Corrective Action Plans

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Name: Community Services Office of Hot Springs and Garland County Arkansas Contact: Leslie P. Barnes Contact Phone Number: (501) 538-5626 Audit Period Ending: 05/31/2022 Anticipated Completion Date: May 5, 2025 Finding 2022-004: Management concurs with the finding. The Organization has implemented a...
Name: Community Services Office of Hot Springs and Garland County Arkansas Contact: Leslie P. Barnes Contact Phone Number: (501) 538-5626 Audit Period Ending: 05/31/2022 Anticipated Completion Date: May 5, 2025 Finding 2022-004: Management concurs with the finding. The Organization has implemented a process where a staff accountant will prepare the necessary reports and the chief financial officer will review such reports. Alternatively, if the chief financial officer must prepare such reports, the review will be performed by the executive director.
Child Care and Development Block Grant– Assistance Listing No. 93.575 Recommendation: We recommend that management reinforce the importance of its control to ensure costs are charged to federal awards within the period of performance with employees through on-going training. Explanation of disagreem...
Child Care and Development Block Grant– Assistance Listing No. 93.575 Recommendation: We recommend that management reinforce the importance of its control to ensure costs are charged to federal awards within the period of performance with employees through on-going training. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: The YMCA has worked diligently to strengthen its accounting standards when it comes to Federal awards, including the centralization of reporting through its YESS shared services accounting systems and procedures. Operations personnel review the tenants of the grants up front in the process of executing each Federal grant. Name of the contact person responsible for corrective action: David Wyman Planned completion date for corrective action plan: Complete
Contact Person Jackie Cordie, Business Manager Corrective Action Plan The District plans to implement the auditor's recommendation. Planned Completion Date for CAP Fiscal year beginning July 1, 2024
Contact Person Jackie Cordie, Business Manager Corrective Action Plan The District plans to implement the auditor's recommendation. Planned Completion Date for CAP Fiscal year beginning July 1, 2024
Contact Person Jackie Cordie, Business Manager Corrective Action Plan The District plans to implement the auditor's recommendation. Planned Completion Date for CAP Fiscal year beginning July 1, 2024
Contact Person Jackie Cordie, Business Manager Corrective Action Plan The District plans to implement the auditor's recommendation. Planned Completion Date for CAP Fiscal year beginning July 1, 2024
Management’s Response: We concur with this finding. Views of Responsible Officials and Corrective Action: We will work to implement policies to ensure that all employees who begin to work under a federal or state fund sign certifications of all time working on a single award. Name of Responsible Per...
Management’s Response: We concur with this finding. Views of Responsible Officials and Corrective Action: We will work to implement policies to ensure that all employees who begin to work under a federal or state fund sign certifications of all time working on a single award. Name of Responsible Person: G. Janina Trzmiel (Chief School Financial Officer) Implementation Date: Immediately
Head Start of Lane County has created a timeline in partnership with Wipfli to ensure the completion of delinqunet audits and to ensure timely completion after August 31, 2026
Head Start of Lane County has created a timeline in partnership with Wipfli to ensure the completion of delinqunet audits and to ensure timely completion after August 31, 2026
Head Start of Lane County has created a paln with assitance of Wipfli to complete outstanding audits. See corrective action item 2022-004 for more details. The agency has implemented a yearly closeout starting in the year 2024-2025 going forward. This will allow for timely audit preparation, reconci...
Head Start of Lane County has created a paln with assitance of Wipfli to complete outstanding audits. See corrective action item 2022-004 for more details. The agency has implemented a yearly closeout starting in the year 2024-2025 going forward. This will allow for timely audit preparation, reconciliations and adjustments to occur
Finding 1175570 (2022-008)
Material Weakness 2022
The County will include discussion of all required compliance requirements for each federal program presented in our Officers’ meetings.
The County will include discussion of all required compliance requirements for each federal program presented in our Officers’ meetings.
Finding 1175569 (2022-007)
Material Weakness 2022
The County will include all federal grant discussion in our Officers’ meetings so that all Elected Officials are aware. We will discuss the Control Environment, Risk Assessment, Information and Communication, and Monitoring for all federal grants.
