Corrective Action Plans

Finding 565012 (2024-001)

Material Weakness 2024

Lapeer County

MI

Questioned Costs Internal Control / Segregation of Duties Procurement, Suspension & Debarment § 200.317 § 200.318 § 200.327

May 27, 2025 Roslund, Prestage & Company, P.C. 525 W. Warwick Drive, Suite A Alma, MI 48801 Re: Corrective Action Plan Regarding Section III: Schedule of Findings and Questioned Costs for the Fiscal Year Ended September 30, 2024, in Reference to 2024-001 Procurement It was identified in the findings...

May 27, 2025 Roslund, Prestage & Company, P.C. 525 W. Warwick Drive, Suite A Alma, MI 48801 Re: Corrective Action Plan Regarding Section III: Schedule of Findings and Questioned Costs for the Fiscal Year Ended September 30, 2024, in Reference to 2024-001 Procurement It was identified in the findings of 2024-001 Procurement (repeat comment) that LCCMH had not followed proper procurement requirements and procedures regarding the agreement in reference to ALN 93.969 Certified Community Behavioral Health Clinics (CCBHC) expansion Grants. LCCMH Management has taken actions to revise policies and procedures to ensure their alignment with federal regulations, as well as providing training regarding federal procurement requirements for the relevant personnel. The Standards Committee, which is responsible for regularly reviewing Policies and Procedures and approving or recommending changes, reviewed and approved the following policy revisions at its November 19, 2024 meeting to maintain compliance with federal regulation standards. 0.1.02.65 Provider Procurement and Best Value Purchasing 01.02.85 Procuring Employment Services Providers, Independent Contractors and Network Providers. The approved policies were also presented at the LCCMH Full Board meeting on November 21, 2024. All LCCMH Staff were advised on December 2, 2024, to review the revised policies and procedures. On April 22, 2025, SAMSHA provided LCCMH written notification identifying the 2023 citation for procurement as resolved. Thank you, Brooke Sankiewicz Chief Executive Officer Lapeer County Community Mental Health (810) 667-0500 bsankiewicz lapeercmh.org

View Audit 358880 Questioned Costs: $1

Finding 564659 (2024-003)

Material Weakness 2024

McIntosh Senior Living

MN

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

Federal Agency Name: United States Department of Agriculture Program Name: Community Facilities Loans and Grants Cluster Federal Assistance Listing: #10.766 Finding Summary: The Organization did not have an adequate internal control policy in place to ensure the reserve account was separately trac...

Federal Agency Name: United States Department of Agriculture Program Name: Community Facilities Loans and Grants Cluster Federal Assistance Listing: #10.766 Finding Summary: 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. Responsible Individuals: Sharlene Knutson, Administrator Corrective Action Plan: 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: 6/30/2025

View Audit 358780

Finding 564651 (2024-004)

Material Weakness 2024

Teach.org Inc.

CA

Subrecipient Monitoring Reporting Matching / Level of Effort / Earmarking § 200.303

Auditor’s Recommendation: Internal control should be documented to ensure compliance with the reporting compliance requirement. Documentation should include a signed certification by the preparer and a reviewer that the requests for payment, written summaries of reporting-specific meetings with gran...

Auditor’s Recommendation: Internal control should be documented to ensure compliance with the reporting compliance requirement. Documentation should include a signed certification by the preparer and a reviewer that the requests for payment, written summaries of reporting-specific meetings with grantors, and any other reporting activities are complete, accurate, and agree to supporting records of expenditures or other accounting or database information. Written policies and procedures should be designed and implemented for documentation of internal controls performed for reporting. Corrective Action: TEACH.org will write a policy to address internal controls for reporting. TEACH staff will obtain training on documentation of internal controls performed for reporting related to Federal awards. After training, TEACH staff will review all documentation of internal controls and make changes to our policies as needed to properly document our internal controls. Responsible for Corrective Action: TEACH.org Deputy Chief of Staff will obtain training on internal controls documentation for Federal grants. Once training is completed, DCoS will review all fiscal policies and add or edit our policies as needed to address proper documentation of internal controls performed for reporting. Anticipated Completion Date: TEACH.org DCoS will obtain training by September 30, 2025 and conclude their review of TEACH fiscal policies by December 31, 2025.

