Corrective Action Plans

Finding 503072 (2023-007)

Material Weakness 2023

Point of Freedom

OH

Subrecipient Monitoring Matching / Level of Effort / Earmarking Internal Control / Segregation of Duties § 200.512

Finding 2023-007: Timely Submission of Single Audit Report (SAR) and Document Collection Form (DCF) To eliminate this finding recurring in future periods, POF will create an internal Annual Audit Plan (AAP), identifying required tasks, deliverables, due dates, and responsible internal and external ...

Finding 2023-007: Timely Submission of Single Audit Report (SAR) and Document Collection Form (DCF) To eliminate this finding recurring in future periods, POF will create an internal Annual Audit Plan (AAP), identifying required tasks, deliverables, due dates, and responsible internal and external personnel for each task. POF’s AAP will include five-six (5-6) months' lead time prior to future mandatory submission dates. Simultaneously, POF will communicate the AAP timelines with the Audit Engagement Partner to ensure audit staffing continuity and availability. POF will achieve accurate, complete, and timely future SAR and DCF submissions through incorporating these process improvements along with strengthening its internal controls, gaining experience in its first two Single Audits, and in acquiring an understanding of the Auditor’s role in verifying compliance and the adequacy of related supporting documentation.

View Audit 325057

Finding 503070 (2023-005)

Material Weakness 2023

Point of Freedom

OH

Subrecipient Monitoring Matching / Level of Effort / Earmarking Internal Control / Segregation of Duties § 200.1 § 200.303

Finding 2023-005 Accuracy of Federal Reports POF's initial and current exposure a few months later to Single Audit compliance requirements have sharpened its focus on the need to purposefully identify and maintain corroborating evidence regarding its timely submission and acceptance by each of the ...

Finding 2023-005 Accuracy of Federal Reports POF's initial and current exposure a few months later to Single Audit compliance requirements have sharpened its focus on the need to purposefully identify and maintain corroborating evidence regarding its timely submission and acceptance by each of the respective funding sources. While POF believes that all these reporting requirements were timely met and accepted by all funding sources, It did not consistently maintain either the report itself, or the related documentation such as copies of the emails sent or the associated read-receipts as evidence of these reports. Effective July 1, POF routinely and consistently accumulated and organized these documents as well as ancillary evidence of their transmission to, receipt by, and acknowledgement of acceptance by the federal agency. POF will be more diligent in its transmissions to funders. POF noted that the 2022 Closeout Report was inexplicably re-submitted instead of the correct 2023 Closeout Report. This is unacceptable, and POF will add a second set of reviews by a second person to improve quality control in this area. As necessary, POF will seek professional education and advice in implementing policies, practices, and procedures in addition to those already described herein.

View Audit 325057

Finding 503069 (2023-004)

Material Weakness 2023

Point of Freedom

OH

Questioned Costs Subrecipient Monitoring Allowable Costs / Cost Principles § 200.303 § 200.516

Finding 2023-004 Adequate Allowable Cost Documentation As indicated in the 2022 POFCAP response to Finding 2022-003, and as reiterated herein, POF began to implement additional internal control procedures and practices effective July 1, 2024, to ensure that underlying cost documentation is adequate...

Finding 2023-004 Adequate Allowable Cost Documentation As indicated in the 2022 POFCAP response to Finding 2022-003, and as reiterated herein, POF began to implement additional internal control procedures and practices effective July 1, 2024, to ensure that underlying cost documentation is adequate, reasonable, and complete in accordance with 2 CFR Part 200 Subpart E and other regulatory requirements. More specifically, vendor invoices as of that date and related supporting documents such as weekly meeting reports and sign-in sheets are being scanned and retained electronically. As in 2022, the contact information from the 2023 weekly reports was transmitted to either Wright State University or The Ohio State University for data mining purposes. On July 22, 20224, the POF Board of Directors unanimously adopted the POF Record Retention Policy, as recommended by the auditors. The Board also unanimously adopted a Code of Conduct along with Conflict of Interest, and Whistleblower policies as further evidence of their commitment to instituting policies and procedures designed to strengthen internal controls and comply with federal regulations. Questioned Cost Totaling $19,179 Effective July 1, 2024, POF's new internal control policies, and procedures will eliminate or drastically reduce future discrepancies of this nature.

