Corrective Action Plans

Finding 499282 (2023-001)

Significant Deficiency 2023

Wildberry Manor Project of Community Housing, Inc.

IA

Internal Control / Segregation of Duties Reporting

Recommendation: While we do recognize that the Corporation is not large enough to permit a segregation of duties for effective internal controls, we believe it is important the Corporation be aware that this condition does exist. Action Taken: Management is cognizant of this limitation and will i...

Recommendation: While we do recognize that the Corporation is not large enough to permit a segregation of duties for effective internal controls, we believe it is important the Corporation be aware that this condition does exist. Action Taken: Management is cognizant of this limitation and will implement additional controls where possible. Anticipated Date of Completion: December 31, 2024

View Audit 322097

Finding 499275 (2023-001)

Significant Deficiency 2023

Lutheran Senior Services

MO

Internal Control / Segregation of Duties Questioned Costs HUD Housing Programs

Management agrees that they had lost revenue that wasn’t utilized that was sufficient to cover the amount of expenses that were reported in error. There is no disagreement with the audit finding and will implement proper training, education, and review processes to ensure reporting is completed accu...

Management agrees that they had lost revenue that wasn’t utilized that was sufficient to cover the amount of expenses that were reported in error. There is no disagreement with the audit finding and will implement proper training, education, and review processes to ensure reporting is completed accurately going forward.

View Audit 322085

Finding 499263 (2023-001)

Significant Deficiency 2023

Baptist Health

AR

Student Financial Aid Special Tests & Provisions Matching / Level of Effort / Earmarking

Responsible Party: Kristin Waddell, Registrar and Coordinator of Enrollment Services, Christy Garrett-Jones, Financial Aid Director Phone Number: 501-202-7457 Audit Period Ending: December 31, 2023 Audit Firm: Forvis Mazars, LLP Federal Program: Student Financial Assistance Program Assistance List...

Responsible Party: Kristin Waddell, Registrar and Coordinator of Enrollment Services, Christy Garrett-Jones, Financial Aid Director Phone Number: 501-202-7457 Audit Period Ending: December 31, 2023 Audit Firm: Forvis Mazars, LLP Federal Program: Student Financial Assistance Program Assistance Listing Numbers: 84.007, 84.063, 84.268 Federal Agency: U.S. Department of Education Finding – Enrollment Reporting The College did not report the address change within 60 days for 1 student, and the College did not ensure submission of enrollment status changes within 60 days for 2 students. Comments on the Finding and Recommendation Management is in agreement with this finding and the related recommendation. Action(s) Taken or Planned on the Finding Financial Aid Director will begin receiving email correspondence regarding enrollment report submission due dates from the National Student Clearinghouse. They will then confirm with the Registrar that the report was submitted by the due date each month. This will implement controls to ensure timely submission of address changes and enrollment reporting in the less than the 60-day requirement. Estimated completion date for the above mentioned corrective action is October 31, 2024.

View Audit 322077

Finding 499262 (2023-002)

Significant Deficiency 2023

Inupiat Community of the Arctic Slope

AK

Reporting Significant Deficiency

Finding 2023-002 Late Reporting and Noncompliance with Reporting Requirements Significant Deficiency Name of Contact Person: Lisa Taylor, CPA, ICAS Comptroller Corrective Action: ICAS has hired a grants manager that will administer grants and contracts within ICAS. Additional oversight should pre...

Finding 2023-002 Late Reporting and Noncompliance with Reporting Requirements Significant Deficiency Name of Contact Person: Lisa Taylor, CPA, ICAS Comptroller Corrective Action: ICAS has hired a grants manager that will administer grants and contracts within ICAS. Additional oversight should prevent late reporting. Proposed Completion Date: December 1, 2024.

View Audit 322071

Finding 499246 (2023-002)

Significant Deficiency 2023

Parkview Services

WA

HUD Housing Programs Reporting Matching / Level of Effort / Earmarking

Management agrees with this finding. Management will review all new funding contracts and agreements and keep track of all reporting requirements and deadlines in order to stay in compliance. Management will document all requirements and deadlines by December 31st, 2024. The Finance Director will no...

Management agrees with this finding. Management will review all new funding contracts and agreements and keep track of all reporting requirements and deadlines in order to stay in compliance. Management will document all requirements and deadlines by December 31st, 2024. The Finance Director will notify reporting staff that a report is due and confirm that it has been submitted prior to the due date.

