Corrective Action Plans

Finding 398432 (2023-005)

Significant Deficiency 2023

Women's Foundation for the State of Arizona

AZ

Reporting Internal Control / Segregation of Duties

The Foundation will work to have the staffed CEO review and sign off on all reports and payroll registers in general with a specific focus on those tied to government grants.

View Audit 307125

Finding 398419 (2023-001)

Material Weakness 2023

Metro Towers, Inc. St. James Place

MO

HUD Housing Programs Questioned Costs Special Tests & Provisions

CORRECTIVE ACTION PLAN FOR THE YEAR ENDED DECEMBER 31, 2023 Title 2, U.S. Code of Federal Regulations Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (Uniform Guidance), Subpart F, Section 511 – Audit Findings Follow-up requires the auditee t...

CORRECTIVE ACTION PLAN FOR THE YEAR ENDED DECEMBER 31, 2023 Title 2, U.S. Code of Federal Regulations Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (Uniform Guidance), Subpart F, Section 511 – Audit Findings Follow-up requires the auditee to prepare a corrective action plan to address each audit finding included in the current year auditor’s reports. The Corrective Action Plan for Current Year Findings present our corrective action plan for the Financial Statement and/or Federal Award Findings described in the accompanying Schedule of Findings and Questioned Costs for the period ended December 31, 2023. Finding 2023-001 Responsible Party Name: Fred Gibbs Position: President – Management Agent Telephone Number: 913-709-1811 Federal Agency U.S. Department of Housing and Urban Development Federal Program Mortgage Insurance for Purchase or Refinancing of Existing Multifamily Rental Housing (Section 207/223(F)) Compliance Requirements N – Special Tests and Provisions Finding Type Financial Statement and Federal Awards Auditee’s Comment on Finding We agree with the auditor’s finding. Corrective Action We will follow our policies and procedures to ensure that accounting records are kept accurate and complete, and a responsible official will review and sign off on the monthly financial statements. Anticipated Completion Date June 30, 2024

View Audit 307115

Finding 398413 (2023-001)

Significant Deficiency 2023

Wahkiakum School District No. 200

WA

Subrecipient Monitoring Allowable Costs / Cost Principles Internal Control / Segregation of Duties

CORRECTIVE ACTION PLAN FOR FINDINGS REPORTED UNDER UNIFORM GUIDANCE Wahkiakum School District No. 200 September 1, 2022 through August 31, 2023 This schedule presents the corrective action the District is planning to take for findings included in this report in accordance with Title 2 U.S. Code o...

CORRECTIVE ACTION PLAN FOR FINDINGS REPORTED UNDER UNIFORM GUIDANCE Wahkiakum School District No. 200 September 1, 2022 through August 31, 2023 This schedule presents the corrective action the District is planning to take for findings included in this report in accordance with Title 2 U.S. Code of Federal Regulations (CFR) Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (Uniform Guidance). Finding ref number: 2023-001 Finding caption: The District did not have adequate controls for ensuring compliance with federal requirements for allowable costs and cost principles Name, address, and telephone of District contact person: Sue Ellyson, Business Manager P.O. Box 398 Cathlamet, WA 98612 (360) 795-3971 Corrective action the auditee plans to take in response to the finding: The District will be more prompt in requesting refunds. Anticipated date to complete the corrective action: The refund was requested 3/1/24 and received 3/15/24.

View Audit 307112 Questioned Costs: $1

Finding 398402 (2023-001)

Material Weakness 2023

South Kitsap School District No. 402

WA

Subrecipient Monitoring Internal Control / Segregation of Duties Special Tests & Provisions

Finding ref number: 2023-001 Finding caption: The District did not have adequate internal controls for ensuring compliance with federal wage rate requirements. Name, address, and telephone of District contact person: Andrea Cooper 2689 Hoover Ave SE Port Orchard, WA 98366 360-874-7015 Corrective...

