Corrective Action Plans

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2025-005: REPORTING Program: Child Nutrition Cluster Federal Assistance Listing Number: 10.553, 10.555, 10.559 Federal Agency: U.S. Department of Agriculture Pass-Through Agency: Arizona Department of Education Grantor Number: ADE ED09-0001 Questioned Costs: $-0- Type of Finding: Noncompliance (Othe...
2025-005: REPORTING Program: Child Nutrition Cluster Federal Assistance Listing Number: 10.553, 10.555, 10.559 Federal Agency: U.S. Department of Agriculture Pass-Through Agency: Arizona Department of Education Grantor Number: ADE ED09-0001 Questioned Costs: $-0- Type of Finding: Noncompliance (Other Matter), significant deficiency in internal control Compliance Requirement: L. Reporting Condition/Context: During our review of meals claims submitted for reimbursement, we noted variances between the District’s meal counts and what was submitted to the Arizona Department of Education. For four months tested, meals claims were net under-reported by 10,403 lunch and breakfast meals, which calculated to $3,616.29. Additionally, for three of 4 months tested, the District did not maintain any documentation to support that the claims were reviewed by a second person. Action planned in response to finding: The District will ensure a second employee verifies and approves all NSLP Claim forms to ensure the claims submitted are accurate and complete prior to submission. Planned completion date for corrective action plan: For the period ending June 30, 2026. Name of the contact person responsible for corrective action: Jim Serbin, CFO.
Finding 2025-001 – Noncompliance – Reporting (Repeat) Recommendation: The auditors recommend the Organization implement procedures to ensure the data collection form is submitted within the earlier of 30 calendar days of the audit report being issues, or 9 months after the end of the audit period. A...
Finding 2025-001 – Noncompliance – Reporting (Repeat) Recommendation: The auditors recommend the Organization implement procedures to ensure the data collection form is submitted within the earlier of 30 calendar days of the audit report being issues, or 9 months after the end of the audit period. Actions Taken or Planned: Management understands the data collection form was not submitted within 9 months of June 30th year end. Procedures will be implemented to make sure the audit is completed prior to the 9 month deadline. Data collection forms will then be uploaded to the Federal Audit Clearinghouse prior to the 9 month deadline or within 30 days of the audit report being issued. Name of Contact Person: Larissa Dickens, Director of Finance Estimated Date of Completion: June 30, 2026
The Finance Staff will perform quarterly reconciliations of expenditures to ensure accurate reporting of amounts. Personnel responsible for implementation: Carmen Tsui, Grant Accountant Completion Date: June 30, 2026
The Finance Staff will perform quarterly reconciliations of expenditures to ensure accurate reporting of amounts. Personnel responsible for implementation: Carmen Tsui, Grant Accountant Completion Date: June 30, 2026
The Accounting Manager assumed responsibility for the quarterly Coronavirus State and Local Fiscal Recovery Funds (CSLFRF) reporting process following the unexpected departure of the former Finance Director. Due to the abrupt transition and issues associated with obtaining access to the portal, the ...
The Accounting Manager assumed responsibility for the quarterly Coronavirus State and Local Fiscal Recovery Funds (CSLFRF) reporting process following the unexpected departure of the former Finance Director. Due to the abrupt transition and issues associated with obtaining access to the portal, the entity experienced a delay in submitting the Q1 2025 Project and Expenditure Report by the required deadline. Management acknowledges the importance of timely compliance with federal reporting requirements. Since access to the Treasury reporting portal was established, all subsequent Project and Expenditure Reports have been submitted timely. Personnel responsible for implementation: Veronica Alvarez, Deputy Finance Director Completion Date: June 30, 2026
The Finance Department staff will review all items prior to completing the report. Personnel responsible for implementation: Carmen Tsui, Grant Accountant Completion Date: June 30, 2026
The Finance Department staff will review all items prior to completing the report. Personnel responsible for implementation: Carmen Tsui, Grant Accountant Completion Date: June 30, 2026
The Housing Manager and Management Analyst/Grant Writer are collaboratively working to ensure FFATA reports are completed prior to disbursing funds to subawardees. Personnel responsible for implementation Vanessa Sedano, Housing Manager Completion Date: June 30, 2026
The Housing Manager and Management Analyst/Grant Writer are collaboratively working to ensure FFATA reports are completed prior to disbursing funds to subawardees. Personnel responsible for implementation Vanessa Sedano, Housing Manager Completion Date: June 30, 2026
June 25, 2026 Dear Cognizant or Oversight Agency for Audit: DePelchin Children’s Center (DePelchin) respectfully submits the following corrective action plan for the year ended December 31, 2025. Name and address of independent public accounting firm: Doeren Mayhew Assurance, 2600 North Loop West, S...
