Corrective Action Plans

Finding 481242 (2023-012)

Material Weakness 2023

MD

HUD Housing Programs Material Weakness Reporting

Moving to Work Demonstration Program – Assistance Listing No. 14.881 Recommendation: We recommend the Authority implements controls to ensure that recertifications are uploaded to PIC in accordance with reporting requirements. Explanation of disagreement with audit finding: There is no disagreemen...

Moving to Work Demonstration Program – Assistance Listing No. 14.881 Recommendation: We recommend the Authority implements controls to ensure that recertifications are uploaded to PIC in accordance with reporting requirements. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken or planned in response to finding: The HCVP shall recruit and hire a dedicated Data Analyst to oversee the PIC entries and to ensure that recertifications are uploaded in accordance with reporting requirements. The PIC uploads will be quality-controlled monthly by HCVP and quarterly by the OAC. Name of the contact person responsible for corrective action: Khaliah Payne. Planned completion date for corrective action plan: 9/30/24.

View Audit 317348

Finding 481170 (2023-003)

Material Weakness 2023

Dickinson County

MI

Procurement, Suspension & Debarment Matching / Level of Effort / Earmarking § 200.214

Action taken in response to finding: Dickinson County will use sam.gov or the ELPS listing to review clients at the beginning of the year or before a transaction is incurred in accordance with Uniform Guidance requirements. Name of the contact person responsible for corrective action: Brian Bousley,...

Action taken in response to finding: Dickinson County will use sam.gov or the ELPS listing to review clients at the beginning of the year or before a transaction is incurred in accordance with Uniform Guidance requirements. Name of the contact person responsible for corrective action: Brian Bousley, Controller/Administrator Planned completion date for corrective action plan: December 31, 2024

View Audit 317267

Finding 481111 (2023-002)

Significant Deficiency 2023

Adams County Housing Authority

WI

Matching / Level of Effort / Earmarking Internal Control / Segregation of Duties

Finding 2023-002 - Identity of lnterest Forms Not Current (Loan Programs #10.415 and #10.447) Condition: Identity of Interest forms were not current during the year under audit. ...

Finding 2023-002 - Identity of lnterest Forms Not Current (Loan Programs #10.415 and #10.447) Condition: Identity of Interest forms were not current during the year under audit. Effect: Adam's County Housing Authority's system of internal control may not prevent, detect, or correct noncompliance with applicable programs. Cause: The Identity of Interest forms were not updated and approved by Rural Development when expired. Criteria: Adams County Housing Authority must monitor compliance requirements and update forms as needed. Recommendation: Adams County Housing Authority track compliance requirements to ensure Identity of Interest forms are updated timely. Response: All Identity oflnterest forms have been updated in 2024. Contact Person: Jayne Anderson, Controller Anticipated Completion Date: 9/30/2024

View Audit 317249

Finding 481080 (2023-002)

Material Weakness 2023

Stanislaus Council of Governments

CA

Procurement, Suspension & Debarment Material Weakness Reporting § 200.338 § 200.512

Finding 2023-002 – Material Weakness Program: Federal Highway Works Administration - Highway Planning and Construction Cluster The delays in the commencement and completion of the audit, as well as the material misstatements and excessive year-end closing journal entries, were primarily due to signi...

Finding 2023-002 – Material Weakness Program: Federal Highway Works Administration - Highway Planning and Construction Cluster The delays in the commencement and completion of the audit, as well as the material misstatements and excessive year-end closing journal entries, were primarily due to significant turnover in our finance department during the fiscal year and the financial closing process. Effect of Condition: We acknowledge that these issues led to material adjustments identified through the audit procedures, which significantly delayed the audit process Corrective Action Plan: 1. Enhanced Accounting Processes: o StanCOG is in the process of reviewing and strengthening internal controls to ensure that all assets, liabilities, revenues, and expenses are properly recorded and reported in a timely manner. o StanCOG is implementing a more robust financial closing process, ensuring proper application of accounting principles to all financial closing accounts and processes. 2. Staffing and Training: o StanCOG has brought in new staff with an education and background in accounting principles. o StanCOG has begun the recruitment process to fill the vacancies in the finance department with qualified personnel. o StanCOG has retained experts in Financial Metropolitan Planning that will assist with cross-training staff. o StanCOG will continue to provide finance team members with training, tools, and resources to continue to educate the finance team to help mitigate material weaknesses in the department going forward. 3. Internal Review and Monitoring: o StanCOG will institute a monthly internal review process to identify and correct any discrepancies promptly. o StanCOG will monitor the financial closing process closely to ensure timely and accurate completion. o StanCOG will review and revise existing accounting policies and procedures to reflect updates as necessary. Timeline for Implementation: • Recruitment and onboarding of new finance staff: By in-progress - Ongoing • Completion of cross-training programs: By August 2024 - Ongoing • Full implementation of enhanced accounting processes: By October 31, 2024