View Audit 325057 Questioned Costs: $1

Finding 503061 (2023-003)

Significant Deficiency 2023

Breakthrough Charter School

AL

Procurement, Suspension & Debarment Matching / Level of Effort / Earmarking Internal Control / Segregation of Duties

Implementation of plan of action - Management will review control policies to ensure that approvals of purchases are documented prior to disbursement of federal funds. Implementation date - Complete as of June 30, 2024. Persons responsible for the implementation - The Board of Directors and Head o...

Implementation of plan of action - Management will review control policies to ensure that approvals of purchases are documented prior to disbursement of federal funds. Implementation date - Complete as of June 30, 2024. Persons responsible for the implementation - The Board of Directors and Head of School.

View Audit 325032

Finding 503055 (2023-003)

Material Weakness 2023

Village of Leesburg

OH

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

Reporting was corrected through the ODOD

View Audit 325029

Finding 503038 (2023-002)

Significant Deficiency 2023

Family Service Center of Galveston County

TX

Procurement, Suspension & Debarment Allowable Costs / Cost Principles Internal Control / Segregation of Duties

Family Service Center will thoroughly test all calculations in forms to verify the accuracy. Lock formulas feature will be utilized in excel based forms to ensure the formulas are not inadvertently changed.

View Audit 325016

Finding 503037 (2023-001)

Significant Deficiency 2023

Family Service Center of Galveston County

TX

Reporting Internal Control / Segregation of Duties Subrecipient Monitoring

Family Service Center recognizes the important of a complete and accurate SEFA. Family Service Center will thoroughly review all federal and state award contracts to insure accurate and correct CFDA numbers are recorded properly on the SEFA

View Audit 325016

Finding 503035 (2023-008)

Material Weakness 2023

County of Orangeburg

SC

Internal Control / Segregation of Duties Allowable Costs / Cost Principles Eligibility

The County is in the process of hiring a Grants Administrator who will be responsible for the allowable cost compliance requirement of State and Local Fiscal Recovery (SLFRF). The Grants Administrator, along with the Chief Financial Officer and Financial Services Division Director will review and up...

The County is in the process of hiring a Grants Administrator who will be responsible for the allowable cost compliance requirement of State and Local Fiscal Recovery (SLFRF). The Grants Administrator, along with the Chief Financial Officer and Financial Services Division Director will review and update the policies and procedures to ensure all internal controls are being followed in order to be compliant with the Uniform Guidance and SLFRF Program.

View Audit 325007

Finding 502973 (2023-001)

Significant Deficiency 2023

Grace House INC

MS

Subrecipient Monitoring Cash Management Material Weakness

Views of Responsible Officials and Planned Corrective Action – Grace House has created and will implement the following new controls: a) Every reimbursement request made by any employee will require approval from the Executive Director, Assistant Director, or board of directors vote where appropriat...

Views of Responsible Officials and Planned Corrective Action – Grace House has created and will implement the following new controls: a) Every reimbursement request made by any employee will require approval from the Executive Director, Assistant Director, or board of directors vote where appropriate. b) For rental invoices, the immediate supervisor must approve all rental invoices for payment processing before being submitted to the administrative office. If the immediate supervisor is absent, the invoice must be approved by the Executive Director or Assistant Director. c) When a new client invoice is submitted for approval for an existing approved landlord, the invoice along with the traditional client identifying information will be reviewed by both the immediate supervisor and the Executive Director.d) When a new client invoice is submitted for approval for a new landlord, the invoice will be reviewed by both the immediate supervisor and the Executive Director. Each invoice requires a W9 form to validate the legal name, property records verifying ownership matching the legal name on the W9, a picture ID of the individual listed on the W9, and a copy of the agreement if a property management company is listed on the W9 instead of an individual. e) All new clients and landlords will be researched through an investigative software to prove there is no evidence of false identity. f) Grace House has contracted an independent certified fraud investigator to conduct periodic reviews for compliance with fraud prevention policies at least semiannually but beginning quarterly through 2025