View Audit 322053

Finding 499233 (2023-001)

Material Weakness 2023

Entrepreneurship for All, Inc.

MA

Allowable Costs / Cost Principles Material Weakness Reporting

Item # 2023-001 Conditional Grant Revenue Recognition (Material Weakness in Internal Control) Criteria: Under Generally Accepted Accounting Principles (GAAP), advances received for conditional grants for expenses not yet incurred are considered a refundable advance liability and should be recognize...

Item # 2023-001 Conditional Grant Revenue Recognition (Material Weakness in Internal Control) Criteria: Under Generally Accepted Accounting Principles (GAAP), advances received for conditional grants for expenses not yet incurred are considered a refundable advance liability and should be recognized as revenue only once the barriers are overcome, which includes incurrence of allowable costs under Office of Management and Budget Circular A-122. Condition: Management did not recognize conditional grant revenue for the full amount of the award after allowable costs were incurred. Cause: Management was unaware that conditional grant revenue was required to be deferred until allowable costs under the federal grant agreement were incurred and did not record the related revenue in the proper period. Effect: Conditional grant revenue was understated by $593,838. This is considered a material weakness in the Organization’s internal control over financial reporting. Recommendation: We recommend that management ensure that conditional grant revenue is recognized upon incurrence of allowable costs under the federal grant. We also recommend that management enroll in a professional education program that covers Uniform Guidance compliance. Views of Responsible Officials and Planned Corrective Actions: Management has been making updates to its policies and procedures throughout 2024 to be in full compliance with GAAP and the Uniform Guidance. This exercise is anticipated to be complete by the end of the fiscal year.

View Audit 322032

Finding 499231 (2023-002)

Material Weakness 2023

Everett Recovery Cafe

WA

Internal Control / Segregation of Duties Questioned Costs Subrecipient Monitoring

Management’s Response: Management agrees with the finding. Management plans to complete a review of resources assigned to accounting and finance departments as well as identify and implement sufficient internal controls over expenditures cutoff to ensure compliance with the period of performance com...

Management’s Response: Management agrees with the finding. Management plans to complete a review of resources assigned to accounting and finance departments as well as identify and implement sufficient internal controls over expenditures cutoff to ensure compliance with the period of performance compliance requirement.

View Audit 322025

Finding 499214 (2023-001)

Material Weakness 2023

Southwest Behavioral Health Services, Inc. and Subsidiaries

AZ

Subrecipient Monitoring Reporting Questioned Costs § 200.303

Finding Number: 2023-001- Schedule of Expenditures of Federal Awards (SEFA) Preparation – Material Weakness Criteria: Non-federal entities in receipt of federal funds must comply with the requirements of 2 CFR 200.303(a), which require an entity to establish and maintain effective internal control ...

Finding Number: 2023-001- Schedule of Expenditures of Federal Awards (SEFA) Preparation – Material Weakness Criteria: Non-federal entities in receipt of federal funds must comply with the requirements of 2 CFR 200.303(a), which require an entity to establish and maintain effective internal control over the federal award to ensure compliance with federal statutes, regulations, and the terms and conditions of the federal award. This includes properly identifying all federal awards subject to the Uniform Guidance and fairly presenting the required information in the schedule of expenditures of federal awards. Condition: Subsequent to the issuance of the Audit Report on the Consolidated Financial Statements and Supplementary Information for the year ended September 30, 2023, it was discovered that there was an omission of two federal grants with expenditures totaling $1,591,715 from the schedule of expenditures of federal awards. Cause: The Organization did not communicate with Care 1st Health Plan regarding the details of certain contracts to determine the amounts were subject to the Uniform Guidance and were to be included on the schedule of expenditures of federal awards. In addition, Care 1st Health Plan became the Regional Behavioral Health Authority for the Northern Arizona region effective October 1, 2022. Due to this transition, various changes occurred causing uncertainties with classifications of certain types of federal awards as subrecipient awards versus as contractor payments. Effect: The schedule of expenditures of federal awards was understated by $1,591,715, which resulted in the restatement of the previously issued schedule of expenditures of federal awards to correct the omission. Questioned Costs: Not applicable. Recommendation: We recommend that all funding contracts are carefully reviewed to determine whether amounts awarded should be classified as contractor payments or as subrecipient payments. If there is any uncertainty, we recommend that the Organization contact the funding source for clarification. Name of Contact Person: Mike Fett, CFO Phone Number: 602-265-8338 Anticipated Completion Date: September 30, 2024 Views of Responsible Officials and Corrective Actions: Southwest Behavioral Health Services, Inc. and Subsidiaries will establish procedures to review all contracts and to if necessary, to communicate with funding sources to ensure that receipts of federal funding are properly classified as being subrecipient versus contractor arrangements to ensure completeness of the Schedule of Expenditures of Federal Awards.