June 25, 2026 Dear Cognizant or Oversight Agency for Audit: DePelchin Children’s Center (DePelchin) respectfully submits the following corrective action plan for the year ended December 31, 2025. Name and address of independent public accounting firm: Doeren Mayhew Assurance, 2600 North Loop West, Suite 600, Houston, TX 77092. The finding discussed below from the Schedule of Findings and Questioned Costs (the schedule) for the year ended December 31, 2025 is numbered consistently with the number assigned in the schedule. Federal Award Finding 2025-001 Corrective Action Plan: DePelchin has implemented an internal review process whereby a grant specialist on the evaluation team conducts a monthly review of all enrollments to verify that eligibility requirements, including priority characteristics and service area criteria, have been met. Program staff, evaluation staff, and data team members have been provided additional training on the applicable eligibility requirements and documentation standards. Additionally, DePelchin has implemented an annual cross-functional review process involving program leadership, evaluation staff, and fiscal representatives to review eligibility requirements and key contract provisions prior to the start of each fiscal year. This review is intended to ensure that any changes in program requirements are identified, communicated, and incorporated into program operations in a timely manner. Based on these corrective actions and enhanced monitoring procedures, DePelchin believes the risk of similar eligibility documentation issues has been substantially mitigated. Contact Person Responsible for Corrective Action: Mr. Brian Pate, Senior VP and CFO Anticipated Completion Date: The corrective action plan is anticipated to be completed by October 31, 2026. Respectfully submitted, Mr. Brian Pate Senior VP and CFO
Finding 2025-002 – Significant Deficiency and Noncompliance - Lack of Required Uniform Guidance Policies and Procedures Condition: The City did not update their federal policies and procedures to be in full compliance with Uniform Guidance. Corrective Action: The City is in the process of updating a...
Finding 2025-002 – Significant Deficiency and Noncompliance - Lack of Required Uniform Guidance Policies and Procedures Condition: The City did not update their federal policies and procedures to be in full compliance with Uniform Guidance. Corrective Action: The City is in the process of updating and adopting written policies and procedures that are in compliance with Uniform Guidance. Anticipated Completion Date: December 31, 2026 Responsbile Official: John Szymanski, City Manager
With the help of a consulting firm, the City has reviewed our internal controls, processes and procedures to correct these issues. Within the last six months, experienced staff have increased our ability to more closely monitor and record budgeting issues in a timely manner, according to federal gra...
With the help of a consulting firm, the City has reviewed our internal controls, processes and procedures to correct these issues. Within the last six months, experienced staff have increased our ability to more closely monitor and record budgeting issues in a timely manner, according to federal grant requirements. Anticipated Completion Date: December 31, 2026 Responsible Contact Person: Linda H. Conover, Interim Finance Director
· Review current cost allocation plan and policy to determine if all information presented and needed is included in the policy document · Work with outside agency to review top down approach to cost allocation philosophy and determine if revisions are warranted · Work to payroll vendor to review th...
