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Corrective Action Plans

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Finding 1166998 (2025-001)
Material Weakness 2025
Our Saviour's Manor SR Hsg Corp/vlg of Our Saviour's Manor 044-Ee071
MI
HUD Housing Programs Reporting Significant Deficiency
Finding Number: 2025-001 Condition: Withdrawals totaling $13,846 were made from the replacement reserve without HUD authorization. Planned Corrective Action: Management has acknowledged noncompliance in the current fiscal year and has taken measures to improve internal controls over compliance. Mana...
Finding Number: 2025-001 Condition: Withdrawals totaling $13,846 were made from the replacement reserve without HUD authorization. Planned Corrective Action: Management has acknowledged noncompliance in the current fiscal year and has taken measures to improve internal controls over compliance. Management has deposited the underfunded amount of $13,846 to the replacement reserve account on July 10, 2025. Contact person responsible for corrective action: Tyler Luce Anticipated Completion Date: July 10, 2025
View Audit 378057
Finding 1166995 (2025-001)
Material Weakness 2025
Hillside Apartments Phase Ii, Inc.
MI
HUD Housing Programs Reporting Significant Deficiency
Finding Number: 2025-001 Condition: The Organization accrued for and expensed an invoice for professional service fees incurred by another project. Planned Corrective Action: Management has acknowledged noncompliance in the current fiscal year and has taken measures to improve internal controls to e...
Finding Number: 2025-001 Condition: The Organization accrued for and expensed an invoice for professional service fees incurred by another project. Planned Corrective Action: Management has acknowledged noncompliance in the current fiscal year and has taken measures to improve internal controls to ensure the invoice approval process is adequate for professional fees to ensure expenses are charged to the project that incurred the cost. Contact person responsible for corrective action: Tyler Luce Anticipated Completion Date: June 30, 2025
View Audit 378054
Finding 1166993 (2025-002)
Material Weakness 2025
Spring Meadows II- Village of Spring Meadows II 047-Ee047
MI
Internal Control / Segregation of Duties HUD Housing Programs Reporting
Finding Number: 2025-002 Condition: During testing of tenant files, it was noted that the EIV report was missing for one tenant. Planned Corrective Action: Management has acknowledged the noncompliance and related internal control deficiency over compliance and will implement proper procedures and c...
Finding Number: 2025-002 Condition: During testing of tenant files, it was noted that the EIV report was missing for one tenant. Planned Corrective Action: Management has acknowledged the noncompliance and related internal control deficiency over compliance and will implement proper procedures and controls to ensure EIV is properly utilized. Contact person responsible for corrective action: Tyler Luce Anticipated Completion Date: June 30, 2026
View Audit 378044
Finding 1166991 (2025-001)
Material Weakness 2025
Spring Meadows II- Village of Spring Meadows II 047-Ee047
MI
Cash Management HUD Housing Programs Significant Deficiency
Finding Number: 2025-001 Condition: The Organization paid for expenses and an invoice for professional service fees incurred by another project. Planned Corrective Action: Management has acknowledged noncompliance in the current fiscal year and has taken measures to improve internal controls over co...
Finding Number: 2025-001 Condition: The Organization paid for expenses and an invoice for professional service fees incurred by another project. Planned Corrective Action: Management has acknowledged noncompliance in the current fiscal year and has taken measures to improve internal controls over compliance. Management received reimbursement from the other project on September 8, 2025. Contact person responsible for corrective action: Tyler Luce Anticipated Completion Date: September 8, 2025
View Audit 378044
Finding 1166973 (2025-001)
Material Weakness 2025
Bethany Presbyterian Manor
MI
HUD Housing Programs Reporting Significant Deficiency
Finding Number: 2025-001 Condition: Withdrawals totaling $8,603 were made from the replacement reserve without HUD authorization. Planned Corrective Action: Management has acknowledged noncompliance in the current fiscal year and has taken measures to improve internal controls over compliance. Manag...
Finding Number: 2025-001 Condition: Withdrawals totaling $8,603 were made from the replacement reserve without HUD authorization. Planned Corrective Action: Management has acknowledged noncompliance in the current fiscal year and has taken measures to improve internal controls over compliance. Management has deposited the underfunded amount of $8,603 to the replacement reserve account on September 3, 2025. Contact person responsible for corrective action: Tyler Luce Anticipated Completion Date: September 3, 2025
View Audit 378018
Finding 1166844 (2025-003)
Material Weakness 2025
City of Donaldsonville
LA
Reporting Internal Control / Segregation of Duties
Management shall establish and maintain procedures within its federal grants policy to ensure compliance with all applicable federal reporting requirements, including the timely, accurate, and complete submission of required reports.