Finding ref number: 2023-001 Finding caption: The District did not have adequate internal controls for ensuring compliance with federal wage rate requirements. Name, address, and telephone of District contact person: Andrea Cooper 2689 Hoover Ave SE Port Orchard, WA 98366 360-874-7015 Corrective action the auditee plans to take in response to the finding: The District was compliant with federal wage rates and will ensure that all public works projects funded with federal funds have appropriate contract language included in order to comply with all federal wage rate requirements. Anticipated date to complete the corrective action: Immediately.

View Audit 307099

Finding 398348 (2023-001)

Significant Deficiency 2023

Chicago Horticultural Society

IL

Internal Control / Segregation of Duties Questioned Costs Cash Management § 200.303

Finding Number: 2023-001 Condition: Two reimbursement requests submitted during 2023 did not have documentation available to indicate that the reimbursement request was reviewed by a supervisor for accuracy before submission. Planned Corrective Action: Staff turnover in early 2023 resulted in a temp...

Finding Number: 2023-001 Condition: Two reimbursement requests submitted during 2023 did not have documentation available to indicate that the reimbursement request was reviewed by a supervisor for accuracy before submission. Planned Corrective Action: Staff turnover in early 2023 resulted in a temporary lapse of documentation proving that the internal control process was followed. The Society follows its internal review process and is maintaining documentation that appropriate approvals are in place. Contact person responsible for corrective action: Dharshni Sabapathy, Senior Director of Accounting Anticipated Completion Date: April 25, 2024

View Audit 307016

Finding 398342 (2023-001)

Material Weakness 2023

St Croix Valley Supportive Housing for the Elderly, Inc.

WI

Questioned Costs HUD Housing Programs Material Weakness

Section 202 Capital Advance – Assistance Listing No. 14.157 Recommendation: Accounting staff should reconcile the Replacement Reserve account on a periodic (monthly or quarterly) basis to ensure the monthly transfers are being made. Management should also make the deposit to fully fund the replaceme...

Section 202 Capital Advance – Assistance Listing No. 14.157 Recommendation: Accounting staff should reconcile the Replacement Reserve account on a periodic (monthly or quarterly) basis to ensure the monthly transfers are being made. Management should also make the deposit to fully fund the replacement reserve as soon as possible. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: Management is in agreement with the finding and has since corrected the issue. Name(s) of the contact person(s) responsible for corrective action: Chuck Armstrong, Director Independent & Affordable Living Planned completion date for corrective action plan: September 30, 2023

View Audit 307011 Questioned Costs: $1

Finding 398335 (2023-002)

Significant Deficiency 2023

Texarkana Arkansas School District

AR

Internal Control / Segregation of Duties Reporting

The District will contact DESE to determine if further steps are needed. The Assistant Superintendent of Student Services will facilitate this action.

View Audit 307003

Finding 398333 (2023-001)

Material Weakness 2023

Texarkana Arkansas School District

AR

Internal Control / Segregation of Duties Special Tests & Provisions Matching / Level of Effort / Earmarking

The District has made several attempts to secure weekly certified payrolls for construction projects on-going since July 2023 once notified of this deficiency for the 2022-2023 audit. We will continue to request certified payrolls for the months prior to April 2024 and will request the payroll info...

The District has made several attempts to secure weekly certified payrolls for construction projects on-going since July 2023 once notified of this deficiency for the 2022-2023 audit. We will continue to request certified payrolls for the months prior to April 2024 and will request the payroll information for current and future construction projects from this point forward. Documentation of attempts to collect the information will be maintained. This will be monitored by the Comptroller and Business Manager for the District.

View Audit 307003

Finding 398321 (2023-004)

Material Weakness 2023

Fremont County School District No. 14

WY

Questioned Costs Internal Control / Segregation of Duties

CORRECTIVE ACTION - FINDING 2023-004 - SEGREGATION OF DUTIES Anticipated Date of Completion: June 1, 2024 Name of Contact Person: Robin Vail, Business Manager Management Response: Management acknowledges the repeated finding concerning the segregation of duties within the accounting and bookkeeping ...