View Audit 358749

Finding 564605 (2024-004)

Material Weakness 2024

Kipp Delta, Inc. D/b/a Kipp Delta Public Schools

AR

Questioned Costs Subrecipient Monitoring Matching / Level of Effort / Earmarking § 200.302

Views of responsible officials and planned corrective actions: Management agrees with this finding and will put procedures in place for the review and approval of expenditures and maintenance of supporting documentation surrounding federal awards. Action Plan:  See the “Conduct Training Sessions fo...

Views of responsible officials and planned corrective actions: Management agrees with this finding and will put procedures in place for the review and approval of expenditures and maintenance of supporting documentation surrounding federal awards. Action Plan:  See the “Conduct Training Sessions for Expenditures Personnel” and “Audit of all FY25 YTD Expenditures” sections of management’s action plan for finding 2024-001  Review and update the Allowable Funds document o Locate the latest Allowable Funds Guide created by KIPP Delta. o Review and update the guide as necessary. o Store the updated guide in a central cloud location for responsible personnel to access easily. o Process completed as of April 17, 2025.  Develop a Federal Funds Workflow in Avid for POs and invoices: o A designated finance team member must review all federally funded purchases to improve the federal funds purchasing process. Steps include:  Create a separate workflow in Avid for POs and invoices to track federal purchases.  Ensure a purchase order is created before an invoice is submitted and paid.  Attach all required documentation to the PO, as with all other expenditures.  Verify that the expenditure complies with the Allowable Funds guide o Anticipated completion date of May 30, 2025.

View Audit 358741 Questioned Costs: $1

Finding 564593 (2024-005)

Significant Deficiency 2024

Goshen Community Schools

IN

Cash Management Subrecipient Monitoring Significant Deficiency § 200.303

FINDING 2024-005 Finding Subject: Special Education Cluster (IDEA) - Internal Controls Contact Person Responsible for Corrective Action: Whitney Dixon, Treasurer Contact Phone Number: 574-533-8631 Views of Responsible Official: We concur with the finding. Description of Corrective Action Plan: Cash ...

FINDING 2024-005 Finding Subject: Special Education Cluster (IDEA) - Internal Controls Contact Person Responsible for Corrective Action: Whitney Dixon, Treasurer Contact Phone Number: 574-533-8631 Views of Responsible Official: We concur with the finding. Description of Corrective Action Plan: Cash Management Requests for reimbursement will not be submitted until the Treasurer has attached the supporting documentation from the financial software system (member schools will provide documentation). The documentation will be reviewed and approved by the Executive Director of ECSEC prior to submission to the Treasurer. The reimbursement request will require an approval signature from the Chief Financial Officer/Treasurer prior to submittal. Anticipated Completion Date: June 2025

View Audit 358719

Finding 564584 (2024-003)

Material Weakness 2024

Goshen Community Schools

IN

School Nutrition Programs Internal Control / Segregation of Duties Allowable Costs / Cost Principles § 200.303

FINDING 2024-003 Finding Subject: Child Nutrition Cluster – Internal Controls Contact Person Responsible for Corrective Action: Heather Bontrager, Director of Nutrition and Whitney Dixon, Treasurer Contact Phone Number: 574-533-8631 Views of Responsible Official: We concur with the finding. Descript...

FINDING 2024-003 Finding Subject: Child Nutrition Cluster – Internal Controls Contact Person Responsible for Corrective Action: Heather Bontrager, Director of Nutrition and Whitney Dixon, Treasurer Contact Phone Number: 574-533-8631 Views of Responsible Official: We concur with the finding. Description of Corrective Action Plan: Activities Allowed or Unallowed, Allowable Costs/Cost Principles This finding was limited to payroll claims and payroll vendor disbursements and did not involve accounts payable vendor disbursements. For payroll disbursements, once payroll is processed, a distribution report is sent to the Director of Nutrition to review all employees paid from the Federal Nutrition Program (Fund 0800). The Director communicates any necessary corrections to employee distributions, which are then adjusted by the payroll specialist, if needed. During the audit period, the school corporation experienced a vacancy in the payroll specialist position. As a result, the Treasurer processed payroll and the Deputy Treasurer conducted the reviews. However, the school corporation did not obtain signatures on the payroll reports during this time. The only signed documentation was the ACH report used for the bank upload. Going forward, the school will implement the use of digital signatures whenever possible to document payroll report reviews. For payroll vendor claims, vouchers are generated from the financial system and are signed by both the payroll specialist and the Chief Financial Officer. These signed vouchers are also included on the board docket. Although this process was in place during the audit period, the school corporation did not have a fully effective internal control system to ensure that all payroll reports were consistently signed following review by the Treasurer. Anticipated Completion Date: June 2025

View Audit 358719

Finding 564563 (2024-003)

Significant Deficiency 2024

New Hampshire College & University Council

NH

Matching / Level of Effort / Earmarking

Management acknowledges the recommendation and will track all expenses allocated by match funds by grant year in the same spreadsheet. Note - Auditors were provided with documentation showing salary allocations verifying that no salaries were used simultaneously across grants.