View Audit 317237

Finding 481075 (2023-002)

Significant Deficiency 2023

Roots Community Health

CA

Allowable Costs / Cost Principles Reporting Significant Deficiency

Management and Corrective Action: The organization has had meetings with both Alameda and Santa Clara Counties, and it has been resolved that all awards are to specify either the federal amount or percentage of federal money. We expect to do all filings within Uniform Guidance which states that fede...

Management and Corrective Action: The organization has had meetings with both Alameda and Santa Clara Counties, and it has been resolved that all awards are to specify either the federal amount or percentage of federal money. We expect to do all filings within Uniform Guidance which states that federal single audit must be completed and the data collection form and the reporting package (as defined in the Uniform Grant Guidance), be submitted within 30 days after receipt of the auditors' report or nine months after year end, whichever comes earlier. The organization is in the process of updating her policies and procedures to ensure that the federal single audit reporting package is submitted timely.

View Audit 317213

Finding 481043 (2023-003)

Significant Deficiency 2023

Capitan Municipal Schools

NM

Subrecipient Monitoring Reporting Significant Deficiency

Auditor’s Recommendations – We recommend that the District strengthen the controls in place to provide assurance that proper review and approvals occur and retain backup documentation for support. iews of Responsible Officials and Planned Corrective Action – The District will make sure to document t...

Auditor’s Recommendations – We recommend that the District strengthen the controls in place to provide assurance that proper review and approvals occur and retain backup documentation for support. iews of Responsible Officials and Planned Corrective Action – The District will make sure to document the review and approval process to include sign off and date by the preparer and reviewer. Responsible Officials – Jamie Shepperd, Chief Financial Officer; Becky Huey, Federal Programs Director; Vance Lee, Superintendent Timeline and Estimated Completion Date – July 31, 2024

View Audit 317182

Finding 481040 (2023-002)

Significant Deficiency 2023

Colorado Poverty Law Project

CO

Allowable Costs / Cost Principles Cash Management Significant Deficiency § 200.303

We agree with this finding, and corrective action was taken in May 2024. The Executive Director along with the Operations Manager review all time entries at each month-end to ensure staff time is accurately recorded and appropriately allocated to each funding source prior to submitting to the granto...

We agree with this finding, and corrective action was taken in May 2024. The Executive Director along with the Operations Manager review all time entries at each month-end to ensure staff time is accurately recorded and appropriately allocated to each funding source prior to submitting to the grantor for reimbursement.

View Audit 317176

Finding 481038 (2023-002)

Material Weakness 2023

Ripley County

IN

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

FINDING 2023-002 Finding Subject: COVID-19 – Coronavirus State and Local Fiscal Recovery Funds – Reporting Summary of Finding: The County did not have procedures in place to prevent, or detect and correct, errors on Project and Expenditure (P&E) reports submitted to the U.S. Department of the Treasu...

FINDING 2023-002 Finding Subject: COVID-19 – Coronavirus State and Local Fiscal Recovery Funds – Reporting Summary of Finding: The County did not have procedures in place to prevent, or detect and correct, errors on Project and Expenditure (P&E) reports submitted to the U.S. Department of the Treasury. The report submitted during the audit period included projects with current period obligations and cumulative obligations totaling $3,319,955 that had not yet been obligated by the end of the reporting period. It was recommended that management of the County design and implement a proper system of internal controls, including policies and procedures that would provide segregation of duties to ensure appropriate reviews, approvals, and oversight of federal reports are taking place and to ensure the County provides the Treasury with complete and accurate information for the P&E report. Contact Person Responsible for Corrective Action: Amy Copeland Contact Phone Number and Email Address: acopeland@ripleycounty.com; 812-689-6311 INDIANA STATE BOARD OF ACCOUNTS 21 Ripley County Auditor Amy Copeland – Auditor 102 West 1st North Street, PO Box 235 Versailles, IN 47042 Ph: 812-689-6311 Fax: 812-689-3006 Views of Responsible Officials: We concur with the finding. Description of Corrective Action Plan: I, Amy Copeland, Auditor, plan to have the county attorney sit with me when I fill this report out from now on. I will also have one of my employees look over it before it is submitted. Anticipated Completion Date: April 30, 2025

