Corrective Action Plans

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Finding Number: 2024-001: Allowable Costs – 2 out of the 38 samples tested included charges that were either unsupported or refunded back to the Organization and not corrected to return those funds to the grantor. Planned Corrective Action: The Turning Point has updated policies that include a proce...
Finding Number: 2024-001: Allowable Costs – 2 out of the 38 samples tested included charges that were either unsupported or refunded back to the Organization and not corrected to return those funds to the grantor. Planned Corrective Action: The Turning Point has updated policies that include a process for managing refunds and crediting them back to grants. We also updated our Expense Reimbursement and Credit Card policies in 2024 to simplify our payment process which includes both the Finance Director and Executive Director checking all expenses have the proper documentation prior to paying the statements/invoices and submitting to payors (funders) for reimbursement. Completion Date: June 1, 2025 Responsible Contact Person: Tana Rice, Director of Finance
Finding 569045 (2024-001)
Significant Deficiency 2024
Management will establish a more robust month-end close process, that should result in a more timely report submission. Management will review the donor reporting requirements and engage in discussion with the donor.
Management will establish a more robust month-end close process, that should result in a more timely report submission. Management will review the donor reporting requirements and engage in discussion with the donor.
Condition: The Board could not provide a copy, with supporting documentation, of the annual required information submission to the Alabama Department of Education for the federal program. Planned Corrective Action: The Board will keep a copy of all annual required federal programs submission and sup...
Condition: The Board could not provide a copy, with supporting documentation, of the annual required information submission to the Alabama Department of Education for the federal program. Planned Corrective Action: The Board will keep a copy of all annual required federal programs submission and supporting documentation to the Alabama State Department of Education. Anticipated Completion Date: Effective immediately Point of Contact: Gwendolyn Rogers
Condition: Construction contracts for three federally funded projects did not include the required prevailing wage rate clauses. Monitoring for compliance with the prevailing wage requirements was not performed by the Board. Planned Corrective Action: Going forward, all federally funded construction...
Condition: Construction contracts for three federally funded projects did not include the required prevailing wage rate clauses. Monitoring for compliance with the prevailing wage requirements was not performed by the Board. Planned Corrective Action: Going forward, all federally funded construction projects will include the prevailing wage rate clauses. The Board will monitor for compliance with the prevailing wage requirements. Anticipated Completion Date: Effective immediately Point of Contact: Dr. Timothy Thurman
View Audit 360698 Questioned Costs: $1
Finding Number: 2024-001 Title: Inaccessibility of Accounting Records Program Name: N/A ALN: N/A Description: During the performance of the audit the Authority was unable to provide timely access to key accounting records necessary to verify financial transactions and support federal expenditure...
Finding Number: 2024-001 Title: Inaccessibility of Accounting Records Program Name: N/A ALN: N/A Description: During the performance of the audit the Authority was unable to provide timely access to key accounting records necessary to verify financial transactions and support federal expenditures. Requested documentation, including general ledger entries, supporting documentation, federal reimbursement requests and related expenditures were either not provided or significantly delayed beyond the response period. Planned Corrective Action: Today’s Marlboro County Housing Authority management acknowledges the finding and concurs with the auditor’s assessment regarding delays in providing access to key accounting records during the audit period. The Authority recognizes the importance of timely, complete, and well-organized documentation to support financial transactions and federal expenditures. The Authority's current staff did not have access to most of the data necessary to respond to the Auditor's request as the Authority was managed by the Housing Authority of Florence during the current year under audit. The Authority severed ties with the Housing Authority of Florence effective October 1, 2024. Going forward, The Housing Authority will ensure internal controls are in place including policies and procedures regarding financial reporting.
2024-002 – REPORTING Other Matter/Significant Deficiency Auditee’s Response and Planned Corrective Action The Authority hired a new Executive Director in November 2023. Under new management, the year-end financial statements will be prepared and submitted timely and formalized guidelines for fina...