CORRECTIVE ACTION - FINDING 2023-004 - SEGREGATION OF DUTIES Anticipated Date of Completion: June 1, 2024 Name of Contact Person: Robin Vail, Business Manager Management Response: Management acknowledges the repeated finding concerning the segregation of duties within the accounting and bookkeeping functions at the beginning of the audit period. We recognize the importance of segregating these duties to safeguard assets and ensure the accuracy of financial information. While we faced limitations in resources during that period, we have since hired additional staff to mitigate this risk. Moving forward, we remain committed to maintaining an appropriate segregation of duties to strengthen internal controls and mitigate potential risks.

View Audit 306985

Finding 398271 (2023-001)

Material Weakness 2023

Hope Family Health Services, Inc.

TN

Special Tests & Provisions Questioned Costs Internal Control / Segregation of Duties

In Finding 2023-001, it was reported that the Organization did not properly substantiate that proper documentation was obtained and that proper sliding fee discounts were applied for certain patients for the year ended December 31, 2023. Employees will be properly trained to document and apply the...

In Finding 2023-001, it was reported that the Organization did not properly substantiate that proper documentation was obtained and that proper sliding fee discounts were applied for certain patients for the year ended December 31, 2023. Employees will be properly trained to document and apply the sliding fee discounts in accordance with the Organization’s sliding fee policy. Sliding fee discounts will be reviewed by a supervisor on a periodic basis to ensure compliance with the sliding fee scale. This review and training will be completed by May 31, 2024.

View Audit 306981

Finding 398267 (2023-001)

Significant Deficiency 2023

Mora Valley Community Health Serivces, Inc.

NM

Internal Control / Segregation of Duties Special Tests & Provisions Questioned Costs

MVCHS recognizes that in 2023 income for 4 out of 30 patients was incorrectly entered into the system and the slide was improperly applied. 1. MVCHS will also ensure that required income documents are obtained and that the correct income (s) are applied. MVCHS will also ensure that patients who are ...

MVCHS recognizes that in 2023 income for 4 out of 30 patients was incorrectly entered into the system and the slide was improperly applied. 1. MVCHS will also ensure that required income documents are obtained and that the correct income (s) are applied. MVCHS will also ensure that patients who are unable to provide written verification at the time of their first appointment will complete the self-declaration portion of the SFDP application. 2. MVCHS will provide training to Front Office staff to ensure that income and family size are properly entered into the system and the Slide is properly applied. MVCHS will ensure that proper documentation is collected from patients and that accurate information is entered into the system, even during staff turnover. Finance/Billing staff will ensure oversite of documentation. 3. MVCHS reached out to the New Mexico Primary Care Association and was provided training for the Front Office Staff regarding the Sliding Fee Discount Program process in April 2024.

View Audit 306968

Finding 398260 (2023-002)

Significant Deficiency 2023

West Cocalico Township Authority

PA

Internal Control / Segregation of Duties Significant Deficiency

In response to your audit Findings 2023-001 and 2023-002, I would like to offer the following response: Due to the size of the Authority, it is not feasible at this time to hire additional employees to segregate the financial responsibilities. Management will continue to monitor this situation and s...

In response to your audit Findings 2023-001 and 2023-002, I would like to offer the following response: Due to the size of the Authority, it is not feasible at this time to hire additional employees to segregate the financial responsibilities. Management will continue to monitor this situation and segregate duties as is economically feasible.

View Audit 306956

Finding 398259 (2023-001)

Significant Deficiency 2023

West Cocalico Township Authority

PA

Internal Control / Segregation of Duties Significant Deficiency

In response to your audit Findings 2023-001 and 2023-002, I would like to offer the following response: Due to the size of the Authority, it is not feasible at this time to hire additional employees to segregate the financial responsibilities. Management will continue to monitor this situation and s...

In response to your audit Findings 2023-001 and 2023-002, I would like to offer the following response: Due to the size of the Authority, it is not feasible at this time to hire additional employees to segregate the financial responsibilities. Management will continue to monitor this situation and segregate duties as is economically feasible.

View Audit 306956

Finding 398250 (2023-001)

Significant Deficiency 2023

Rialto Unified School District

CA

Special Tests & Provisions Subrecipient Monitoring Internal Control / Segregation of Duties

The District will revisit the drop protocols with staff to ensure that all required documentation is on file prior to processing drop code in the calpads.