View Audit 317157

Finding 480997 (2023-002)

Significant Deficiency 2023

Indiana University Health, Inc. and Subsidiaries

IN

Allowable Costs / Cost Principles HUD Housing Programs Reporting § 200.303

Finding 2023-02 Reporting (ALN 14.241) Indiana University Health established a control of programmatic review of the Consolidated Annual Performance and Evaluation Report (CAPER). A discrepancy in the amount of expenditures reported on the CAPER related to the Indiana Housing and Community Departme...

Finding 2023-02 Reporting (ALN 14.241) Indiana University Health established a control of programmatic review of the Consolidated Annual Performance and Evaluation Report (CAPER). A discrepancy in the amount of expenditures reported on the CAPER related to the Indiana Housing and Community Department Authority (IHCDA) grants for the report period ended June 30, 2023 was not discovered in review. Indiana University Health submitted a corrected, amended CAPER for this award period on July 19, 2024. The control for the amended CAPER (and for future CAPERs) was strengthened to include documented reconciliation to expenditures claimed as well as both programmatic and financial services review. Contact Person(s) Responsible for Corrective Action: Christine Smith Completion Date: July 19, 2024

View Audit 317105

Finding 480996 (2023-001)

None 2023

Indiana University Health, Inc. and Subsidiaries

IN

Subrecipient Monitoring Eligibility Reporting

Finding 2023-01 Scope Limitation – Eligibility (ALN 10.557) Indiana University Health utilizes a paperless system in accordance with U.S. Department of Agriculture and State of Indiana guidelines. As such, no corrective action will be taken. Contact Person(s) Responsible for Corrective Action: Chri...

Finding 2023-01 Scope Limitation – Eligibility (ALN 10.557) Indiana University Health utilizes a paperless system in accordance with U.S. Department of Agriculture and State of Indiana guidelines. As such, no corrective action will be taken. Contact Person(s) Responsible for Corrective Action: Christine Smith Anticipated Completion Date: N/A

View Audit 317105

Finding 480967 (2023-002)

Material Weakness 2023

City of Dillingham

AK

Reporting Subrecipient Monitoring Significant Deficiency § 200.1 § 200.329

Finding 2023-002 Late Reporting and Noncompliance with Reporting Requirements Name of Contact Person: Anita Fuller, Finance Director Corrective Action Plan: Proposed Completion Date: Immediately

View Audit 317088

Finding 480946 (2023-002)

Significant Deficiency 2023

Town of Wilbraham, Ma

MA

Internal Control / Segregation of Duties Reporting Significant Deficiency § 200.329

Audit Finding Reference: 2023-002 – Improve Oversight of Reporting of Federal Funds The March 2023 Annual Performance report showed an expense of $239,098 in FY2023 which was not actually expended until FY2024. The Town agrees with the finding. Planned Corrective Action: When the FY2023 report w...

Audit Finding Reference: 2023-002 – Improve Oversight of Reporting of Federal Funds The March 2023 Annual Performance report showed an expense of $239,098 in FY2023 which was not actually expended until FY2024. The Town agrees with the finding. Planned Corrective Action: When the FY2023 report was filed, the expense in the wrong period was discovered. Efforts were made to try and correct this error prior to filing the FY2023 Report, but the system would not allow any corrections. The Town makes every effort to include the source documents that support the reports submitted, which is the way this was discovered prior to submitting the FY2023 report. The Town will continue this procedure to include the source documents (Trial Balances) which support the projects and amounts filed within the report. This will ensure that the General Ledger and the reports filed are in balance. The only corrective measure for this error will occur when the FY2024 Single Audit is prepared which shows the expense expended in FY2024.