Management shall establish and maintain procedures within its federal grants policy to ensure compliance with all applicable federal reporting requirements, including the timely, accurate, and complete submission of required reports.
View Audit 377983
Finding 1166822 (2025-007)
Material Weakness 2025
Independent School District No. 381
MN
Internal Control / Segregation of Duties Allowable Costs / Cost Principles Material Weakness
Recommendation: We recommend that the District implement procedures and controls to ensure that only eligible students are included on the MARSS listing. Explanation of Disagreement with Audit Findings: There is no disagreement with the audit finding. Actions Planned in Response to the Finding: The ...
Recommendation: We recommend that the District implement procedures and controls to ensure that only eligible students are included on the MARSS listing. Explanation of Disagreement with Audit Findings: There is no disagreement with the audit finding. Actions Planned in Response to the Finding: The District will continue to work on establishing procedures and controls to ensure that only eligible students are included on the MARSS listing. Official Responsible for Ensuring CAP: Tanner Spawn, Business Manager. Planned Completion Date for CAP: June 30, 2026.
View Audit 377938
Finding 1166820 (2025-006)
Material Weakness 2025
Independent School District No. 381
MN
Internal Control / Segregation of Duties Allowable Costs / Cost Principles Material Weakness
Recommendation: We recommend that the District implement procedures and controls to ensure the journal entries are accurate before posting. Explanation of Disagreement with Audit Findings: There is no disagreement with the audit finding. Actions Planned in Response to the Finding: The District will ...
Recommendation: We recommend that the District implement procedures and controls to ensure the journal entries are accurate before posting. Explanation of Disagreement with Audit Findings: There is no disagreement with the audit finding. Actions Planned in Response to the Finding: The District will continue to work on implementing procedures and controls to ensure all journal entries are reviewed and accurate before posting. Official Responsible for Ensuring CAP: Tanner Spawn, Business Manager. Planned Completion Date for CAP: June 30, 2026.
View Audit 377938
Finding 1166818 (2025-005)
Material Weakness 2025
Independent School District No. 381
MN
Internal Control / Segregation of Duties Eligibility Material Weakness
Recommendation: We recommend that the District implement procedures and controls to ensure that all paper applications are being reviewed. Explanation of Disagreement with Audit Findings: There is no disagreement with the audit finding. Actions Planned in Response to the Finding: The District will c...
Recommendation: We recommend that the District implement procedures and controls to ensure that all paper applications are being reviewed. Explanation of Disagreement with Audit Findings: There is no disagreement with the audit finding. Actions Planned in Response to the Finding: The District will continue to work on establishing procedures and controls to ensure that all paper applications are being reviewed. Official Responsible for Ensuring CAP: Tanner Spawn, Business Manager. Planned Completion Date for CAP: June 30, 2026.
View Audit 377938
Finding 1166815 (2025-001)
Material Weakness 2025
Twin Rivers Unified School District
CA
Internal Control / Segregation of Duties
We agree with the auditor's comments, and the following actions will be taken to ensure official written documentation is obtained for a student enrolled in another school or in an educational program before removing the student from the graduation cohort: 1. Annual training to school office staff a...
We agree with the auditor's comments, and the following actions will be taken to ensure official written documentation is obtained for a student enrolled in another school or in an educational program before removing the student from the graduation cohort: 1. Annual training to school office staff at the August enrollment and attendance meeting provided by the Attendance Accounting Analyst. 2. Additional reminder training was provided to all school office staff on December 4, 2025 and December 5, 2025. 3. The policies and procedures related to the training are on a shared drive to be accessed at any time. Please reach out to us with any questions.
View Audit 377931
Finding 1166739 (2025-003)
Material Weakness 2025
Hegg Memorial Hospital D/b/a Hegg Health Center
IA
Special Tests & Provisions Subrecipient Monitoring Significant Deficiency § 200.303
Federal Agency Name: Department of Agriculture Program Name: Community Facilities Loans and Grants Federal Financial Assistance Listing #10.766 Compliance Requirement: Special Tests and Provisions Finding Summary: The Center's reserve account is fully funded per the requirements of the loan resoluti...