The County will include all federal grant discussion in our Officers’ meetings so that all Elected Officials are aware. We will discuss the Control Environment, Risk Assessment, Information and Communication, and Monitoring for all federal grants.
Finding 2022-018 Eligibility Individual(s) Responsible: Michelle Cadue, Tribal Treasurer and Jonnah McKinney, KTIK IHS Director. Action:Complete patient files will be maintained to document eligibility in accordance with program requirements. Records will be made available for audit review while mai...
Finding 2022-018 Eligibility Individual(s) Responsible: Michelle Cadue, Tribal Treasurer and Jonnah McKinney, KTIK IHS Director. Action:Complete patient files will be maintained to document eligibility in accordance with program requirements. Records will be made available for audit review while maintaining confidentiality, i.e., HIPPA. Anticipated Completion Date: March 2026.
Finding 2022-016 Program Income Individual(s) Responsible: Tribal Council; Rona Johnson-Murillo, Accounting Director; Program Directors; Enterprise Managers; and Tyce Martin, HR Generalist. Action: Ensure that documentation is available for every item purchased or run through payroll. Anticipated Co...
Finding 2022-016 Program Income Individual(s) Responsible: Tribal Council; Rona Johnson-Murillo, Accounting Director; Program Directors; Enterprise Managers; and Tyce Martin, HR Generalist. Action: Ensure that documentation is available for every item purchased or run through payroll. Anticipated Completion Date: March 2026.
Finding 2022-015 Allowable Costs and Activities Individual(s) Responsible: Tribal Council; Michelle Thomas, Acting Executive Director; Tyce Martin, HR Generalist; Program Directors; and Enterprise Managers. Action: The current Tribal Council will ensure that all required documentation is maintained ...
Finding 2022-015 Allowable Costs and Activities Individual(s) Responsible: Tribal Council; Michelle Thomas, Acting Executive Director; Tyce Martin, HR Generalist; Program Directors; and Enterprise Managers. Action: The current Tribal Council will ensure that all required documentation is maintained as supporting backup for all purchase requisitions, including proper signatures, prior authorization, and related approvals. In addition, all employees will have appropriate Personnel Action Notices (PANs) on file, and all timesheets will be properly completed and signed by both the employee and their supervisor. Anticipated Completion Date: March 2026.
Finding 2022-014 Special Tests and Provisions Individual(s) Responsible: Michelle Cadue, Tribal Treasurer; Paula Vann, Grants Compliance Officer; and Cheryl DuBois, Head Start Director. Action: Review annual and quarterly reporting to ensure timely filing. Implementation of procedures to ensure all ...
Finding 2022-014 Special Tests and Provisions Individual(s) Responsible: Michelle Cadue, Tribal Treasurer; Paula Vann, Grants Compliance Officer; and Cheryl DuBois, Head Start Director. Action: Review annual and quarterly reporting to ensure timely filing. Implementation of procedures to ensure all required Head Start facilities documentation is obtained, accurately completed, retained, and readily accessible for review. Resources will be allocated to develop, implement, and monitor policies and procedures that support effective operations, timely reporting, and full compliance with Head Start facilities requirements. Anticipated Completion Date: March 2026.
Finding 2022-013 Reporting Individual(s) Responsible: Michelle Cadue, Tribal Treasurer; Rona Johnson-Murillo, Accounting Director; Paula Vann, Grants Compliance Officer; and Program Directors. Action: Reporting requirements will be reviewed with department heads, and submitted reports will be monito...
Finding 2022-013 Reporting Individual(s) Responsible: Michelle Cadue, Tribal Treasurer; Rona Johnson-Murillo, Accounting Director; Paula Vann, Grants Compliance Officer; and Program Directors. Action: Reporting requirements will be reviewed with department heads, and submitted reports will be monitored for accuracy and timeliness. To strengthen compliance, a Grants Compliance Officer will be hired to oversee reporting obligations and ensure all required reports are submitted on time. Anticipated Completion Date: March 2026.
Condition: Costs charged to ALN 97.036 – Disaster Grants: Public Assistance were also charged to ALN 93.498, U.S. Department of Health and Human Services, Provider Relief Fund in a prior fiscal year, as reported in the Period 1 submission to the Provider Relief Fund portal. Planned Corrective Action...