· Review current cost allocation plan and policy to determine if all information presented and needed is included in the policy document · Work with outside agency to review top down approach to cost allocation philosophy and determine if revisions are warranted · Work to payroll vendor to review the process to re-establish time-and-effort reporting through the timesheet entry process and the consolidation of time-and-effort information into reporting that can be easily summated by department/project and uploaded to MIP · Determine the allocation and cost distribution methods needed and the resulting detail reporting needed to substantiate the allocation methods used for propriety · Reinstitute the timesheet entry process by project/cost code and train staffing at an upcoming All Staff meeting to reset the view of timesheets and their importance of timesheet tracking to minimize errors for cost allocation purposes · Have staff begin using timesheets in Paylocity (by December 1st) · Complete update of Fiscal Policies Manual (inclusive of Cost Allocation methodology and philosophy) and timely reviews (i.e. at a minimum semiannually or with major program changes/contracts) to ensure no substantive changes needed to policy or actions needed to ensure appropriate accounting updates
In its 2025 Compliance Report, auditors made the following finding: Finding 2025‐001: Reporting – Significant deficiency in internal controls over compliance and compliance finding. Criteria: Under this grant program, the Foundation is required to complete semi‐annual performance reports in the Disa...
In its 2025 Compliance Report, auditors made the following finding: Finding 2025‐001: Reporting – Significant deficiency in internal controls over compliance and compliance finding. Criteria: Under this grant program, the Foundation is required to complete semi‐annual performance reports in the Disaster Recovery Grant Reporting (DRGR) system. Condition: During reporting testing, it was noted that the Foundation had not completed or submitted the required performance reports during the year. Cause: The Foundation didn’t implement an effective control for ensuring the required reporting under the grant was completed and submitted timely. Effect: Internal control was not properly designed to identify the required reporting and prevent noncompliance, and the Foundation was not in compliance with the reporting requirement. Recommendation: The Foundation should implement internal controls over the reporting process that ensures the required reporting is submitted in a timely manner. In addition, the Foundation should ensure grant agreements are reviewed in detail so no required reporting is overlooked. In response, Southern Gateway Public Green Foundation commits to the following Corrective Action Plan:  Remedy: In order to remedy this violation, staff will take immediate action to file missing semiannual reports in cooperation with general contractor.  Responsibility for Implementing Remedy: Reports will be filed by Anne Hagan, VP of Strategic Initiatives.  Verification of Remedy: Reports will be reviewed by April Allen, President and CEO, and filing of reports will also be confirmed by April Allen, President and CEO  Deadline for Remedy: As soon as possible but no later than 7/31/26.  Consequences in the event remedy is not undertaken: Failure to file reports could result in request for reimbursement of grant revenue.  Training to Prevent future violations: Reporting requirements and grant agreements will be reviewed by Anne Hagan.  Statement on Consequences of Repeated Violations: If future reports are late or missed, already reimbursed grant payments may have to be repaid and SGPGF may not be eligible for future grant payments.
Recommendation – As the Organization continues to improve in processes and as time allows, completion of the annual audit and required work earlier in the year to allow for more timely reporting will assist in relieving this compliance finding. Management’s Response – The Organization will work to e...
Recommendation – As the Organization continues to improve in processes and as time allows, completion of the annual audit and required work earlier in the year to allow for more timely reporting will assist in relieving this compliance finding. Management’s Response – The Organization will work to establish policies and procedure, and management took steps in 2026 to change personnel within the finance functions and hired a new Chief Financial Officer in 2026 with extensive hospital finance and accounting experience. The Chief Financial Officer’s duties will include additional reviews and assistance with account reconciliations as well as training of current staff and process improvements in this area, with a goal of removing this deficiency in the future.
Management will implement procedures designed to ensure the timely preparation, review, and completion of the Schedule of Expenditures of Federal Awards ("SEFA") and the timely submission of the Single Audit reporting package to the Federal Audit Clearinghouse. Specific actions include: • Reviewing ...