View Audit 358679

Finding 564558 (2024-004)

Significant Deficiency 2024

Campus Compact for New Hampshire

NH

Matching / Level of Effort / Earmarking

Management will track all expenses allocated by match funds by grant year in the same spreadsheet

View Audit 358678

Finding 564492 (2024-003)

Significant Deficiency 2024

Prairie State College - Community College District No. 515

IL

Student Financial Aid Reporting Matching / Level of Effort / Earmarking

At the time that the last FISAP was completed, the Financial Aid office was severely understaffed. As a result, an oversight occurred in reporting dependent undergraduate students with Baccalaureate degrees. In thi instance, the correct information was retrieved, however it was reported incorrectly...

At the time that the last FISAP was completed, the Financial Aid office was severely understaffed. As a result, an oversight occurred in reporting dependent undergraduate students with Baccalaureate degrees. In thi instance, the correct information was retrieved, however it was reported incorrectly. Staffing in the Financial Aid office has been addressed by hiring an Advisor and Assistant Director. Moving forward, the Assitant Dean will continue to complete the FISAP. However, prior to submission, the application will be reviewed by both Assistant Directors of Financial Aid. Contact person(s) responsible for corrective action: Yvette McGhee, Assistant Dean of Financial Aid. Anticipated completion date: Immediate

View Audit 358618

Finding 564472 (2024-002)

Material Weakness 2024

Wright County Community Action, Inc.

MN

Material Weakness Matching / Level of Effort / Earmarking Internal Control / Segregation of Duties § 200.303

Head Start ‐ ALN #93.600 Recommendation: We recommend that the assigned individual to review formally documents their review and approval of the reports with a signature before the required date to be submitted. Explanation of disagreement with audit finding: There is no disagreement with the audit ...

Head Start ‐ ALN #93.600 Recommendation: We recommend that the assigned individual to review formally documents their review and approval of the reports with a signature before the required date to be submitted. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: WCCA has already implemented a process to ensure all reports are reviewed and approved with documentation before submission. Name(s) of the contact person(s) responsible for corrective action: Carrie Tripp, Executive Director Planned completion date for corrective action plan: September 30, 2025

View Audit 358612

Finding 564425 (2024-102)

Significant Deficiency 2024

B J Enterprises, Inc.

AZ

Cash Management Reporting Matching / Level of Effort / Earmarking § 200.303

REFERENCE: 2024-102 CFDA NUMBER: 10.558 – CHILD AND ADULT CARE FOOD PROGRAM U.S. DEPARTMENT OF AGRICULTURE - FOOD AND NUTRITION - 2024 PASSED THROUGH ARIZONA STATE DEPARTMENT OF EDUCATION GRANT NUMBER 6AZ300003 CLIENT RESPONSE AND CORRECTIVE ACTION PLAN We concur with the condition. 1. Name of the...

REFERENCE: 2024-102 CFDA NUMBER: 10.558 – CHILD AND ADULT CARE FOOD PROGRAM U.S. DEPARTMENT OF AGRICULTURE - FOOD AND NUTRITION - 2024 PASSED THROUGH ARIZONA STATE DEPARTMENT OF EDUCATION GRANT NUMBER 6AZ300003 CLIENT RESPONSE AND CORRECTIVE ACTION PLAN We concur with the condition. 1. Name of the contact person responsible for corrective action: Katie O’Neill, MPH, RD 2. Corrective action planned: B J Enterprises has hired a Payroll Service that double checks the timesheets each month. Both the Director and Assistant Director will double check the Administrative costs prior to submitting that month’s claim in order to ensure that the administrative costs are accurately reported. 3. Anticipated completion date: June 2025

View Audit 358561

Finding 564424 (2024-101)

Significant Deficiency 2024

B J Enterprises, Inc.

