Corrective Action Plans

Finding 20412 (2022-003)

None 2022

Western Seminary

OR

Reporting Questioned Costs Student Financial Aid

Incorrect and Late Enrollment Reporting to National Student Loan Data System (NSLDS) Planned Corrective Action: Upon the current finding of incorrect enrollment reporting to NSLDS, the Western Seminary Financial Aid office will seek to make three changes to its operational practices; integrating NSL...

Incorrect and Late Enrollment Reporting to National Student Loan Data System (NSLDS) Planned Corrective Action: Upon the current finding of incorrect enrollment reporting to NSLDS, the Western Seminary Financial Aid office will seek to make three changes to its operational practices; integrating NSLDS reporting into a master calendar, institute standard practices in pulling withdraw data and create a training emphasis around proper withdraw practices. Person Responsible for Corrective Action Plan: Matthew Jolley, Director of Financial Aid Anticipated Date of Completion: 06/2023

View Audit 25878

Finding 20411 (2022-002)

Significant Deficiency 2022

Western Seminary

OR

Questioned Costs Student Financial Aid Significant Deficiency

Return of Title IV (R2T4) Calculations Planned Corrective Action: Upon the current finding of deficient Return of Title IV practices, the Western Seminary Financial Aid office will seek to make three substantial changes to its operational practices, integrate a master calendar integrating processing...

Return of Title IV (R2T4) Calculations Planned Corrective Action: Upon the current finding of deficient Return of Title IV practices, the Western Seminary Financial Aid office will seek to make three substantial changes to its operational practices, integrate a master calendar integrating processing R2T4, institute standard practices in pulling withdraw data and create a training emphasis around R2T4. First, the Western Seminary Financial Aid Office will see to institute and integrate a Financial Aid Master calendar. This calendar will dictate when withdraw (0-credit) reports will be pulled for an evaluation to assess if a Return to Title IV is necessary. Secondly, the Financial Aid office will implement a standard procedure where the date of last participation is pulled from within the WISE system. The last date of participation data standard will be recorded and updated in the FA Policy and Procedures manual. Thirdly, the Financial Aid office will emphasize training on R2T4 with Attain consulting. Person Responsible for Corrective Action Plan: Matthew Jolley, Director of Financial Aid Anticipated Date of Completion: 06/2023

View Audit 25878 Questioned Costs: $1

Finding 20406 (2022-005)

Material Weakness 2022

Landmann-Jungman Memorial Hospital, Inc.

SD

Special Tests & Provisions Questioned Costs Subrecipient Monitoring § 200.303

Finding 2022-005 Federal Agency Name: Department of Agriculture Program Name: Communities Facilities Loans and Grants Cluster Federal Financial Assistance Listing #10.766 Finding Summary: UMH did set aside a reserve amount within a saving account; however, the funds were not segregated in a separat...

Finding 2022-005 Federal Agency Name: Department of Agriculture Program Name: Communities Facilities Loans and Grants Cluster Federal Financial Assistance Listing #10.766 Finding Summary: UMH did set aside a reserve amount within a saving account; however, the funds were not segregated in a separate bookkeeping account or bank account. Additionally, UMH entered into three debt arrangements during the fiscal year with a financial institution without obtaining prior written consent from the agency. Responsible Individuals: Melissa Gale, CEO; Erin Odens, CFO Corrective Action Plan: LJMH will have the USDA reserve money segregated as a separate line item in the financials. LJMH did submit proper information to the USDA for the three loans that were entered into without consent and USDA did reply back with post-loan approval concurrence. Future loans will be approved through the USDA prior to entering into them. Anticipated Completion Date: March 1, 2023

View Audit 24965

Finding 20405 (2022-004)

Significant Deficiency 2022

Landmann-Jungman Memorial Hospital, Inc.

SD

Questioned Costs Reporting Significant Deficiency § 200.303

Finding 2022-004 Federal Agency Name: Department of Agriculture Program Name: Communities Facilities Loans and Grants Cluster Federal Financial Assistance Listing #10.766 Finding Summary: Audited financial statements were submitted to USDA prior to review and approval from Board of Directors. Resp...