Management will implement procedures designed to ensure the timely preparation, review, and completion of the Schedule of Expenditures of Federal Awards ("SEFA") and the timely submission of the Single Audit reporting package to the Federal Audit Clearinghouse. Specific actions include: • Reviewing and adjusting the formal year-end timetable for preparation of the SEFA. • Assigning responsibility for accumulating and reconciling federal expenditure information to a single accountable resource. • Enhancing periodic management and auditor review of the status of the audit and reporting process. • Conducting a post-audit review to ensure recurring delays do not occur.• Engaging external consultants to evaluate accounting department staffing levels, workflow processes, and internal controls and to provide and implement recommendations for strengthening the financial reporting function. Management believes these corrective actions will reduce the risk of undetected errors, improve the timeliness of account reconciliations, and strengthen the overall system of internal control over financial reporting.
Finding 2025-005 - Untimely Release of Title IV Credit Balances (Significant Deficiency): Condition - During testing of student account activity, we identified that fourteen (14) out of sixty (60) sampled students had Title IV created credit balances that remained on their accounts for more than 14 ...
Finding 2025-005 - Untimely Release of Title IV Credit Balances (Significant Deficiency): Condition - During testing of student account activity, we identified that fourteen (14) out of sixty (60) sampled students had Title IV created credit balances that remained on their accounts for more than 14 days without being released to the student or parent. All refunds were eventually released to the students. Corrertive Action Plan The College experienced significant staff turnover within the business office. In addition, the College is undergoing conversion to a new Enterprise Resource Planning (ERP) system which affected its ability to complete some functions within a timely manner. A new bursar was hired in May 2026. Timely processing of student refunds was emphasized during her training. Going forward, student refunds will be released within 14 days after credit balances are reflected on student accounts." Completion Date - September 30, 2026 Responsible Party - Chief Financial Officer
Management strives to operate within a model of continuous improvement and will review and improve processes appropriately to provide for timely reporting on a go-forward basis.
Management strives to operate within a model of continuous improvement and will review and improve processes appropriately to provide for timely reporting on a go-forward basis.
Condition/Finding: There were instances in which payroll timesheets and resolutions authorizing payroll expenseswere not available for review at the time of audit. Recommendation:The District should ensure that all payroll timesheets and resolutions authorizing payroll expenses are available for rev...
Condition/Finding: There were instances in which payroll timesheets and resolutions authorizing payroll expenseswere not available for review at the time of audit. Recommendation:The District should ensure that all payroll timesheets and resolutions authorizing payroll expenses are available for review at the time of audit. Method of Implementation: The district will improve the filing and retention of payroll timesheets and resolutions authorizing payroll expenses for federal programs. All payroll documentation will be properly maintained and made readily available for review at the time of audit.
The Organization will continue to rely on the outside assistance of its auditors for the necessary guidance to adjust the general ledger to accrual and to prepare financial statements and related notes and the schedule of expenditures of federal and state awards in accordance to generally accepted a...
The Organization will continue to rely on the outside assistance of its auditors for the necessary guidance to adjust the general ledger to accrual and to prepare financial statements and related notes and the schedule of expenditures of federal and state awards in accordance to generally accepted accounting principles because it is the most cost effective solution.
Management agrees with the finding above. Management will review the existing accounting policies and procedures and implement additional controls to validate timely submission of reports.
Management agrees with the finding above. Management will review the existing accounting policies and procedures and implement additional controls to validate timely submission of reports.
Management's Response and Planned Corrective Action: This finding relates primarily to the submission of annual grant reports SF-271 and SF-425, which are required by the FAA to be filed each year. The SF-271 (Outlay Report and Request for Reimbursement) are used to report project expenditures and r...