View Audit 324929

Finding 502958 (2023-004)

Material Weakness 2023

Campbell County

WY

Internal Control / Segregation of Duties Reporting

Internal Controls Over the Bank Account Reconciliation of the General County Condition/Cause/Context: The County did not reconcile the operating account during the year under audit. This was discovered during audit procedures when County personnel were unable to provide a bank reconciliation that a...

Internal Controls Over the Bank Account Reconciliation of the General County Condition/Cause/Context: The County did not reconcile the operating account during the year under audit. This was discovered during audit procedures when County personnel were unable to provide a bank reconciliation that agreed to their accounting records. According to our auditors, the breakdown in internal controls resulted from both lack of oversight and lack of knowledge. The employee tasked with reconciling the bank accounts was not aware of the importance of the task and was not held accountable for completing it. The breakdown of internal controls allowed the County to operate for the entire fiscal year under audit without once reconciling the main operating account of the County Treasurer. The County does have an internal control policy in place requiring the monthly reconciliation of all bank accounts. However, the policy was not followed during the fiscal year under audit. Views of Responsible Officials and Planned Corrective Action: The Campbell County Board of Commissioners will request from the Treasurer’s Office a presentation of monthly reconciliation on all County bank accounts, including supporting documentation, to the Board as evidence of completion, approval, and enforcement of accountability. Internal controls and written policies and procedures over monthly bank reconciliation preparation and bank account maintenance will be significantly strengthened and expanded to include a multi-layer monitoring and review process to ensure timely and accurate reconciliations, consistent with the underlying accounting records within the Tyler Technologies financial management system utilized by the county. The following individuals can be contacted for further information: Treasurer’s Office: Rachael Knust, County Treasurer and Darcy Goni, Accounting Manager Commissioner’s Office: Shelly Edwards, Chief Finance Executive and Sandra Beeman, Administrative Director

View Audit 324926

Finding 502955 (2023-005)

Significant Deficiency 2023

Urban League of Metropolitan Seattle

WA

Allowable Costs / Cost Principles Eligibility Significant Deficiency

Finding Number 2023-005 Contact Person(s): Mansour Camara, CFO, Carmelle Palomino, Controller Corrective Action Planned: Management reviewed the document retention policy with all program managers and directors and IT created online files for each department to retain program documents as per the ...

Finding Number 2023-005 Contact Person(s): Mansour Camara, CFO, Carmelle Palomino, Controller Corrective Action Planned: Management reviewed the document retention policy with all program managers and directors and IT created online files for each department to retain program documents as per the policy. Management will conduct implementation audits for each department. Anticipated Completion Date: Date completed 10/31/2024

View Audit 324915

Finding 502918 (2023-001)

Significant Deficiency 2023

El Ada INC

ID

Internal Control / Segregation of Duties Reporting

The Organization has already made personnel changes in key accounting positions andis currently in the process of updating accounting software. With these changes theentity expects to add an additional layer of review and oversight in the accounting functionto help ensure compliance with grant requi...

The Organization has already made personnel changes in key accounting positions andis currently in the process of updating accounting software. With these changes theentity expects to add an additional layer of review and oversight in the accounting functionto help ensure compliance with grant requirements. The entity further expects to havegrant reporting information more readily available.

View Audit 324906

Finding 502901 (2023-002)

Significant Deficiency 2023

Reset to Success Foundation, Inc.

IL

Cash Management Reporting Internal Control / Segregation of Duties

We will engage with an outside consultant/independent CPA firm to review and manage the internal control process. This corrective action will be implemented by December 31, 2024 by the Administrator and Board.