Federal Agency Name: Department of Agriculture Program Name: Community Facilities Loans and Grants Federal Financial Assistance Listing #10.766 Compliance Requirement: Special Tests and Provisions Finding Summary: The Center's reserve account is fully funded per the requirements of the loan resolution security agreement. However, there is no documented secondary monitoring of the reserve balance as compared to the required minimum reserve balance. Responsible Individuals: Crystal Richter, Interim CFO Corrective Action Plan: Hired an Accountant July 2025. Management will ensure there are multiple people involved and overseeing the reserve balance and documentation will be retained review and approval over the reserve balance. Anticipated Completion Date: December 2025
View Audit 377856
Finding 1166719 (2025-001)
Material Weakness 2025
The Open Door Network
CA
Eligibility HUD Housing Programs Internal Control / Segregation of Duties
Management's Response/Planned Corrective Action: The Organization's Director overseeing these programs will provide training to staff on policies. The Organization has recently implemented internal chart audits to aid in verifying compliance with funder regulations and identifying any deficiency in ...
Management's Response/Planned Corrective Action: The Organization's Director overseeing these programs will provide training to staff on policies. The Organization has recently implemented internal chart audits to aid in verifying compliance with funder regulations and identifying any deficiency in supporting document retention and will continue this practice going forward.
View Audit 377799
Finding 1166712 (2025-001)
Material Weakness 2025
Urban Minority Alcoholism and Drug Abuse Outreach Program of Lucas County, Inc.
OH
Subrecipient Monitoring Allowable Costs / Cost Principles Period of Performance § 200.1 § 200.308 § 200.309 § 200.344 § 200.403
2025-001 Costs Incurred Beyond the Period of Performance Criteria: According to 2 CFR §§200.1, 200.308, 200.309, 200.344, and 200.403(h), a non-Federal entity may only charge allowable costs incurred during the approved budget period of the Federal award’s period of performance, and any costs incurr...
2025-001 Costs Incurred Beyond the Period of Performance Criteria: According to 2 CFR §§200.1, 200.308, 200.309, 200.344, and 200.403(h), a non-Federal entity may only charge allowable costs incurred during the approved budget period of the Federal award’s period of performance, and any costs incurred before the Federal award was made that were authorized by the Federal awarding agency or pass-through entity. All financial obligations incurred under the Federal award must be liquidated within the required time period. Costs incurred outside the approved period of performance are unallowable and constitute questioned costs. Client’s Response: During the grant cycle, the Organization submitted for an extension but did not receive confirmation of said extension. During the current fiscal year, the Organization has implemented additional controls to ensure that all grant funding is expended within the timeframe allotted. Proposed Implementation Date – 12/31/2025 Name of Contact Person – John Edwards, Sr. Email: jledwards@umadaop.org Phone: 419-255-4444
View Audit 377793
Finding 1166711 (2025-003)
Material Weakness 2025
Independent School District No. 162
MN
Special Tests & Provisions HUD Housing Programs Matching / Level of Effort / Earmarking
Contact Person – Superintendent, Dr. Erich Heise Corrective Action Plan – Will establish policy to ensure payrolls are submitted a week after the week of work is performed. Completion Date – Ongoing
Contact Person – Superintendent, Dr. Erich Heise Corrective Action Plan – Will establish policy to ensure payrolls are submitted a week after the week of work is performed. Completion Date – Ongoing
View Audit 377791
Finding 1166709 (2025-004)
Material Weakness 2025
Hamilton Health Center, Inc.
PA
Internal Control / Segregation of Duties
HHC has reviewed our process for reporting appropriate charges for each CPT code on bills to all third-party payors and found that in isolated cases, the EPIC system was reporting the Sliding Fee Discount Fee on the bill and not the charge from our Fee Schedule for selected CPT codes. HC will collab...
HHC has reviewed our process for reporting appropriate charges for each CPT code on bills to all third-party payors and found that in isolated cases, the EPIC system was reporting the Sliding Fee Discount Fee on the bill and not the charge from our Fee Schedule for selected CPT codes. HC will collaborate with our EPIC partner- UPMC- to identify why the bills are not appropriately reflecting the CPT code fees from our Fee Schedule instead of the Sliding Fee Discount Fee. HHC has implemented a quarterly internal review process for compliance with all Sliding Fee Discount program requirements. HHC has reviewed our Sliding Fee Discount Policy and determined that there are areas that require revision. There should not be any patients that are given a sliding fee discount based on their self-declaration of income and then continue to receive care without the provision of income verification. HHC is in the process of a total review of our Sliding Fee Discount Policy/Process/Application and will make appropriate adjustments to ensure compliance with the HRSA Sliding Fee Discount Requirements. HHC will replace our One-Time Sliding Fee process with a more compliant approach that will involve: Self-Declaration of Income, whereby the patient will provide us with the income and family size without the required supporting documentation and the appropriate sliding fee will be applied for that visit only, and all future visits will be considered a full fee patient until the patient provides the appropriate support for income and family size; All patients will be requested to provide their income and family size. HHC has implemented a quarterly internal review process for compliance with all Sliding Fee Discount program requirements. HHC has reviewed the claim in question and has no explanation as to why the income reported for a patient was different than the supporting income documents provided by the patient. HHC recognizes that this occurred in only one of forty patient samples. HHC will ensure that all employees that are involved with the Sliding Fee Discount program are re-trained on the importance of accurately reporting the patient’s income based on the supporting documentation provided by the patient. HHC has implemented a quarterly internal review process for compliance with all Sliding Fee Discount program requirements.
