Corrective Action Plans

Finding 401251 (2023-003)

Significant Deficiency 2023

DC

Subrecipient Monitoring Reporting Questioned Costs § 200.303

2023-003 – Internal Control over Compliance and Compliance with Reporting Contact Name: Charlie Feeney Position: Chief Financial Officer Telephone Number: (202) 796 2496 Corrective Action Plan – Management will continue to work with Federal agencies to resolve any grants that a FAIN was not i...

2023-003 – Internal Control over Compliance and Compliance with Reporting Contact Name: Charlie Feeney Position: Chief Financial Officer Telephone Number: (202) 796 2496 Corrective Action Plan – Management will continue to work with Federal agencies to resolve any grants that a FAIN was not issued. Estimated Completion – September 30, 2024

View Audit 309269

Finding 401231 (2023-002)

Material Weakness 2023

Community Counseling Solutions

OR

Material Weakness Reporting Internal Control / Segregation of Duties

Corrective Action Taken: The entity understands the importance of timely maintenance of the general ledger and has taken steps to document procedures, cross train the accounting team, and hire additional employees to assist with processing transactions.

View Audit 309220

Finding 401176 (2023-003)

Significant Deficiency 2023

Trellis Co.

MN

HUD Housing Programs Questioned Costs Cash Management

FINDING 2023-003: Unauthorized receipt of COVID-19 Supplemental Payments (CSP) Name of contact person – Megan Netland, Vice President of Asset Management Corrective action – The applications for reimbursement for program periods 1 through 3 were made in error. The Corporation has contacted HUD and i...

FINDING 2023-003: Unauthorized receipt of COVID-19 Supplemental Payments (CSP) Name of contact person – Megan Netland, Vice President of Asset Management Corrective action – The applications for reimbursement for program periods 1 through 3 were made in error. The Corporation has contacted HUD and is awaiting a response. Proposed completion date – Management has contacted HUD and is awaiting a response.

View Audit 309200 Questioned Costs: $1

Finding 401141 (2023-004)

Significant Deficiency 2023

City of Orange Township Public Schools

NJ

Questioned Costs Cash Management

Part of the payroll reconciliatiion will be revised to include review of employees charged to grants to ensure they are assigned to the grant and tracking their time properly including salaire snad stipends.

View Audit 309190 Questioned Costs: $1

Finding 401126 (2023-002)

None 2023

The University of Alabama at Birmingham

AL

Questioned Costs Subrecipient Monitoring

MANAGEMENT'S VIEWS AND CORRECTIVE ACTION PLAN The following is the University of Alabama at Birmingham’s Response to the audit of Federal programs in accordance with the Uniform Guidance for the year ending September 30, 2023. Finding 2023-002 – E-Sign Act Program: Student Financial Assistance Clust...

MANAGEMENT'S VIEWS AND CORRECTIVE ACTION PLAN The following is the University of Alabama at Birmingham’s Response to the audit of Federal programs in accordance with the Uniform Guidance for the year ending September 30, 2023. Finding 2023-002 – E-Sign Act Program: Student Financial Assistance Cluster Federal Agency: Department of Education Assistance Listing Title and Number: All Management understands the requirement to obtain student voluntary consent to participate in electronic transactions. Management acknowledges and agrees with the finding as presented. As required by Federal law, The University of Alabama at Birmingham (“University”) must inform students that it conducts business electronically and allow students to choose to conduct business through other means. Beginning with the 2023-24 academic year, the University required students to consent to terms and conditions of using BlazerNet but did not disclose E-Sign Act specific terms and conditions. Management recognizes that to satisfy the E-sign Act requirements that all relevant terms and conditions must be disclosed for the student to review prior to consent. Management plans to resolve this finding in two phases. • Phase I implemented the process where students that completed a FASFA voluntarily consent to participate in electronic transactions through the terms and conditions disclosed on the financial aid page on BlazerNet beginning with the 2023-24 academic year. • Phase II will require an update to BlazerNet which will direct students logging in for the first time during an academic year to a "consent to do business electronically" statement. The statement will outline the agreements and transactions covered by the consent and the students’ rights and responsibilities. The University implemented Phase I for students that applied for Federal Title IV financial aid beginning with the 2023-24 academic year. The University expects to complete Phase II beginning with the 2024-25 academic year. For follow-up questions and information, contact Bernard Mays, University Controller at bmaysjr@uab.edu.