Finding 2022-004 Federal Agency Name: Department of Agriculture Program Name: Communities Facilities Loans and Grants Cluster Federal Financial Assistance Listing #10.766 Finding Summary: Audited financial statements were submitted to USDA prior to review and approval from Board of Directors. Responsible Individuals: Melissa Gale, CEO; Erin Odens, CFO Corrective Action Plan: For the current year a waiver was obtained from the USDA acknowledging that the financial statements were not approved from Board of Directors. Going forward the audit will need to be completed and approved by the Board of Directors prior to submission to the USDA. Anticipated Completion Date: February 1, 2023

View Audit 24965

Finding 20401 (2022-002)

None 2022

Minnehaha County Supportive Housing, Inc.

MN

Questioned Costs HUD Housing Programs

MINNEHAHA COUNTY SUPPORTIVE HOUSING, INC. HUD PROJECT NO. 091-EE005 CORRECTIVE ACTION PLAN (CONTINUED) YEAR ENDED DECEMBER 31, 2022 DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT Minnehaha County Supportive Housing, Inc. respectfully submits the following c...

MINNEHAHA COUNTY SUPPORTIVE HOUSING, INC. HUD PROJECT NO. 091-EE005 CORRECTIVE ACTION PLAN (CONTINUED) YEAR ENDED DECEMBER 31, 2022 DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT Minnehaha County Supportive Housing, Inc. respectfully submits the following corrective action plan for the year ended December 31, 2022. Name and address of independent public accounting firm: Hinrichs & Associates, Ltd 1000 Shelard Parkway, Suite 110 Minneapolis, MN 55426 Audit Period: December 31, 2022 The findings from the December 31, 2022 schedule of findings and questioned costs are discussed below. The findings are numbered consistently with the numbers assigned in the schedule. Section A of the schedule, Summary of Audit Results, does not include findings and is not addressed. FINDINGS - FINANCIAL STATEMENT AUDIT NONE FINDINGS - FEDERAL AWARD PROGRAMS AUDIT DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT FINDING 2022-002: SECTION 202, ASSISTANCE LISTING NUMBER 14.157 In 1 of 25 cash disbursements tested, the Project paid the expense of another project under common management. Recommendation: The Project should carefully review invoices before payment to make sure it only pays the proper amount. Action Taken: The Project agrees with the finding. The accounts payable staff will be reminded to be careful when entering invoices for payment. If the Department of Housing and Urban Development has questions regarding this plan, please call Chuck Reuter at 651-645-7271.

View Audit 20226 Questioned Costs: $1

Finding 20400 (2022-001)

None 2022

Minnehaha County Supportive Housing, Inc.

MN

Questioned Costs HUD Housing Programs

MINNEHAHA COUNTY SUPPORTIVE HOUSING, INC. HUD PROJECT NO. 091-EE005 CORRECTIVE ACTION PLAN YEAR ENDED DECEMBER 31, 2022 DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT Minnehaha County Supportive Housing, Inc. respectfully submits the following...

MINNEHAHA COUNTY SUPPORTIVE HOUSING, INC. HUD PROJECT NO. 091-EE005 CORRECTIVE ACTION PLAN YEAR ENDED DECEMBER 31, 2022 DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT Minnehaha County Supportive Housing, Inc. respectfully submits the following corrective action plan for the year ended December 31, 2022. Name and address of independent public accounting firm: Hinrichs & Associates, Ltd. 1000 Shelard Parkway, Suite 110 Minneapolis, MN 55426 Audit Period: December 31, 2022 The findings from the December 31, 2022 schedule of findings and questioned costs are discussed below. The findings are numbered consistently with the numbers assigned in the schedule. Section A of the schedule, Summary of Audit Results, does not include findings and is not addressed. FINDINGS - FINANCIAL STATEMENT AUDIT NONE FINDINGS - FEDERAL AWARD PROGRAMS AUDIT DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT FINDING 2022-001: SECTION 202, ASSISTANCE LISTING NUMBER 14.157 The Project's security deposit liability account was underfunded at December 31, 2022. Recommendation: The Project should carefully review the statement of financial position to make sure the security deposit liability account is funded. Action Taken: The Project agrees with the finding. Management will be reminded to review the tenant security deposit cash balance versus the security deposit liability balance on a monthly basis. This finding was corrected in February 2023. If the Department of Housing and Urban Development has questions regarding this plan, please call Chuck Reuter at 651-645-7271.