AZ

Procurement, Suspension & Debarment Cash Management Eligibility § 200.303

REFERENCE: 2024-101 REPEAT FINDING REFERENCE: 2023-001 CFDA NUMBER: 10.558 – CHILD AND ADULT CARE FOOD PROGRAM U.S. DEPARTMENT OF AGRICULTURE - FOOD AND NUTRITION - 2024 PASSED THROUGH ARIZONA STATE DEPARTMENT OF EDUCATION GRANT NUMBER 6AZ300003 CLIENT RESPONSE AND CORRECTIVE ACTION PLAN We concur ...

REFERENCE: 2024-101 REPEAT FINDING REFERENCE: 2023-001 CFDA NUMBER: 10.558 – CHILD AND ADULT CARE FOOD PROGRAM U.S. DEPARTMENT OF AGRICULTURE - FOOD AND NUTRITION - 2024 PASSED THROUGH ARIZONA STATE DEPARTMENT OF EDUCATION GRANT NUMBER 6AZ300003 CLIENT RESPONSE AND CORRECTIVE ACTION PLAN We concur with the condition. 1. Name of the contact person responsible for corrective action: Katie O’Neill, MPH, RD 2. Corrective action planned: The menu reader (Area Coordinator) will double check the meal counts to the menus to ensure all meal counts: * are clerically accurate; * are claimed for providers own, only when day care children are present; * are claimed only when children are present to eat those meals and; * are claimed only when 2 snacks and 1 meal or 2 meals and 1 snack are claimed for each child. The menu reader will double check the list of Income Eligible providers each month to make sure providers’ own are claimed only when we have the Income Affidavits. The Director will re-train the menu readers in these specific areas at the next staff meeting and through virtual training. 3. Anticipated completion date: June 2025 through October 2025

View Audit 358561

Finding 564422 (2024-001)

None 2024

Johnson County Housing Development Corporation

NC

Reporting Matching / Level of Effort / Earmarking

JOHNSON COUNTY HOUSING DEVELOPMENT CORPORATION P.O. Box 10248 Greensboro, North Carolina 27404 CORRECTIVE ACTION PLAN March 31, 2025 Federal Audit Clearinghouse 1201 East 10th Street Jeffersonville, Indiana 47132 Johnson County Housing Development Co...

JOHNSON COUNTY HOUSING DEVELOPMENT CORPORATION P.O. Box 10248 Greensboro, North Carolina 27404 CORRECTIVE ACTION PLAN March 31, 2025 Federal Audit Clearinghouse 1201 East 10th Street Jeffersonville, Indiana 47132 Johnson County Housing Development Corporation (the "Organization"), respectfully submits the following Corrective Action Plan for Hillcrest Apartments for the year ended December 31, 2024. Bernard Robinson & Company, L.L.P. 1501 Highwoods Blvd., Suite 300 Greensboro, North Carolina 27410 Audit period: Year ended December 31, 2024 The finding from the December 31, 2024 Schedule of Findings and Questioned Costs is discussed below. The finding is numbered consistently with the number assigned in the schedule. Findings and Questioned Costs: Finding 2024-001: Section III - Findings and questioned costs relating to the major programs which are required to be reported as defined by the Uniform Guidance [2 CFR 200.516(a)]: Recommendation: The Organization should continuously monitor cash balances to ensure that funds are always covered by FDIC insurance limits, collateral agreements are obtained, or funds are invested in government securities. Reporting Views of Responsible Officials: Management agrees with the above finding and is in the process of transferring funds to provide adequate FDIC insurance coverage for the reserve for replacements account. Management will re-evaluate its policies and procedures to determine any necessary changes. If you have questions regarding this plan, please call Hona Moore at 336-544-2300. Sincerely yours, Hona Moore Partnership Property Management

View Audit 358549

Finding 564317 (2024-001)

Significant Deficiency 2024

Adventhealth University

FL

Reporting Significant Deficiency Matching / Level of Effort / Earmarking § 200.210 § 200.303

2024-001 – Preparation of the Schedule of Expenditures of Federal Awards (SEFA) (Significant Deficiency) Criteria: According to 2 CFR 200.210(b), a recipient of Federal awards is required to prepare a SEFA for the period covered by the entity’s financial statement which must include the total Federa...