Management's Response and Planned Corrective Action: This finding relates primarily to the submission of annual grant reports SF-271 and SF-425, which are required by the FAA to be filed each year. The SF-271 (Outlay Report and Request for Reimbursement) are used to report project expenditures and request reimbursement of federal funds. It shows how much of the grant has been spent (outlays) and how much reimbursement is being requested from the funding agency. SF-425 (Federal Financial Report) provides a comprehensive summary of the financial status of a grant, including total expenditures, federal funds used, recipient cost share (if applicable), and remaining balances, to ensure proper accountability and compliance with grant requirements. Although these reports were submitted after the established due dates, management maintained the reporting requirements as an active and ongoing priority. These reports were regularly discussed during monthly coordination meetings involving Airport staff and the FAA Airports District Office (ADO), as well as during weekly internal staff meetings. During these regular discussions with the FAA ADO, the Airport was not advised that it was out of compliance with reporting deadlines. Rather, the FAA consistently indicated that reports should be submitted as soon as practicable. The Airport remained aware of its reporting obligations and their importance, particularly in support of ongoing efforts to secure funding for the terminal expansion project. Notwithstanding the above, management acknowledges that formal tracking mechanisms and documented follow-up procedures can be strengthened to ensure earlier identification and resolution of incomplete or missing grant data. To address this, management will enhance internal controls over grant reporting to ensure timely and complete submissions. Improvements will include implementing calendar-based tracking tools and structured notification procedures, with reminders and follow-up communications beginning at the FAA fiscal year-end (September 30) and continuing through the reporting due date (December 31). Additionally, management will coordinate with the FAA and MDOT to secure reliable access to the FAA’s Delphi System, where the data necessary to complete these reports resides. Communication with both the FAA ADO and MDOT will be further strengthened during the critical period leading up to reporting deadlines to ensure that any missing or incomplete information is promptly identified and addressed. Regular internal discussions regarding grant reporting status will also continue to support timely resolution of outstanding items. Management believes these corrective actions will mitigate the risk of delayed or incomplete reporting and strengthen overall compliance with grant requirements. Responsible Party for Corrective Action: Mark Bishop, Chief Financial Officer Anticipated Completion Date: June 2026.
Federal Agency: U.S. Department of Education Federal Program: Student Financial Assistance Cluster Assistance Listing Number: Various Federal Award Numbers: Various Finding No.: 2025-004 Corrective Action Plan: The identified conditions relate to students who experienced a change in status code with...
Federal Agency: U.S. Department of Education Federal Program: Student Financial Assistance Cluster Assistance Listing Number: Various Federal Award Numbers: Various Finding No.: 2025-004 Corrective Action Plan: The identified conditions relate to students who experienced a change in status code within the Union College system specifically related to graduation and withdrawal dates. A report that includes status code changes will be reconciled with student status changes transmitted by the National Student Clearinghouse (NSC) to the National Student Loan Database System (NSLDS), and any necessary corrections will be made in the appropriate time frame. Timeline for Implementation of Corrective Action Plan: The corrective action plan was implemented at the end of the Spring 2026 term.
Federal Agency: Various Federal Program: Research and Development Cluster Assistance Listing Number: Various Federal Award Numbers: Various Finding No.: 2025-002 Corrective Action Plan: To address the finding, the College will continue to implement a corrective action plan to strengthen internal con...
Federal Agency: Various Federal Program: Research and Development Cluster Assistance Listing Number: Various Federal Award Numbers: Various Finding No.: 2025-002 Corrective Action Plan: To address the finding, the College will continue to implement a corrective action plan to strengthen internal controls over the application of indirect cost rates to federally funded awards. Although corrective actions were initiated following the prior year's finding, the College has identified opportunities to enhance the review and monitoring of indirect cost rate calculations to ensure consistent compliance with Uniform Guidance. Going forward, the accounting group, in collaboration with the Office of Sponsored Programs, will maintain the current federally negotiated indirect cost rates, apply approved rates to applicable awards, and perform periodic reviews to verify that the correct rates are consistently applied. Timeline for Implementation of Corrective Action Plan: The College will finalize written procedures governing the application and review of indirect cost rates, implement a documented review process for indirect cost calculations prior to posting, and provide guidance to employees responsible for grant accounting. These actions will be completed by September 30, 2026. Management will periodically monitor compliance to ensure indirect cost rates are applied accurately and in accordance with federal requirements.