View Audit 377787
Finding 1166708 (2025-002)
Material Weakness 2025
Hamilton Health Center, Inc.
PA
Reporting Internal Control / Segregation of Duties § 200.327 § 200.328
HHC recognizes their responsibility to ensure that all required Federal Reports, including FFRs, are filed on a timely basis. HHC recognizes that during the fiscal year ended 3/31/2025, we were deficient in meeting the timely filing requirement for FFR reports. HHC established a new process in Augus...
HHC recognizes their responsibility to ensure that all required Federal Reports, including FFRs, are filed on a timely basis. HHC recognizes that during the fiscal year ended 3/31/2025, we were deficient in meeting the timely filing requirement for FFR reports. HHC established a new process in August 2025, whereby the Controller will review the Payment Management System on a bi-weekly basis, but not less frequently than monthly, to identify the deadline for all required Federal Grant reports, including but not limited to FFR reports. The Controller will notify all appropriate individuals of any reports that require attention to meet the reporting deadlines and will be responsible for the timely completion of all such required reporting.
View Audit 377787
Finding 1166702 (2025-001)
Material Weakness 2025
Spartanburg County, South Carolina
SC
Internal Control / Segregation of Duties
CONTACT PERSON: Dana Hudgins, Executive Director Upstate Workforce Board 864-596-2028 dana@upstatewb.org CORRECTIVE ACTION: The County will follow its internal control policies and procedures. Effective immediately, all agreements between the County and its consultant for the WIOA program will be up...
CONTACT PERSON: Dana Hudgins, Executive Director Upstate Workforce Board 864-596-2028 dana@upstatewb.org CORRECTIVE ACTION: The County will follow its internal control policies and procedures. Effective immediately, all agreements between the County and its consultant for the WIOA program will be updated and signed. PROPOSED COMPLETION DATE: June 30, 2026
View Audit 377771
Finding 1166688 (2025-008)
Material Weakness 2025
Ogallala Public Schools
NE
Allowable Costs / Cost Principles Material Weakness School Nutrition Programs
Management will review the claims list for completeness and accuracy before presenting the list to the board for approval.
Management will review the claims list for completeness and accuracy before presenting the list to the board for approval.
View Audit 377765
Finding 1166686 (2025-006)
Material Weakness 2025
Ogallala Public Schools
NE
Allowable Costs / Cost Principles Material Weakness School Nutrition Programs
Management will review the claims list for completeness and accuracy before presenting the list to the board for approval.
Management will review the claims list for completeness and accuracy before presenting the list to the board for approval.
View Audit 377765
Finding 1166685 (2025-002)
Material Weakness 2025
MacOmb Intermediate School District
MI
Subrecipient Monitoring Allowable Costs / Cost Principles Cash Management § 200.303
Condition: The Intermediate School District (ISD) did not have internal controls in place to ensure that all the expenditures included in the quarterly claims for reimbursement were allowable. Planned Corrective Action: The ISD will review the process used by the local districts to report quarterly ...
Condition: The Intermediate School District (ISD) did not have internal controls in place to ensure that all the expenditures included in the quarterly claims for reimbursement were allowable. Planned Corrective Action: The ISD will review the process used by the local districts to report quarterly expenditures for the Administrative Outreach program. We will then create a process that ensures that the local districts provide supporting documentation that allows us to monitor the quarterly submission amounts for accuracy. Contact person responsible for corrective action: Chris Frank, Asst. Superintendent for Business Anticipated Completion Date: 1/31/2026
View Audit 377762
Finding 1166670 (2025-001)
Material Weakness 2025
Sea Mar Community Health Center and Subsidiaries
WA
Eligibility Significant Deficiency Internal Control / Segregation of Duties
RE: Finding Reference Number: 2025-001 Corrective Action: Sea Mar will implement a compliance worksheet that will be used by staff to ensure they have collected all necessary documentation for each tenant. This tool will assist in tracking income verification documents and move-in/move-out dates and...