View Audit 306933

Finding 398242 (2023-001)

Material Weakness 2023

White Pass School District No. 303

WA

Subrecipient Monitoring Internal Control / Segregation of Duties Special Tests & Provisions

Finding ref number: 2023-001 Finding caption: The District did not have adequate internal controls for ensuring compliance with federal wage rate requirements. Name, address, and telephone of District contact person: Angela Bowen 516 Silverbrook Rd, Randall, WA 98377 360-497-3791 Corrective action t...

Finding ref number: 2023-001 Finding caption: The District did not have adequate internal controls for ensuring compliance with federal wage rate requirements. Name, address, and telephone of District contact person: Angela Bowen 516 Silverbrook Rd, Randall, WA 98377 360-497-3791 Corrective action the auditee plans to take in response to the finding: The White Pass School District will immediately implement the following controls to assure that the District has adequate internal controls in place for any future expenditures for Capital Projects where federal funds will be used. 1-The District will review the Federal Procurement and contractor requirements prior to submitting applications to use federal funds for Capital Projects. 2- The District will have a meeting with the appropriate staff involved with the project to insure that compliance with the Federal Program Procurement including compliance with the federal wage rate requirements are met. 3- As part of the verification process to ensure adequate internal controls the District will identify who the person will be who will secure and monitor weekly certified payroll from the contractors to stay in compliance with the federal wage rate requirements at the beginning of each project. Anticipated date to complete the corrective action: Effective immediately 5/13/2024

View Audit 306916

Finding 398168 (2023-004)

Significant Deficiency 2023

Wakefield Community School

NE

Subrecipient Monitoring Reporting School Nutrition Programs

The District relies on the auditor to propose adjustments necessary to prepare the schedule of expenditures of federal awards including the related note disclosures. The District reviews schedule of expenditures of federal awards and approves all adjustments.

View Audit 306885

Finding 398104 (2023-001)

Material Weakness 2023

Talbot County, Maryland

MD

Questioned Costs Subrecipient Monitoring Internal Control / Segregation of Duties

First, we created a general ledger account for each bank account, which involved the rewrite of multiple processes, including changes in our software. We then needed to address reconciliation of past banking and general ledger transactions that were recorded using the old processes. To achieve this ...

First, we created a general ledger account for each bank account, which involved the rewrite of multiple processes, including changes in our software. We then needed to address reconciliation of past banking and general ledger transactions that were recorded using the old processes. To achieve this step, we contracted for accounting services with a firm independent of our auditors. This firm is reconciling every cash transaction in our general ledger going back to July l, 2022, to the present day. The third step of our plan involves contracting with this same firm to work with the County and its financial software company to set up our cash management software module so that we may eliminate the manual process by leveraging technology to reconcile our multiple bank accounts on a monthly basis.

View Audit 306847

Finding 398100 (2023-002)

Significant Deficiency 2023

Warren County Housing Authority

IA

Internal Control / Segregation of Duties Special Tests & Provisions Eligibility

Response and Corrective Action Plan The Authority has attempted to segregate accounting duties by having a person who does not initiate, prepare or post disbursements review the bank statements and co-sign all checks. The Authority will continue to monitor its policies and procedures in an effort ...

Response and Corrective Action Plan The Authority has attempted to segregate accounting duties by having a person who does not initiate, prepare or post disbursements review the bank statements and co-sign all checks. The Authority will continue to monitor its policies and procedures in an effort to improve control efficiencies, however, at this time, the Authority has determined that the cost of eliminating the deficiency would exceed its benefit.

View Audit 306825

Finding 398094 (2023-002)

Significant Deficiency 2023

Sioux Falls Regional Airport Authority

SD

Questioned Costs Reporting Significant Deficiency § 200.303 § 200.327 § 200.328

Department of Transportation Airport Improvement Program, CFDA #20.106 AIP3-46-0050-60, AIP3-46-0050-62 Finding Summary: The SF-425 annual report dated September 30, 2023, for award AIP3-46-0050-54 underreported the federal share of expenditures by $80,133, while the FAA Form 5100-127 annual report ...