Finding #2025-002 – Reporting Description of Finding: As a recipient of a direct federal award under the Public Safety Partnership and Community Policing Grants (ALN 16.710) program, the County is required to comply with mandatory compliance requirements. Per the OMB Compliance Supplement, this fede...
Finding #2025-002 – Reporting Description of Finding: As a recipient of a direct federal award under the Public Safety Partnership and Community Policing Grants (ALN 16.710) program, the County is required to comply with mandatory compliance requirements. Per the OMB Compliance Supplement, this federal award has a financial reporting requirement and a performance reporting requirement. The County’s year end financial report submitted to the grantor indicated that the project was completed as of December 31, 2025, and the full grant award had been expended. Additionally, the performance report submitted for the period ending July 31, 2025, indicated that all equipment had been purchased and delivered. However, per the financial records of the County, there were unexpended grant funds as of December 31, 2025, as the final program deliverables had not been received or invoiced. Statement of Concurrence of Nonconcurrence: Concurrence Planned Corrective Action: This was a unique circumstance where federal awards were being suspended by our federal government and then reinstated. Our goal was to draw down on the COPS Grant for $715,000 and spend the funds on the Dispatch radios as quickly as possible before the funds were suspended again. Reported to the federal award program as such and then there was a delay in the purchasing of all radios and equipment. Anticipated Completion Date: The specified federal award program has been completed and closed.
Management has implemented procedures effective 7/1/2025 to ensure that reports are submitted timely and that any new filing deadlines will be documented and met without exception.
Management has implemented procedures effective 7/1/2025 to ensure that reports are submitted timely and that any new filing deadlines will be documented and met without exception.
View of Responsible Officials and Corrective Actions: Management agrees with the finding. Management will implement procedures to identify all federal awards expended, including funds passed through state and local governments. For each grant and contract, management will review the executed agreeme...
View of Responsible Officials and Corrective Actions: Management agrees with the finding. Management will implement procedures to identify all federal awards expended, including funds passed through state and local governments. For each grant and contract, management will review the executed agreement and related funder documentation for indicators of federal funding, including an Assistance Listing Number, a federal award identification number, the originating federal agency, the pass-through entity identifying number, and references to the Uniform Guidance, and should confirm the federal funding status with the pass-through entity when it is not clear. Management will maintain a centralized listing of awards that is reconciled to the general ledger and reviewed for completeness in preparing the schedule of expenditures of federal awards. Contact Persons Responsible: Dr. Sharrone Ward, President and Chief Executive Officer Kim Shelton-Mamon, Vice President of Finance Completion Date: July 31,2026
View of Responsible Officials and Corrective Actions: Management agrees with the finding. Management will establish and implement formal procedures to ensure timely completion and submission of required Federal reporting. Management will develop and enforce a formal month-end and year-end close proc...
View of Responsible Officials and Corrective Actions: Management agrees with the finding. Management will establish and implement formal procedures to ensure timely completion and submission of required Federal reporting. Management will develop and enforce a formal month-end and year-end close process that includes defined close deadlines, assigned responsibilities for each close task, a documented reconciliation checklist, and supervisory review controls to ensure the books are closed accurately and on schedule prior to the commencement of the annual audit. In addition to close procedures, management will implement a documented audit timeline aligned with Federal reporting deadlines, including defined roles and responsibilities and monitoring controls to track progress and escalate delays. Management will also enhance process documentation and cross-training to mitigate the impact of personnel changes and support continuity of the reporting process. Contact Persons Responsible: Dr. Sharrone Ward, President and Chief Executive Officer Kim Shelton-Mamon, Vice President of Finance Completion Date: July 31, 2026
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