Corrective Action Plans

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Reporting Federal Agency Name: Department of Hea lth and Human Services Program Name: COVID-19 Provider Relief Fund and American Rescue Plan Rural Distribution Federal Assistance Listing #93.498 Finding Summary: The Medical Center claimed lost revenues that were incorrectly calculated or not supp...
Reporting Federal Agency Name: Department of Hea lth and Human Services Program Name: COVID-19 Provider Relief Fund and American Rescue Plan Rural Distribution Federal Assistance Listing #93.498 Finding Summary: The Medical Center claimed lost revenues that were incorrectly calculated or not supported. These were improperly included within the HHS Report Period 4 and caused the Report to be inaccurate. Responsible Individuals: Corey Ulmer, CFO Corrective Action Plan: We will implement internal control policies to ensure that the required reports are properly reviewed prior to submission to ensure all key line items are necessary, correct, meet the requirements of the federal program, and are properly recorded in the reports required to be submitted to the federal agency. Anticipated Completion Date: 6/30/2024
Finding 391303 (2023-007)
Significant Deficiency 2023
Student Financial Aid Cluster – Assistance Listing No. 84.007, 84.063, 84.268, 84.379 Recommendation: We recommend the College evaluate its procedures and policies around reporting to the COD to ensure that student information is reported timely. Explanation of disagreement with audit finding: There...
Student Financial Aid Cluster – Assistance Listing No. 84.007, 84.063, 84.268, 84.379 Recommendation: We recommend the College evaluate its procedures and policies around reporting to the COD to ensure that student information is reported timely. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: The college will evaluate our procedures and review regulations to ensure the appropriate enrollment information is reported, timely. In the summer of 2023, the financial aid office implemented weekly COD mismatch updates and real time R2T4 adjustments. In doing so, we are ensuring that COD has the most accurate information and adjustments are reported in a timely manner. Name(s) of the contact person(s) responsible for corrective action: Jossie Johnson – Director of Financial Aid and Michael Reig – Registrar. Planned completion date for corrective action plan: June 30, 2024
Finding 391301 (2023-006)
Significant Deficiency 2023
Student Financial Aid Cluster – Assistance Listing No. 84.063, 84.268 Recommendation: We recommend the College evaluate its procedures and review regulations set by the Department of Education around NSLDS to ensure the College understands the definitions for each enrollment information that gets re...
Student Financial Aid Cluster – Assistance Listing No. 84.063, 84.268 Recommendation: We recommend the College evaluate its procedures and review regulations set by the Department of Education around NSLDS to ensure the College understands the definitions for each enrollment information that gets reported. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: The college will evaluate our procedures and review regulations to ensure the appropriate enrollment information is reported, timely. Name(s) of the contact person(s) responsible for corrective action: Jossie Johnson – Director of Financial Aid and Michael Reig – Registrar. Planned completion date for corrective action plan: June 30, 2024
Finding 391294 (2023-003)
Significant Deficiency 2023
Student Financial Aid Cluster – Assistance Listing No. 84.063, 84.268 Recommendation: We recommend the College evaluate its procedures and policies around reporting to the COD to ensure that student information is reported timely. Explanation of disagreement with audit finding: There is no disagreem...
Student Financial Aid Cluster – Assistance Listing No. 84.063, 84.268 Recommendation: We recommend the College evaluate its procedures and policies around reporting to the COD to ensure that student information is reported timely. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: Financial Aid policies and procedures will be reviewed and amended as necessary. In conjunction with the Registrar’s Office all student changes and information will be reported and reconciled timely. Name(s) of the contact person(s) responsible for corrective action: Jossie Johnson – Director of Financial Aid Planned completion date for corrective action plan: September 30, 2024
The corrective action plan was documented in our response to the auditor’s comment. See the Schedule of Findings and Questioned Costs.
The corrective action plan was documented in our response to the auditor’s comment. See the Schedule of Findings and Questioned Costs.
The Municipality will be implementing the internal controls and procedures to assure that the required reports are completed and be submitted as per program regulations on the 15th day of the following month; the expenses were incurred.
The Municipality will be implementing the internal controls and procedures to assure that the required reports are completed and be submitted as per program regulations on the 15th day of the following month; the expenses were incurred.
Common Origination and Disbursement (COD) Reporting Planned Corrective Action: The University’s Financial Aid Office will update the anticipated disbursement date to reflect the actual disbursement for 2022-23. We will review the current award year to ensure that the anticipated disbursement dates...