2024-001 – Preparation of the Schedule of Expenditures of Federal Awards (SEFA) (Significant Deficiency) Criteria: According to 2 CFR 200.210(b), a recipient of Federal awards is required to prepare a SEFA for the period covered by the entity’s financial statement which must include the total Federal awards expended. In addition, 2 CFR 200.303 requires non-Federal entities to, among other things, establish, document, and maintain effective internal control over Federal awards that provides reasonable assurance that the non-Federal entity is managing the Federal awards in compliance with Federal statutes, regulations, and the terms and conditions of the Federal awards. Effective internal controls should include procedures to ensure expenditures are properly reported on the SEFA. In addition to providing an accurate SEFA, an organization must also be able to demonstrate that it has a system of internal control that supports the preparation of the SEFA. Condition: The University did not have an adequate process in place to prepare and review its SEFA. Cause: The University’s internal control process for preparing the SEFA did not include review and approval of the SEFA prior to providing it to the auditor. Effect: Failure to accurately report federal expenditures on the SEFA could result in noncompliance with federal regulations. Recommendation: We recommend the University establish, document, and maintain effective internal controls over the preparation of the SEFA. At a minimum, an organization should be able to show documentation that the SEFA was reviewed and approved by an individual who was not directly involved with the initial preparation of the SEFA. The review process should include checking both the reported expenditures of federal awards and the assistance listing numbers reported for each grant program. Action Taken: Management has put in place the following procedures: We will establish, document and maintain effective internal control over Federal awards by performing reconciliation of federal funds at the end of each trimester. The account reconciled will be listed on the SEFA. The Director of Financial Aid will be responsible for preparing the SEFA. It will be reviewed and re-reconciled by the Business Systems Analyst and the FA Asst. Director. Reports used to reconcile come from our Sonis system and are the Award Summary Detail and the Charges and Credits reports. Responsible Party and contact information: Valerie Souza, FA Business Systems Analyst and Lynda Swanson, Asst. Director of Financial Aid. Expected Date of Correction: At the end of each trimester. Full completion of processes will be at the end of our fiscal year/calendar year when audit preparation begins.

View Audit 358473

Finding 564297 (2024-003)

Material Weakness 2024

Brazos Valley Community Action Programs

TX

Reporting Equipment & Real Property Management Matching / Level of Effort / Earmarking

CORRECTIVE ACTION PLANNED: We agree with the finding and have implemented corrective action, including strengthening of written procedures as well as the engagement of outside consultants to assist with training and policy direction. The control deficiencies noted were originally identified in fisca...

CORRECTIVE ACTION PLANNED: We agree with the finding and have implemented corrective action, including strengthening of written procedures as well as the engagement of outside consultants to assist with training and policy direction. The control deficiencies noted were originally identified in fiscal year 2022 but certain programmatic changes delayed full completion of corrective action. However, management believes that now-implemented procedures will address the deficiency in future years. PERSON RESPONSIBLE FOR CORRECTION ACTION: James McCullough, Board President ANTICIPATED COMPLETION DATE: September 30, 2025

View Audit 358437

Finding 564272 (2024-005)

None 2024

Los Angeles Community College District

CA

Allowable Costs / Cost Principles Reporting Matching / Level of Effort / Earmarking

Corrective Actions: The District will continue to focus on learning and improving the delivery of its grant programs. While proud of the effort and engagement demonstrated in this program, which has been recognized as a gold standard for similar programs nationwide, the District is committed to sett...

Corrective Actions: The District will continue to focus on learning and improving the delivery of its grant programs. While proud of the effort and engagement demonstrated in this program, which has been recognized as a gold standard for similar programs nationwide, the District is committed to setting higher goals and expectations. We will continue to work diligently to achieve these ambitious objectives in future programs. Going forward, we will establish a communication protocol with the granting agencies to clarify the program goals and grant requirements as needed. We will implement more frequent monitoring tools for the early identification of potential concerns that may require further attention from the granting agencies. Personnel Responsible for Implementation: Nyame-Tease Prempeh, Director of Accounting, Los Angeles Community College District College Personnel, Grant Coordinators Expected Date of Implementation: December 1, 2024

View Audit 358384

Finding 564262 (2024-002)

Significant Deficiency 2024

Los Angeles Community College District

CA

Questioned Costs Student Financial Aid Special Tests & Provisions

Corrective Actions: A. Incorrect Calculation of Return of Title IV Funds Los Angeles Harbor College The District’s Central Financial Aid Unit (CFAU) R2T4 Unit centralized the R2T4 process at all nine colleges during the 2023-24 aid year. CFAU is currently processing R2T4 calculations for Los Angeles...

