 Anticipated Completion Date: Ongoing

View Audit 322446

Finding 499571 (2023-004)

Significant Deficiency 2023

Housing Authority of Kansas City, Missouri

MO

Questioned Costs Special Tests & Provisions Significant Deficiency

Response to Finding 2023-004 The Authority generally concurs with the auditor’s findings and recommendations regarding the handling of HQS deficiencies. To address this, the Authority will implement a more rigorous process to ensure timely correction of deficiencies and adherence to abatement proced...

Response to Finding 2023-004 The Authority generally concurs with the auditor’s findings and recommendations regarding the handling of HQS deficiencies. To address this, the Authority will implement a more rigorous process to ensure timely correction of deficiencies and adherence to abatement procedures. 1. Enhanced Correction Process: • Effective October 2024, the Authority will introduce stricter timelines and automated reminders for staff to manage I IQS deficiencies. • Tf a deficiency is not corrected within the timeframe specified in the HAKC HCV Admin Plan, it will automatically escalate to the HCV Inspection Manager and Supervisor for immediate action. • Immediate actions include placing the unit on hold in the Elite system, issuing a notice to the landlord and participant, and sending an email to the Specialist to issue a voucher for the participant to move, if necessary. • A formal letter will be sent to both the landlord and tenant notifying them of the identified deficiencies, along with a set timeframe of 30 days for the repairs to be completed. A re-inspection date will be scheduled to verify that repairs have been made. 2. Abatement Process: • If repairs are not made by the set re-inspection date, an abatement letter will be sent to both the landlord and tenant, notifying them that HAP payments will cease on the first day of the following month, providing a minimum of 30 days' notice. • At this time, a letter will also be sent to the tenant notifying them that a voucher will be issued to allow them to move to a more suitable unit. 3. Termination of HAP Contract: • If repairs are still not completed by the end of the 30-day abatement period, the HAP contract will be terminated along with the HAP payment. A termination of HAP letter will be sent to the landlord and tenant for the current unit. 4. Documentation and Review Process: • The Inspection Department will maintain a weekly abatement spreadsheet documenting the reason for abatement, the start and end dates of the abatement, and any associated inspection reports. • This spreadsheet, along with the abated inspection documentation, will be reviewed at the beginning and end of each month before closeout to ensure that the abatement process is properly initiated and managed. Name of the contact person responsible for corrective action: Deputy Executive Director LaMonyka French Completion Date: December 2024 If the Department of Housing and Urban Development has questions regarding this plan, please call LaMonyka French, Deputy, Executive Director at (816) 968-4100.

View Audit 322424 Questioned Costs: $1

Finding 499570 (2023-003)

Significant Deficiency 2023

Housing Authority of Kansas City, Missouri

MO

HUD Housing Programs Special Tests & Provisions Significant Deficiency

Response to Finding 2023-003 The Authority generally concurs with the auditor’s findings and recommendations. To address the finding related to inadequate documentation for rent reasonableness determinations, the Authority will implement the following corrective actions: 1. Immediate and Ongoing Tra...

Response to Finding 2023-003 The Authority generally concurs with the auditor’s findings and recommendations. To address the finding related to inadequate documentation for rent reasonableness determinations, the Authority will implement the following corrective actions: 1. Immediate and Ongoing Training: • To ensure consistency, increase staff knowledge, and reduce errors, the Authority will conduct immediate training sessions for all relevant staff, followed by annual refresher training. These sessions will focus on the correct procedures for documenting rent reasonableness and the importance of maintaining accurate and complete records. 2. Enhanced Quality Control and Error Monitoring: • The Authority will increase the frequency of quality control file reviews to identify errors promptly and address their root causes to prevent systemic issues. • Errors will be tracked by type and by the staff member responsible, allowing for the identification of patterns. Additional training will be provided for common error types and to individuals who are frequently responsible for errors. 3. Comprehensive File Reviews: • Quality reviews will be conducted on all files to ensure the presence of all required documents. It is anticipated that the initial comprehensive file review will take approximately one year to complete. • After the initial review, files will be selected randomly for review according to an established quality control schedule. This ongoing review process will ensure continuous compliance and address any issues as they arise. 4. Responsibility for Document Collection: • Each team member will be responsible for collecting any missing documents identified during the annual recertification, interim recertification, or change of unit processes. This accountability measure ensures that all necessary documentation is gathered and maintained consistently. 5. Adoption of a Digital Platform: • As part of the corrective action, the Authority has adopted a digital platform that requires the completion of all necessary fields before a rent determination can be finalized. This platform will also retain all documentation used to determine rent reasonableness for at least two years, ensuring thorough and accessible records. 6. Increased Random Audits: • Effective October 2024, random audits will be increased to monthly reviews to identify any discrepancies early and to ensure ongoing compliance with documentation requirements. Name of the contact person responsible for corrective action: Deputy Executive Director LaMonyka French Completion Date: December 2024