Common Origination and Disbursement (COD) Reporting Planned Corrective Action: The University’s Financial Aid Office will update the anticipated disbursement date to reflect the actual disbursement for 2022-23. We will review the current award year to ensure that the anticipated disbursement dates reflect the actual disbursement date. Person Responsible for Corrective Action Plan: Nicholas Capodice, Director of Financial Aid Anticipated Date of Completion: April 30, 2024
Finding No. 2023-006: Reporting (Material Weakness - Internal Control Over Compliance) Federal Award: 21.023 - COVID‐19 – Emergency Rental Assistance Program (ERA) Audit Recommendation: We recommend the City be more diligent in following its policies and procedures for submitting quarterly infor...
Finding No. 2023-006: Reporting (Material Weakness - Internal Control Over Compliance) Federal Award: 21.023 - COVID‐19 – Emergency Rental Assistance Program (ERA) Audit Recommendation: We recommend the City be more diligent in following its policies and procedures for submitting quarterly information to the Department of Treasury. We also recommend the City implement retention procedures to track the reports and supporting information submitted to the Department of Treasury. Administration’s Comments: The City will follow policies and procedures for submitting quarterly information to the Department of Treasury and also implement retention procedures to track the reports and supporting information submitted to the Department of Treasury. Office of Economic Revitalization (OER) will provide Fiscal with a copy of the reports. Anticipated Completion Date: May 1, 2024 Contact Person(s): Denise Obrero, Mayor’s Office, Planner VII Rowena Santamaria, Department of Budget and Fiscal Services, Fiscal Officer II
Finding No. 2023-005: Eligibility (Significant Deficiency - Internal Control Over Compliance) Federal Award: 17.258, 17.259, 17.278 - WIOA Cluster Audit Recommendation: We recommend the City be more diligent in following its policies and procedures for tracking, documenting and performing its ex...
Finding No. 2023-005: Eligibility (Significant Deficiency - Internal Control Over Compliance) Federal Award: 17.258, 17.259, 17.278 - WIOA Cluster Audit Recommendation: We recommend the City be more diligent in following its policies and procedures for tracking, documenting and performing its exit processes. Administration’s Comments: The City will adhere to established policies and procedures for effectively tracking, documenting and executing its exit processes. The "Exit & Follow Up Services Form" will undergo revision to incorporate the following statement and signature line: "This form has been reviewed and approved by the WIOA Manager." Anticipated Completion Date: March 31, 2024 Contact Person(s): Leinaala Nakamura, Department of Community Services, Program Administrator Lee Ann Williams-Naelo, Department of Community Services, Job Resource Specialist V
Finding No. 2023-004: Reporting (Material Weakness - Internal Control Over Compliance) Federal Award: 14.218 - CDBG – Entitlement Grants Cluster Audit Recommendation: We recommend that the City establish procedures to ensure that subawards are uploaded to the FSRS system timely. Administration’...
Finding No. 2023-004: Reporting (Material Weakness - Internal Control Over Compliance) Federal Award: 14.218 - CDBG – Entitlement Grants Cluster Audit Recommendation: We recommend that the City establish procedures to ensure that subawards are uploaded to the FSRS system timely. Administration’s Comments: The City will establish and follow policies and procedures to ensure that subawards are uploaded to the FSRS system timely. City will establish roles to improve execution of the reporting process. Anticipated Completion Date: June 30, 2024 Contact Person(s): Timothy Ho, Department of Community Services, Planner VII Holly Kawano, Department of Budget and Fiscal Services, Federal Grants Coordinator
Based on FY2022 findings, Higher Horizons implemented internal control policies and procedures, effective May 1, 2023. The procedures address all the segregation of duties from journal entries to posting, reconciliation to reporting, and access to the accounting software. The implementation of the i...
Based on FY2022 findings, Higher Horizons implemented internal control policies and procedures, effective May 1, 2023. The procedures address all the segregation of duties from journal entries to posting, reconciliation to reporting, and access to the accounting software. The implementation of the internal control policies and procedures were initiated in May and June of 2023 (the last two months of FY 2023). During FY2024, these procedures were enforced to mitigate risks due to lack of sound internal control. To further strengthen the internal control system, Higher Horizons changed the requisition and accounts payable paper-based to paperless (electronic) process effective July 1, 2023. The electronic requisition system (Microix) is integrated with the accounting software (Abila), which has noticeably enhanced the internal control system.The Microix electronic requisition system eliminates the need to monitor the flow of paper documents, eliminates the risk of losing documents, and disallows purchases without approval. Microix features also require allowability of requisitions to be determined, all changes & communications to be captured, eliminates re-keying the information into Abila, minimizes manual interventions in entering & posting transactions, and much more. Higher Horizons will continue assessing & monitoring the effectiveness of our internal control, review the outcomes, and as needed, will further strengthen the process. Higher Horizons will monitor individual access to general ledger, subsidiary ledger, assets of the organization, accounting software, and Paycom. Access control procedures will be developed and implemented before the end of May 2024. As indicated in FY2023 audit findings, one of the causes for inadequate segregation of duties is the small number of staff in the Finance Department. Higher Horizons will contract with a finance consultant to review the current finance department staffing structure. The consultant will provide feedback and recommendation for adequately staffing the finance department to ensure segregation of duties. The finance management staff will conduct a comprehensive study of accounting and financial tasks, policies and procedures, and standard operating procedures by contracting the financial consultant before the end of June 2024. The study will be presented to the Board for approval, and OFC and OHS for funding.
