Corrective Action Plans

Finding 574640 (2024-005)

Material Weakness 2024

AZ

Internal Control / Segregation of Duties Material Weakness Reporting

2024-005 REPORTING REQUIREMENTS Program: Impact Aid Federal Assistance Listing Number: 84.041 Federal Agency: U.S. Department of Education Questioned Costs: None Type of Finding: Material weakness in internal controls and Material Noncompliance Compliance Requirement: L. Reporting Condition/Context...

2024-005 REPORTING REQUIREMENTS Program: Impact Aid Federal Assistance Listing Number: 84.041 Federal Agency: U.S. Department of Education Questioned Costs: None Type of Finding: Material weakness in internal controls and Material Noncompliance Compliance Requirement: L. Reporting Condition/Context: Documentation was not provided to support the number of federally connected students reported on the Impact Aid application. Corrective Action: The District will establish a process to ensure proper documentation is maintained to support the Impact Aid application. Planned completion date for corrective action plan: For the period ending August 31, 2025. Name of the contact person responsible for corrective action: Laticia John, Business Coordinator

View Audit 364909

Finding 574638 (2024-005)

Material Weakness 2024

Shelby County

IN

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

FINDING 2024-005 Contact Person Responsible for Corrective Action: Amy L. Glackman Contact Phone Number: 317-392-6310 Views of Responsible Official: We concur with the finding. Description of Corrective Action Plan: Control procedures will be put into place effective immediately. The Auditor will ha...

FINDING 2024-005 Contact Person Responsible for Corrective Action: Amy L. Glackman Contact Phone Number: 317-392-6310 Views of Responsible Official: We concur with the finding. Description of Corrective Action Plan: Control procedures will be put into place effective immediately. The Auditor will have the Deputy Auditor start signing off on all reports to verify the dates are correct for the reporting period. Anticipated Completion Date: August 30, 2025

View Audit 364904

Finding 574636 (2024-003)

Material Weakness 2024

Shelby County

IN

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

FINDING 2024-003 Contact Person Responsible for Corrective Action: Amy L. Glackman Contact Phone Number: 317-392-6310 Views of Responsible Official: We concur with the finding. Description of Corrective Action Plan: Control procedures will be put into place effective immediately. The Auditor or Depa...

FINDING 2024-003 Contact Person Responsible for Corrective Action: Amy L. Glackman Contact Phone Number: 317-392-6310 Views of Responsible Official: We concur with the finding. Description of Corrective Action Plan: Control procedures will be put into place effective immediately. The Auditor or Department head will review and document their review for all Federal Grant disbursements for applicable grant requirements and Federal regulations. Anticipated Completion Date: August 30, 2025

View Audit 364904

Finding 574616 (2024-003)

Material Weakness 2024

Southwestern Christian University, Inc.

OK

Material Weakness

Gramm-Leach-Bliley Act (GLBA) Compliance Planned Corrective Action: Southwestern Christian University acknowledges the importance of the Gramm-Leach-Bliley Act (GBLA) and the responsibilities it places on higher education institutions to protect personal and financial information of students, fami...

Gramm-Leach-Bliley Act (GLBA) Compliance Planned Corrective Action: Southwestern Christian University acknowledges the importance of the Gramm-Leach-Bliley Act (GBLA) and the responsibilities it places on higher education institutions to protect personal and financial information of students, families, and employees. We are committed to safeguarding sensitive data as part of our responsibility to operate with integrity and stewardship. To address these findings, SCU is working closely with our IT specialist in taking the following steps: a. Information Security Program: we are formalizing a written information security plan that meets the GLBA requirements, including risk assessment, safeguards, and monitoring. b. Designation of Coordinator: A qualified staff member has been designated to oversee GLBA compliance and ensure accountability in implementing safeguards. c. Employee training: Faculty and staff will be trained on data privacy, cybersecurity practices, and proper handling of sensitive information. d. Technical Safeguards: We will be enhancing systems for data encryption, access controls, and monitoring to reduce risks related to unauthorized access or disclosure. e. Ongoing review: Regular testing, audits, and updates will be conducted to ensure continuous improvement and adherence to GLBA standards. At Southwestern Christian University, we believe in protecting the personal information of our students and families is part of our mission of stewardship. Just as we are called to be faithful with financial resources, we are equally called to be trustworthy in safeguarding data. We are confident that the corrective actions being implemented will ensure that SCU not only meets compliance standards but also reflects our values of integrity, accountability and care. Person Responsible for Corrective Action Plan: Mark Arthur, Chief Financial Officer Anticipated Date of Completion: June 30, 2026