View Audit 20226

Finding 20392 (2022-004)

Material Weakness 2022

Wickenburg Community Hospital

AZ

Questioned Costs Allowable Costs / Cost Principles Material Weakness § 200.303

Finding 2022-004 Federal Agency Name: Department of Health and Human Services Program Name: COVID-19 Provider Relief Fund and American Rescue Plan Rural Distribution Federal Assistance Listing #93.498 Compliance Requirement: Reporting Finding Summary: The Hospital did not properly include 340B reve...

Finding 2022-004 Federal Agency Name: Department of Health and Human Services Program Name: COVID-19 Provider Relief Fund and American Rescue Plan Rural Distribution Federal Assistance Listing #93.498 Compliance Requirement: Reporting Finding Summary: The Hospital did not properly include 340B revenues and final audit adjustments in net patient service revenue. In addition, the Hospital did not properly report payor categories for quarters in which the net patient service revenues were negative. Responsible Individuals: Patti Clavette, Chief Financial Officer; Jackie Lundblad, Chief Executive Officer Corrective Action Plan: Management will modify the lost revenue reported on future reports, if any, to reflect an accurate total lost revenue amount. In addition, a formal review and approval process will be implemented to ensure calculations are in accordance with applicable requirements and a member of management will be identified to review all reporting requirements for federal grants and awards to ensure the Hospital is in compliance with the requirements. Anticipated Completion Date: September 30, 2023

View Audit 21564

Finding 20391 (2022-006)

Significant Deficiency 2022

Wickenburg Community Hospital

AZ

Questioned Costs Allowable Costs / Cost Principles Cash Management

Finding 2022-006 Federal Agency Name: Department of Agriculture Program Name: Communities Facilities Loans and Grants Cluster Federal Assistance Listing #10.766 Compliance Requirement: Allowable Costs Finding Summary: Management calculated the applicant?s contribution as 25% of the funds requested ...

Finding 2022-006 Federal Agency Name: Department of Agriculture Program Name: Communities Facilities Loans and Grants Cluster Federal Assistance Listing #10.766 Compliance Requirement: Allowable Costs Finding Summary: Management calculated the applicant?s contribution as 25% of the funds requested for reimbursements instead of first applying the full contribution to the requested reimbursement. Responsible Individuals: Patti Clavette, Chief Financial Officer; Jackie Lundblad, Chief Executive Officer Corrective Action Plan: Management will properly adjust subsequent requests for reimbursement under the grant agreement for the remaining portion of the applicant?s contribution. In addition, management will evaluate controls in place to ensure conditions of future grants are met in order to prevent further noncompliance or question costs. Anticipated Completion Date: September 30, 2023

View Audit 21564 Questioned Costs: $1

Finding 20389 (2022-005)

Significant Deficiency 2022

Wickenburg Community Hospital

AZ

Questioned Costs Student Financial Aid Subrecipient Monitoring

Finding 2022-005 Federal Agency Name: Department of Agriculture Program Name: Communities Facilities Loans and Grants Cluster Federal Assistance Listing #10.766 Compliance Requirement: Reporting Finding Summary: Management was unaware of the requirement to submit the annual proposed budget to the R...

Finding 2022-005 Federal Agency Name: Department of Agriculture Program Name: Communities Facilities Loans and Grants Cluster Federal Assistance Listing #10.766 Compliance Requirement: Reporting Finding Summary: Management was unaware of the requirement to submit the annual proposed budget to the Rural Development Area Office within 30 days of each year end. The Hospital approves the budget annually. However, the budget is not submitted to USDA. Responsible Individuals: Patti Clavette, Chief Financial Officer; Jackie Lundblad, Chief Executive Officer Corrective Action Plan: Management will put a process in place to ensure the approved budget is submitted to USDA within 30 days of year end. Anticipated Completion Date: December 31, 2023

View Audit 21564

Finding 20384 (2022-004)

Material Weakness 2022

Morris Area Public School 2769

MN

Allowable Costs / Cost Principles Questioned Costs Material Weakness

Finding Summary: During the course of our engagement, we noted instances where documentation was not retained supporting payroll expenditures and invoices were paid in an incorrect amount that was charged to the federal Child Nutrition Cluster program. Responsible Individuals: Shane Monson, Superint...