Department of Transportation Airport Improvement Program, CFDA #20.106 AIP3-46-0050-60, AIP3-46-0050-62 Finding Summary: The SF-425 annual report dated September 30, 2023, for award AIP3-46-0050-54 underreported the federal share of expenditures by $80,133, while the FAA Form 5100-127 annual report dated December 31, 2022, for all awards underreported the externally restricted assets by $397,646 Responsible Individuals: Dan Letellier, Executive Director Corrective Action Plan: Management will ensure correct support documentation is provided to 3rd party account for correct submission of FAA Forms 5100-127. Director will also verify that annual report form SF-425 reconciles to underlying supporting records. Anticipated Completion Date: Ongoing

View Audit 306816

Finding 398065 (2023-002)

Significant Deficiency 2023

Lee County, Florida

FL

Allowable Costs / Cost Principles Questioned Costs Significant Deficiency § 200.302 § 200.303 § 200.403

2023-002 Significant Deficiency in Internal Control over Compliance, Other Matters Recommendation: We recommend the County establish internal control procedures to ensure that all amounts charged to grant programs for employee payroll costs be reconciled to the specific employee payroll records and...

2023-002 Significant Deficiency in Internal Control over Compliance, Other Matters Recommendation: We recommend the County establish internal control procedures to ensure that all amounts charged to grant programs for employee payroll costs be reconciled to the specific employee payroll records and that supporting documentation be maintained throughout the grant award period and beyond. Views of responsible officials: Management concurs with the finding. There were minimal variances in the number of employees tested and the County believes the wage report discrepancies are isolated due to the complexity of the EMS salary structure. The County claimed $26,038,852 of the $37,618,256 total eligible expenses available. Action planned/taken in response to finding: Effective fiscal year 2024, Management will implement the following corrective action: The County will create a process to ensure the payroll wage reports generated by Human Resources agrees to support documentation. Name of the contact person responsible for corrective action plan: Pete Winton Planned completion date for corrective action plan: The above action plan will be implemented in fiscal year 2024.

View Audit 306784 Questioned Costs: $1

Finding 398062 (2023-003)

Material Weakness 2023

Southwestern Wisconsin Community School District

WI

Material Weakness Reporting Internal Control / Segregation of Duties

Finding #2023-003 - Material Adjustments (Prior year finding #2022-003) Condition: Johnson Block and Company, Inc. proposed numerous adjusting journal entries. We deem these entries to be significant in relation to the financial statements. Since the District did not make these adjustments in its a...

Finding #2023-003 - Material Adjustments (Prior year finding #2022-003) Condition: Johnson Block and Company, Inc. proposed numerous adjusting journal entries. We deem these entries to be significant in relation to the financial statements. Since the District did not make these adjustments in its accounting system prior to the audit, a material weakness exists in the District’s internal controls. Effect: This means that the proper recording and reporting of financial information may not occur within a timely manner. Cause: Financial information was not recorded in a timely manner and material adjustments were needed in order to correct various transactions. Criteria: Material adjusting journal entries not prepared by the District before the audit are considered an internal control weakness. Recommendation: Policies and procedures should be implemented to ensure account balances are properly recorded in a timely manner. Response: The District will work to establish policies and procedures to reduce the number of adjusting journal entries proposed by the auditor. Contact Person: John Costello Anticipated Completion: June 30, 2024

View Audit 306776

Finding 398061 (2023-001)

Material Weakness 2023

Southwestern Wisconsin Community School District

WI

Internal Control / Segregation of Duties

Finding #2023-001 - Segregation of Duties (Prior year finding #2022-001) Condition: The limited size of the District’s office staff prevents the ideal separation of functions. The bookkeeper prints accounts payable checks, has access to the password to print electronic signatures and performs ba...