View Audit 364878

Finding 574606 (2024-003)

Material Weakness 2024

Jefferson County

IN

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

FINDING 2024-003 Finding Subject: COVID-19 Coronavirus State and Local Fiscal Recovery Funds- Reporting Contact Person Responsible for Corrective Action: Heather Huff Contact Phone Number and Email Address: 812-265-8907 heather.huff@jeffersoncounty.in.gov Views of Responsible Officials: We concur wi...

FINDING 2024-003 Finding Subject: COVID-19 Coronavirus State and Local Fiscal Recovery Funds- Reporting Contact Person Responsible for Corrective Action: Heather Huff Contact Phone Number and Email Address: 812-265-8907 heather.huff@jeffersoncounty.in.gov Views of Responsible Officials: We concur with the finding. Description of Corrective Action Plan: The Auditor’s Office will collect dual signatures on all submissions for reporting requirements. The Auditor’s Office will also have additional employees verify submissions to ledgers for accuracy. Anticipated Completion Date: Completion is anticipated for all reports due after 12-31-2025.

View Audit 364861

Finding 574463 (2024-004)

Material Weakness 2024

Winner Regional Healthcare Center

SD

Special Tests & Provisions Subrecipient Monitoring Material Weakness

Federal Agency Name: United States Department of Agriculture Program Name: Community Facilities Loans and Grants FFAL #10.766 Finding Summary: There was no documented independent review of the monthly reserve fund account balance as compared to the required minimum balance. Corrective Action Plan:...

Federal Agency Name: United States Department of Agriculture Program Name: Community Facilities Loans and Grants FFAL #10.766 Finding Summary: There was no documented independent review of the monthly reserve fund account balance as compared to the required minimum balance. Corrective Action Plan: The required monthly balance and the actual monthly reserve fund account balance will be presented to the board on a monthly basis for review and approval. Previously only the actual balance and a YES/NO were provided. Starting in August 2025, monthly board packets for approval will now include the required vs actual comparison with a YES/NO of meeting the requirement. Responsible Individuals: Amanda Soesbe, Chief Finance Officer Anticipated Completion Date: August 2025

View Audit 364799

Finding 574131 (2024-004)

Material Weakness 2024

Legacy Medical Care Inc.

IL

Allowable Costs / Cost Principles Material Weakness Matching / Level of Effort / Earmarking

Action taken in response to finding: A new process has been put in place documenting the review and approval of payroll. Name(s) of the contact person(s) responsible for corrective action: Melissa D’Onorio, CEO, and Donna Landy, CFO. Planned completion date for corrective action plan: 07/14/2025

View Audit 364705

Finding 574129 (2024-002)

Material Weakness 2024

Legacy Medical Care Inc.

IL

Material Weakness Internal Control / Segregation of Duties

Action taken in response to finding: •LMC will increase the frequency and sample size of its review of patient encounters. •LMC will be providing additional training for front desk staff regarding the collection and verification of patient information. Name(s) of the contact person(s) responsible fo...

Action taken in response to finding: •LMC will increase the frequency and sample size of its review of patient encounters. •LMC will be providing additional training for front desk staff regarding the collection and verification of patient information. Name(s) of the contact person(s) responsible for corrective action: Melissa D’Onorio, CEO, and Donna Landy, CFO. Planned completion date for corrective action plan: 08/15/2025

View Audit 364705

Finding 574121 (2024-001)

Material Weakness 2024

Wessington Springs School District No. 36-2

SD

Internal Control / Segregation of Duties Material Weakness

For this finding, Dr. Michael Ormsmith is the contact person responsible for the corrective action plan. This finding is due to having only two employees in the Business Office, both who have separate duties to cover the workload. Staffing in the office is at an efficient and financially feasible ...