2024-002 – REPORTING Other Matter/Significant Deficiency Auditee’s Response and Planned Corrective Action The Authority hired a new Executive Director in November 2023. Under new management, the year-end financial statements will be prepared and submitted timely and formalized guidelines for financial reporting will be created. New controls over financial close process will ensure more accurate financial reporting prior to the audit. Planned Implementation Date of Corrective Action: Immediately Person Responsible for Corrective Action: Kayla Potter, Executive Director
The Management of the Authority agrees with the findings; we will implement improved internal controls to ensure that all annual recertifications are performed in a timely manner and that all required documents are kept in an organized manner. The Authority hired a Compliance Specialist in May 2025...
The Management of the Authority agrees with the findings; we will implement improved internal controls to ensure that all annual recertifications are performed in a timely manner and that all required documents are kept in an organized manner. The Authority hired a Compliance Specialist in May 2025 to perform quality control checks on the files to eliminate errors. The HCV Program Director is the responsible party, and controls will be in place by the end of the September 30, 2025 fiscal year.
The Management of the Authority agrees with the findings; we will implement improved internal controls to ensure that all annual recertifications are performed in a timely manner and that all required documents are kept in an organized manner. The Authority hired a Compliance Specialist in May 2025...
The Management of the Authority agrees with the findings; we will implement improved internal controls to ensure that all annual recertifications are performed in a timely manner and that all required documents are kept in an organized manner. The Authority hired a Compliance Specialist in May 2025 to perform quality control checks on the files to eliminate errors. The Public Housing Director is the responsible party, and controls will be in place by the end of the September 30, 2025 fiscal year.
Planned Implementation Date of Corrective Action: July 2025 Person Responsible for Correctove Action: Krishonna Murray, Executive Director I. 2024-001 Eligibility Rent Calculation Other Matter/Significant Deficiency The Authority had instances of missing income verifcation. Gardner Housing Au...
Planned Implementation Date of Corrective Action: July 2025 Person Responsible for Correctove Action: Krishonna Murray, Executive Director I. 2024-001 Eligibility Rent Calculation Other Matter/Significant Deficiency The Authority had instances of missing income verifcation. Gardner Housing Authority has establised a system of internal control over the participant recertification process that meets HUD's requirements. Seven (7) to ten (10) files will be reviewed fiscally for quality assurance.
Action taken: Management has updated the process to verify that the reporting package, including the Single Audit report, is submitted to the FAC successfully. While management previously certified the reporting package properly, the final step of submission was not properly monitored and verified. ...
Action taken: Management has updated the process to verify that the reporting package, including the Single Audit report, is submitted to the FAC successfully. While management previously certified the reporting package properly, the final step of submission was not properly monitored and verified. Effective immediately, management has implemented a new step requiring the inclusion of a physical screenshot for the final submission to the FAC. This adjustment ensures proper documentation and alignment with compliance requirements. Person responsible: Maria Cardiellos, Executive Director Date completed: March 13, 2025
Finding 2024-004 Federal Grantor: United States Department of Health and Human Services Planned Corrective Actions: Management will improve internal controls to include the documentation and retention of approval on all supply expenditures and the annual fringe benefit analysis. Responsible Offici...
Finding 2024-004 Federal Grantor: United States Department of Health and Human Services Planned Corrective Actions: Management will improve internal controls to include the documentation and retention of approval on all supply expenditures and the annual fringe benefit analysis. Responsible Official – Dawn Ksepka, VP of Finance and System Controller Anticipated completion date –August 2025 Management agrees with the finding. Remediation: The accounting manager reviewed and approved the updated 2025 fringe benefit analysis with 2024 actuals on February 28, 2025. Upon finalization of the 2025 budget, the analysis will be revised and reviewed again. Accounting will collect evidence of review and approval of supply expenditure throughout the year to ensure proper retention of the documentation.
The Company acknowledges the importance of accurately documenting key personnel requirements in support of federal contract compliance. The audit noted one contract with two projects where the individual listed as key personnel did not match the most current contract documentation. However, internal...