View Audit 309173

Finding 401100 (2023-004)

Significant Deficiency 2023

Seattle Indian Health Board

WA

Questioned Costs Allowable Costs / Cost Principles Internal Control / Segregation of Duties

Planned Corrective Action: Management of the Health Board have placed appropriate measures to oversee the internal control process of the month and year-end close. The accounting staff will prepare the transactions and the controller will approve it accordingly and the Director of FP&A will rectify ...

Planned Corrective Action: Management of the Health Board have placed appropriate measures to oversee the internal control process of the month and year-end close. The accounting staff will prepare the transactions and the controller will approve it accordingly and the Director of FP&A will rectify them whenever FFR reports are completed. We have implemented strong internal control by separating the preparation of the month and year end reporting to be done by staff accountant and approved by Controller or Director of FPA. In addition, the CFO is reviewing month-end reconciliations on a quarterly basis. Name of Responsible Party: Zecharias Mesgane, CMA, Director of FP&A Anticipated Completion Date: September 30, 2024.

View Audit 309158 Questioned Costs: $1

Finding 401098 (2023-002)

Material Weakness 2023

Seattle Indian Health Board

WA

Questioned Costs Eligibility Material Weakness

Planned Corrective Action: The Seattle Indian Health Board has adopted a sliding fee program that provides discounts to eligible patients and Indian tribes. To address the auditors' concerns and further strengthen our internal controls, we are implementing a comprehensive corrective action plan. Fir...

Planned Corrective Action: The Seattle Indian Health Board has adopted a sliding fee program that provides discounts to eligible patients and Indian tribes. To address the auditors' concerns and further strengthen our internal controls, we are implementing a comprehensive corrective action plan. Firstly, we will ensure that all personnel involved in eligibility checks, including front desk staff and benefits specialists, are fully trained and aware of federal regulations and internal policies. This will be achieved through comprehensive training sessions and the development of a detailed training manual outlining eligibility criteria, documentation requirements, and procedural steps. Periodic refresher training sessions will reinforce adherence to these policies. Secondly, we will establish a robust internal audit system to regularly review and verify compliance with eligibility requirements. This includes integrating a monthly audit of eligibility determinations into the month-end reporting process, conducted by the clinical operations team. The clinical operations team will use a standardized checklist during these audits to ensure consistency and thoroughness. They will document findings and follow up on any issues or discrepancies with the relevant personnel to ensure timely corrections and adherence to procedures. Management believes that we have adequate internal control systems to safeguard the organization's assets and comply with federal and local regulations. However, we remain committed to further strengthening our controls and processes where necessary. Name of Responsible Party: Zecharias Mesgane, CMA, Director of FP&A Anticipated Completion Date: September 30, 2024

View Audit 309158

Finding 401074 (2023-002)

Material Weakness 2023

Choice Regional Health Network

WA

Questioned Costs Allowable Costs / Cost Principles § 200.430

Finding 2023-002 Material weakness in internal controls over compliance and instances of noncompliance related to allowable costs. Repeat Finding Yes. 2022-04 Contact Person(s): Beth Mizushima, Chief Operating Officer, mizushimab@crhn.org Explanation and specific reasons for disagreement with the au...

