Corrective Action Plans

Finding 537926 (2022-004)

Material Weakness 2022

PR

Subrecipient Monitoring Material Weakness Reporting

Management concurs with the finding. We will enforce and continue strengthening control over financial reporting and enforce procedures to reconcile information of accounting balances, transactions, and ARPA annual report (Project and Expenditure Report), in order to prevent future differences.

View Audit 348980

Finding 537925 (2022-003)

Material Weakness 2022

Municipality of Camuy

PR

Reporting Material Weakness Matching / Level of Effort / Earmarking

Management concurs with the finding. We will monitor our internal control activities directly related to the financial accounting of state funds and federal funds. We will implement procedures for improving information communica-tion between the accounting finance office and the office of compliance...

Management concurs with the finding. We will monitor our internal control activities directly related to the financial accounting of state funds and federal funds. We will implement procedures for improving information communica-tion between the accounting finance office and the office of compliance so rec-ords are reconciled and are available on time for audit financial statements, including Single Audit.

View Audit 348980

Finding 530121 (2022-005)

Material Weakness 2022

Healthsource Saginaw, Inc.

MI

Material Weakness Reporting Matching / Level of Effort / Earmarking

Finding Number: 2022-005 Condition: HealthSource's controls in place for reporting submissions did not identify that guidelines were not followed related to the lost revenue calculations. Planned Corrective Action: All future submissions will be reviewed with CEO and President for accuracy and thoro...

Finding Number: 2022-005 Condition: HealthSource's controls in place for reporting submissions did not identify that guidelines were not followed related to the lost revenue calculations. Planned Corrective Action: All future submissions will be reviewed with CEO and President for accuracy and thoroughness prior to submission upload. Contact person responsible for corrective action: Sonja Martinez, Chief Financial Officer Anticipated Completion Date: 12/31/2024

View Audit 348199

Finding 530120 (2022-004)

Material Weakness 2022

Healthsource Saginaw, Inc.

MI

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

Condition: HealthSource does not have a review process in place related to the lost revenue calculation used to input into the required reporting submissions to the U.S. Department of Health and Human Services for the Provider Relief Fund program and not having a review process in place over the fo...

Condition: HealthSource does not have a review process in place related to the lost revenue calculation used to input into the required reporting submissions to the U.S. Department of Health and Human Services for the Provider Relief Fund program and not having a review process in place over the forementioned required submissions. Planned Corrective Action: A review of all updates to Covid lost revenue will be performed with the CEO and President as indicated by new activity, and before any submissions are uploaded. Contact person responsible for corrective action: Sonja Martinez, Chief Financial Officer Anticipated Completion Date: 12/31/2024

View Audit 348199

Finding 529977 (2022-004)

Material Weakness 2022

Fairbanks Rescue Mission, Inc.

AK

Allowable Costs / Cost Principles Internal Control / Segregation of Duties Procurement, Suspension & Debarment

Financial Statement Finding: 2022-004 Material Weakness in Internal Control over Financial Reporting and Noncompliance – Allowable Costs/Cost Principles - Repeat Name and Contact Person: Pete Kelly, Chief Executive Officer Corrective Action: Management hired a Finance Director and contracted with an...

Financial Statement Finding: 2022-004 Material Weakness in Internal Control over Financial Reporting and Noncompliance – Allowable Costs/Cost Principles - Repeat Name and Contact Person: Pete Kelly, Chief Executive Officer Corrective Action: Management hired a Finance Director and contracted with an Accountant that has made significant improvements to the processes and record keeping to ensure that sufficient documentation is maintained by the Organization. Proposed Completion Date: January 1, 2024

View Audit 348068

Finding 529226 (2022-002)

Material Weakness 2022

Neighborhoods, Inc. of Battle Creek

MI

Allowable Costs / Cost Principles Material Weakness Reporting

Now that disbursements are 100% in-house, the President & CEO provides final written approval on all timecards and payables. Chairman of the Loan & Finance Committee remotely reviews journal entries in accounting software monthly. Contact Person Responsible for Corrective Action: Lisa Ripper Antic...