The Company acknowledges the importance of accurately documenting key personnel requirements in support of federal contract compliance. The audit noted one contract with two projects where the individual listed as key personnel did not match the most current contract documentation. However, internal “load sheets” and program communications consistently reflected the correct personnel assignments, and there was no impact on contract performance or deliverables. Given the isolated nature of these discrepancies and their lack of effect on program execution or financial reporting, the Company does not consider this matter to be material. Nonetheless, to strengthen internal controls, the Contracts Department now records and maintains all key personnel data directly in Costpoint. Additionally, the Controller performs a quarterly internal review of these records to verify accuracy and completeness. These measures provide added assurance that the Company remains fully compliant with federal award requirements. Director of Contracts/Elena Einstein now oversees this control which was put into place as of April 2025.Notwithstanding these findings, management is confident that the accompanying financial statements present fairly, in all material respects, the Company’s financial position for the fiscal year ended September 30, 2024.
We are aware of the condition and will review procedures to make changes when appropriate and cost effective.
We are aware of the condition and will review procedures to make changes when appropriate and cost effective.
Finding Number: 2024-001 Finding Title: SEGREGATION OF DUTIES Name of Contact Person Responsible for Corrective Action Lucas Heikkila, City Administrator Corrective Action Planned Management will attempt to monitor transactions and structure the duties of office personnel to help ensure as much s...
Finding Number: 2024-001 Finding Title: SEGREGATION OF DUTIES Name of Contact Person Responsible for Corrective Action Lucas Heikkila, City Administrator Corrective Action Planned Management will attempt to monitor transactions and structure the duties of office personnel to help ensure as much segregation of duties as possible within the City’s staffing limitations and funding constraints. Anticipated Completion Date Ongoing.
Corrective Action Plan Details Finding Number: 2024-002 Program: Disaster Grants - Public Assistance (Presidentially Declared Disasters) Assistance Listing Number 97.036 Federal Emergency Management Agency Passed through Mississippi Emergency Management Agency Responsible Official: Adam Moor...
Corrective Action Plan Details Finding Number: 2024-002 Program: Disaster Grants - Public Assistance (Presidentially Declared Disasters) Assistance Listing Number 97.036 Federal Emergency Management Agency Passed through Mississippi Emergency Management Agency Responsible Official: Adam Moore, CFO Finding Detail: Expenses reimbursed from other sources and unsupported expenses were not identified. Appropriate calculations of cost formulas were not utilized for medication reimbursement amounts claimed. Corrective Action Planned: Management concurs with the finding and will implement additional internal controls over the identification of eligible expenditures for the Disaster Grants program. Expenditures identified as potential grant program expenditures will be reviewed by the controller, and final approval of each expense by the chief financial officer to ensure they are eligible expenses and have not been reimbursed by any other sources. We anticipate these additional controls to be in place by September 30. 2025. The Chief Development Officer will oversee the corrective action. Anticipated Completion Date: September 2025
View Audit 360576 Questioned Costs: $1
Finding 568845 (2024-005)
Significant Deficiency 2024
Finding: 2024-005 – Reporting Auditor Description of Condition and Effect: The County has not performed all of the required Coronavirus State and Local Fiscal Recovery Funds expenditure reporting. Specifically, the Project and Expenditure report for the second quarter of 2024 was not filed. However...
Finding: 2024-005 – Reporting Auditor Description of Condition and Effect: The County has not performed all of the required Coronavirus State and Local Fiscal Recovery Funds expenditure reporting. Specifically, the Project and Expenditure report for the second quarter of 2024 was not filed. However, these reports were filed for the first, third and fourth quarters of 2024. As a result of this condition, the County did not comply completely with the reporting requirements of the Coronavirus State and Local Fiscal Recovery Funds grant. Auditor Recommendation: We recommend that the County review the reporting requirements for each grant and complete all reporting as required under the terms of the grant agreement. Corrective Action: Management acknowledges the oversight regarding the 2nd quarter reporting and agrees with the condition as noted. The County will provide a reminder to all grant administrators of the policy. An additional confirmation step is under consideration for verification of completion, at the discretion of County Administration, which would require notification to Financial Services personnel that filing activities have occurred. This oversight process change would require additional resources to complete. Contact Person: Brian Dissette, County Administrator/Controller Estimated Completion Date: December 31, 2025
CHASS management concurs with the audit findings and will put the following corrective action plan in place to mitigate this finding in the future: During the fiscal year, the organization submitted requests for reimbursement of federal grant funds before incurring allowable expenses under the terms...