Finding 2023-002 Material weakness in internal controls over compliance and instances of noncompliance related to allowable costs. Repeat Finding Yes. 2022-04 Contact Person(s): Beth Mizushima, Chief Operating Officer, mizushimab@crhn.org Explanation and specific reasons for disagreement with the audit finding or that corrective action is not required (if applicable): Not applicable. Corrective action planned: We agree that all awards should be charged the actual allocation percentages of time and effort. It is our assessment that staffing turnover did contribute to challenges with the set-up and deployment of Paylocity in Fall of 2022. We are committed to improving our time and effort system. Currently, we are in the process of migrating accounting and payroll functions to new systems. Additionally, we have dedicated a fiscal staff member’s time to review all payroll expenditures and adjust as needed prior to our next draw. Anticipated completion date: April 30, 2024.

View Audit 309096 Questioned Costs: $1

Finding 401006 (2023-002)

None 2023

Lincoln County

MT

Questioned Costs Subrecipient Monitoring

FINDING 2023-002: Late Audit Submission Response: Lincoln County will endure it will be done by the deadline for FY- 24.

View Audit 309060

Finding 400984 (2023-002)

Material Weakness 2023

Elko County, Nevada

NV

Questioned Costs Subrecipient Monitoring Material Weakness

Finding Number 2023-002 Federal Award Agency: U.S. Department of Treasury Program Name: Coronavirus State and Local Fiscal Recovery Funds CFDA #: 21.027 Finding Summary: During the performance of the audit, it was noted the County did not correctly report quarterly expenditures for amounts related t...

Finding Number 2023-002 Federal Award Agency: U.S. Department of Treasury Program Name: Coronavirus State and Local Fiscal Recovery Funds CFDA #: 21.027 Finding Summary: During the performance of the audit, it was noted the County did not correctly report quarterly expenditures for amounts related to items reported under loss of revenue for each quarter in the fiscal year. Responsible Individuals: Susan Paprocki, Elko County Comptroller Corrective Action Plan: Management will closely review the Project and Expenditure Report User Guide to ensure future reports are in compliance and are properly reviewed prior to submission. Anticipated Completion Date: 6/30/2024

View Audit 309046

Finding 400978 (2023-001)

Material Weakness 2023

Oakland Intrgrated Healthcare Network, Inc.

MI

Questioned Costs Material Weakness Special Tests & Provisions

2023-001, 2022-001 - MATERIAL WEAKNESS AND MATERIAL NONCOMPLIANCE - SLIDING FEE Contact Person – Patricia Fournier, CFO Completion Date – 02/01/2024 Finding – We tested 60 sliding fee encounters and noted that 10 out of 60 patients were discounted, charged or adjusted the wrong amount and 4 out of ...

2023-001, 2022-001 - MATERIAL WEAKNESS AND MATERIAL NONCOMPLIANCE - SLIDING FEE Contact Person – Patricia Fournier, CFO Completion Date – 02/01/2024 Finding – We tested 60 sliding fee encounters and noted that 10 out of 60 patients were discounted, charged or adjusted the wrong amount and 4 out of 60 patients sliding fee applications had documentation issues. The Organization failed to verify sliding fee applications were obtained for all patients receiving discounts and incorrectly applied sliding fee discounts to charges. We recommend the Organization continue with the corrective action plan implemented in the prior year in response to audit finding 2022-001 to ensure sliding fee applications are completed before encounters are billed. We recommend that management continue to review and monitor the internal sliding fee application auditing process for further improvements and consider increasing sample sizes. RESOLUTION: 1.Staff Training. Honor continued in-depth monthly trainings for front-end processes. The training includes patient check-in, insurance verification, and sliding fee application completion. We determined through our audit process that health centers without a clinical receptionist continued to have issues. We expanded our training to include all employee classes that complete patient check-in This includes CHWs, BHCs, and call center staff. Participants complete a test to ensure the necessary knowledge and skills were obtained during the training. If the participant’s score is under our benchmark, they will complete the training again. All staff also complete the training as part of new employee on-boarding and participate in the all staff annual update training. 2.Dashboard Reporting. Honor Practice Managers use a daily dashboard to monitor prior day visits to ensure that all patient check-in, insurance verification, and sliding fee applications information is input correctly. 3.Monthly Audit & Follow-up. The Revenue Cycle Manager will publish a monthly report to include all sliding fee applications. The report will be sent on the 15th of the month for the prior month. The report will include all sliding fee applications by location that are not in compliance. The Practice Managers will work with staff to address and correct these applications. The RCM will publish a subsequent report on the 30th of the month to ensure all sliding fee applications have been corrected and are in compliance. Any location with remaining sliding fee application out of compliance on the 30th will report to their immediate supervisor to correct the sliding fee applications. 4.Sliding Fee Application Workflow. Honor worked with a consultant to review the sliding fee workflow process from patient registration through patient payment. With our review we identified processes to implement within the EHR that will automate steps in the workflow to eliminate errors in the entry process. We also updated the payment posting process to auto write-off the remaining balance of the encounter at the time of the patient payment.