View Audit 322000

Finding 499185 (2023-001)

Significant Deficiency 2023

Crossroads Young Men's Christian Association, Inc.

IN

Questioned Costs Allowable Costs / Cost Principles Reporting

STARTING IN QUARTER 4, 2023, ALL METHODOLOGY FOR TRACKING AND ALLOCATING WAGES HAS BEEN MOVED TO TRACKING VIA OUR HRIS SYSTEM. INSURANCE BENEFITS ARE CODED DIRECTLY FROM THE SOURCE DOCUMENT. ONLY FICA/MEDICARE IS BEING TRACKED VIA A SPREADSHEET, WHICH IS BEING REVIEWED EACH MONTH.

View Audit 321979

Finding 499184 (2023-001)

None 2023

Operator Foundation

TX

Questioned Costs Subrecipient Monitoring Reporting

Views of Responsible Officials and Planned Corrective Actions Finding Reference: 2023-001 Responsible Individual: Melissa Mason Operator Foundation received a pass-through, subgrant extension from a partner organization under 19.22 Regional Democracy Program during the calendar year 2023. The subgr...

Views of Responsible Officials and Planned Corrective Actions Finding Reference: 2023-001 Responsible Individual: Melissa Mason Operator Foundation received a pass-through, subgrant extension from a partner organization under 19.22 Regional Democracy Program during the calendar year 2023. The subgrant paperwork Operator received from the partner did not include an Audit Certification form. The form was later provided and requested by the pass through entity on March 18, 2024, and Operator provided the form on the same day that the email request was received. However, passthrough recipients are required to submit a completed Audit Certification Form within 30 days of the end of each subrecipient fiscal year. Operator’s controls did not realize that the form was missing from the provided award package. Corrective Action Plan (CAP) Operator Foundation will strengthen the internal controls as it relates to submitting required reports to its granting agencies by establishing policies and procedures to ensure that reporting information is submitted timely. Operator will review each grant at inception and list out requirements related to reporting and deadlines. Operator Foundation will ensure that all reporting requirements are put on the organizational tracking system including calendars and that reminders are set to ensure timely submission. Operator will communicate any missing requirements in award packages to the funder for the purpose of strengthening compliance of all responsible parties receiving federal funds. Anticipated Completion date: 10/31/2024

View Audit 321976

Finding 499182 (2023-004)

Significant Deficiency 2023

Shiloh Home Inc.

CO

Reporting Internal Control / Segregation of Duties Significant Deficiency § 200.328

Corrective Action Plan: Management is developing a process to include a periodic review of all compliance aspects related to the grants including financial and performance reporting. This will be completed by December 31, 2024. Individual responsible for corrective action plan: Steven Ramirez

View Audit 321973

Finding 499175 (2023-004)

Significant Deficiency 2023

Act for Alexandria

VA

Reporting Subrecipient Monitoring § 200.502 § 200.510

During our review of the December 31, 2023 Schedule of Expenditures of Federal Awards (SEFA) prepared by management, we noted that controls over the preparation of the SEFA were not properly designed resulting in adjustments to the SEFA for amounts passed through to subrecipients that were identifie...