Finding Summary: During the course of our engagement, we noted instances where documentation was not retained supporting payroll expenditures and invoices were paid in an incorrect amount that was charged to the federal Child Nutrition Cluster program. Responsible Individuals: Shane Monson, Superintendent. Corrective Action Plan: The District will review and strengthen the controls surrounding the review and approval of allowable costs to ensure they are supported, approved of, and calculations are accurate. Anticipated Completion Date: June 30, 2023

View Audit 20655

Finding 20381 (2022-001)

Significant Deficiency 2022

Tri-County Community Health Council, Inc. (d/b/a Commwell Health)

NC

Questioned Costs Special Tests & Provisions Subrecipient Monitoring

CORRECTIVE ACTION PLAN November 4, 2022 Health Resources and Services Administration Tri-County Community Health Council, Inc. (d/b/a CommWell Health) respectfully submits the following corrective action plan for the year ended March 31, 2022. _______________________________________________________...

CORRECTIVE ACTION PLAN November 4, 2022 Health Resources and Services Administration Tri-County Community Health Council, Inc. (d/b/a CommWell Health) respectfully submits the following corrective action plan for the year ended March 31, 2022. ____________________________________________________________________________________ CohnReznick LLP 1301 Avenue of the Americas New York, NY 10019 Audit Period: March 31, 2022 The findings from the March 31, 2022 schedule of findings and questioned costs are discussed below. The findings are numbered consistently with the number assigned in the schedule. FINDINGS ? FEDERAL AWARDS PROGRAM AUDIT U.S. Department of Health and Human Services, COVID-19 Health Centers Program Cluster (Assistance listing number 93.224/93.527) Finding 2022-001 - Special Tests and Provisions SIGNIFICANT DEFICIENCY Recommendation We recommend that proper training be given to employees at registration to ensure that the sliding fee discounts be monitored and reviewed by a supervisor on a periodic basis to ensure compliance with the sliding fee scale. In addition, management should conduct internal audits to ensure the sliding fee is calculated properly. Action Taken CommWell Health concurs with the recommendation and has designed a series of enhancements to existing registration orientation and ongoing training. Additional training time will be dedicated with current front desk registration colleagues to ensure that they can determine household income from the documentation given to them by patients. This education will be completed by December 31, 2022. New hire orientation training will include a thorough review of the Front Desk Handbook and slide fee procedures. Post-test will be given to each front desk colleague upon completion of education. Scores of at least 90% will required or training and testing will be repeated. In addition, CommWell Health is moving to a new electronic health record (EHR), EPIC, beginning November 7, 2022. This system has much better controls built in to help ensure that slide fee is documented correctly. EPIC also does not have many of the system limitations our previous EHR had. Audits of 100% of slide fee records will be done every day by designated colleagues to ensure slide fee documentation is correct. Supervisors will review daily audit findings and ensure additional training is given accordingly. Corrective action will be taken on any errors noted during audits. Finance staff will conduct random internal audits of slide fee records each month to evaluate for compliance with applicable requirements. Results of internal audits will be reviewed monthly in Utilization Review Committee. If the Health Resources and Services Administration has questions regarding this plan, please call Cheryl Stanley, Chief Financial Officer, at 910-567-7008.

View Audit 20022

Finding 20379 (2022-001)

Significant Deficiency 2022

Junior Achievement of Arizona, Inc.

AZ

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

Management has implemented procedures to verify that the expenditures that are requested for reimbursement are not duplicated and are allowable under the Uniform Guidance. Review procedures have been added to help ensure that only allowable salaries expenses are included in reimbursement requests an...