View Audit 322424

Finding 499569 (2023-002)

Significant Deficiency 2023

Housing Authority of Kansas City, Missouri

MO

HUD Housing Programs Reporting Significant Deficiency

Response to Finding 2023-002 The Authority generally concurs with the auditor’s findings and recommendations. The Authority has implemented procedures to ensure recertifications are promptly uploaded to the PIC system. Effective August 2024, we have adopted a system that flags any recertification no...

Response to Finding 2023-002 The Authority generally concurs with the auditor’s findings and recommendations. The Authority has implemented procedures to ensure recertifications are promptly uploaded to the PIC system. Effective August 2024, we have adopted a system that flags any recertification not uploaded to PIC. A HAKC Quality Control employee is responsible for daily uploads from Monday through Friday. With each upload, any fatal errors encountered are documented in an Excel spreadsheet. Once the error has been corrected in the PIC system, the correction is recorded on the spreadsheet, and the corresponding green status from PIC is printed for documentation, confirming that the issue has been resolved. To maintain ongoing compliance, bi-weekly audits will be conducted to verify that no files are missing from the PIC system. Name of the contact person responsible for corrective action: Deputy Executive Director LaMonyka French Completion Date: December 2024

View Audit 322424

Finding 499568 (2023-001)

Significant Deficiency 2023

Housing Authority of Kansas City, Missouri

MO

Eligibility Significant Deficiency Internal Control / Segregation of Duties

Response to Finding 2023-001 The Authority generally concurs with the auditor’s findings and recommendations. To address these issues, the Authority has implemented the following corrective actions: 1. Mandatory Refresher Training: • Effective May 2024, the Authority has rolled out mandatory refresh...

Response to Finding 2023-001 The Authority generally concurs with the auditor’s findings and recommendations. To address these issues, the Authority has implemented the following corrective actions: 1. Mandatory Refresher Training: • Effective May 2024, the Authority has rolled out mandatory refresher training for all relevant staff on eligibility documentation and recertification processes. This training ensures that all staff are fully aware of the correct procedures and policies, and that they understand the importance of maintaining complete and accurate tenant files and performing recertifications in a timely manner. 2. Implementation of a New Tracking System: • A new tracking system has been implemented to ensure that all documentation is completed timely and verified by a supervisor. This system allows for real-time monitoring of the documentation process, ensuring that all required documents are included in the tenant files. 3. Utilization of Checklists: • The Authority has introduced a mandatory checklist that staff are required to use every time a file is accessed or updated. This checklist serves as a tool to ensure that all necessary steps are taken, and all required documentation is included in the tenant file. 4. Enhanced Monitoring by HCV Director and Supervisors: • The HCV Director and Supervisors will closely monitor the recertification process to ensure that all recertifications are completed in a timely manner and in accordance with policy. This includes ensuring that all participants receive and return their recertification paperwork as required. 5. Increased Frequency of Quality Control Reviews: • The Authority will continue to conduct quality control file reviews and will increase the frequency of these reviews to identify errors sooner. This proactive approach will help address the root causes of errors quickly and prevent systemic issues from developing. 6. Ongoing Quality Reviews: • Continuous quality reviews will be conducted for all files to ensure that all required documents are present and that all recertifications are performed on time. This ongoing process is designed to maintain high standards of accuracy and compliance in tenant file management. Name of the contact person responsible for corrective action: Deputy Executive Director LaMonyka French Completion Date: December 2024

View Audit 322424

Finding 499559 (2023-001)

Significant Deficiency 2023

Nonprofit Finance Fund and Affiliate

NY

Questioned Costs Matching / Level of Effort / Earmarking Allowable Costs / Cost Principles § 200.303 § 200.430

Planned Corrective Action: NFF revised current year SEFA for expenses which did not meet the compliance requirement. In addition, management implemented review control whereby the expenditures will be reviewed to ensure compliance with federal agency requirements. Beginning in August 2024, NFF wil...