Finding #2023-001 - Segregation of Duties (Prior year finding #2022-001) Condition: The limited size of the District’s office staff prevents the ideal separation of functions. The bookkeeper prints accounts payable checks, has access to the password to print electronic signatures and performs bank reconciliations. The bookkeeper also performed all payroll functions. Effect: Because of the lack of segregation of duties, errors or irregularities could occur and not be detected on a timely basis. Cause: Limited number of personnel. Criteria: Checks and balances should be in place to allow management or employees, in the normal course of performing their assigned functions, to prevent, or detect and correct any misstatements on a timely basis. Recommendation: Procedures should be implemented segregating duties among different employees. Management should continue to maintain a working knowledge of matters relating to the District’s operations. Response: We agree with this 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. The Board reviews and approves all expenditures on a monthly basis prior to mailing accounts payable checks. Contact Person: John Costello Anticipated Completion: Not Applicable

View Audit 306776

Finding 398053 (2023-003)

Significant Deficiency 2023

Kaskaskia Community College District #501

IL

Questioned Costs Student Financial Aid Reporting § 200.303

Action taken in response to finding: will include Institutional Research compiling the data and then sending to Financial Aid/Admissions for review of the enrollment files. The Financial Aid/Admissions department will test a sample of the student enrollment data that it is correct. The Department ...

Action taken in response to finding: will include Institutional Research compiling the data and then sending to Financial Aid/Admissions for review of the enrollment files. The Financial Aid/Admissions department will test a sample of the student enrollment data that it is correct. The Department will maintain evidence of the review and confirm back to Institutional Research the review has been completed. Institutional Research can then submit the enrollment files to the National Student Clearinghouse.

View Audit 306769

Finding 398049 (2023-002)

Significant Deficiency 2023

Kaskaskia Community College District #501

IL

Questioned Costs Procurement, Suspension & Debarment Significant Deficiency § 200.303

Action taken in response to finding: The College started to immediately document the SAM check on every purchase requisition, check request, travel request and new vendor entry with IRS Form W-9. The College is also collecting the certification from vendors as part of the bid process. The College ...

Action taken in response to finding: The College started to immediately document the SAM check on every purchase requisition, check request, travel request and new vendor entry with IRS Form W-9. The College is also collecting the certification from vendors as part of the bid process. The College has also updated the process document for these actions.

View Audit 306769

Finding 398045 (2023-001)

Significant Deficiency 2023

Kaskaskia Community College District #501

IL

Questioned Costs Student Financial Aid Significant Deficiency § 200.303

Action taken in response to finding: Adjustments have been made to reflect the full spring break period in our return of funds process. The number of days campus is considered to be closed for spring break has been updated to nine days for Spring 2024. Spring terms in the future will be set up in C...

Action taken in response to finding: Adjustments have been made to reflect the full spring break period in our return of funds process. The number of days campus is considered to be closed for spring break has been updated to nine days for Spring 2024. Spring terms in the future will be set up in Colleague with the day following the last day of classes prior to spring break as the first day of spring break and the day prior to the first day of classes after spring break as the last day of spring break. For 2023-2024 and 2024-2025, this equates to a nine-day spring break. All R2T4 calculations for Spring 2024 have been reviewed and recalculated using a nine-day spring break rather than a seven-day spring break. In communicating with Ellucian regarding the processing of R2T4, we discovered a report that we can run in Colleague to identify students that have withdrawn from all courses and will not complete any courses for the semester. This will be used instead of the report made in house, previously utilized for this process. A financial aid staff member will run the report and perform the R2T4 calculations in Colleague. Then the staff member that performed the calculations will run the Return of Funds Detail Report in Colleague, indicate on that report that they performed the calculations, and send the report to the Director of Financial Aid. The Director will review the Return of Funds Detail Report and the calculations. The Director will sign off on the Return of Funds Detail Report approving the calculations. The report will then be saved in the Return of Funds folder in the Financial Aid Files. All Financial Aid staff members will be trained and have the ability to perform R2T4 calculations to ensure that the calculations can be performed regularly prior to each student refund date during the term. All R2T4 calculations for the 2023-2024 school year have been reviewed for accuracy. Calculations performed for the fall 2023 semester have been reviewed by the Director of Financial Aid for accuracy. Due to short staffing in the Financial Aid Office in the spring semester, and remaining staff not being trained on the R2T4 process, calculations for the Spring 2024 semester were performed by the Director of Financial Aid. To ensure the accuracy of the calculations, the calculations were checked using the R2T4 calculation tool in COD (Common Origination Disbursement).

View Audit 306769

Corrective Action Plans

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