During our review of the December 31, 2023 Schedule of Expenditures of Federal Awards (SEFA) prepared by management, we noted that controls over the preparation of the SEFA were not properly designed resulting in adjustments to the SEFA for amounts passed through to subrecipients that were identified during the audit. Recommendation: We recommend management review current internal controls over preparation and tracking of federal expenditures to ensure that all federal awards are captured and reported in the correct period and that internal controls are properly designed to detect and correct errors to the SEFA. Views of Responsible Officials and Planned Corrective Action: ACT accepts the auditors' recommendation. In preparing the SEFA for future Single Audit periods, ACT will update its processes to include a more rigorous review of the SEFA schedule prior to submission to the auditors. The process will include preparation of the SEFA by ACT’s accounting team, followed by a review and signoff by ACT’s Program Officer and the CEO. An internal schedule prepared by the accounting team that totals amounts separately for beneficiary payments and for subrecipient pass-through payments will be included as part of the review process for the SEFA and presented for signoff by the Program Officer and CEO. For further discussion, please contact Heather Peeler, President and CEO at healther.peeler@actforalexandria.org. 703-739-7778.

View Audit 321962

Finding 499171 (2023-001)

None 2023

City of Aurora

IL

Reporting Internal Control / Segregation of Duties

2023-001 Reporting - Coronavirus State and Local Fiscal Recovery Funds Assistance Listing Number 21.027 Grant Period - Year Ended December 31, 2023 Condition Found The City failed to submit all quarterly reports, in a timely manner. We consider this to be an instance of non-compliance relating to ...

2023-001 Reporting - Coronavirus State and Local Fiscal Recovery Funds Assistance Listing Number 21.027 Grant Period - Year Ended December 31, 2023 Condition Found The City failed to submit all quarterly reports, in a timely manner. We consider this to be an instance of non-compliance relating to the Reporting Compliance Requirement. Corrective Action Plan The City attempted to file the required quarterly reports during the year ended December 31, 2023. However, the U.S. Treasury changed the reporting software during the first quarter of the year. Due to a technical issue with the file validation process, the City was unable to submit the reports. The information was tracked and compiled but the software prevented the City from completing the reporting process. The City contacted the technical support team numerous times for assistance in resolving this issue, however the issue was not resolved until the second quarter of 2024 when the City was finally able to file their report. This will not be an issue going forward. Responsible Person for Corrective Action Plan Linda Read, Comptroller/Deputy Treasurer Implementation Date of Corrective Action Plan The City received communication from the U.S. Treasury on June 18, 2024 that the technical issue has been fixed and the city was able to file the report for the second quarter in 2024.

View Audit 321954

Finding 499168 (2023-001)

None 2023

Historic Hudson Valley

NY

Allowable Costs / Cost Principles Cash Management Period of Performance § 200.300 § 200.400

Historic Hudson Valley will adopt written policies and procedures, and standards of conduct as required by 2 CFR 200, Subparts D and E.

View Audit 321947

Finding 499167 (2023-003)

Significant Deficiency 2023

National Casa Association

WA

Subrecipient Monitoring Reporting § 200.303

Responsible: Denice Hairston, Chief Quality, Compliance and Accountability Officer Corrective Actions: Update FFATA reporting procedures to document and maintain documentation of Supervisory review and approval of FFATA data preparation. Completion Date: March 29, 2023 and July 10, 2024. Explana...

Responsible: Denice Hairston, Chief Quality, Compliance and Accountability Officer Corrective Actions: Update FFATA reporting procedures to document and maintain documentation of Supervisory review and approval of FFATA data preparation. Completion Date: March 29, 2023 and July 10, 2024. Explanation: National CASA/GAL has consistently maintained policies and procedures to ensure FFATA reports are filed timely. Documentation of review/approval from a person separate from the person filing the FFATA report was not readily available in some instances, so procedures were updated to include maintenance of such review/approval. FFATA reports are required to be filed “by the end of the month following the month after the subaward obligation date”. National CASA/GAL filed FFATA reports to adhere to this deadline in compliance with what it understood to be the obligation date, understanding an obligation date could not occur prior to the grant period. This finding was noted in the 2022 audit which was issued August 13, 2024. The 2023 audit, completed in September 2024, included in its scope, the same FFATA reports from the same federal grant that had been reviewed in the 2022 audit and OJJDP/OCFO monitoring visit. National CASA/GAL did not have an opportunity between the 2022 and 2023 audits to cure this finding in practice until the issuance of new subrecipient awards in 2024.

View Audit 321944

Finding 499153 (2023-001)

Material Weakness 2023

Tarrant County Homeless Coalition

TX

Questioned Costs Material Weakness Period of Performance § 200.403

Management Response Management acknowledges the recommendation of placing internal controls in place to ensure that costs are charged and allocated to the proper grant period. REMEDIATION PLAN Management has hired Jess Vaughn-Jansen as Director of Financial Strategy (Director) to ensure transaction...