For this finding, Dr. Michael Ormsmith is the contact person responsible for the corrective action plan. This finding is due to having only two employees in the Business Office, both who have separate duties to cover the workload. Staffing in the office is at an efficient and financially feasible level and precludes the hiring of additional personnel to provide an ideal environment for internal controls. The Wessinton Springs School Districted adopted Policy DA-R(1) Fiscal Management Internal Controls and Procedures on January 9, 2023. The district is aware of the weakness in internal controls and will adhere to the policy we have in place while providing compensating controls to reduce the risk. This is an ongoing process.

View Audit 364703

Finding 574078 (2024-002)

Material Weakness 2024

Village of Blanchardville

WI

Material Weakness Reporting Internal Control / Segregation of Duties

Finding #2024-002- Material Adjustments Condition: Johnson Block and Company, Inc. proposed adjusting journal entries during the audit process. We deem these entries to be material in relation to the financial statements. Since the Village did not make these adjustments in its accounting system pri...

Finding #2024-002- Material Adjustments Condition: Johnson Block and Company, Inc. proposed adjusting journal entries during the audit process. We deem these entries to be material in relation to the financial statements. Since the Village did not make these adjustments in its accounting system prior to the audit, a material weakness exists in the Village’s internal controls. Criteria: Material adjusting journal entries not prepared by the Village before the audit are considered an internal control weakness. Cause: The Village does not have policies and procedures in place to ensure that all transactions are properly recorded on the general ledger prior to the audit. Effect: This means that the proper recording and reporting of financial information may not occur within a timely manner. Recommendation: Policies and procedures should be implemented to ensure account balances are properly recorded in a timely manner. Response: The Village will work to establish policies and procedures to reduce the number of adjusting journal entries proposed by the auditor. Contact Person: Amy Barnes, Village Clerk/Treasurer, 608-523-4521, Email: clerk@blanchardvillewi.gov Anticipated Completion: December 31, 2025

View Audit 364647

Finding 574076 (2024-002)

Material Weakness 2024

City of Palmer, Alaska

AK

Subrecipient Monitoring Material Weakness Reporting

Finding 2024-002 Reporting – Material Weakness in Internal Control over Compliance and Material Noncompliance Corrective Action Implementation Finance will report the subawards to the Federal Funding Accountability and Transparency Act (FFATA) Subaward Reporting System. Future internal controls will...

Finding 2024-002 Reporting – Material Weakness in Internal Control over Compliance and Material Noncompliance Corrective Action Implementation Finance will report the subawards to the Federal Funding Accountability and Transparency Act (FFATA) Subaward Reporting System. Future internal controls will include a review by the Finance Director and the Controller to evaluate the applicability of grant requirements for all grants that the City receives. Anticipated Completion Date Finance plans to have the FFATA report filed by 9/30/2025.

View Audit 364645

Finding 573910 (2024-004)

Material Weakness 2024

Sicangu Oyate Ho, INC

SD

Special Tests & Provisions Material Weakness

Management Response: With new procedures in place when accepting applications a drug test, finger prints and background checks are completed prior to hiring. We utilize and outside adjudicator to conduct an investigation and adjudicate the backgrounds and provide a report to the Superintendent in a ...

Management Response: With new procedures in place when accepting applications a drug test, finger prints and background checks are completed prior to hiring. We utilize and outside adjudicator to conduct an investigation and adjudicate the backgrounds and provide a report to the Superintendent in a timely manner. Anticipated Completion Date: On going process, a file review is being completed to ensure current files and backgrounds have been completed and updated. Anticipated completion by September 30, 2025. Responsible Party: HR Director, Payroll Manager, Benefits Coordinator and Business Manager will have oversight.

View Audit 364557

Finding 573907 (2024-001)

Material Weakness 2024

Sicangu Oyate Ho, INC

SD

Procurement, Suspension & Debarment Cash Management Material Weakness

Management Response: Our CPA will train our Accounting Tech to complete bank reconciliations. A huge part of the GL not being updated is due to credit card expenditures and not utilizing the software to update when there is credit card usage. We will begin using the School Accounting Software to tra...