View Audit 324851

Finding 502748 (2023-003)

Significant Deficiency 2023

Butler County Health Center

MO

Reporting Equipment & Real Property Management Internal Control / Segregation of Duties

CORRECTIVE ACTION PLAN The Center will implement procedures requiring a monthly reconciliation of the vaccine received, vaccine expenditures incurred, and vaccine inventory amount held by the Center. Contact Person: Emily Goodin, Administrator

View Audit 324818

Finding 502738 (2023-007)

Significant Deficiency 2023

Martin University

IN

Questioned Costs Eligibility Significant Deficiency § 200.303

United States Department of Education 2023-007 Student Financial Aid Cluster – Assistance Listing No. 84.063 Condition: Students were disbursed Pell funds inaccurately. Auditors’ Recommendation: We recommend the University implement policies to review all student award packages at the start of the ...

United States Department of Education 2023-007 Student Financial Aid Cluster – Assistance Listing No. 84.063 Condition: Students were disbursed Pell funds inaccurately. Auditors’ Recommendation: We recommend the University implement policies to review all student award packages at the start of the academic year to ensure no over and under awards exist. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: Summer 2023 Martin University’s main power source was struck by lightning. This caused all Summer processing, that had not yet been backed up on our servers, to be deleted from the system. All transactions that took place at that time had to be manually re-entered. During that manual process, there appears to be a human error in inputting the dates. SIS dates will be corrected to original and actual COD disbursement dates. Name(s) of the contact person(s) responsible for corrective action: Qiana Hall, Associate VP of Enrollment Services Planned completion date for corrective action plan: November 30, 2024

View Audit 324814 Questioned Costs: $1

Finding 502724 (2023-008)

Significant Deficiency 2023

Martin University

IN

Special Tests & Provisions Student Financial Aid Subrecipient Monitoring § 200.303

United States Department of Education 2023-008 Student Financial Aid Cluster – Assistance Listing No. 84.007, 84.033, 84.063, 84.268 Condition: Under an institution’s Program Participation Agreement with the Department of Education and the Gramm-Leach-Bliley Act, schools must protect student financ...

United States Department of Education 2023-008 Student Financial Aid Cluster – Assistance Listing No. 84.007, 84.033, 84.063, 84.268 Condition: Under an institution’s Program Participation Agreement with the Department of Education and the Gramm-Leach-Bliley Act, schools must protect student financial aid information, with particular attention to information provided to institutions by the Department or otherwise obtained in support of the administration of the federal student financial aid programs. Auditors’ Recommendation: We recommend the University engage a third party or perform the risk assessment for the two areas required by the Gramm-Leach-Bliley Act that have not been completed and documented and ensure that there are documented safeguards for identified risks. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: The University has implemented a new SIS and Financial Aid processing system. The new systems are Jenzebar products and are fully compliant. Name(s) of the contact person(s) responsible for corrective action: Qiana Hall, Associate VP of Enrollment Services Planned completion date for corrective action plan: June 30, 2024

View Audit 324814

Finding 502721 (2023-004)

Significant Deficiency 2023

Martin University

IN

Student Financial Aid Significant Deficiency Matching / Level of Effort / Earmarking § 200.303

United States Department of Education 2023-004 Student Financial Aid Cluster – Assistance Listing No. 84.007, 84.033, 84.063, 84.268 Condition: Student checks related to student refunds of Title IV federal financial aid was outstanding more than 240 days as of June 30, 2023. Auditors’ Recommendatio...