Management Response Management acknowledges the recommendation of placing internal controls in place to ensure that costs are charged and allocated to the proper grant period. REMEDIATION PLAN Management has hired Jess Vaughn-Jansen as Director of Financial Strategy (Director) to ensure transactions are charged and allocated to the individual grants in the proper grant period. The Director has reviewed the process documents that are in place to assist in recording transactions. Excel Tracking Sheets have been created and are maintained by the Director for each grant. Per the grant agreements, the Grant Period (i.e., Effective Date and Expiration Date) has been documented on all the Tracking Sheets. This will allow the Director to properly include and exclude items that may occur before the Effective Date or after the Expiration Date. These Tracking Sheets have been used by the Director since February 2023. The 1 selection not in compliance was posted prior to the Director’s hire date. No findings have been identified after the Director’s hire date. The Director has and will continue to be cognizant of including and excluding items that may occur before the Effective Date or after the Expiration Date.

View Audit 321935

Finding 499148 (2023-004)

Significant Deficiency 2023

Children's Hospital Medical Center of Akron

OH

Questioned Costs Allowable Costs / Cost Principles Cash Management § 200.303

Finding: Management did not have an internal control in place to review the allowability of the expenses to be allocated to the Congressional Directives grant. Corrective Action Plan: Akron Children's will implement a more detailed review and documentation process for allowable expenses prior to de...

Finding: Management did not have an internal control in place to review the allowability of the expenses to be allocated to the Congressional Directives grant. Corrective Action Plan: Akron Children's will implement a more detailed review and documentation process for allowable expenses prior to determining expenses that are eligible for federal grant reimbursement. Responsible Party: Vice President Finance Completion Date: November 30, 2024

View Audit 321917

Finding 499146 (2023-003)

Material Weakness 2023

Children's Hospital Medical Center of Akron

OH

Questioned Costs Reporting Matching / Level of Effort / Earmarking

Finding: Management did not retain sufficient evidence supporting the review and approval of the financial reports prior to submission. Corrective Action Plan: Akron Children’s implemented a review checklist and sign-off process to document controls for the review of the monthly financial reports s...

Finding: Management did not retain sufficient evidence supporting the review and approval of the financial reports prior to submission. Corrective Action Plan: Akron Children’s implemented a review checklist and sign-off process to document controls for the review of the monthly financial reports submitted to the granting agency. Completion Date: October 31, 2023 Corrective Action Plan: Akron Children’s will implement a review checklist and sign-off process to document controls for the review of the quarterly performance reporting. Completion Date: November 30, 2024 Responsible Party: Vice President Finance

View Audit 321917

Finding 499139 (2023-001)

Significant Deficiency 2023

Fort Worth Housing Solutions

TX

Reporting § 200.302 § 200.303

U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT 2023-001 Coronavirus Local Fiscal Recovery– Assistance Listing No. 21.027 Recommendation: We recommend that the Authority implements a control to ensure that the preliminary SEFA is mostly accurate so that the correct programs are tested. Explanation ...

U.S. DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT 2023-001 Coronavirus Local Fiscal Recovery– Assistance Listing No. 21.027 Recommendation: We recommend that the Authority implements a control to ensure that the preliminary SEFA is mostly accurate so that the correct programs are tested. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: The Finance Department has implemented several processes and procedures to ensure pass-through funds or sub-awards are reported timely and accurately in the SEFA. The new processes include (1) review of grant award letters to determine reporting requirements, (2) comparing the award letter against the Minutes of the City Council or County Commissioners meetings to ensure grants accepted during the year are disclosed as such on both ends, (3) confirmed with source Agency Single Audit requirements, (4) and the implementation of revenue source checklist that will identify the source of the funds, type of grant, program name and cluster title, name of federal funding agency, federal assisting listing number (formerly known as CFDA number), etc. Name(s) of the contact person(s) responsible for corrective action: Hector Ordonez, Vice President of Finance and Administration Planned completion date for corrective action plan: December 31, 2024 If the U.S. Department of Housing and Urban Development has questions regarding this plan, please contact Hector Ordonez, Vice President of Finance and Administration at (817) 333-3421 or hordonez@fwhs.org.