Management Response: Our CPA will train our Accounting Tech to complete bank reconciliations. A huge part of the GL not being updated is due to credit card expenditures and not utilizing the software to update when there is credit card usage. We will begin using the School Accounting Software to track credit card expenditures so we won't have to wait until we get credit card statements to reconcile. Anticipated Completion Date: September 30, 2025 - we will begin utilizing the credit card feature in the Accounting Software immediately. Responsible Party: Accounts Payable Personnel; Accounting Tech will work with CPA's ; Business Manager will have oversight for completion.

View Audit 364557

Finding 573882 (2024-005)

Material Weakness 2024

Northern Lakes Community Mental Health

MI

Reporting Subrecipient Monitoring Cash Management § 200.328

Finding 2024-005 – Reporting (repeat finding): Type: Material Weakness in Internal Control/Noncompliance. Condition: The CMHSP did not file the required annual Federal Financial Report as required for this grant. Corrective Action: Current Finance staff will review internal controls and make changes...

Finding 2024-005 – Reporting (repeat finding): Type: Material Weakness in Internal Control/Noncompliance. Condition: The CMHSP did not file the required annual Federal Financial Report as required for this grant. Corrective Action: Current Finance staff will review internal controls and make changes to ensure that reports are filed in accordance with the grant requirements. Contact Person: Kevin Hartley, CFO Completion date: October 1, 2024

View Audit 364530

Finding 573779 (2024-002)

Material Weakness 2024

Elkhorn Rural Public Power District

NE

Reporting Material Weakness

Federal Agency Name: Department of Homeland Security Pass‐Through Entity: State of Nebraska Office of Emergency Management Assistance Listing Number: 97.039 Program Name: Hazard Mitigation Grant Program Finding Summary: The District does not have an internal control system designed to provide for a...

Federal Agency Name: Department of Homeland Security Pass‐Through Entity: State of Nebraska Office of Emergency Management Assistance Listing Number: 97.039 Program Name: Hazard Mitigation Grant Program Finding Summary: The District does not have an internal control system designed to provide for a complete and accurate schedule of expenditures of federal awards (the schedule) being audited. We requested our auditors to assist with the preparation of the schedule. Responsible Individuals: Carmen Christensen, CFO/Office Manager Corrective Action Plan: It is not cost effective to have an internal control system designed to provide for the preparation of the schedule. We requested that our auditors, Eide Bailly, LLP, prepare the schedule as a part of their single audit. Anticipated Completion Date: Ongoing

View Audit 364452

Finding 573727 (2024-003)

Material Weakness 2024

West Virginia Community Development Hub, Inc.

WV

Allowable Costs / Cost Principles Material Weakness Reporting

Planned Corrective Action: The Hub implemented a new software system with fully integrated payroll and timekeeping functionality. Name of Contact Person: Cindy Heltzel, CPA, CFO c.heltzel@wvhub.org Anticipated completion date: Completed

View Audit 364385

Finding 573725 (2024-001)

Material Weakness 2024

Alternatives to Hunger

WA

Subrecipient Monitoring Eligibility Material Weakness

The following represents Alternatives to Hunger dba Bellingham Food Bank’s corrective action plan for the items identified in the audit of the December 31, 2024 financial statements in accordance with 2 CFR 200.511(c): Section III – Federal Award Findings and Questioned Costs Finding 2024-001 – Elig...

The following represents Alternatives to Hunger dba Bellingham Food Bank’s corrective action plan for the items identified in the audit of the December 31, 2024 financial statements in accordance with 2 CFR 200.511(c): Section III – Federal Award Findings and Questioned Costs Finding 2024-001 – Eligibility – Material Weakness in Internal Controls Over Compliance and Material Non-Compliance Condition and Context: Alternatives to Hunger dba Bellingham Food Bank (the Organization) did not require intake forms be completed by recipients of food commodities at certain distribution centers to determine and document eligibility throughout the entire year. No other verification was performed to determine whether individuals were eligible before receiving food commodities. The Organization did not finish implementing its new eligibility verification process until mid-2024 and, as such, was not in compliance with these requirements for the full year. Planned Corrective Action: In mid-2024 the organization implemented procedures to collect client intake data at the largest program identified in testing and was following intake guidelines for all programs by the end of 2024. Responsible Division/Office and Individual: Mike Cohen, Executive Director Estimated Completion Date: 12/31/2024

View Audit 364383

Finding 573664 (2024-001)

Material Weakness 2024

Trilogy, Inc.