Now that disbursements are 100% in-house, the President & CEO provides final written approval on all timecards and payables. Chairman of the Loan & Finance Committee remotely reviews journal entries in accounting software monthly. Contact Person Responsible for Corrective Action: Lisa Ripper Anticipated Completion Date: 7/1/2023

View Audit 347220

Finding 529159 (2022-003)

Material Weakness 2022

Oregon Coalition Against Domestic & Sexual Violence

OR

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

Contact person(s) responsible: Associate Director, BB Beltran Recommendation: The Coalition should establish monitoring procedures to ensure that charges to federal awards and other funders are adequately documented and approved and comply with all established policies. Specifically, adequate docume...

Contact person(s) responsible: Associate Director, BB Beltran Recommendation: The Coalition should establish monitoring procedures to ensure that charges to federal awards and other funders are adequately documented and approved and comply with all established policies. Specifically, adequate documentation should include original itemized invoices or receipts, and clear documentation of review and approval. Management Response: NEW Corrective Action Plan: OCADSV implemented a third-party service for tracking the Coalitions costs by program in January of 2023. The submission, coding, approval and payment are processed within this software, which also allows for an audit trail of the processes performed by user and quick access to scanned original documentation. Quarterly budget expense reimbursements are prepared and submitted for review to the Associate Director and/or the Grants Manager. The monthly/quarterly reports are reviewed and approved, with general ledger support, before sending them to the funding agency as the quarterly invoice for reimbursements. Anticipated completion date: 09/30/24

View Audit 347141

Finding 528934 (2022-009)

Material Weakness 2022

Iliff School of Theology

CO

Student Financial Aid Matching / Level of Effort / Earmarking Material Weakness

Condition: The Institution does not have evidence that exit counseling was provided to students who withdrew or graduated as required by 34 CFR 682.604. Planned Corrective Action: The Iliff School of Theology has contracted with a professional, third-party processing company to administer its stude...

Condition: The Institution does not have evidence that exit counseling was provided to students who withdrew or graduated as required by 34 CFR 682.604. Planned Corrective Action: The Iliff School of Theology has contracted with a professional, third-party processing company to administer its student aid programs. The school has also ensured that this third-party processor is properly coordinated with the registrar’s office to meet federal requirements for exit counseling when status changes are processed. Contact person responsible for corrective action: Jason Warr, VP for Business, Controller Anticipated Completion Date: May 2024

View Audit 346905

Finding 528933 (2022-008)

Material Weakness 2022

Iliff School of Theology

CO

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

Condition: The Institution does not have written policies and procedures that incorporate the provisions of 34 CFR 668.51 through 668.61. Planned Corrective Action: The Iliff School of Theology has contracted with a professional, third-party processing company to administer its student aid program...

Condition: The Institution does not have written policies and procedures that incorporate the provisions of 34 CFR 668.51 through 668.61. Planned Corrective Action: The Iliff School of Theology has contracted with a professional, third-party processing company to administer its student aid programs. All verification procedures are established, and documentation will be maintained to demonstrate compliance. Contact person responsible for corrective action: Jason Warr, VP for Business, Controller Anticipated Completion Date: May 2024

View Audit 346905

Finding 528932 (2022-007)

Material Weakness 2022

Iliff School of Theology

CO

Student Financial Aid Material Weakness Matching / Level of Effort / Earmarking

Condition: The Institution does not have a documented Direct Loan quality assurance program. Planned Corrective Action: The Iliff School of Theology has contracted with a professional, third-party processing company to administer its student aid programs. The school will coordinate with this third-...

Condition: The Institution does not have a documented Direct Loan quality assurance program. Planned Corrective Action: The Iliff School of Theology has contracted with a professional, third-party processing company to administer its student aid programs. The school will coordinate with this third-party processor to ensure that there is a documented quality assurance program that is regularly exercised for compliance purposes. All documentation will be maintained. Contact person responsible for corrective action: Jason Warr, VP for Business, Controller Anticipated Completion Date: May 2024

View Audit 346905

Finding 528931 (2022-006)

Material Weakness 2022

Iliff School of Theology

CO

Questioned Costs Student Financial Aid Material Weakness

Condition: Our audit procedures identified an instance where the Institution could not locate evidence that the required R2T4 calculation under federal regulation was completed. The total aid disbursed to this student was $5,125. Planned Corrective Action: The Iliff School of Theology has contracte...