View Audit 317055

Finding 480928 (2023-002)

Material Weakness 2023

The Simple Foundation

NE

Procurement, Suspension & Debarment Subrecipient Monitoring Matching / Level of Effort / Earmarking § 200.318 § 200.326

FINDING 2023-002: Procurement Please provide an explanation of how your organization plans to resolve procurement error moving forward The Simple Foundation has implemented a newly developed procurement policy that aligns with the Uniform Guidance procurement standards. Moving forward, this policy w...

FINDING 2023-002: Procurement Please provide an explanation of how your organization plans to resolve procurement error moving forward The Simple Foundation has implemented a newly developed procurement policy that aligns with the Uniform Guidance procurement standards. Moving forward, this policy will be strictly followed for all agreements and transactions under the Federal procurement requirements within Uniform Guidance. Attached below in the procurement policy and the Purchase Justification Form. Reasonable completion date: 08/04/2024 Responsible Party: D&K Financial, Compliance

View Audit 317033

Finding 480919 (2023-004)

Material Weakness 2023

Pembroke Hill School

NH

Questioned Costs School Nutrition Programs Internal Control / Segregation of Duties § 200.303

Audit Finding Reference: 2023-004 Excess Food Service Fund Balance Management's View and Planned Corrective Action: Management agrees that the Food Service Fund Balance needs to be reduced The Department of Education in FY2023 they did not require a spend down plan for the application. With that s...

Audit Finding Reference: 2023-004 Excess Food Service Fund Balance Management's View and Planned Corrective Action: Management agrees that the Food Service Fund Balance needs to be reduced The Department of Education in FY2023 they did not require a spend down plan for the application. With that said we currently have a spend down plan in place to reduce the fund balance to a more appropriate fund balance and to meet the regulation. The spend down plan was submitted in March 2024. Name of Contact Person and Completion Date: Name 1 Amber Wheeler Name 2 Danielle Rossetti Anticipated Completion Date - December 31, 2024

View Audit 317015 Questioned Costs: $1

Finding 480888 (2023-003)

Material Weakness 2023

Four Oaks Family and Children's Services and Combined Entities

IA

Allowable Costs / Cost Principles Procurement, Suspension & Debarment Matching / Level of Effort / Earmarking § 200.303

Identifying number: 2023-003 Finding: There are allowable costs such as a benefit allocation and supplies in which there was no formal approval of the cost. Corrective actions taken or planned: Additional levels of review will be added to verify the allowable cost have been approved. Contact ...

Identifying number: 2023-003 Finding: There are allowable costs such as a benefit allocation and supplies in which there was no formal approval of the cost. Corrective actions taken or planned: Additional levels of review will be added to verify the allowable cost have been approved. Contact person: Steve Schuring, CFO Date of completion: June 2024

View Audit 317013

Finding 480886 (2023-002)

Material Weakness 2023

Four Oaks Family and Children's Services and Combined Entities

IA

Allowable Costs / Cost Principles Procurement, Suspension & Debarment Matching / Level of Effort / Earmarking § 200.303

Identifying Number: 2023-002 Finding : There are allowable costs such as a benefit allocation and supplies in which there was no formal approval of the cost. Corrective Actions Taken or Planned: Additional levels of review and monitoring over compliance with the contract will be put in place. ...

Identifying Number: 2023-002 Finding : There are allowable costs such as a benefit allocation and supplies in which there was no formal approval of the cost. Corrective Actions Taken or Planned: Additional levels of review and monitoring over compliance with the contract will be put in place. Contact person: Steve Schuring, CFO Date of completion: June 2024

View Audit 317013

Finding 480779 (2023-001)

Significant Deficiency 2023

Puerto Rico Office Management and Budget

PR

Reporting Significant Deficiency Matching / Level of Effort / Earmarking

GOBIERNO DE PUERTO RICO OFICINA DE GERENCIA Y PRESUPUESTO July 23, 2024 OFFICE OF MANAGEMENT AND BUDGET CORRECTIVE ACTION PLAN FOR PROGRAM SPECIFIC AUDIT FINDING FISCAL YEAR 2022-2023 Finding No. 2023-001: Program 21.027 Condition: Single Audit report for fiscal year 2022-2023 was ...