IL

Questioned Costs Allowable Costs / Cost Principles Material Weakness

Action taken in response to finding: Trilogy has recently implemented a new payroll system UKG in January 2024 that includes enhanced functionality for tracking staff allocations across multiple grants and programs. This system also allows employees to self-report hours worked on specific grants or ...

Action taken in response to finding: Trilogy has recently implemented a new payroll system UKG in January 2024 that includes enhanced functionality for tracking staff allocations across multiple grants and programs. This system also allows employees to self-report hours worked on specific grants or non-grant activities if the varies from primary allocations ensuring that payroll costs are distributed based on actual effort. Allocations are reviewed monthly with program staff and updated as needed based, which improves the accuracy of cost distribution and ensures that payroll charges reflect current work assignments. Timecard hours are reviewed and approved by supervisors to maintain oversight. Staff involved in time reporting with grant management received training on the new system, allocation procedures, and federal requirements for payroll cost documentation. We are updating our timekeeping and payroll allocation policies to reflect the new system’s capabilities and to reinforce compliance with Uniform Guidance (2 CFR §200.430). These policies will include clear guidance on documenting effort and allocating wages across cost objectives. Name(s) of the contact person(s) responsible for corrective action: Shunita Rhodes and Hagar Buster Planned completion date for corrective action plan: January 2024

View Audit 364306 Questioned Costs: $1

Finding 573512 (2024-005)

Material Weakness 2024

Engineers Without Borders USA

CO

Subrecipient Monitoring Material Weakness Reporting

Corrective Action: 1. Develop policies for subaward reporting, and implement reporting procedures including FFATA (Federal Funding Accountability and Transparency Act) subaward reporting requirements for awards exceeding the required threshold. 2. Provide training to relevant staff on the new proced...

Corrective Action: 1. Develop policies for subaward reporting, and implement reporting procedures including FFATA (Federal Funding Accountability and Transparency Act) subaward reporting requirements for awards exceeding the required threshold. 2. Provide training to relevant staff on the new procedures for subaward reporting and the importance of compliance with federal regulations.

View Audit 364224

Finding 573511 (2024-004)

Material Weakness 2024

Engineers Without Borders USA

CO

Subrecipient Monitoring Procurement, Suspension & Debarment Material Weakness § 200.332

Corrective Action: 1. Develop a policy for subrecipient monitoring, and implement procedures to oversee the programmatic and financial activities of subrecipients and ensure compliance with regulations. 2. Develop a standardized checklist to guide the monitoring of subrecipients. 3. Provide training...

Corrective Action: 1. Develop a policy for subrecipient monitoring, and implement procedures to oversee the programmatic and financial activities of subrecipients and ensure compliance with regulations. 2. Develop a standardized checklist to guide the monitoring of subrecipients. 3. Provide training to relevant staff on the new procedures for subrecipient monitoring and the importance of compliance with federal regulations.

View Audit 364224

Finding 573510 (2024-003)

Material Weakness 2024

Engineers Without Borders USA

CO

Questioned Costs Allowable Costs / Cost Principles Cash Management

Corrective Action: 1. Review and revise existing policies and procedures for the application of indirect rates with the appropriate oversight by the Finance/Accounting department across federal grants to ensure accuracy and compliance with relevant regulations. 2. Review the allowable indirect rate ...

Corrective Action: 1. Review and revise existing policies and procedures for the application of indirect rates with the appropriate oversight by the Finance/Accounting department across federal grants to ensure accuracy and compliance with relevant regulations. 2. Review the allowable indirect rate methodologies to ensure the method used is based upon an equitable distribution across federal and non-federal programs. 3. Provide training to relevant staff on the revised policies, procedures to ensure the proper application of the indirect rate and calculation of indirect costs.