RE: Finding Reference Number: 2025-001 Corrective Action: Sea Mar will implement a compliance worksheet that will be used by staff to ensure they have collected all necessary documentation for each tenant. This tool will assist in tracking income verification documents and move-in/move-out dates and will be included as a cover sheet for each tenant file. Sea Mar will also provide staff with additional training on eligibility determination for qualifying applicants in alignment with applicable program guidelines. This will be completed by 3/31/2026. Name of Contact Person Responsible for Implementation: John Clerkin, Housing Director Sincerely, John Clerkin Housing Director P: (206) 788-3399 E: johnclerkin@seamarchc.org Proudly serving the community since 1978
View Audit 377683
Finding 1166582 (2025-001)
Material Weakness 2025
Academy of Interactive Entertainment
WA
Student Financial Aid Material Weakness Internal Control / Segregation of Duties
Enforce the organization's R2T4 refund calculation proceedures
Enforce the organization's R2T4 refund calculation proceedures
View Audit 377570
Finding 1166465 (2025-003)
Material Weakness 2025
L'anse Area Schools
MI
Allowable Costs / Cost Principles School Nutrition Programs Internal Control / Segregation of Duties
2025-003 – UNALLOWABLE COSTS Corrective Action Plan: We have implemented a new policy that requires the Superintendent to review and sign-off on all outgoing EFT and ACH payments. We have implemented a new policy that requires the Superintendent to review and sign-off on all bank statements. Respons...
2025-003 – UNALLOWABLE COSTS Corrective Action Plan: We have implemented a new policy that requires the Superintendent to review and sign-off on all outgoing EFT and ACH payments. We have implemented a new policy that requires the Superintendent to review and sign-off on all bank statements. Responsible Party(ies): • Superintendent and Board of Education Anticipated Completion Date: June 30, 2026
View Audit 377488
Finding 1166307 (2025-003)
Material Weakness 2025
Bolivar-Richburg Central School District
NY
Internal Control / Segregation of Duties
Adjusting Journal Entries and Required Disclosures to the Financial Statements. Year ended June 30, 2025. Auditor's Recommendation: Although auditors may continue to provide such assistance both now and, in the future, under new pronouncement, the District should continue to review and accept both p...
Adjusting Journal Entries and Required Disclosures to the Financial Statements. Year ended June 30, 2025. Auditor's Recommendation: Although auditors may continue to provide such assistance both now and, in the future, under new pronouncement, the District should continue to review and accept both proposed adjusting journal entries and footnote disclosures, along with the draft financial statements. School District's Response: The District has received, reviewed and accepted all journal entries, footnote disclosures and draft financial statements proposed for the current year audit and will continue to review similar information in future years. Further, the School Business Administrator believes she has a thorough understanding of these financial statements and the ability to make informed judgements based on these financial statements.
View Audit 377390
Finding 1166262 (2025-001)
Material Weakness 2025
City Colleges of Chicago
IL
Student Financial Aid Eligibility Matching / Level of Effort / Earmarking § 200.303
Condition During our testing over direct loan disbursement notifications, we found that for twenty out of twenty students tested, City Colleges could not provide evidence that notifications were sent within the required timeframe informing the student, or parent, that a credit will be made to the st...
Condition During our testing over direct loan disbursement notifications, we found that for twenty out of twenty students tested, City Colleges could not provide evidence that notifications were sent within the required timeframe informing the student, or parent, that a credit will be made to the student’s account for a direct loan disbursement. While City Colleges demonstrated that its system was configured to automatically send notification letters and confirmed that notifications were issued, City Colleges could not provide documentation showing the specific date each notification was sent in relation to the loan disbursement. Cause City Colleges’ system is designed to record the date notifications are sent to students; however, it does not retain a copy of the actual notification content that was transmitted. Corrective Action Taken or Planned City Colleges’ IT team, in collaboration with a consultant, will configure the system to bring all Direct Loan communication letters into the Financial Aid (FA) Status pages. Integrating these letters directly into the FA Status page will ensure they are easily accessible for FA staff. As part of this enhancement, City Colleges will be able to view a timestamp indicating when each communication was sent to the student, as well as view the information required to be communicated by 34 CFR 668.165. Contact Person: Leticia Garcia, District Director of Student Financial Aid Anticipated Completion Date: December 13, 2025
View Audit 377334
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