Management has implemented procedures to verify that the expenditures that are requested for reimbursement are not duplicated and are allowable under the Uniform Guidance. Review procedures have been added to help ensure that only allowable salaries expenses are included in reimbursement requests and that all voided checks are omitted.

View Audit 19855 Questioned Costs: $1

Finding 20378 (2022-002)

Significant Deficiency 2022

Housing Authority of the Township of Neptune

NJ

Questioned Costs Allowable Costs / Cost Principles Internal Control / Segregation of Duties § 200.423 § 200.438 § 200.473

Views of responsible officials and planned corrective action: The Authority accepts the recommendation of the auditor. The Authority will increase oversight in the Public and Indian Housing Program to ensure that established internal control policies are being followed on a timely basis. Bart Cook,...

Views of responsible officials and planned corrective action: The Authority accepts the recommendation of the auditor. The Authority will increase oversight in the Public and Indian Housing Program to ensure that established internal control policies are being followed on a timely basis. Bart Cook, Executive Director, is responsible for implementing this corrective action by September 30, 2023.

View Audit 19315 Questioned Costs: $1

Finding 20377 (2022-001)

Significant Deficiency 2022

Peacehealth Networks

WA

Matching / Level of Effort / Earmarking Questioned Costs Allowable Costs / Cost Principles § 200.303

As noted within the portal filing summary for the general reporting Period 1, the Corporation?s consolidated lost revenue totaled $141,363,926. Payments from the PRF for Period 1 totaled $53,982,121 for the consolidated parent and $14,810,675 for St. John?s Medical Center Period 2 targeted report. A...

As noted within the portal filing summary for the general reporting Period 1, the Corporation?s consolidated lost revenue totaled $141,363,926. Payments from the PRF for Period 1 totaled $53,982,121 for the consolidated parent and $14,810,675 for St. John?s Medical Center Period 2 targeted report. As a result, there were sufficient qualifying lost revenues to receive and earn all PRF funds received, regardless of the reporting error identified and described in the ?condition found? section above. Therefore, management believes no repayment of PRF funds received would be required. Management is implementing a process to add additional review steps prior to finalizing future reporting submissions.

View Audit 19419

Finding 20318 (2022-001)

Material Weakness 2022

Advance Community Health

NC

Allowable Costs / Cost Principles Questioned Costs HUD Housing Programs

Advance Community Health was inundated with HRSA reporting due to the multiple funding we received in response to the Covid-19 Pandemic. In an effort to help health centers deal expeditiously with the Covid crisis some of the funding was given in advance with reporting requirements to follow. The ...

Advance Community Health was inundated with HRSA reporting due to the multiple funding we received in response to the Covid-19 Pandemic. In an effort to help health centers deal expeditiously with the Covid crisis some of the funding was given in advance with reporting requirements to follow. The rush to get funding out to address the Covid-19 pandemic crisis resulted in reporting requirements that were developed and implemented very quickly, and the reporting requirements were confusing to many health centers. The Provider Relief Funding was one of the instances in which funding was given in advance with reporting requirements to follow. As a result of the confusion surrounding these last-minute reporting requirements, we believe that the former CFO inadvertently omitted certain revenue that perhaps should have been included in the Provider Relief Funding (PRF) report and there was no clear explanation in the narrative section as to why these revenues were omitted. We attempted to recall and amend the PRF report but were told by the PRF reporting team that we are unable to amend the report at this time. However, should the opportunity to amend the PRF Report occur, we will make the appropriate amendment to the PRF report with a reconciliation and narrative that will support the earning of the PRF funding. To prevent future occurrences of where it is not clear why revenue items are being omitted or included on a federal provider relief report, a reconciliation will be prepared that ties the revenue section of the PRF report with the revenue section of the internal financial statements. The reconciliation will clearly outline what is included in and what is omitted from the report and establish clear documentation to strongly support the amounts on the PRF report. A narrative documenting why certain revenue is omitted should be attached, which will clearly and concisely explain how the revenue amounts on the PRF report were derived. The reconciliation will be prepared by our senior accountant and reviewed by the CFO. Tiffany Robertson, the interim CFO and Rhonda Payne, our Chief Compliance Officer will be responsible for and will continue to assess our internal reporting processes. We will continue to conduct staff training as deemed necessary to ensure compliance with federal reporting requirements for PRF funding. The training and procedure should be implemented by December 2022.