Planned Corrective Action: NFF revised current year SEFA for expenses which did not meet the compliance requirement. In addition, management implemented review control whereby the expenditures will be reviewed to ensure compliance with federal agency requirements. Beginning in August 2024, NFF will update its time and effort management and review of employees who perform work related to federal grants. This includes circulating a tracking spreadsheet monthly to relevant staff to certify their time and effort spent on eligible activities allowable for grant expenditure relative to their overall work performed, which will be used for salary and benefit allocations. The Finance team will circulate the spreadsheet first to relevant staff members for certification, and then department heads for management review and approval. For department head time and effort review and approval, the executive suite will review and approve. The spreadsheet and approvals will be saved as back up for the allocations each month.

View Audit 322416 Questioned Costs: $1

Finding 499557 (2023-001)

Significant Deficiency 2023

America's Poison Centers

VA

Allowable Costs / Cost Principles Matching / Level of Effort / Earmarking Internal Control / Segregation of Duties

Views of Responsible Officials: In 2024, the recommendation was implemented. Allocations will be reviewed by the outsourced accounting team to ensure that this has been executed upon. The CEO is responsible for overseeing both the new HR service provider and the outsourced accounting team and will e...

Views of Responsible Officials: In 2024, the recommendation was implemented. Allocations will be reviewed by the outsourced accounting team to ensure that this has been executed upon. The CEO is responsible for overseeing both the new HR service provider and the outsourced accounting team and will ensure that this does not recur.

View Audit 322412

Finding 499554 (2023-001)

Material Weakness 2023

Des Moines Valley Health and Human Services

MN

Internal Control / Segregation of Duties

Explanation of Disagreement with Audit Findings: There is no disagreement with the audit finding. Actions Planned in Response to Finding: Management will continue to review and gain an understanding of the audit adjustments in order to reduce the number of entries necessary for future audits. Offici...

Explanation of Disagreement with Audit Findings: There is no disagreement with the audit finding. Actions Planned in Response to Finding: Management will continue to review and gain an understanding of the audit adjustments in order to reduce the number of entries necessary for future audits. Official Responsible for Ensuring CAP: Natane Sadusky, Director of Business Management, is the official responsible for ensuring corrective action of the significant deficiency. Planned Completion Date for CAP: December 31, 2024 Plan to Monitor Completion of CAP: The Agency Board will be monitoring this corrective action plan.

View Audit 322409

Finding 499553 (2023-002)

Material Weakness 2023

Putnam County

IN

Internal Control / Segregation of Duties Reporting Allowable Costs / Cost Principles § 200.1 § 200.303

FINDING 2023-002 Finding Subject: COVID-19 – Coronavirus State and Local Fiscal Recovery Funds - Reporting Summary of Finding: The SLRF report did not include project information or amounts. Contact Person Responsible for Corrective Action: Auditor Contact Phone Number and Email Address: 765-653-551...

FINDING 2023-002 Finding Subject: COVID-19 – Coronavirus State and Local Fiscal Recovery Funds - Reporting Summary of Finding: The SLRF report did not include project information or amounts. Contact Person Responsible for Corrective Action: Auditor Contact Phone Number and Email Address: 765-653-5513, auditor@putnam.in.us Views of Responsible Officials: We concur with the finding Description of Corrective Action Plan: We have reached out to Baker Tilly, who does the reports for the County, regarding our audit finding so they know the reporting requirements that will need to be done for the next project and expenditure report which is due to be filed by April 30, 2025. Once we receive the report from Baker Tilly we will have a county employee review for accuracy of the report. Anticipated Completion Date: April 30, 2025

View Audit 322406

Finding 499549 (2023-002)

Significant Deficiency 2023

Lakewood Resource & Referral Center-D/b/a/ Center for Health Education

NJ

Special Tests & Provisions Eligibility Internal Control / Segregation of Duties

CORRECTIVE ACTION PLAN September 27, 2024 Health Resources and Services Administration Lakewood Resource and Referral Center, Inc. D/B/A Center for Health Education, Medicine and Dentistry respectfully submits the following corrective action plan for the year ended December 31, 2023. _____________...