View Audit 309040

Finding 400973 (2023-003)

Significant Deficiency 2023

B'nai B'rith Women Senior Citizen Housing

TX

Questioned Costs

We have provided additional training to the accounting team, underscored the importance of verifying vendor invoices are related to the Organization, and have implemented an additional control to detect misappropriation of Project funds prior to release of payments.

View Audit 309038 Questioned Costs: $1

Finding 400956 (2023-002)

Significant Deficiency 2023

National Railroad Passenger Corporation

DC

Equipment & Real Property Management Questioned Costs Procurement, Suspension & Debarment § 200.1 § 200.303 § 200.313

Finding 2023-002 – Preparation and Maintenance of Equipment Population The single audit report included the following recommendation: To address the Condition identified above, we recommend Amtrak to continue integration of the systems in such a way that appropriate funding source would be tagged ...

Finding 2023-002 – Preparation and Maintenance of Equipment Population The single audit report included the following recommendation: To address the Condition identified above, we recommend Amtrak to continue integration of the systems in such a way that appropriate funding source would be tagged to each asset automatically and that required property records would automatically be consolidated into one system of record and updated in that system. Ensure that adequate IT interface and business process application controls over the completeness, accuracy, validity, confidentiality, and availability of transactions and data during application processing (input, processing, output, etc.) are in place. Additionally, management should consider breaking out large purchase orders containing multiple items of equipment and tools under one purchase request, by creating separate level 2 WBSE codes in order to distinguish between different types of items being acquired, in order to be able to provide more appropriate classification. Identification as a repeat finding: Not a repeat finding Management Response/Status of Action Plans: Amtrak will implement the following to mitigate the finding related to the equipment population. 1. To prevent errors regarding the mapping of grant funding to equipment, the Capital Accounting Department will be implementing additional procedures and validations in the preparation and approval of the equipment review population file. This will include additional cross checks to validate mappings from fund sources to equipment and an additional review by EAMDT. The additional review and approval steps will be formalized with documented steps before September 2024. 2. To prevent errors related to missing asset numbers, the Capital Accounting Department, in coordination with EAMDT, has implemented an additional review of the single audit eligible indicator and inclusion of an asset unit number at the time the equipment asset is recorded in the fixed asset ledger. Additionally, EAMDT and Capital Accounting are now utilizing automated reporting that allows real time review of single audit equipment additions and data fields from the Company’s systems. This reporting allows for a timely view of key data fields from the related systems including Asset Equipment Description, Asset Unit Number, Single Audit Flag, Last Audit Date and Conditions. All equipment with missing asset unit numbers will be investigated and corrected. If any equipment marked as single audit eligible appears as not being eligible, Capital Accounting will investigate and resolve. The contacts for this item are Carol Hanna, VP Controller and Michele Millsaps, Assistant Controller, Capital and Inventory Accounting. Amtrak anticipates that changes above will remediate this finding in the fiscal year ending September 30, 2024 and beyond.