View Audit 321913

Finding 499130 (2023-009)

Significant Deficiency 2023

Nobles County

MN

Allowable Costs / Cost Principles Internal Control / Segregation of Duties Questioned Costs § 200.303 § 200.403

Federal Agency: U.S. Department of Human Services Federal Program Name: Medical Assistance Assistance Listing Number: 93.778 Federal Award Identification Number and Year: 2305MN5ADM, 2305MN5MAP; 2023 Pass-Through Agency: Minnesota department of Human Services Type of Finding: Significant Deficiency ...

Federal Agency: U.S. Department of Human Services Federal Program Name: Medical Assistance Assistance Listing Number: 93.778 Federal Award Identification Number and Year: 2305MN5ADM, 2305MN5MAP; 2023 Pass-Through Agency: Minnesota department of Human Services Type of Finding: Significant Deficiency in Internal Control over Compliance and Other Matters Award Period: Year Ended December 31, 2023 Recommendation: We recommend that the County implement review procedures to ensure that the reports are submitted timely and accurately, and record of review is kept on file. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: The County has implemented procedures and policies to have a secondary person review the reports and in a timely manner. Name of the contact person responsible for corrective action: Stacie Golomiecki, Community Services Director – Stephani Diekmann, Fiscal Supervisor Planned completion date for corrective action plan: December 31, 2024

View Audit 321906

Finding 499129 (2023-008)

Significant Deficiency 2023

Nobles County

MN

Reporting Internal Control / Segregation of Duties Significant Deficiency

Federal Agency: U.S. Department of Human Services Federal Program Name: Medical Assistance Assistance Listing Number: 93.778 Federal Award Identification Number and Year: 2305MN5ADM, 2305MN5MAP; 2023 Pass-Through Agency: Minnesota department of Human Services Type of Finding: Significant Deficiency ...

Federal Agency: U.S. Department of Human Services Federal Program Name: Medical Assistance Assistance Listing Number: 93.778 Federal Award Identification Number and Year: 2305MN5ADM, 2305MN5MAP; 2023 Pass-Through Agency: Minnesota department of Human Services Type of Finding: Significant Deficiency in Internal Control over Compliance and Other Matters Award Period: Year Ended December 31, 2023 Recommendation: We recommend that the County review the contract with MN DHS, and implement proper review and approval procedures for all LCTS reports. We recommend that paper copies are kept on file for the required timeframe. We recommend that the County implement procedures to remit the quarterly funding to the collaborative in a timely manner. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: The County has implemented procedures and policies to ensure all requirements of LCTS special provisions are followed. Name of the contact person responsible for corrective action: Stacie Golomiecki, Community Services Director – Stephani Diekmann, Fiscal Supervisor Planned completion date for corrective action plan: December 31, 2024

View Audit 321906

Finding 499114 (2023-002)

Significant Deficiency 2023

Bronx Community Health Network, Inc.

NY

Subrecipient Monitoring Reporting Questioned Costs § 200.303

Bronx Community Health Network, Inc. (“BCHN”) Corrective Action Plan For the Year Ended December 31, 2023 Health Resources and Services Administration (“HRSA”) Federal Award Finding Finding 2023-002 – Reporting: Federal Funding Accountability and Transparency Act (“FFATA”) – Significant Deficienc...

Bronx Community Health Network, Inc. (“BCHN”) Corrective Action Plan For the Year Ended December 31, 2023 Health Resources and Services Administration (“HRSA”) Federal Award Finding Finding 2023-002 – Reporting: Federal Funding Accountability and Transparency Act (“FFATA”) – Significant Deficiency Description of Finding: There was no evidence of review and approval by someone other than the preparer of the FFATA subawards that were submitted to the FSRS. The FFATA subawards were not submitted timely to the Federal Funding Accountability and Transparency Act Subaward Reporting System (“FSRS”). Statement of Concurrence: We concur with the finding above. Corrective Action: As of September 1, 2023, BCHN implemented a workflow where FFATA information will be reported to the FSRS upon receipt of the Notices of Award. In addition, as of September 9, 2024, the FFATA report will be reviewed by someone other than the preparer prior to submission and evidence of the approval maintained. Completion Date: September 9, 2024. Name of Contact Person: James Paine, Ph.D. Chief Executive Officer Tel. No.: (718) 405-4993 E-mail: jpaine@bchnhealth.org If HRSA has questions regarding this Corrective Action Plan, please call James Paine at (718) 405-4993. Sincerely yours, _________________________ James Paine, Ph.D. Chief Executive Officer