Condition: Our audit procedures identified an instance where the Institution could not locate evidence that the required R2T4 calculation under federal regulation was completed. The total aid disbursed to this student was $5,125. Planned Corrective Action: The Iliff School of Theology has contracted with a professional, third-party processing company to administer its student aid programs. This third-party processor is adequately skilled to complete Return of Title IV calculations and includes an established review process for quality control. All documentation will be maintained. Contact person responsible for corrective action: Jason Warr, VP for Business, Controller Anticipated Completion Date: May 2024

View Audit 346905 Questioned Costs: $1

Finding 528930 (2022-005)

Material Weakness 2022

Iliff School of Theology

CO

Student Financial Aid Material Weakness Matching / Level of Effort / Earmarking

Condition: The Institution does not reconcile institutional records with Direct Loan funds received from the Secretary of the U.S. Department of Education and the Direct Loan disbursement records submitted to and accepted by the Secretary of the U.S. Department of Education. Planned Corrective Acti...

Condition: The Institution does not reconcile institutional records with Direct Loan funds received from the Secretary of the U.S. Department of Education and the Direct Loan disbursement records submitted to and accepted by the Secretary of the U.S. Department of Education. Planned Corrective Action: The Iliff School of Theology has contracted with a professional, third-party processing company to administer its student aid programs who will ensure that direct loan reconciliations are conducted on a monthly basis in coordination with the business office. Contact person responsible for corrective action: Jason Warr, VP for Business, Controller Anticipated Completion Date: May 2024

View Audit 346905

Finding 528927 (2022-002)

Material Weakness 2022

Iliff School of Theology

CO

Student Financial Aid Reporting Material Weakness

Condition: Our audit procedures identified instances of inaccurate or untimely reporting of enrollment information to NSLDS. Planned Corrective Action: The Iliff School of Theology has contracted with a professional, third-party processing company to administer its student aid programs. The school ...

Condition: Our audit procedures identified instances of inaccurate or untimely reporting of enrollment information to NSLDS. Planned Corrective Action: The Iliff School of Theology has contracted with a professional, third-party processing company to administer its student aid programs. The school has also ensured that this third-party processor is properly coordinated with the registrar’s office to meet federal requirements for NSLDS enrollment reporting. Contact person responsible for corrective action: Jason Warr, VP for Business, Controller Anticipated Completion Date: May 2024

View Audit 346905

Finding 528923 (2022-004)

Material Weakness 2022

Iliff School of Theology

CO

Student Financial Aid Material Weakness

Condition: The institution submitted a FISAP to the U.S. Department of Education that reported inaccurate information in several data fields within the report. In addition, there was no evidence that an individual other than the preparer reviewed the report. Planned Corrective Action: The Iliff Sch...

Condition: The institution submitted a FISAP to the U.S. Department of Education that reported inaccurate information in several data fields within the report. In addition, there was no evidence that an individual other than the preparer reviewed the report. Planned Corrective Action: The Iliff School of Theology has contracted with a professional, third-party processing company to administer its student aid programs. Preparation and submission of the FISAP will be completed with coordination between the VP of Business and the third-party processor. This includes a quality review process for accuracy. Contact person responsible for corrective action: Jason Warr, VP for Business, Controller Anticipated Completion Date: May 2024

View Audit 346905

Finding 528922 (2022-003)

Material Weakness 2022

Iliff School of Theology

CO

Student Financial Aid Material Weakness Internal Control / Segregation of Duties

Condition: Due to the limited number of personnel within the Financial Aid Department, the director of financial aid is solely responsible for packaging, awarding, and disbursing to student accounts Federal Student Financial Aid (Title IV) as well as calculating return of Title IV funds for students...