View Audit 309029

Finding 400954 (2023-001)

Significant Deficiency 2023

National Railroad Passenger Corporation

DC

Questioned Costs Equipment & Real Property Management § 200.303 § 200.313

Finding 2023-001 – Equipment and Real Property Management The single audit report included the following recommendation: We recommend that Amtrak continue to work toward a full integration or reconciliation between Amtrak’s fixed asset system of record and the different equipment-tracking systems...

Finding 2023-001 – Equipment and Real Property Management The single audit report included the following recommendation: We recommend that Amtrak continue to work toward a full integration or reconciliation between Amtrak’s fixed asset system of record and the different equipment-tracking systems. We recommend that management consider redesigning one of its key controls to help ensure that the monitoring of the observations is occurring on a preventive basis to help identify any exposure to non-compliance before it occurs. For example, Amtrak should consider an automated system report that would flag an asset proactively when a 2-year inventory deadline is approaching. During the observation process, management should ensure there is a review control within the process to validate that the asset is accurately tagged and such identifying information matches the equipment-tracking system. Additionally, this review control should also be performed when the asset is first logged into the equipment-tracking system. In the interim, until such processes are fully implemented, Amtrak should enhance the current control procedures surrounding the asset documentation and ensure that field personnel are aware of and are consistently and carefully updating the asset records such that clerical/human errors are minimized and that the asset records contain the necessary asset details in order to properly track equipment by federal requirements. This would include enhancing the asset chain of custody recordkeeping so that such changes are identified and reported timely. Additionally, management should consider requiring the serial number and model number to be documented in the system of record at set up in addition to the asset tag number. This will help ensure that the equipment has a unique ID number that can help it be identified and matched to the system record should an asset number not get added timely. Finally, as it relates to condition #4 above, management should investigate the root cause of the asset that could not be located and determine if additional control changes or modifications need to be made in order to prevent reoccurrence. Identification as a repeat finding: This finding was identified as a repeat finding in the immediate prior year as Finding 2022-001. This finding was reported in prior years as well, beginning in at least FY2012. Management Response/Status of Action Plans: Amtrak agrees with the recommendation to redesign key controls to help ensure that the monitoring of the observations happens on a preventive basis to help identify any exposure to non-compliance before it occurs. Amtrak continues to progress on a multi-year effort to remediate this finding. Amtrak created the EAMDT which has been tasked to improve equipment record keeping which will resolve this finding. 1. In April 2024, Amtrak completed an engagement with an outside consulting firm that delivered three items: an updated Equipment Control Policy (ECP), standard operating procedures (SOPs) for equipment management based on the accountable property system of record, and a one-hour eLearning course that reinforces the importance of good equipment management practices and the need to follow the equipment tracking requirements of 2 CFR Part 200. These deliverables will improve policies and corporate governance over assets by providing training to the employees and improving the processes needed for oversight of equipment management, as well as to help ensure that assets are not capitalized without a complete record, which would include a unique asset identifier and the condition and location of the asset. The ECP was approved and published in the Amtrak Policy and Instruction Manual in May 2024. Amtrak will communicate the updated policy to all relevant personnel by the end of June 2024. The EAMDT is working with the Learning and Development team to identify the employees who will need to take the eLearning course, and these employees will be required to take the eLearning material beginning in the first quarter of FY25. 2. The EAMDT is implementing controls throughout the equipment lifecycle as it identifies improvement opportunities. For example, EAMDT has been added as an approver to the purchase requisition workflow for equipment purchases, and EAMDT is working with Capital Accounting to ensure that assets are recorded completely before being capitalized, which would include a unique asset identifier, condition, and location of the asset. EAMDT is reviewing assets currently in the system that do not have assigned asset IDs. EAMDT’s goal is to resolve and update existing records that are missing IDs and other information by the end of April 2025. Additionally, in August 2023, the Asset Disposition group began reporting into EAMDT which enables centralization of a more complete oversight of Amtrak’s assets. EAMDT is working to improve the record keeping for asset dispositions. 3. EAMDT is working with Amtrak’s Digital Technology (DT) Department to find ways to track equipment electronically. This includes installing location tracking technology on yard and Engineering Maintenance of Way equipment to better track and locate Amtrak assets. As of the end of April 2024, location tracking technology has been installed on over 1,500 pieces of equipment with the goal of having location tracking technology installed on approximately 2,400 assets by the end of June 2024. EAMDT is also coordinating with DT on an application accessible via a mobile device (e.g., cell phone, tablet) used by field personnel to perform audits and update equipment records. 4. EAMDT has developed trend reporting and operational reporting to help EAMDT and the departments track their compliance progress and identify assets that are out of compliance or soon-to-be out of compliance to both bring assets back into compliance, as well as to ensure an inventory is done and recorded within the two-year period. As of September 2023, two primary dashboards have been developed and can be used by all departments to help identify assets that are out of compliance and/or need to be audited. 5. EAMDT performs site visits to assist the equipment managers in performing equipment and vehicle audits. During these visits, equipment managers are educated on their responsibilities and tools available for performing audits. The contacts for this item are Ian Hinke, AVP Supply Chain Management and Robert Hoban, Director Asset Management. Amtrak anticipates the implementation of the above procedures, along with continual process monitoring and refinement, will fully remediate this finding by June 2026.