View Audit 26499

Finding 20316 (2022-001)

Significant Deficiency 2022

The Guthrie Clinic

PA

Internal Control / Segregation of Duties Questioned Costs Reporting § 200.303

The Guthrie Clinic and Affiliates Corrective Action Plan For the Year Ended June 30, 2022 Finding 2022-001: Significant Deficiency in Internal Control - Reporting Assistance Listing No.: 93.498 COVlD-19: Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Condition/Context. In th...

The Guthrie Clinic and Affiliates Corrective Action Plan For the Year Ended June 30, 2022 Finding 2022-001: Significant Deficiency in Internal Control - Reporting Assistance Listing No.: 93.498 COVlD-19: Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Condition/Context. In the Corporation's Period 2 submission, using the Lost Revenues Reporting Method: Alternative Reasonable Methodology (Option 3), the lost revenues for quarter 4 of 2020 were incorrectly reported as $0 (rather than $4,934,624) and the lost revenues for quarter 1 of 2021 were incorrectly reported as $4,934,624 (rather than $0). This is not a statistically valid sample. Corrective Action Plan Corrective Action Planned: The Corporation has implemented additional internal controls through independent review and sign off of the draft PRF reporting, prior to final submission, to ensure completeness and accuracy. Name(s) of Contact Person(s) Responsible for Corrective Action: Sean Monahan, Corporate Financial Controller and Fran Macafee, VP, CFO -Guthrie Hospitals Anticipated Completion Date: This was corrected in the Period 3 submission filed on September 30, 2022

View Audit 26519

Finding 20315 (2022-004)

Significant Deficiency 2022

Straight and Narrow, Inc. Roman Catholic Diocese of Paterson

NJ

Reporting Internal Control / Segregation of Duties Questioned Costs

Finding --- Internal controls should be strengthened to ensure proper preparation and reviews of the Schedules of Expenditures of Federal Awards and State Financial Assistance. Corrective action --- Subsequent to year end, management has hired new members of management and reorganized other roles a...

Finding --- Internal controls should be strengthened to ensure proper preparation and reviews of the Schedules of Expenditures of Federal Awards and State Financial Assistance. Corrective action --- Subsequent to year end, management has hired new members of management and reorganized other roles at the entity level to allow for reviews to occur. Training and education will occur at all supervisory levels to ensure that responsible parties to contracts report completely and accurately. Status --- Commenced Completion date --- by June 30, 2023 Contact --- Dimpal Patel, Controller Contact phone --- 973-737-2077 Contact address --- 777 Valley Road, Clifton, New Jersey 07013

View Audit 26249

Finding 20296 (2022-002)

Significant Deficiency 2022

Independent School District No. 273

MN

Procurement, Suspension & Debarment Internal Control / Segregation of Duties Questioned Costs

SIGNIFICANT DEFICIENCY IN INTERNAL CONTROL OVER COMPLIANCE ? U.S. DEPARTMENT OF EDUCATION, PASSED THROUGH MINNESOTA DEPARTMENT OF EDUCATION, SPECIAL EDUCATION CLUSTER ? FEDERAL ALN 84.027 AND 84.173 2022-002 Internal Control Over Compliance With Federal Suspension and Debarment Requirements Findi...

SIGNIFICANT DEFICIENCY IN INTERNAL CONTROL OVER COMPLIANCE ? U.S. DEPARTMENT OF EDUCATION, PASSED THROUGH MINNESOTA DEPARTMENT OF EDUCATION, SPECIAL EDUCATION CLUSTER ? FEDERAL ALN 84.027 AND 84.173 2022-002 Internal Control Over Compliance With Federal Suspension and Debarment Requirements Finding Summary 2 CFR ? 180 requires the District to establish and maintain effective internal control over compliance with requirements applicable to federal program expenditures, including suspension and debarment requirements. The District did not have sufficient controls in place within its special education cluster federal programs to assure that it was not contracting for goods or services with parties that are suspended or debarred, or whose principals are suspended or debarred from participating in contracts involving the expenditures of federal program funds. Corrective Action Plan Actions Planned ? The District will review policies and procedures relating to suspension and debarment for its federal programs and will ensure that all parties with which it contracts for goods or services are eligible to participate in contracts involving the expenditures of federal program funding. Official Responsible ? Mert Woodard, Director of Business Services. Planned Completion Date ? June 30, 2023. Disagreement With or Explanation of Finding ? The District agrees with this finding. Plan to Monitor ? Mert Woodard, Director of Business Services, will assure appropriate controls are in place, and will review internal control procedures relating to suspension and debarment to ensure they are in line with the Uniform Guidance requirements.