Condition: Due to the limited number of personnel within the Financial Aid Department, the director of financial aid is solely responsible for packaging, awarding, and disbursing to student accounts Federal Student Financial Aid (Title IV) as well as calculating return of Title IV funds for students who withdraw from the School to student accounts. The packaging of Title IV aid and the return of Title IV funds are complex calculations that are not formally reviewed by another employee. Planned Corrective Action: The Iliff School of Theology has contracted with a professional, third-party processing company to administer its student aid programs. This third-party processing company is structured to properly segregate financial processing and includes a quality review function. Contact person responsible for corrective action: Jason Warr, VP for Business, Controller Anticipated Completion Date: May 2024

View Audit 346905

Finding 527031 (2022-008)

Material Weakness 2022

The Wellness Plan Medical Centers

MI

Material Weakness Reporting

Finding Number: 2022-008 Condition: Due to material entries identified and recorded during the 2022 financial statement audit of the Organization, the data submitted within the annual performance report was not accurate. Additionally, there was no evidence of review over the required reports. Planne...

Finding Number: 2022-008 Condition: Due to material entries identified and recorded during the 2022 financial statement audit of the Organization, the data submitted within the annual performance report was not accurate. Additionally, there was no evidence of review over the required reports. Planned Corrective Action: Management will enhance controls such that the preparation and review of account reconciliation in completed for all fiscal cycles in a timely manner. Contact person responsible for corrective action: Chief Financial Officer Anticipated Completion Date: 06/30/2025

View Audit 346114

Finding 527027 (2022-007)

Material Weakness 2022

The Wellness Plan Medical Centers

MI

Questioned Costs Allowable Costs / Cost Principles Material Weakness

Finding Number: 2022-007 Condition: Costs with prior written approval to be applied against the C8ECS43729 grant (ALN 93.526) by the federal award agency (HRSA) were coded and applied to the H8FCS40356 grant (ALN 93.224/527). Planned Corrective Action: Management will implement controls to ensure al...

Finding Number: 2022-007 Condition: Costs with prior written approval to be applied against the C8ECS43729 grant (ALN 93.526) by the federal award agency (HRSA) were coded and applied to the H8FCS40356 grant (ALN 93.224/527). Planned Corrective Action: Management will implement controls to ensure all allowable costs are properly coded and applied to the correct grant. Contact person responsible for corrective action: Chief Financial Officer Anticipated Completion Date: 06/30/2025

View Audit 346114 Questioned Costs: $1

Finding 527015 (2022-004)

Material Weakness 2022

The Wellness Plan Medical Centers

MI

Material Weakness

Finding Number: 2022-004 Condition: Not all patients had valid sliding fee applications on file and not all patients received accurate sliding fee adjustments. Planned Corrective Action: Management will ensure that all sliding fee applications are maintained and sliding fee adjustments are accurate ...

Finding Number: 2022-004 Condition: Not all patients had valid sliding fee applications on file and not all patients received accurate sliding fee adjustments. Planned Corrective Action: Management will ensure that all sliding fee applications are maintained and sliding fee adjustments are accurate based on correct family income and size In addition, internal audits will be conducted to ensure compliance with Uniform Guidance. Contact person responsible for corrective action: Chief Financial Officer and the Chief Operating Officer Anticipated Completion Date: 06/30/2025

View Audit 346114

Finding 526762 (2022-003)

Material Weakness 2022

Choctaw County City of Hugo Hospital Authority Dba Choctaw Memorial Hospital

OK

Internal Control / Segregation of Duties Eligibility Material Weakness § 200.303

Reporting - Material Weakness in Internal Control over Compliance and Noncompliance Deemed not Material Identification of the Federal Program: Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution - 93.498. Finding Summary: The Authority tracked patiet care revenues intern...