Condition: Costs charged to ALN 97.036 – Disaster Grants: Public Assistance were also charged to ALN 93.498, U.S. Department of Health and Human Services, Provider Relief Fund in a prior fiscal year, as reported in the Period 1 submission to the Provider Relief Fund portal. Planned Corrective Action: Management agrees and has revised existing internal control processes and policies to implement review and approval procedures to ensure expenditures submitted were not already reimbursed under a separate grant. Contact person responsible for corrective action: Kevin Riley Anticipated Completion Date: 12/31/2025
Management's response: When the federal grant award came out at the end of December 2021, we did not get an approved budget and signed contract for work with the State until the beginning of July 2022 for work that dated back to October 1, 2021. Because of this, once we were able to begin invoicing,...
Management's response: When the federal grant award came out at the end of December 2021, we did not get an approved budget and signed contract for work with the State until the beginning of July 2022 for work that dated back to October 1, 2021. Because of this, once we were able to begin invoicing, we utilized percentage allocations for employee's t ime, knowing that the majority of the employees had been doing work tied to the grant were allocated 100% to the grant and that significant time had been going to building up for the grant. However, it was not possible to go back and get time sheets that were tied to the grant for the majority of 2022 because we simply didn't have a contract in place yet. At the end of 2022, we began to utilize a more structured process for tracking allocations, requiring leadership to review their team member's allocations to grants on a quarterly basis and submit those to our Finance, HR, and Grants Compliance team to review. Because this didn't happen early enough in 2022, we did not have enough backup documentation to support the allocations based on what the audit requested. Views of Responsible Officials and Corrective Action : In 2023, we continued our structured process of time allocation reviews and quarterly approvals by leadership, HR, and Finance, and then in 2024, we launched our fi rst ever time study to also review and ensure time allocations were corresponding correctly with the time being spent on the grants. Name of Contact Person: Name:Julie Davis Title Chief Executive Officer Email: juliedavis@ywcatulsa.org Phone: 918-828-2346 Projected Implementation: The implementation is complete.
Response: Management concurs with the finding. Corrective Action Plan: Management will implement and document a formal employee onboarding procedure that requires timely completion and retention of Form I-9 for all new hires. Existing personnel files will be reviewed for completeness and missing I-9...
Response: Management concurs with the finding. Corrective Action Plan: Management will implement and document a formal employee onboarding procedure that requires timely completion and retention of Form I-9 for all new hires. Existing personnel files will be reviewed for completeness and missing I-9 forms will be remediated where permissible. Management will retain evidence of completion and conduct periodic compliance reviews to ensure ongoing adherence. Designation of Employee Position Responsible for Meeting Deadline: Financial Analyst — by January 31, 2023.
Recommendation: We recommend the College review the reporting requirements and implement procedures to ensure that all required reports are issued/posted in an accurate and timely manner. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in...
Recommendation: We recommend the College review the reporting requirements and implement procedures to ensure that all required reports are issued/posted in an accurate and timely manner. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: Collaborative workflow was developed between Grant PI's and IS department personnel to ensure that all reports are posted to the website in a timely manner. Name of the contact person responsible for corrective action: Clarissa Salhus, Finance Manager, Duane VanderGriend, CFO Planned completion date for corrective action plan: Completed as of January 14, 2026
Recommendation: We recommend the College enhance their controls around payroll disbursements to ensure employees are paid properly. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: The College has recognized the cha...
Recommendation: We recommend the College enhance their controls around payroll disbursements to ensure employees are paid properly. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: The College has recognized the challenge of hiring a Payroll Specialist. In September 2022, the College outsourced “Payroll” to Paycom. We continue to develop and communicate the unique needs of our College Payroll structure and Federal and private funding sources with Paycom and the College Human Resources to ensure that employees are paid properly. As such, the Business Office is undergoing a restructure and we have identified an internal candidate to take the lead on Payroll. Name of the contact person responsible for corrective action: Clarissa Salhus, Finance Manager, Reatha Tom, Accounts Payable Specialist, Michelle Ferron-Guppy, Director – Human Resources, and Zoy Zamudio-Lane, Human Resources Generalist Planned completion date for corrective action plan: September 30, 2024
Recommendation: We recommend the college retain evidence of the review of student accounts prior to disbursement of HEERF funds. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: No longer disbursing student HEERF fu...