GOBIERNO DE PUERTO RICO OFICINA DE GERENCIA Y PRESUPUESTO July 23, 2024 OFFICE OF MANAGEMENT AND BUDGET CORRECTIVE ACTION PLAN FOR PROGRAM SPECIFIC AUDIT FINDING FISCAL YEAR 2022-2023 Finding No. 2023-001: Program 21.027 Condition: Single Audit report for fiscal year 2022-2023 was not submitted by March 31, 2024, as required by regulations. Recommendation: Keep track and communication of federal programs compliances with regulatory parties and among agency's responsible departments involve and establish a program deadline calendar. Views of Responsible Officials/Corrective Action Plan: 1. Engagement of CPA Firm: o Action: The Puerto Rico Office of Management and Budget has contracted a CPA firm, contract number 2024-00003 7 for the Single Audit 2023 that was signed on August 2, 2023. o Responsible Officer: Mrs. Nivis Gonzalez Rodriguez o Timeline: Immediate and ongoing 2. Early Initiation of the Audit Process: o Action: Initiate the audit process well in advance of the deadline to ensure sufficient time for completion and review. o Responsible Officer: Mrs. Nivis Gonzalez Rodriguez o Timeline: Audit process to begin six months prior to the submission deadline. 3. Improvement of Internal Controls: o Action: Develop and implement stronger internal controls over financial reporting to ensure timely production of financial statements. o Responsible Officer: Mrs. Nivis Gonzalez Rodriguez o Timeline: Within three months 4. Training and Communication: o Action: Conduct training sessions for all relevant personnel on compliance requirements and the importance of timely financial reporting. Calle Cruz #254 Esq. Tetu~n, San Juan, PR/ PO Box 9023228, San Juan, PR 00902-3228 o Responsible Officer: Mrs. Nivis Gonzalez Rodriguez o Timeline: Bi annually training sessions 5. Establishment of Deadline Calendar: o Action: Create and maintain a detailed program deadline calendar to ensure all involved departments are aware of key dates and responsibilities. o Responsible Officer: Mrs. Nivis Gonzalez Rodriguez o Timeline: Calendar to be established and communicated within one month Responsible Officials: ( Mrs. Nivis Gonzalez Rodrigu Estimated Completion Date: July 2024 for Single audit implementation, if apply.

View Audit 316956

Finding 480695 (2023-001)

Significant Deficiency 2023

Southwest Mississippi Regional Medical Center

MS

Subrecipient Monitoring Allowable Costs / Cost Principles Reporting § 200.303 § 200.430

Finding 2023-001 – Allowable Activities and Costs of Provider Relief Fund Significant Deficiency in Internal Control over Compliance Program: COVID-19 Provider Relief Fund (PRF) and American Rescue Plan (ARP) Rural Distribution Federal Assistance Listing Number: 93.498 Federal Grantor: U.S. D...

Finding 2023-001 – Allowable Activities and Costs of Provider Relief Fund Significant Deficiency in Internal Control over Compliance Program: COVID-19 Provider Relief Fund (PRF) and American Rescue Plan (ARP) Rural Distribution Federal Assistance Listing Number: 93.498 Federal Grantor: U.S. Department of Health and Human Services Pass-Through Entity: None Criteria: Per 2 CFR 200.430(i), personnel costs charged to federal grants are required to be supported by documentation including time records. Per 2 CFR 200.303, a non-federal entity must establish and maintain effective internal control over Federal awards that provides reasonable assurance that the non-Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and terms and conditions of the Federal award. Condition: Our audit procedures over the calculation of COVID patient days used to allocate the payroll cost to the PRF/ARP federal program disclosed the amounts were not properly calculated. Cause: The Medical Center has controls in place to review the calculation; however, the control did not operate to identify an error in the calculation of COVID patient days. Effect: The error in the calculation resulted in underreporting payroll costs allowed to be charged to PRF/ARP in the amount of $566,272. Questioned Costs: None Perspective: The error in the calculation resulted in underreporting payroll costs allowed to be charged to PRF/ARP in the amount of $566,272. Repeat Finding: This is not a repeat finding. Recommendation: We recommend the Medical Center implement additional internal controls over compliance in order to properly identify any errors in calculation. Management’s Action Plan: The Medical Center will implement additional internal controls over compliance. Such controls will include verification of all calculations used by two parties, the Director of Finance and CFO as well as signoff on calculations. Name of Person Responsible for the Plan: Mallory Ginn, CFO Anticipated Completion Date of the Plan: 7/31/2024

View Audit 316922

Finding 480669 (2023-001)

Significant Deficiency 2023

City of St. Charles, Missouri

MO

Reporting Matching / Level of Effort / Earmarking

The City will make any necessary adjustments in the next reporting period since the Project and Expenditure Report includes cumulative expenditures under the program.