United States Department of Education 2023-004 Student Financial Aid Cluster – Assistance Listing No. 84.007, 84.033, 84.063, 84.268 Condition: Student checks related to student refunds of Title IV federal financial aid was outstanding more than 240 days as of June 30, 2023. Auditors’ Recommendation: We recommend that the University review its procedures related to outstanding student refund checks to ensure they are being returned to the Department of Education after 240 days. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: The University engaged an external consultant in June 2023, hired a new staff accountant in September 2023 and a CFO in November 2023. The University is implementing financial internal controls policies and processes to improve the financial statements preparation and preparation of the schedule of expenditures and federal awards and ensure compliance with the DOE. This includes procedures related to outstanding student refund checks over 240 days. Name(s) of the contact person(s) responsible for corrective action: E. ZeNai Savage, CPA, CFO and Executive VP of Finance and Administration

View Audit 324814

Finding 502720 (2023-003)

Significant Deficiency 2023

Martin University

IN

Internal Control / Segregation of Duties Student Financial Aid Reporting § 200.303

United States Department of Education 2023-003 Student Financial Aid Cluster – Assistance Listing No. 84.007, 84.033, 84.063, 84.268 Condition: The University submitted inaccurate data in its annual FISAP report. Auditors’ Recommendation: We recommend the applicable campus revise procedures to ens...

United States Department of Education 2023-003 Student Financial Aid Cluster – Assistance Listing No. 84.007, 84.033, 84.063, 84.268 Condition: The University submitted inaccurate data in its annual FISAP report. Auditors’ Recommendation: We recommend the applicable campus revise procedures to ensure that the record retention requirements are met and supporting documentation agrees to the FISAP, including a supervisory review by someone other than the preparer. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: The Unduplicated Recipients for Ungrad/Dependent with salary range of $1000,000 and over was reported as one but should have been two. Completed FISAP reports are sent to the CFO for additional review prior to submission. Name(s) of the contact person(s) responsible for corrective action: Qiana Hall, Associate VP of Enrollment Services Planned completion date for corrective action plan: June 30, 2024

View Audit 324814

Finding 502719 (2023-002)

Material Weakness 2023

Martin University

IN

Internal Control / Segregation of Duties Material Weakness Reporting

MATERIAL WEAKNESS 2023-002 Segregation of Duties and Control Documentation Recommendation: The University should evaluate their financial reporting processes and controls, including the segregation of duties among its internal staff (including number of internal staff), to determine whether addition...

MATERIAL WEAKNESS 2023-002 Segregation of Duties and Control Documentation Recommendation: The University should evaluate their financial reporting processes and controls, including the segregation of duties among its internal staff (including number of internal staff), to determine whether additional processes and controls over the financial records of the University are complete, accurate, and retained to support the University’s financial statement prepared in accordance with U.S. GAAP. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: The University engaged an external consultant in June 2023, hired a new staff accountant in September 2023 and a CFO in November 2023. The University has begun to restructure all accounting and reconciliation functions, including implementation of new accounting software. The University is implementing financial internal controls to improve the financial statements preparation and preparation of the schedule of expenditures and federal awards. Name of the contact person responsible for corrective action: E. ZeNai Savage, CPA, CFO and Executive VP of Finance and Administration Planned completion date for corrective action plan: June 30, 2024

View Audit 324814

Finding 502718 (2023-001)

Material Weakness 2023

Martin University

IN

Material Weakness Reporting Internal Control / Segregation of Duties

MATERIAL WEAKNESS 2023-001 Financial Statement Preparation Recommendation: We recommend that management review controls related to financial statement preparation review at the end of each period. Financial statement preparation should include a review of reconciliations and balances to ensure that ...

MATERIAL WEAKNESS 2023-001 Financial Statement Preparation Recommendation: We recommend that management review controls related to financial statement preparation review at the end of each period. Financial statement preparation should include a review of reconciliations and balances to ensure that financial statement line items are properly stated and classified. Internally prepared financial statements should also be thoroughly reviewed by members of the board and management outside the finance department on a periodic (monthly or quarterly). Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: The University engaged an external consultant in June 2023, hired a new staff accountant in September 2023 and a CFO in November 2023. The University has begun to restructure all accounting and reconciliation functions, including implementation of new accounting software. The University is implementing financial internal controls to improve the financial statements preparation and preparation of the schedule of expenditures and federal awards. Name of the contact person responsible for corrective action: E. ZeNai Savage, CPA, CFO and Executive VP of Finance and Administration Planned completion date for corrective action plan: June 30, 2024

View Audit 324814

Finding 502706 (2023-006)

Material Weakness 2023

Grady County

OK

Procurement, Suspension & Debarment Subrecipient Monitoring Internal Control / Segregation of Duties

We will work to implement a risk assessment plan. We will implement controls to help make sure we comply with grant requirements and that federal funds are expended in accordance with grant agreements and in a timely manner. We will ensure employees have the current and correct compliance supplement...