Corrective Actions: A. Incorrect Calculation of Return of Title IV Funds Los Angeles Harbor College The District’s Central Financial Aid Unit (CFAU) R2T4 Unit centralized the R2T4 process at all nine colleges during the 2023-24 aid year. CFAU is currently processing R2T4 calculations for Los Angeles Harbor College. Personnel Responsible for Implementation: Ludwig Perez, Financial Aid Manager, Los Angeles Harbor College Steve Giorgi, Financial Aid Manager, Central Financial Aid Unit Expected Date of Implementation: Already Implemented B. Distance Education (DE) Courses – Implementation of Formal Process to Determine Accuracy of Student Withdrawal Date – Partial Implementation of Prior Year Corrective Action Plan (CAP) EPIE will share the most recent annual internal audit review with each college team and require each college to develop a corrective action plan. EPIE will submit a request to add a pop-up message to the faculty roster directly tied to completion of the mandatory exclusion roster (census roster), supplemental roster, and active enrollment roster. The pop-up message will continue to be displayed until the faculty member successfully submits their roster. EPIE will work with the distance education (DE) faculty coordinators to create professional development training geared toward using Canvas to determine an online student’s last date of academic engagement and will offer the training annually. Additionally, EPIE will conduct training for administrators on the use of queries to monitor pending rosters. Personnel Responsible for Implementation: Nicole Albo-Lopez, Vice Chancellor, EPIE Expected Date of Implementation: June 30, 2025

View Audit 358384 Questioned Costs: $1

Finding 564260 (2024-001)

None 2024

Los Angeles Community College District

CA

Student Financial Aid Reporting Matching / Level of Effort / Earmarking

Corrective Action: The District’s Educational Programs & Institutional Effectiveness (EPIE) and Information Technology (IT) divisions will analyze the current programming and test cases and develop programming to correct the misalignment of the student status effective date reported to the NSC and s...

Corrective Action: The District’s Educational Programs & Institutional Effectiveness (EPIE) and Information Technology (IT) divisions will analyze the current programming and test cases and develop programming to correct the misalignment of the student status effective date reported to the NSC and student status date in PeopleSoft. EPIE will continue to monitor post-submission errors and warning reports to review the effectiveness of the programming change. Personnel Responsible for Implementation: Maury Pearl, Associate Vice Chancellor Andrew Alvarez, IT Business Analyst Stan Levin, Senior Research Analyst Expected Date of Implementation: March 31, 2025

View Audit 358384

Finding 564248 (2024-001)

Material Weakness 2024

Lorna Doone Associates, LLC

UT

Questioned Costs HUD Housing Programs Matching / Level of Effort / Earmarking

a. Management is negotiating a solution with the State of Utah and HUD for a refund of the payment.

View Audit 358354 Questioned Costs: $1

Finding 564243 (2024-015)

Material Weakness 2024

Charter County of Wayne, Michigan

MI

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

Condition: The County’s controls over meal participants did not ensure a review was in place to check the intake forms for Halal Home Delivered meal participants or that updated assessments were obtained for home delivered meals. Lastly there was not a control in place to ensure liquid meal particip...

Condition: The County’s controls over meal participants did not ensure a review was in place to check the intake forms for Halal Home Delivered meal participants or that updated assessments were obtained for home delivered meals. Lastly there was not a control in place to ensure liquid meal participants maintained a physician order, renewed every six months, stating the need for the continued supplement service. Planned Corrective Action: Wayne County’s Department of Senior Services will implement processes to ensure only eligible individuals receive meals. A quarterly report will be run to verify all home delivered meal clients have updated assessments and reassessments and will be reviewed by the Department Director and or Division Director quarterly. Halal home delivered meal clients assessments will be reviewed by a second staff member to ensure eligibility and verified by the Department Director and or Division Director monthly. Contact person responsible for corrective action: Joan Siavrakas, Division Director Anticipated Completion Date: 04/25/2025

View Audit 358351

Finding 564239 (2024-002)

Significant Deficiency 2024

Housing Connector

WA

Matching / Level of Effort / Earmarking Subrecipient Monitoring § 200.306

Corrective action planned: Housing Connector will develop and implement a written policy to address company match contributions used to meet federal cost share requirements, in alignment with 2 CFR 200.306. The policy will provide general guidance on the allowability, tracking, and reporting of matc...