View Audit 19273

Finding 20293 (2022-001)

Material Weakness 2022

MacCormac College Dba Generations College

IL

Questioned Costs Procurement, Suspension & Debarment Subrecipient Monitoring

2022-001 - Procurement Policy Recommendation: The auditors recommended that the College formally adopt a procurement procedures document to ensure the applicable procurement requirements are adhered to and supported. Actions Taken or Planned: A procurement policy was formally approved by the Boar...

2022-001 - Procurement Policy Recommendation: The auditors recommended that the College formally adopt a procurement procedures document to ensure the applicable procurement requirements are adhered to and supported. Actions Taken or Planned: A procurement policy was formally approved by the Board of Trustees of the College on February 23, 2023. Person Responsible: Matt Gawenda, Dean of Finance Estimated Date of Completion: February 23, 2023

View Audit 21161

Finding 20291 (2022-001)

None 2022

Northwest Mississippi Community College

MS

Questioned Costs Reporting Internal Control / Segregation of Duties

Individuals Responsible for Corrective Action Plan: Management will submit a revised second quarter 2022 reports that includes all funds expended through June 30, 2022. Anticipated Completion Date: September 30, 2023

View Audit 19194

Finding 20290 (2022-001)

None 2022

Casa Bienvivir

TX

Questioned Costs Special Tests & Provisions Cash Management

November 17, 2022 HUD Service Office Director Mr. Donald R. Hogan U. S. Department of Housing and Urban Development Kansas City Multifamily Regional Center 400 State Avenue, Room 200 Kansas City, KS 66101-2406 Casa Bienvivir, respectfully submits the following corrective action plan for the year e...

November 17, 2022 HUD Service Office Director Mr. Donald R. Hogan U. S. Department of Housing and Urban Development Kansas City Multifamily Regional Center 400 State Avenue, Room 200 Kansas City, KS 66101-2406 Casa Bienvivir, respectfully submits the following corrective action plan for the year ended September 30, 2022. Strickler & Prieto, LLP 201 E. Main, Suite 1615, El Paso, TX 79912 Audit Period: Year Ended September 30, 2022 The findings from the September 30, 2022 schedule of findings and questions costs are discussed below. The findings are numbered consistently with the numbers assigned in the schedule. FINDINGS-FINANCIAL STATEMENT AUDIT No matters were reported FINDINGS AND QUESTIONED COSTS-MAJOR FEDERAL AWARD PROGRAMS AUDIT 2022-001: FAILURE TO FUND THE RESIDUAL RECEIPTS RESERVE ACCOUNT WITHIN 60 DAYS OF FISCAL YEAR END a. Recommendation We agree the funding of the residual receipts reserve account was not made within the 60 day after fiscal year end per HUD regulations. b. Action Taken Funding of the residual receipts reserve account will be made in a timely manner. If HUD has questions regarding this plan, please call Luis Ortiz at (915) 562-3444. Sincerely yours, ______________________________ Luis Ortiz, Vice President of Finance

View Audit 18808

Finding 20278 (2022-001)

Significant Deficiency 2022

Epic Academy

IL

Allowable Costs / Cost Principles Questioned Costs Subrecipient Monitoring § 200.410

Identifying Number: 2022-001 Finding: The following discrepancies and inconsistencies were identified: administrative procedures and requirements of the grantor were not followed; there were no proper review or approval of required reporting prior to submission. Contact person responsible for corr...