Reporting - Material Weakness in Internal Control over Compliance and Noncompliance Deemed not Material Identification of the Federal Program: Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution - 93.498. Finding Summary: The Authority tracked patiet care revenues internally within a spreadsheet. The calculations of revenue by payor within the spreadsheet and included in Period 2 report to HRSA, which are utilized to calculate lost revenues, contained errors. Responsible Individual: Dawn Ballard. Corrective Action Plan: While there were errors in the reported net patient revenue by payor for specific quarters, the total net patient service revenue, by quarter, was accurately reported and did not impact the calculated lost revenue. Management believes that the control process in place is sufficient to identify material errors in reported amounts. Anticipated Completion Date: January 15, 2025

View Audit 345762

Finding 526761 (2022-002)

Material Weakness 2022

Choctaw County City of Hugo Hospital Authority Dba Choctaw Memorial Hospital

OK

Allowable Costs / Cost Principles Material Weakness Reporting § 200.303

Reporting - Material Weakness in Internal Control over Compliance and Material Noncompliance Identification of the Federal Program: Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution - 93.498. Finding Summary: The Authority selected Option 1, as defined by HRSA, to calc...

Reporting - Material Weakness in Internal Control over Compliance and Material Noncompliance Identification of the Federal Program: Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution - 93.498. Finding Summary: The Authority selected Option 1, as defined by HRSA, to calculate lost revenue. This option consists of reporting actual revenues from relevant quarters in the period of availability with the system calculating the lost revenues because of deadlines. The fiscal year 2021 single audit identified unallowable expenses totaling $263,861. The Company utilized excess lost revenues at the time to cover this difference. To capture the use of these lost revenues from Period 1, the Authority should have used Option 3, as defined by HRSA, to calculate and report lost revenues. Within that calculation, lost revenues could then be reduced by the $263,861. Responsible Individual: Dawn Ballard. Corrective Action Plan: Due to the timing of completion of the single audit requirements and identification of questioned costs, the report for Period 2 was unable to properly reflect the identified questioned costs. Management will implement process and procedures to ensure all required reports are completed accurately, in the event similar funding is received in the future. Anticipated Completion Date: January 16, 2025

View Audit 345762

Finding 526433 (2022-001)

Material Weakness 2022

State Education Resource Center

CT

Internal Control / Segregation of Duties Material Weakness Reporting

Description of Finding: In fiscal year 2022, the Organization’s accounting processes and internal controls over financial reporting were not functioning timely to support generating complete and accurate financial information. The year end was not closed in accordance with the Organization’s financi...

Description of Finding: In fiscal year 2022, the Organization’s accounting processes and internal controls over financial reporting were not functioning timely to support generating complete and accurate financial information. The year end was not closed in accordance with the Organization’s financial close policy. Multiple adjustments to the trial balances were made, necessitating repeated revisions to balance sheet account reconciliations, and grant schedules. The books and records were not closed and finalized until many months after year end. In addition, many accounting adjustments were needed throughout the audit process. Statement of Concurrence or Nonconcurrence: The State Education Resource Center agrees with this finding. The Fiscal Department experienced staff shortages and related difficulties during the fiscal year. Because of this the books and records were not closed and completed until many months after the year end. In addition, SERC’s accounting processes and internal controls over financial reporting did not function properly. Corrective Action: In May of 2024, the State Education Resource Center hired a new Chief Financial Officer whose focus is to bring the organization up to date on all audits and reporting and to ensure that the Fiscal team has the proper tools and guidance to perform their tasks and to improve policy and process for the department. Name of Contact Person: Jim Fried, Chief Financial Officer, 860-740-4263, fried@ctserc.org will be responsible for completing the corrective action plan. Projected Completion Date: The anticipated date for completing the corrective action plan is June 30, 2025. The action plan will be monitored on a bi-annual basis to ensure ongoing compliance.

View Audit 345377

Finding 526012 (2022-003)

Material Weakness 2022

Town of Anthony, Texas

TX

Material Weakness

2022-003 (2021-006, 2020-007) Data Collection Form: Timely Submission - Significant Deficiency Criteria: The 0MB Circular A-133 and Uniform Guidance require entities who spend $750,000 or more in federal awards to obtain a single audit and submit a data collection form either 30 days after receipt o...