View Audit 316849

Finding 480668 (2023-003)

Significant Deficiency 2023

Yankton Transit, Inc.

SD

Procurement, Suspension & Debarment Allowable Costs / Cost Principles Significant Deficiency § 200.313

Response to "2023 - 003 Finding: Activities Allowed/Unallowed and Cost Principles (Compliance; Internal Controls Over Compliance)" Yankton Transit will become familiar with the requirements of 2 CFR, §200.313(a) and will establish internal control policies and procedures and will train staff on tho...

Response to "2023 - 003 Finding: Activities Allowed/Unallowed and Cost Principles (Compliance; Internal Controls Over Compliance)" Yankton Transit will become familiar with the requirements of 2 CFR, §200.313(a) and will establish internal control policies and procedures and will train staff on those policies and procedures.

View Audit 316848

Finding 480549 (2023-002)

Material Weakness 2023

Stilwell Area Devlopment Authority

OK

Equipment & Real Property Management Matching / Level of Effort / Earmarking Internal Control / Segregation of Duties

CORRECTIVE ACTION PLAN: IMPROVING MONTH-END CLOSING RECONCILIATION-OBJECTIVE: TO ENHANCE THE ACCURACY AND EFFICIENCY OF THE MONTH-END CLOSING PROCESS, PARTICULARLY IN RECONCILING ACCOUNTS RECEIVABLE, INVENTORY, AND CUSTOMER DEPOSITS. 1. IDENTIFY AND DOCUMENT CURRENT ISSUES-ACTION: CONDUCT A THOROUGH...