View Audit 321903

Finding 499112 (2023-002)

Material Weakness 2023

Morrison County

MN

Reporting Questioned Costs Material Weakness § 200.303

Finding Number: 2023-002 Finding Title: Reporting Program: 21.027 COVID-19 – Coronavirus State and Local Fiscal Recovery Funds Name of Contact Person Responsible for Corrective Action: Shannon Coyle, County Auditor-Treasurer Corrective Action Planned: Morrison County management is aware that the ann...

Finding Number: 2023-002 Finding Title: Reporting Program: 21.027 COVID-19 – Coronavirus State and Local Fiscal Recovery Funds Name of Contact Person Responsible for Corrective Action: Shannon Coyle, County Auditor-Treasurer Corrective Action Planned: Morrison County management is aware that the annual Project and Expenditure Report submitted for Coronavirus State and Local Fiscal Recovery Funds (CSLFRF) to the U.S. Treasury was done so incorrectly. The County has reviewed the U.S. Department of the Treasury guidance and form instructions to ensure it is correctly reporting its CSLFRF activity going forward. Anticipated Completion Date: The correction will be made on the Annual Project and Expenditure Report due in April 2024, for the reporting period ending March 31, 2024.

View Audit 321900 Questioned Costs: $1

Finding 499105 (2023-001)

Material Weakness 2023

St. Charles Parish Housing Authority

LA

HUD Housing Programs Allowable Costs / Cost Principles Eligibility

ST. CHARLES PARISH HOUSING AUTHORITY________________________________________PHONE: 985-785-2601 ·FAX:985-785-6238· 200 BOUTTE ESTATES DRIVE ·BOUTTE, LA 70039-0448 ________________________________________ HOUSING AUTHORITY OF ST. CHARLES PARISH, LOUISIANA CORRECTIVE ACTION PLAN YEAR ENDED SEPTEMBER...

ST. CHARLES PARISH HOUSING AUTHORITY________________________________________PHONE: 985-785-2601 ·FAX:985-785-6238· 200 BOUTTE ESTATES DRIVE ·BOUTTE, LA 70039-0448 ________________________________________ HOUSING AUTHORITY OF ST. CHARLES PARISH, LOUISIANA CORRECTIVE ACTION PLAN YEAR ENDED SEPTEMBER 30, 2023 Corrective Action Plan Finding: Finding 2023-001-Internal Controls Inadequate for Disbursements-Allowable Costs Condition: Good internal controls should be in place to make sure that disbursements are for eligible payments, are correctly classified, and are timely paid. Good controls ensure that there is proper, documented review of all these functions. Records should be maintained in an order that is conducive to efficient and timely summarizing by the outside fee accounting firm. Unaudited financial statements should be produced on a timely basis, and reviewed by the Board of Commissioners. Corrective Action Planned I am Jedidiah Jackson. I was hired as E.D., effective July 1, 2024. We are in the process of addressing the problems noted in the audit, as well as correcting other issues noted by HUD. Person responsible for corrective action: Jedidiah Jackson, E.D. Telephone: (985) 785-2601 St. Charles Parish Housing Authority Fax: (985) 785-6238 200 Boutte Estates Dr. Boutte, LA 70039 Anticipated Completion Date- October 31, 2024

View Audit 321894

Finding 499098 (2023-004)

Significant Deficiency 2023

Children's Health System of Texas

CA

Reporting

93.493 Congressional Directives Significant adjustments were made to the SEFA during the audit due to unforeseen issues with supporting documentation of expenditures previously included by the grant project team. Grant project team will review allowable expenditures under grant specific and federa...

93.493 Congressional Directives Significant adjustments were made to the SEFA during the audit due to unforeseen issues with supporting documentation of expenditures previously included by the grant project team. Grant project team will review allowable expenditures under grant specific and federal grant requirements prior to SEFA preparation. Management and grant project team will review SEFA amounts prior to submission to auditors. Contact Person: Jane Hardy – VP Corporate Accounting jane.hardy@childrens.com Expected Completion Date: November 30, 2024

View Audit 321892

Corrective Action Plans

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