View Audit 309029 Questioned Costs: $1

Finding 400951 (2023-002)

Material Weakness 2023

Colbert County Board of Education

AL

Questioned Costs Matching / Level of Effort / Earmarking Special Tests & Provisions

Response/Views: We agree with the finding. Corrective Action Planned: All future construction contracts that are being funded with federal funds will have the appropriate Davis Bacon and Related Acts Provisions and Procedures outlined within the contract. The Colbert County Board of Education will v...

Response/Views: We agree with the finding. Corrective Action Planned: All future construction contracts that are being funded with federal funds will have the appropriate Davis Bacon and Related Acts Provisions and Procedures outlined within the contract. The Colbert County Board of Education will verify employees working on the project are paid prevailing wage rates. The contractor or subcontractor will be required to submit to the Colbert County Board of Education weekly, for each week in which any contract work is performed, a copy of the payroll and a statement of compliance (certified payrolls). Anticipated Completion Date: This corrective action plan will be implemented immediately. Contact Person(s): Shauna James, Taylor Leathers

View Audit 309024 Questioned Costs: $1

Finding 400950 (2023-004)

Material Weakness 2023

Gateway Regional Water Company

IL

Questioned Costs

Condition: During the course of the audit it was noted that the prior year Data Collection Form was submitted after the deadline. Plan: The auditor intends to provide the audit in a more timely manner this fiscal year. We recommend the Organization continue to work with the auditor to ensure that th...

Condition: During the course of the audit it was noted that the prior year Data Collection Form was submitted after the deadline. Plan: The auditor intends to provide the audit in a more timely manner this fiscal year. We recommend the Organization continue to work with the auditor to ensure that the Data Collection Form is submitted on time. Anticipated Date of Completion: September 30, 2024 Name of Contact Person: Angela Diss, Treasurer Management's Response: Management agrees and will continue to work with the auditor allowing both parties to ensure all documents are submitted by the deadline.