Corrective action planned: Housing Connector will develop and implement a written policy to address company match contributions used to meet federal cost share requirements, in alignment with 2 CFR 200.306. The policy will provide general guidance on the allowability, tracking, and reporting of match to ensure compliance with federal grant regulations. Relevant staff will be informed once the policy is finalized.

View Audit 358335

Finding 564238 (2024-001)

Significant Deficiency 2024

Housing Connector

WA

Questioned Costs Allowable Costs / Cost Principles Subrecipient Monitoring § 200.430

Corrective action planned: In alignment with 2 CFR 200.430, Housing Connector will develop and implement a formal time tracking policy and procedure to ensure that personnel expenses charged to federal grants are supported by records reflecting the actual time worked on each award.

View Audit 358335 Questioned Costs: $1

Finding 564234 (2024-002)

Significant Deficiency 2024

National Railroad Passenger Corporation

DC

Subrecipient Monitoring Matching / Level of Effort / Earmarking Special Tests & Provisions § 200.302 § 200.303

Finding 2024-002: Review of Compliance Matrices and Narratives The single audit report included the following recommendation: We recommend that Amtrak establishes a more defined timeline for the events that would trigger the update and review of the compliance matrices and compliance narrative, w...

Finding 2024-002: Review of Compliance Matrices and Narratives The single audit report included the following recommendation: We recommend that Amtrak establishes a more defined timeline for the events that would trigger the update and review of the compliance matrices and compliance narrative, which could include execution of any new federal awards or amendments to existing federal awards. Additionally, Amtrak should establish a process where the modifications to the provisions are assessed for materiality/applicability and include documentation of the respective conclusions as part of the review process. Management Response/Status of Action Plans: Amtrak acknowledges the need to augment process documentation around the controls over the preparation and updates to the compliance matrices. The company is in the process of updating these controls now and will incorporate the identified findings in developing more robust controls. The company specifically notes the need to add more documentation on considerations for what provisions are updated in the compliance matrices and the evidence of review. The review procedures and controls are being enhanced to include a checklist to improve the review. This checklist will be completed by both the compliance matrix creator (upon creation) and the compliance matrix reviewer/approver (upon review and final approval). The contact for this item is Lucia Butts, AVP Funding and Grants and Meghan Histand, Director of Discretionary Grants. Amtrak anticipates fully remediating this finding by September 2025.

View Audit 358334

Finding 564143 (2024-001)

Material Weakness 2024

Shelby City School District

OH

Matching / Level of Effort / Earmarking Subrecipient Monitoring HUD Housing Programs

The district will ensure that any contracts that will be paid with Federal Funds will follow the provisions outlined in the grant documentation.

View Audit 358306

Finding 564114 (2024-003)

Material Weakness 2024

Young Men's Christian Association of the Greater Houston Area

TX

Matching / Level of Effort / Earmarking

Finding #2024-003 – Material Weakness and Other Noncompliance. Applicable federal program: U. S. Department of Health and Human Services, 93.567, Refugee and Entrant Assistance Voluntary Agency Programs, Passed through U. S. Committee for Refugees and Immigrants: 10/01/23 – 09/30/24, 2402VARVMG-00....

Finding #2024-003 – Material Weakness and Other Noncompliance. Applicable federal program: U. S. Department of Health and Human Services, 93.567, Refugee and Entrant Assistance Voluntary Agency Programs, Passed through U. S. Committee for Refugees and Immigrants: 10/01/23 – 09/30/24, 2402VARVMG-00. Condition and context: During our testing of 40 transactions reported as matching grant costs, we identified two exceptions totaling $369 with lack of documentation of fair value of in-kind donations. Additionally, the YMCA did not meet its match requirement by approximately $281,000. Recommendation: Provide additional training and emphasize adherence to established policies and procedures to ensure maintenance of documentation for valuation, documentation and monitoring of matching grant funds. Management’s response: Management agrees with the finding. Continued rapid growth in these programs necessitated significantly greater match requirements, and our internal control procedures around match required expansion. Unfortunately, our organization was not able to keep up with the rate at which these requirements grew. We understand the importance of meeting match obligations and have strengthened procedures in this area to detect and prevent future findings. As we move forward with these programs on a smaller scale, we will ensure that those grants accepted have match levels and requirements that are manageable for our organization. Responsible officer: Jennifer Garcia, Chief Financial Officer. Estimated completion date: June 2025.

View Audit 358211

Corrective Action Plans

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