CORRECTIVE ACTION PLAN September 27, 2024 Health Resources and Services Administration Lakewood Resource and Referral Center, Inc. D/B/A Center for Health Education, Medicine and Dentistry respectfully submits the following corrective action plan for the year ended December 31, 2023. ____________________________________________________________________________________ CohnReznick LLP 1301 Avenue of the Americas New York, NY 10019 Audit Period: December 31, 2023 The findings from the December 31, 2023 schedule of findings and questioned costs are discussed below. The findings are numbered consistently with the number assigned in the schedule. FINDINGS – FINANCIAL STATEMENT FINDINGS Finding 2023-001 – Account Analyses MATERIAL WEAKNESS Recommendation We recommend that the Center ensure that all accounting records are analyzed and reconciled on a monthly basis. We also recommend that necessary procedures be enhanced whereby an employee of the Center consistently reviews and follows up on receivables and adjusts the reserves for those receivables appropriately. This will help accurately reflect the cash realizable value of receivables. This will provide the Center with a stronger accounting of patient services receivable with which to better manage cash collections. We also recommend that the Center perform the patient services revenue reconciliation by payor source on a monthly basis. This would help the Center determine whether patient services revenue is being properly recorded by payor source. Action Taken Management of the Center agrees with the finding and has started to work with a new general ledger software package at the start of 2024, to better accommodate monthly reconciliations. We will also ensure that these analyses and reconciliations will be reviewed on a consistent and timely basis. There has been steady improvement throughout 2024, and it is expected to be complete by the end of 2024. FINDINGS – FEDERAL AWARDS PROGRAM AUDIT U.S. Department of Health and Human Services, COVID-19 Health Centers Program Cluster (Assistance Listing Number 93.224/93.527) Finding 2023-002 – Special Tests and Provisions SIGNIFICANT DEFICIENCY Recommendation We recommend that proper training be given to employees at registration to ensure that the sliding fee discounts are being properly calculated. Supervisors should monitor and review the sliding fee calculations on a periodic basis to ensure compliance with the sliding fee scale. In addition, management should conduct internal audits to ensure the sliding fee is calculated properly. Action Taken Management of the Center is providing additional training to the relevant staff that deal with the Sliding Fee Discount (SFD). These staff members include front desk staff, financial counselors, and the general finance and billing departments, as applicable. The SFD Policy and SFD Scale are being reviewed by management to ensure that the guidelines and procedures are clear. Revisions to the SFD Policy and SFD Scale will be made, and Board approved, if necessary to improve clarity. To ensure that the SFD is being properly calculated in accordance with the SFD Scale, a monitoring process will be included, which may include internal periodic audits by supervisors. All changes will be finalized and implemented by the end of 2024. If the Health Resources and Services Administration has questions regarding this plan, please call Scott Jackson, Chief Financial Officer at (732) 364-2144 x6138. Sincerely yours, Scott Jackson, CFO

View Audit 322404

Finding 499546 (2023-006)

Significant Deficiency 2023

Town of Fountain City

IN

Subrecipient Monitoring Reporting Significant Deficiency § 200.302 § 200.328

Finding 2023-006 – Coronavirus State and Local Fiscal Recovery Funds - Reporting (Significant Deficiency) Criteria: "The financial management system of each non-Federal entity must provide for the following: (2) Accurate, current, and complete disclosure of the financial results of each Federal aw...

Finding 2023-006 – Coronavirus State and Local Fiscal Recovery Funds - Reporting (Significant Deficiency) Criteria: "The financial management system of each non-Federal entity must provide for the following: (2) Accurate, current, and complete disclosure of the financial results of each Federal award or program in accordance with the reporting requirements set forth in §§ 200.328 Financial reporting . . . ." 34 CFR 76.722 states: "A State may require a subgrantee to submit reports in a manner and format that assists the State in complying with the requirements under 34 CFR 76.720 and in carrying out other responsibilities under the program." Context: There was no documented review by someone other than the preparer of the annual report to ensure the information submitted was complete and accurate. Per discussion with management, verbal review occurred but there is no documentation to support that review occurred. Views of Responsible Officials: We concur with the finding. Description of Corrective Action Plan: Management will ensure that review of the annual report is documented. Responsible Party and Timeline for Completion: The Clerk-Treasurer is the responsible party. The completion will go into effect in 2024.