View Audit 309021

Finding 400949 (2023-008)

Material Weakness 2023

Housing Authority of the City of Dodge City

KS

Questioned Costs HUD Housing Programs

2023-008. Rent Deposits Corrective action planned: We implemented our new practices in January of 2024. Contact person: Matt Brady, Executive Director. Anticipated completion date: January 2024

View Audit 309004 Questioned Costs: $1

Finding 400948 (2023-007)

Significant Deficiency 2023

Housing Authority of the City of Dodge City

KS

Questioned Costs HUD Housing Programs Reporting

2023-007. SEMAP Supporting Documentation Corrective action planned: QC on all indicators is now being completed as required. Contact person: Matt Brady, Executive Director. Anticipated completion date: September 30, 2024

View Audit 309004

Finding 400947 (2023-006)

Significant Deficiency 2023

Housing Authority of the City of Dodge City

KS

Questioned Costs HUD Housing Programs Reporting

2023-006. Significant Audit Adjustments Corrective action planned: I have spoken with Lindsey and Company and will better communicate. Contact person: Matt Brady, Executive Director. Anticipated completion date: September 30, 2024

View Audit 309004

Finding 400936 (2023-004)

Significant Deficiency 2023

Giving Youth A Chance Initiative

TN

Questioned Costs Cash Management Eligibility

2022-004 – Reimbursement Claims Reported Meals Delivered to Unidentified Participants Corrective Action – GYAC has purchased an electronic system that assists with the tracking of meal count sheets and attendance rosters. This system compares the names on the roll with the number of meals being clai...

2022-004 – Reimbursement Claims Reported Meals Delivered to Unidentified Participants Corrective Action – GYAC has purchased an electronic system that assists with the tracking of meal count sheets and attendance rosters. This system compares the names on the roll with the number of meals being claimed, ensuring that participant rosters are accurately maintained and matched with meal delivery records, thereby preventing discrepancies and reducing the error rate in submissions.

View Audit 308988

Finding 400934 (2023-002)

Significant Deficiency 2023

Giving Youth A Chance Initiative

TN

Cash Management Questioned Costs Significant Deficiency

2023-002 – Reimbursement Claims Not Supported by Meal Count Sheets Corrective Action – This is a repeat finding and improvements have been made since the release of the December 31, 2022, audit. In addition to retraining staff to enhance the accuracy of meal counts, GYAC has purchased an electronic ...

2023-002 – Reimbursement Claims Not Supported by Meal Count Sheets Corrective Action – This is a repeat finding and improvements have been made since the release of the December 31, 2022, audit. In addition to retraining staff to enhance the accuracy of meal counts, GYAC has purchased an electronic system (KID KARE) to assist with tracking both meal count sheets and attendance rosters. This system ensures that meal counts and attendance rosters are reconciled, reducing the error rate in submissions. The system also checks for errors prior to claim submission and compares names on the roll with the number of meals being claimed for accuracy.

View Audit 308988

Finding 400930 (2023-001)

Material Weakness 2023

Western North Carolina Community Health Services, Inc.

NC

Special Tests & Provisions Questioned Costs Internal Control / Segregation of Duties

In Finding 2023-001, it was reported that the Organization did not properly apply the sliding fee discount for four sliding fee patients tested. Management recognizes the importance of complying with sliding fee guidelines. In response to Finding 2023-001, proper training will be given to employ...

In Finding 2023-001, it was reported that the Organization did not properly apply the sliding fee discount for four sliding fee patients tested. Management recognizes the importance of complying with sliding fee guidelines. In response to Finding 2023-001, proper training will be given to employees and sliding fee applications and discounts will be reviewed by a supervisor on a periodic basis to ensure compliance with the sliding fee scale.

View Audit 308976

Finding 400925 (2023-001)

Significant Deficiency 2023

Washington County Memorial Hospital

MO

Questioned Costs Reporting Significant Deficiency

U.S. Department of Health and Human Services Washington County Memorial Hospital (“Hospital”) respectfully submits the following corrective action plan for the year ended August 31, 2023. Audit period: September 1, 2022 – August 31, 2023 The findings from the schedule of findings and questioned cos...