Recommendation: We recommend the college retain evidence of the review of student accounts prior to disbursement of HEERF funds. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: No longer disbursing student HEERF funds. Discussions have taken place between Financial Aid department and Accounting staff requesting that supporting documentation is retained to show evidence that the College reviewed student accounts and eligibility prior to student disbursements. Name of the contact person responsible for corrective action: Clarissa Salhus, Finance Manager, Duane VanderGriend, CFO Planned completion date for corrective action plan: Completed as of January 14, 2026
Recommendation: We recommend the college implement policies and procedures to ensure all procurement documentation is complete and retained. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: Procurement policies are ...
Recommendation: We recommend the college implement policies and procedures to ensure all procurement documentation is complete and retained. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: Procurement policies are in place and trainings have been provided for Purchasing and Accounts Payable staff to ensure that all Procurement documentation is included in payment packets. Name of the contact person responsible for corrective action: Clarissa Salhus, Finance Manager, Duane VanderGriend, CFO Planned completion date for corrective action plan: Completed as of January 14, 2026
Finding: The audit of the Organization for the year ended December 31, 2022, had a submission deadline of September 30, 2023. The Organization did not complete and submit their audit for the year ended December 31, 2022, to the federal clearinghouse until November 2025. Significant delays stemming f...
Finding: The audit of the Organization for the year ended December 31, 2022, had a submission deadline of September 30, 2023. The Organization did not complete and submit their audit for the year ended December 31, 2022, to the federal clearinghouse until November 2025. Significant delays stemming from Finding 2022-001 caused the required audit procedures and the ultimate completion date to extend beyond the regulatory deadline. Views of responsible officials and planned corrective actions: Management agrees with the recommendation to implement procedures and controls to ensure future audits are completed timely. During 2022 and 2023, Baltimore Medical System had significant staff turnover in the finance department which resulted in a delay in the timely completion of the audit. • Changes in the staffing of the finance department include a new Controller, Senior Accountant, Grant Accountant, Accounts Payable Specialist and Payroll Specialist. In addition, a second Senior Accountant was hired. • Baltimore Medical System will engage outside consultants to assist in preparing audit request items and reconciliations. Anticipated date of completion: December 31, 2025 Contact person responsible – Tammy Grinnan, Controller and Margaret Boemmel, CFO
2022-3 Assistance Listing 93.193 Urban Indian Health Services Name of Contact Person Responsible for Corrective Action: Michelle Kellum, Executive Director Corrective Actions Planned: The Organization will take steps to maintain support of payroll charges based on actual results including timesheets...
2022-3 Assistance Listing 93.193 Urban Indian Health Services Name of Contact Person Responsible for Corrective Action: Michelle Kellum, Executive Director Corrective Actions Planned: The Organization will take steps to maintain support of payroll charges based on actual results including timesheets indicating the amounts charged reflect actual staff time spent on the program. The Organization will also take the necessary steps to ensure that grant expenditure billing reports reflect actual program expenses supported by the general ledger and agree to actual amounts charged to the program. Anticipated Completion Date: These procedures will be implemented during the 1st quarter of 2025.
Management concurs that there were staffing and turnover challenges for the Organization. Adequate policies and procedures are in place to ensure timeliness of data requested. Additionally, we will establish milestones to ensure future audits progress within the Uniform Guidance timeline.
Management concurs that there were staffing and turnover challenges for the Organization. Adequate policies and procedures are in place to ensure timeliness of data requested. Additionally, we will establish milestones to ensure future audits progress within the Uniform Guidance timeline.
Corrective Action: Snohomish County Food Bank Coalition will implement a formal document retention policy to ensure source documents are retained in accordance with the requirements of the Uniform Guidance. Anticipated Completion Date: December 31, 2025
Corrective Action: Snohomish County Food Bank Coalition will implement a formal document retention policy to ensure source documents are retained in accordance with the requirements of the Uniform Guidance. Anticipated Completion Date: December 31, 2025
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