View Audit 364224 Questioned Costs: $1

Finding 573499 (2024-002)

Material Weakness 2024

Saginaw Transit Authority Regional Services

MI

Questioned Costs Cash Management Material Weakness

Authority personnel responsible for resolution: Amy Bidwell Corrective Action Response: This finding relates to federal award draws requested by the previous administration. The requests were made prior to a grant amendment being finalized which would have made current expenditures eligible. Manag...

Authority personnel responsible for resolution: Amy Bidwell Corrective Action Response: This finding relates to federal award draws requested by the previous administration. The requests were made prior to a grant amendment being finalized which would have made current expenditures eligible. Management agrees with this finding and is following Uniform Guidance requirements to ensure that all eligible expenditures and incurred and eligible prior to requesting remimbursement from federal funds. Completed date: 10/01/2024

View Audit 364214 Questioned Costs: $1

Finding 573484 (2024-007)

Material Weakness 2024

City of Lodi

CA

Reporting Allowable Costs / Cost Principles Material Weakness

Reference Number: 2024-007 – Delays in Financial Reporting Name of Contact Person: Chia Lor, Accounting Manager Corrective Action: Management agrees with the finding. The City has filled all of its vacant positions in Accounting and anticipates a timely completion of the 2024/25 Audit. Proposed...

Reference Number: 2024-007 – Delays in Financial Reporting Name of Contact Person: Chia Lor, Accounting Manager Corrective Action: Management agrees with the finding. The City has filled all of its vacant positions in Accounting and anticipates a timely completion of the 2024/25 Audit. Proposed Completion Date: December 31, 2025

View Audit 364209

Finding 573464 (2024-001)

Material Weakness 2024

Maquoketa Valley Rural Electric Cooperative

IA

Reporting Material Weakness

Federal Agency Name: Department of Treasury Pass-Through Entity: State of Iowa Department of Management Federal Financial Assistance Listing #21.029 Program Name: Coronavirus Capital Projects Fund Finding Summary: The Cooperative does not have an internal control system designed to provide for a co...

Federal Agency Name: Department of Treasury Pass-Through Entity: State of Iowa Department of Management Federal Financial Assistance Listing #21.029 Program Name: Coronavirus Capital Projects Fund Finding Summary: The Cooperative does not have an internal control system designed to provide for a complete and accurate schedule of federal expenditures of federal awards (the schedule) being audited. We requested our auditors to assist with the preparation of the schedule and the accompanying notes to the schedule. Corrective Action Plan: It is not cost effective to have an internal control system designed to provide for the preparation of the schedule of federal expenditures of federal awards and the accompanying notes to the schedule. We requested that our auditors, Eide Bailly, LLP, prepare the schedule and accompanying notes. We have designated a member of management to review the drafted schedule and accompanying notes to the schedule. Responsible Individuals: Jeremy Richert, CEO and Kelly Gibbs, CFO Anticipated Completion Date: Ongoing

View Audit 364192

Finding 573443 (2024-003)

Material Weakness 2024

Corn Belt Power Cooperative

IA

Cash Management Material Weakness § 200.303

Federal Agency Name: Department of Homeland Security Pass-Through Entity: State of Iowa Department of Homeland Security and Emergency Management Assistance Listing Number: 97.039 Program Name: Hazard Mitigation Grant Program Finding Summary: In two of two draw requests tested, we noted that the Coo...

Federal Agency Name: Department of Homeland Security Pass-Through Entity: State of Iowa Department of Homeland Security and Emergency Management Assistance Listing Number: 97.039 Program Name: Hazard Mitigation Grant Program Finding Summary: In two of two draw requests tested, we noted that the Cooperative did not have formal documentation to support the review of the draw prior to submission for reimbursement. Corrective Action Plan: The Cooperative will prepare an internal request for funds, which will include the amount being requested along with supporting documentation justifying the request. This request will be reviewed and signed by both the Accountant III preparing the documentation and the Vice President of Finance & Administration. Once approved, the request will be submitted to the appropriate authority for further processing. Responsible Individual(s): Faith Warden, VP, Finance & Administration and Sam Moore, Accountant III Anticipated Completion Date: July 2025

View Audit 364186

Corrective Action Plans

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