We will work to implement a risk assessment plan. We will implement controls to help make sure we comply with grant requirements and that federal funds are expended in accordance with grant agreements and in a timely manner. We will ensure employees have the current and correct compliance supplement to work from.

View Audit 324754

Finding 502700 (2023-002)

Significant Deficiency 2023

Housing Authority of the City of Annapolis

MD

HUD Housing Programs Reporting Significant Deficiency § 200.512

Finding 2023-002 Late Submission of Financial Statements to FAC and REAC (Significant Deficiency) Recommendation: The Authority should review and enhance its policies, procedures, and internal controls to ensure the financial reporting package and audited financial statements are submitted by the re...

Finding 2023-002 Late Submission of Financial Statements to FAC and REAC (Significant Deficiency) Recommendation: The Authority should review and enhance its policies, procedures, and internal controls to ensure the financial reporting package and audited financial statements are submitted by the required due date. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: The Authority will evaluate its’ financial reporting and close processes and controls to determine whether additional controls over the preparation of the final trial balances and related schedules should be implemented. As part of this process, we will create a yearend checklist with deadlines established, and set up status meetings to monitor the progress. Name(s) of the contact person(s) responsible for corrective action: Cia Cook, Deputy Executive Director & CFO Planned completion date for corrective action plan: August 31, 2024

View Audit 324736

Finding 502674 (2023-003)

Material Weakness 2023

City of Homer, Alaska

AK

Subrecipient Monitoring Material Weakness Reporting § 200.512

Finding 2023-003 Deadline for Federal Single Audit – Reporting – Noncompliance and Material Weakness in Internal Control over Compliance Planned Corrective Actions: The Finance Department is continuing its efforts in establishing and enforcing internal deadlines to ensure the financial statements ar...

Finding 2023-003 Deadline for Federal Single Audit – Reporting – Noncompliance and Material Weakness in Internal Control over Compliance Planned Corrective Actions: The Finance Department is continuing its efforts in establishing and enforcing internal deadlines to ensure the financial statements are audited within the appropriate reporting deadlines. The department has shifted staff duties to ensure the FY24 financial statements will be completed within the appropriate reporting deadlines. Individual(s) Responsible for Corrective Action Plan Elizabeth Fischer (Finance Director) Jenna deLumeau (Controller) Anticipated Completion Date: The department has developed internal deadlines to ensure the FY24 financial statements will be completed within the appropriate reporting deadlines. This has been completed.

View Audit 324691

Finding 502669 (2023-002)

Material Weakness 2023

Centerville Community School District

IA

Internal Control / Segregation of Duties

The District continues to have a limited number of office employees. The District will attempt, with advice from the auditors, to segregate duties as much as reasonably possible with limited office personnel

View Audit 324687

Finding 502634 (2023-008)

Significant Deficiency 2023

Promise Healthcare Nfp

IL

Questioned Costs Allowable Costs / Cost Principles Cash Management § 200.403

Action taken in response to finding: 1. Create a standard procedure for tracking grant expenses: Completed 2. Train staff on procedures: Completed 3. Create an independent review process for all grant tracking: In progress Name of the contact person responsible for corrective action: Keith Flores, C...

Action taken in response to finding: 1. Create a standard procedure for tracking grant expenses: Completed 2. Train staff on procedures: Completed 3. Create an independent review process for all grant tracking: In progress Name of the contact person responsible for corrective action: Keith Flores, CFO Planned completion date for corrective action plan: End of 2024

View Audit 324609 Questioned Costs: $1

Corrective Action Plans

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