CORRECTIVE ACTION PLAN: IMPROVING MONTH-END CLOSING RECONCILIATION-OBJECTIVE: TO ENHANCE THE ACCURACY AND EFFICIENCY OF THE MONTH-END CLOSING PROCESS, PARTICULARLY IN RECONCILING ACCOUNTS RECEIVABLE, INVENTORY, AND CUSTOMER DEPOSITS. 1. IDENTIFY AND DOCUMENT CURRENT ISSUES-ACTION: CONDUCT A THOROUGH REVIEW OF CURRENT MONTH-END CLOSING PROCEDURES TO IDENTIFY SPECIFIC ISSUES AND DISCREPANCIES IN ACCOUNTS RECEIVABLE, INVENTORY, AND CUSTOMER DEPOSITS. RESPONSIBILITY: FINANCE TEAM LEAD. TIMELINE: 1 WEEK 2. IMPLEMENT ENHANCED RECONCILIATION PROCEDURES - ACTION: DEVELOP AND DOCUMENT DETAILED RECONCILIATION PROCEDURES FOR ACCOUNTS RECEIVABLE, INVENTORY, AND CUSTOMER DEPOSITS, INCLUDING STEP-BY-STEP INSTRUCTIONS AND TIMELINES. RESPONSIBILITY: ACCOUNTING MANAGER. TIMELINE: 2 WEEKS-3. STANDARDIZE DATA ENTRY AND REPORTING-ACTION: ESTABLISH STANDARDIZED PROCESSES FOR DATA ENTRY, REPORTING, AND RECORD-KEEPING TO ENSURE CONSISTENCY AND ACCURACY ACROSS ALL FINANCIAL DOCUMENTS. RESPONSIBILITY: DATA ENTRY SPECIALIST. TIMELINE: 2 WEEKS. 4. UPGRADE ACCOUNTING SOFTWARE AND TOOLS-ACTION: ASSESS CURRENT ACCOUNTING SOFTWARE AND TOLLS FOR GAPS OR INEFFICIENCIES. INVEST IN UPGRADES OR NEW TOOLS IF NECESSARY TO IMPROVE RECONCILIATION PROCESSES. RESPONSIBILITY: IT MANAGER AND FINANCE DIRECTOR. TIMELINE: 4 WEEKS. 5. TRAIN STAFF ON REVISED PROCEDURES. ACTION: CONDUCT TRAINING SESSIONS FOR ALL RELEVANT STAFF ON THE UPDATED RECONCILIATION PROCEDURES AND ANY NEW SOFTWARE OR TOLLS. ENSURE THAT EVERYONE UNDERSTANDS THEIR ROLES AND RESPONSIBILITIES. RESPONSIBILITY: HR TRAINING COORDINATOR. TIMELINE: 2 WEEKS. 6. IMPLEMENT REGULAR RECONCILIATION REVIEWS. ACTION: ESTABLISH A SCHEDULE FOR REGULAR RECONCILIATION REVIEWS (E.G. WEEKLY OR BI-WEEKLY) TO CATCH AND ADDRESS DISCREPANCIES EARLY. ASSIGN RESPONSIBILITY FOR THESE REVIEWS TO SENIOR STAFF MEMBERS. RESPONSIBILITY: SENIOR ACCOUNTANT. TIMELINE: ONGOING, WITH INITIAL SETUP WITHIN 1 WEEK. 7. ENHANCE INTERNAL CONTROLS AND MONITORING. ACTION: REVIEW AND STENGTHEN INTERNAL CONTROLS RELATED TO ACCOUNTS RECEIVABLE, INVENTORY, AND CUSTOMER DEPOSITS. IMPLEMENT ADDITIONAL MONITORING MECHANISMS TO DETECT AND PREVENT ERRORS OR FRAUD. RESPONSIBILITY: INTERNAL AUDITOR. TIMELINE: 3 WEEKS. 8. DEVELOP AND TRACK PERFORMANCE METRICS. ACTION: CREATE PERFORMANCE METRICS TO TRACK THE EFFICIENCY AND ACCURACY OF THE MONTH-END CLOSIN PROCESS. REGULARLY REVIEW THESE METRICS TO IDENTIFY AREAS FOR IMPROVEMENT. RESPONSIBILITY: FINANCE DIRECTOR. TIMELINE: 2 WEEKS. 9. CONDUCT POST-IMPLEMENTATION REVIEW. ACTION: AFTER IMPLEMENTING THE CORRECTIVE ACTIONS, CONDUCT A COMPREHENSIVE REVIEW TO ASSESS THE EFFECTIVENESS OF THE CHANGES. SOLICIT FEEDBACK FROM STAFF AND MAKE ANY NECESSARY ADJUSTMENTS. RESPONSIBILITY: FINANCE TEAM LEAD AND ACCOUNTING MANAGER. TIMELINE: 1 MONTH AFTER IMPLEMENTATION. 10. CONTINUOUS IMPROVEMENT. ACTION: ESTABLISH A PROCESS FOR ONGOING EVALUATION AND REVINEMENT OF MONTH-END CLOSING PROCEDURES. ENCOURAGE STAFF TO PROVIDE FEEDBACK AND SUGGEST IMPROVEMENTS REGULARLY. RESPONSIBILITY: CONTINOUS IMPROVEMENT COMMITTEE. TIMELINE: ONGOING. EXPECTED OUTCOMES: IMPROVED ACCURACY AND EFFICIENCY IN RECONCILING ACCOUNTS RECEIVABLE, INVENTORY, AND CUSTOMER DEPOSITS. REDUCED DISCREPANCIES AND ERRORS IN MONTH-END FINANCIAL REPORTS. ENHANCED STAFF KNOWLEDGE AND ADHERENCE TO UPDATED PROCEDURES BETTER FINANCIAL OVERSIGHT AND CONTROL. BY FOLLOWING THIS CORRECTIVE ACTION PLAN, WE AIM TO STREAMLINE THE MONTH-END CLOSING PROCESS, ENSURING THAT FINANCIAL STATEMENTS ARE ACCURATE, TIMELY, AND RELIABLE.

View Audit 316749

Finding 480543 (2023-003)

Material Weakness 2023

McIntosh Senior Living

MN

Special Tests & Provisions Material Weakness Matching / Level of Effort / Earmarking § 200.303

Single Audit Finding 2023-003 Federal Agency Name: Program Name: Finding Summary: Responsible Individuals: Status: United States Department of Agriculture Community Facilities Loans and Grants Cluster Federal Assistance Listing #10.766 Corrective Action Plan The Organization did not have an adeq...