CHASS management concurs with the audit findings and will put the following corrective action plan in place to mitigate this finding in the future: During the fiscal year, the organization submitted requests for reimbursement of federal grant funds before incurring allowable expenses under the terms of the grant agreement. Moving forward, the new CFO will implement and enforce policies and procedures to ensure that all federal fund requests are supported by documented and allowable expenditures. Staff responsible for grant management will receive training to ensure the organization maintains compliance with all federal funding. All reimbursement requests should be reviewed and approved by the program manager/COO and the new CFO.
Department of Health and Human Services Federal Financial Assistance Listing #93.498 COVID-19 Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution (PRF) Applicable Federal Award Number and Year - Period 6 TIN #205330283 Reporting Material Weakness in Internal Control Over Complia...
Department of Health and Human Services Federal Financial Assistance Listing #93.498 COVID-19 Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution (PRF) Applicable Federal Award Number and Year - Period 6 TIN #205330283 Reporting Material Weakness in Internal Control Over Compliance and Material Noncompliance Finding Summary: Rolette Community Care Center does not have an internal control system to ensure the amounts reported in the HHS Period 6 Special Report agreed to supporting documentation for each of the quarters included. In addition, there was no evidence of review of either the supporting documentation or the HHS Period 6 Special Report by someone other than the preparer. Responsible Individuals: Kathy Morrow, Business Office Manager Corrective Action Plan: Management will ensure that the information contained in the reports agrees to the supporting documentation and both documentation and the reports submitted are reviewed by someone other than the preparer. Anticipated Completion Date: December 31, 2025
Corrective Action Plan: GECAC Finance Department has a Financial and Data Processing System that is followed in regards to posting transactions. GECAC’s Finance department has been challenged due to a shortage of staff since COVID in 2020. As a result, GECAC has experienced a tremendous amount of ...
Corrective Action Plan: GECAC Finance Department has a Financial and Data Processing System that is followed in regards to posting transactions. GECAC’s Finance department has been challenged due to a shortage of staff since COVID in 2020. As a result, GECAC has experienced a tremendous amount of turnover making it extremely difficult to stay on task with all duties. Controls have been implemented to ensure timely record keeping of all fiscal transactions: The Finance department is now fully staffed. When reconciling monthly bank statements, any transactions that are listed as an outstanding item will be researched and the necessary entries will be done to fix the problem so that the item is reconciled before the next month’s statement is issued. When running the monthly balance sheet and revenue/expense statement, any transactions that are incorrect and/or not posted, staff will make the adjusting entry(s) to correct the issue immediately. We currently have a full time Payroll/Fiscal Assistant in place. That staff has implemented a check list to ensure that all payroll transactions are recorded during the correct period. We are currently looking into upgrading our Payroll/HR software system to ensure more efficient processes which will help with time management. We will continue to evaluate and improve the financial processes and procedures as well as work on enhancing and streamlining training for new and existing accounting personnel. Contact Person: Antoinette Nicholson, Vice President of Finance Anticipated Completion Date: September 30, 2025
Audit Report Reference: 2024-003 Program name: Research and Development Completion Date: September 30, 2025 Finding 2024-003 is a repeat finding (2023-001) from fiscal year end September 30, 2023. The Health System implemented change controls and audit of employee permissions per the corrective act...