2022-003 (2021-006, 2020-007) Data Collection Form: Timely Submission - Significant Deficiency Criteria: The 0MB Circular A-133 and Uniform Guidance require entities who spend $750,000 or more in federal awards to obtain a single audit and submit a data collection form either 30 days after receipt of the auditor's report or nine months after the end of the fiscal year, whichever comes first. Condition: The Town has not submitted the data collection form within the specified deadline of June 30, 2022. Cause: The Town has had significant difficulties in retaining both a Town Clerk and Accountant who have the capacity to prepare and analyze financial reports. This caused the audit to be delayed and therefore a late data collection form submission. Effect: The Town is not in compliance with the 0MB Circular A-133 and Uniform Guidance and therefore, the Town has the possibility of not being able to renew contracts in the future. Recommendation: We recommend that the Town plan and coordinate a single audit prior to deadline to ensure timely submission of the data collection form. Views of Responsible Officials and Planned Corrective Actions: The Town has hired an Accounting Manager and Accounting Clerk to help ensure compliance with such deadlines and understands the importance of meeting the requirements.

View Audit 345165

Finding 525844 (2022-002)

Significant Deficiency 2022

Hollandale School District

MS

Subrecipient Monitoring Material Weakness Reporting § 200.512

Finding 2022-002 Corrective Action Plan Details A. Contact person responsible for corrective action: Name: Dr. Mario Willis Title: Superintendent B. Description of corrective action planned: The district will strengthen its internal control systems over reporting to ensure single audit reporting pac...

Finding 2022-002 Corrective Action Plan Details A. Contact person responsible for corrective action: Name: Dr. Mario Willis Title: Superintendent B. Description of corrective action planned: The district will strengthen its internal control systems over reporting to ensure single audit reporting package and data collection form are submitted to the Federal Audit Clearinghouse within established timeframe and financial statements are prepared timely. C. Anticipated completion date of corrective action:

View Audit 344984

Finding 523468 (2022-001)

Material Weakness 2022

Midd-West School District

PA

Questioned Costs School Nutrition Programs Subrecipient Monitoring

Auditee Response: The auditee agrees with the finding. This was a perfect storm of events that created this scenario including COVID requiring the discontinuation of our Point of Sale (POS) System, tally sheets by classroom being used in place of that system, a change in head cooks during the year, ...

Auditee Response: The auditee agrees with the finding. This was a perfect storm of events that created this scenario including COVID requiring the discontinuation of our Point of Sale (POS) System, tally sheets by classroom being used in place of that system, a change in head cooks during the year, and a failure to communicate properly between the Director of Food Service and the new Head Cook. Action Taken: The district has and will reinstitute the use of its POS system so that a child purchasing lunch types in their number and it is credited to that child's account. This system can then be used to track meal purchases throughout the day, week, or month. Since the HeadStart classroom are not MWSD students, they do not have numbers within the system. The Director of Food Services will use this system to report meal purchases and reimbursement rather than rely on head cooks and their tally sheets. Despite this, training should be conducted annually with all head cooks as to the qualifications of a reimbursable meal within the school district, so as to provide a fail safe in the event the POS system goes down for a period of time. Timelines/Contract: Most of this has taken place already in that we have returned to using a POS system. This system has the ability to track data and run reports, so it makes it error free when available. However, people ultimately must have the knowledge too so that they understand the parameters of a reimbursable meal should the system go down. Therefore, annual trainings will be instituted regarding such operations effective immediately. The Director of Food Service will be directed to use one in-service day annually for the purpose of teaching all staff members about reimbursable meals and how the HeadStart Programs fit into that. This should be completed no later than fall of 2025. The contact person would be Joe Stroup, Superintendent.

View Audit 342723 Questioned Costs: $1

Finding 523088 (2022-003)

Material Weakness 2022

City of Wyandotte, Michigan

MI

Material Weakness Reporting Program Income

Condition: The City did not submit the required annual report related to use of program income. Planned Corrective Action: The City will work with the EPA to determine how to report the use of program income. Contact person responsible for corrective action: Robert McMahon, City Administrator Ant...

Condition: The City did not submit the required annual report related to use of program income. Planned Corrective Action: The City will work with the EPA to determine how to report the use of program income. Contact person responsible for corrective action: Robert McMahon, City Administrator Anticipated Completion Date: 09/30/2025

View Audit 342365

Corrective Action Plans

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