U.S. Department of Health and Human Services Washington County Memorial Hospital (“Hospital”) respectfully submits the following corrective action plan for the year ended August 31, 2023. Audit period: September 1, 2022 – August 31, 2023 The findings from the schedule of findings and questioned costs are discussed below. The findings are numbered consistently with the numbers assigned in the schedule. FINDINGS— FINDINGS AND QUESTIONED COSTS – MAJOR FEDERAL PROGRAMS DEPARTMENT OF HEALTH AND HUMAN SERVICES 2023 – 001 COVID-19 Provider Relief Fund and American Rescue Plan Rural Distribution Recommendation: We recommend the Hospital design controls to ensure that reporting is completing in accordance with latest HHS guidelines. Action taken in response to finding: The Hospital will ensure that they use the appropriate method of reporting lost revenue calculations in the future reporting periods. Name of the contact person responsible for corrective action: Debra Pratt, CFO. Planned completion date for corrective action plan: September 1, 2024 If the Department of Health and Human Services has questions regarding this plan, please call Debra Pratt, CFO at (573) 438 5451 Ext 771.

View Audit 308970

Finding 400918 (2023-002)

Material Weakness 2023

Prairie-Hills Elementary School District 144

IL

Questioned Costs Internal Control / Segregation of Duties § 200.516

Prairie-Hills Elementary School District 144 07-016-1440-02 CORRECTIVE ACTION PLAN FOR CURRENT YEAR AUDIT FINDINGS Year Ending June 30, 2023 Corrective Action Plan Finding No.: 2023-002 Condition: During the audit we noted that the District claimed expenditures in excess of amounts ...

Prairie-Hills Elementary School District 144 07-016-1440-02 CORRECTIVE ACTION PLAN FOR CURRENT YEAR AUDIT FINDINGS Year Ending June 30, 2023 Corrective Action Plan Finding No.: 2023-002 Condition: During the audit we noted that the District claimed expenditures in excess of amounts that could be supported by the accounting records by $102,438. Plan: The District will implement a policy that requires the utilization of grant specific expenditure accounts within the accounting software to be used exclusively for managing each individual award. These expenditure accounts will be used to support expenditure claims. Reports from the accounting software system that are utilized to prepare expenditure claims will be reviewed, reconciled and approved by an appropriate member of management prior to final submission. Supporting documentation for each grant expenditure claim submission will be maintained electronically for future reference. Anticipated Date of Completion: June 30, 2024 Name of Contact Person: Ms. Sheryl Coleman; Chief School Business Official

View Audit 308950 Questioned Costs: $1

Finding 400916 (2023-003)

Material Weakness 2023

Prairie-Hills Elementary School District 144

IL

Questioned Costs Internal Control / Segregation of Duties § 200.516

Prairie-Hills Elementary School District 144 07-016-1440-02 CORRECTIVE ACTION PLAN FOR CURRENT YEAR AUDIT FINDINGS Year Ending June 30, 2023 Corrective Action Plan Finding No.: 2023-003 Condition: During the audit we noted that the District claimed expenditures in excess of amounts ...

Prairie-Hills Elementary School District 144 07-016-1440-02 CORRECTIVE ACTION PLAN FOR CURRENT YEAR AUDIT FINDINGS Year Ending June 30, 2023 Corrective Action Plan Finding No.: 2023-003 Condition: During the audit we noted that the District claimed expenditures in excess of amounts that could be supported by the accounting records by $52,112. Plan: The District will implement a policy that requires the utilization of grant specific expenditure accounts within the accounting software to be used exclusively for managing each individual award. These expenditure accounts will be used to support expenditure claims. Reports from the accounting software system that are utilized to prepare expenditure claims will be reviewed, reconciled and approved by an appropriate member of management prior to final submission. Supporting documentation for each grant expenditure claim submission will be maintained electronically for future reference. Anticipated Date of Completion: June 30, 2024 Name of Contact Person: Ms. Sheryl Coleman; Chief School Business Official

View Audit 308950 Questioned Costs: $1

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