Audit Report Reference: 2024-003 Program name: Research and Development Completion Date: September 30, 2025 Finding 2024-003 is a repeat finding (2023-001) from fiscal year end September 30, 2023. The Health System implemented change controls and audit of employee permissions per the corrective action plan for 2023-001.The corrective actions for repeat finding 2024-003 addresses documentation of performed controls and training for employees involved in the control activities. Workday Change Review: The HRIS team will continue with a change review audit as they have done in the previous year with a few enhancements to increase auditability. The Sr. HRIS Manager will send official communication to the HRIS team to initiate the end-of-year change review. This email will provide a clear timeline for the audit period with a hard deadline. Once complete, the HR Compliance Manager and/or the Sr. HRIS Manager will issue a written communication to document the completion of the review summary of findings (if any), and corrective actions taken (if applicable). This will remedy the issue of missing approval documentation. The team will also be reeducated around the need to document written approval and testing for changes throughout the year. Workday Security Review: The HRIS team will continue to conduct an audit of security roles and users within Workday to ensure that permissions are updated appropriately. The HRIS Analyst will generate reports for the Sr. HRIS Manager's review, identifying any required changes. The analyst will then make these updates in Workday, followed by a new report for verification. Upon successful verification, the Sr. HRIS Manager will send a formal written communication of the approved changes. Workday Terminations: To address the access provisioning deficiency as it relates to terminating employees, the management team will be re-trained in the importance of adhering to timely terminations of employees in Workday. Person Responsible: Ashley Cesarano - HR Compliance and Workplace Accommodations Manager; Karen Alvarado – Senior Manager HRIS E-mail address: Ashley.Cesarano@bmc.org; Karen.Alvarado@bmc.org
Person(s) responsible for corrective action: Todd Bolster, Director of Administration and Dietrich Schmitt, Grants Program Manager. Management’s Response/Corrective Action Plan: For this tribal pass-through program, narrative, non-financial progress reports are collected from tribes, reviewed and...
Person(s) responsible for corrective action: Todd Bolster, Director of Administration and Dietrich Schmitt, Grants Program Manager. Management’s Response/Corrective Action Plan: For this tribal pass-through program, narrative, non-financial progress reports are collected from tribes, reviewed and approved by the NWIFC Grants Program Manager and submitted to PSFMC. Effective immediately, the NWIFC grants program manager will increase internal controls by including documentation of internal review and approval prior to progress reports being submitted to PSMFC. Anticipated completion date: July 2025.
Finding 2024-002 Condition: During the auditors’ walkthroughs of the cash draw process, the Organization indicated that there is a lack of evidence supporting preparation and review of federal drawdowns. Corrective action plan: Management agrees with the recommendation and will establish a written ...
Finding 2024-002 Condition: During the auditors’ walkthroughs of the cash draw process, the Organization indicated that there is a lack of evidence supporting preparation and review of federal drawdowns. Corrective action plan: Management agrees with the recommendation and will establish a written policy and implement a documented process for the preparation and review of federal drawdowns, including clear evidence of review such as signoffs or electronic approvals. Responsible Individual: Andres Chavarro, Finance Manager Planned Completion date: 07/01/2025
The Division will enhance controls to ensure timely submission of reports and that there is segregation of duties between the report preparer and reviewer. Reports will be reviewed prior to submission and the review and submission of reports to granting agencies will be documented. A schedule of re...
The Division will enhance controls to ensure timely submission of reports and that there is segregation of duties between the report preparer and reviewer. Reports will be reviewed prior to submission and the review and submission of reports to granting agencies will be documented. A schedule of reports will be added to the TSAMM during the review and approval of new contracts. We will also work with our funders to extend reporting due dates. Anticipated Completion Date: 12/31/25. Responsible Contact Person: Yohannes Gedlu, NW Divisional Finance Director & Julie Luft, NW Social Services Director
The Division will ensure evidence of review is maintained for the inventory worksheets. This was also reviewed during the NW Division’s Social Service conference in April 2025. Anticipated Completion Date: 10/1/25. Responsible Contact Person: Julie Luft, NW Social Services Director
The Division will ensure evidence of review is maintained for the inventory worksheets. This was also reviewed during the NW Division’s Social Service conference in April 2025. Anticipated Completion Date: 10/1/25. Responsible Contact Person: Julie Luft, NW Social Services Director
The Division will enhance controls to ensure timely submission of reports and that there is segregation of duties between the report preparer and reviewer. Reports will be reviewed prior to submission and the review and submission of reports to granting agencies will be documented. A schedule of re...
The Division will enhance controls to ensure timely submission of reports and that there is segregation of duties between the report preparer and reviewer. Reports will be reviewed prior to submission and the review and submission of reports to granting agencies will be documented. A schedule of reports will be added to the TSAMM during the review and approval of new contracts. We will also work with our funders to extend reporting due dates. Anticipated Completion Date: 12/31/25. Responsible Contact Person: Yohannes Gedlu, NW Divisional Finance Director & Julie Luft, NW Social Services Director
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