View Audit 322400

Finding 499543 (2023-004)

Material Weakness 2023

Perry County

IN

Allowable Costs / Cost Principles Material Weakness Reporting § 200.1 § 200.303

FINDING 2023-004 Subject: COVID 19 - Coronavirus State and Local Fiscal Recovery Fund - Reporting Federal Summary of Finding: Perry County did not properly report period expenditures. The County submitted one P&E report during the audit period. Although the Deputy Auditor compiled the information fo...

FINDING 2023-004 Subject: COVID 19 - Coronavirus State and Local Fiscal Recovery Fund - Reporting Federal Summary of Finding: Perry County did not properly report period expenditures. The County submitted one P&E report during the audit period. Although the Deputy Auditor compiled the information for the report and the County Auditor reviewed and submitted the report, the internal controls were not effective in preventing, or detecting and correcting, errors. As a result, the P&E report contained errors. Contact Person Responsible for Corrective Action: Kristinia L. Hammack, Perry County Auditor Contact Phone Number: (812) 547-6427 Views of Responsible Officials: We concur with the audit finding. Description of Corrective Action Plan: The Auditor is now aware that the P&E Reporting Period is not calendar. All internal control will stay in place and this information will be noted for further SLFRF Reporting. The Auditor will review the reports prior to submission to ensure that the reporting period is not on a calendar year when reporting. Completion Date: March 1, 2025 INDIANA STATE

View Audit 322397

Finding 499541 (2023-004)

Material Weakness 2023

Tongue River Valley Joint Powers Board

WY

Material Weakness Internal Control / Segregation of Duties § 200.512

2023-004 Audit Report Submission to Federal Government Material Weakness in Internal Control over Compliance The Chairman of the Tongue River Valley Joint Powers Board will diligently comply with the Federal Reporting deadlines now that a consistent relationship has been established with an auditing...

2023-004 Audit Report Submission to Federal Government Material Weakness in Internal Control over Compliance The Chairman of the Tongue River Valley Joint Powers Board will diligently comply with the Federal Reporting deadlines now that a consistent relationship has been established with an auditing firm. Ongoing process.

View Audit 322395

Finding 499538 (2023-001)

Material Weakness 2023

Tongue River Valley Joint Powers Board

WY

Procurement, Suspension & Debarment Cash Management Material Weakness

2023-001 Inadequate Supporting Documentation Material Weakness The Chairman of the Tongue River Valley Joint Power Board will make two copies of all invoices. One set of invoices will be retained by the Chairman and the other will be retained by the treasurer to improve the necessary documentation. ...

2023-001 Inadequate Supporting Documentation Material Weakness The Chairman of the Tongue River Valley Joint Power Board will make two copies of all invoices. One set of invoices will be retained by the Chairman and the other will be retained by the treasurer to improve the necessary documentation. This process is becoming more streamlined now that the board is current on its invoices. This an ongoing process.

View Audit 322395

Finding 499529 (2023-010)

Significant Deficiency 2023

Hennepin County Minnesota

MN

Reporting Subrecipient Monitoring Significant Deficiency

Subject: Hennepin County’s 2023 Corrective Action Plan Finding# 2023-010 Reporting Program: Congressional Directives (ALN 93.493) Type of Finding: Significant Deficiency in Internal Control over Compliance Condition: The county hospital could not provide documentation that review and approval...

Subject: Hennepin County’s 2023 Corrective Action Plan Finding# 2023-010 Reporting Program: Congressional Directives (ALN 93.493) Type of Finding: Significant Deficiency in Internal Control over Compliance Condition: The county hospital could not provide documentation that review and approval of the semi-annual progress report was conducted prior to the report being submitted. Hennepin County’s Corrective Action Planned in Response to Finding: The semi-annual report information was provided by both program staff and the Grants Accounting Department and submitted by the Grants Director. However, there was no documentation kept of a review. Management has implemented a process to document the review and approval prior to the semi-annual report being submitted. Hennepin County Employee Responsible for the CAP: Mark Willmert Planned Completion Date for CAP: December 31, 2024

View Audit 322389

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