Single Audit Finding 2023-003 Federal Agency Name: Program Name: Finding Summary: Responsible Individuals: Status: United States Department of Agriculture Community Facilities Loans and Grants Cluster Federal Assistance Listing #10.766 Corrective Action Plan The Organization did not have an adequate internal control policy in place to ensure the reserve account was separately tracked and a documented review and approval over the reserve fund occurred. Sharlene Knutson, Administrator We have adopted a policy to enhance internal control to ensure the reserve fund reconciliation has a secondary review and approval that is documented. Anticipated Completion Date: 6/30/2024

View Audit 316739

Finding 480486 (2023-002)

Significant Deficiency 2023

Richland Medical Center, Inc. D/b/a Central Ozarks Medical Center

MO

Allowable Costs / Cost Principles HUD Housing Programs Matching / Level of Effort / Earmarking § 200.430

Item 2023-002 - Activities Allowed and Unallowed Recommendation We recommend that the Organization consistently enforce its internal controls over payroll to ensure that all labor reports are reviewed and show formal approval before payroll is submitted. Repeat Finding No Action Taken As of July 20...

Item 2023-002 - Activities Allowed and Unallowed Recommendation We recommend that the Organization consistently enforce its internal controls over payroll to ensure that all labor reports are reviewed and show formal approval before payroll is submitted. Repeat Finding No Action Taken As of July 20, 2024, we have added the Payroll Summary by grant to the grant draw down packet. In addition, we have changed the procedure to reflect that the payroll summary must have either the CFO and/or CEO approval signature prior to grant draw. If the Cognizant or Oversight Agency for Audit has questions regarding this plan, please call: Sabrina McAfee, CFO at (573) 836-7079.

View Audit 316663

Finding 480465 (2023-001)

Material Weakness 2023

Arbor Place INC

WI

Allowable Costs / Cost Principles Material Weakness Reporting § 200.303

We recommend Arbor Place to implement internal controls over reporting and allowable costs to ensure all financial records are complete and accurate.

View Audit 316660

Finding 480431 (2023-019)

Material Weakness 2023

State of New Hampshire

NH

Material Weakness Reporting Matching / Level of Effort / Earmarking § 200.303

(SSA 4513) The department concurs with this finding and plans to work on the following areas to make reviewing and understanding of the reports an easier process: NHDDS will make sure that line 7 on the 4513 report is checked appropriately on all future reporting. NH DDS will update all process d...

(SSA 4513) The department concurs with this finding and plans to work on the following areas to make reviewing and understanding of the reports an easier process: NHDDS will make sure that line 7 on the 4513 report is checked appropriately on all future reporting. NH DDS will update all process directions for all fiscal reporting. For these directions, NH DDS will update all spreadsheets used for reporting purposes, add labels to column headers and link to cells when able for better understanding of our business processes and where amounts are pulled from. NH DDS will keep all backup documentation needed for these directions, to review all current open grant years. NHDDS will create “Mock” documents of each reporting process to help in any further reviews. (SSA 4514) Administrator runs a leave report for a 1-month time frame. Put in alpha order and date order. In an excel spreadsheet, staff are in alpha order. Leave time is added to each individual staff member for a time frame of 3 months (quarterly report). The total for each individual staff member is then populated to a second spread sheet which is broken out by position categories and each position total is then populated to the 4514 report. • On Duty Hours (column A) are the number of days worked in a quarter, times 7.50 hours per day. • Holiday/Leave Hours (column B) are the number of Holidays (7.50 hours per day) during that quarter plus the amount of leave (hours and minutes) per individual staff member during that quarter. • Total Hours (column C) is the amount of column A, plus column B, equals column C. • Total Part-Time Personnel-Is the number of hours the physician worked during that quarter. A report is run in Virtual Time Clock for the quarterly time frame and hours are entered into Part-Time, Medical Consultants (h.) Prior to completing the quarterly report, the excel spread sheet, sheet 2, will be reviewed to ensure cell equations are correct to eliminate formula errors used to calculate quarterly hours. When emailing the Administrator, the quarterly report for signature, the following statement will be in the body of the email to certify cell equations were reviewed prior, to eliminate formula errors: “I certify that I reviewed the SSA-4514 prior to completion, to ensure that cell equations were correct to eliminate formula errors.” Sent to the Administrator for signature then sent off to Region. Sent emails will be saved in an outlook folder for future reference and proofs that reports were sent.

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