Identifying Number: 2022-001 Finding: The following discrepancies and inconsistencies were identified: administrative procedures and requirements of the grantor were not followed; there were no proper review or approval of required reporting prior to submission. Contact person responsible for corrective action: Kevyn Harmon, Senior Director of Finance & Administration Corrective Action: All personnel involved with the ESSER III ? MFT Programs undergo training on the all the processes and requirements to administer the programs, and management will perform proper review of all claims for reimbursement. In additional, an annual update on the procedures and the requirements to ensure propriety and accuracy. Proposed Completion Date: EPIC Academy will complete implementation of the above procedures by November 30, 2022.

View Audit 23750

Finding 20277 (2022-002)

None 2022

Epic Academy

IL

Allowable Costs / Cost Principles Questioned Costs Subrecipient Monitoring § 200.302 § 200.303 § 200.308 § 200.410 § 200.430

Identifying Number: 2022-002 Finding: The following discrepancies and inconsistencies were identified: administrative procedures and requirements of the grantor were not followed; there were no proper review or approval of required reporting prior to submission. Contact person responsible for corr...

Identifying Number: 2022-002 Finding: The following discrepancies and inconsistencies were identified: administrative procedures and requirements of the grantor were not followed; there were no proper review or approval of required reporting prior to submission. Contact person responsible for corrective action: Kevyn Harmon, Senior Director of Finance & Administration Corrective Action: All personnel involved with the Title programs undergo training on the all the processes and requirements to administer the programs, and management will perform proper review of all claims for reimbursement. In additional, an annual update on the procedures and the requirements to ensure propriety and accuracy. Proposed Completion Date: EPIC Academy will complete implementation of the above procedures by November 30, 2022.

View Audit 23750 Questioned Costs: $1

Finding 20273 (2022-001)

Significant Deficiency 2022

Bristol Hospital, Incorporated

CT

Internal Control / Segregation of Duties Questioned Costs Reporting

The Hospital agrees with the finding. Management will implement procedures to ensure that the most recent guidance is reviewed, and that information used in the preparation of the reports is reviewed by the Chief Financial Officer. The Hospital will not include non-incremental expenses in future rep...

The Hospital agrees with the finding. Management will implement procedures to ensure that the most recent guidance is reviewed, and that information used in the preparation of the reports is reviewed by the Chief Financial Officer. The Hospital will not include non-incremental expenses in future reports. The Hospital has sufficient unused lost revenue to cover the expenses noted above.

View Audit 19849

Finding 20272 (2022-001)

Significant Deficiency 2022

Parallel Senior Villas, INC

KS

Questioned Costs Special Tests & Provisions Subrecipient Monitoring

CORRECTIVE ACTION PLAN FOR THE YEAR ENDED DECEMBER 31, 2022 Title 2, U.S. Code of Federal Regulations Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (Uniform Guidance), Subpart F, Section 511 ? Audit Findings Follow-up requires the auditee t...

CORRECTIVE ACTION PLAN FOR THE YEAR ENDED DECEMBER 31, 2022 Title 2, U.S. Code of Federal Regulations Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (Uniform Guidance), Subpart F, Section 511 ? Audit Findings Follow-up requires the auditee to prepare a corrective action plan to address each audit finding included in the current year auditor?s reports. The Corrective Action Plan for Current Year Findings present our corrective action plan for the Financial Statement and/or Federal Award Findings described in the accompanying Schedule of Findings and Questioned Costs for the period ended December 31, 2022. Finding 2022-001 Responsible Party Name: Fred Arreguin Position: Chief Financial Officer ? Management Agent Telephone Number: 816-561-4240 Federal Agency U.S. Department of Housing and Urban Development Federal Program Supportive Housing for the Elderly ? Section 202 Compliance Requirements N ? Special Tests and Provisions Finding Type Compliance and Internal Control Auditee?s Comment on Finding We agree with the auditor?s finding Corrective Action We will submit a request for retroactive approval of the $10,724 withdrawal from the reserve for replacement account on June 23, 2022. Anticipated Completion Date April 30, 2023

View Audit 22368 Questioned Costs: $1

Corrective Action Plans

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