April 1, 2024 U.S. Department of Health and Human Services St. Claire Regional Medical Center, Inc. respectively submits the following corrective action plan for the year ended June 30, 2023. Name and address of independent public accounting firm: Blue & Co., LLC 2650 Eastpoint Parkway, Suite 300 ...
April 1, 2024 U.S. Department of Health and Human Services St. Claire Regional Medical Center, Inc. respectively submits the following corrective action plan for the year ended June 30, 2023. Name and address of independent public accounting firm: Blue & Co., LLC 2650 Eastpoint Parkway, Suite 300 Louisville, Kentucky 40223 Audit Period: Year ended June 30, 2023 The findings from the Schedule of Findings and Questioned Costs for the year ended June 30, 2023, are discussed below. The findings are numbered consistently with the numbers assigned in the Schedule. FINDINGS – FEDRAL AWARD PROGRAM AUDITS 2023-001 Condition: Untimely disbursement of federal grant funds received: When receiving federal grants funds for the HHS Rural Health Care Services Outreach, Rural Health Network Development, and Small Health Care Provider Quality Improvement Plan Program, the Hospital did not disburse federal grant funds received within 3 working days. Action: Management implemented internal control procedures by December 31, 2023 to ensure proper and timely disbursements of federal grant funds to ensure proper cash management of future HHS Rural Health Care Services Outreach, Rural Health Network Development, and Small Health Care Provider Quality Improvement Plan Program funds.
Audit Firm: RSM US LLP 30 South Wacker Drive, Suite 3300 Chicago, IL 60606 Audit Period: 07/01/2022 – 06/30/2023 Contract Number: FSCWJ00302 Award Year: 2022 – 2023 Comments on Findings and Recommendations: Finding 2023-001—Certification over payroll cost allocation (Control Finding)— Envision Un...
Audit Firm: RSM US LLP 30 South Wacker Drive, Suite 3300 Chicago, IL 60606 Audit Period: 07/01/2022 – 06/30/2023 Contract Number: FSCWJ00302 Award Year: 2022 – 2023 Comments on Findings and Recommendations: Finding 2023-001—Certification over payroll cost allocation (Control Finding)— Envision Unlimited allocated staff salaries and related fringe benefits to the federal program based on budgeted estimates, which were determined before the services were provided. There was no employee certification or documented review of actual time and effort incurred for the payroll costs charged to the grant at the time audit procedures were performed. 2 CFR 200.430(i) Standards for Documentation of Personnel Expenses (1) Charges to federal awards for salaries and wages must be based on records that accurately reflect the work performed. These records must be supported by a system of internal control which provides reasonable assurance that the charges are accurate, allowable, and properly allocated. Budget estimates (i.e., estimates determined before the services are performed) alone do not qualify as support for charges to federal awards, but may be used for interim accounting purposes, provided that the non-federal entity's system of internal controls includes processes to review after-the-fact interim charges made to a federal award based on budget estimates. All necessary adjustments must be made such that the final amount charged to the federal award is accurate, allowable, and properly allocated. Action Taken- Employee certifications were obtained and reviewed by supervisors for all grant payroll costs charged during the award year and were provided to the auditors. A new process is in place for quarterly certifications to follow 2CFR 200.430(i). The required corrective action for Finding 2023-001 for the period 07/01/2022 – 06/30/2023 was completed in December 2023. The person now responsible for completion of the corrective action plan is Dennis James, Chief Financial Officer.
Finding No. 2023-003 Management Response: Management agrees with findings. This was discussed by our Fiscal Manager with the Agency during a meeting on November 15, 2022. The period between our month end close procedures and the report deadlines is to short considering an AUP needs to be performed b...
Finding No. 2023-003 Management Response: Management agrees with findings. This was discussed by our Fiscal Manager with the Agency during a meeting on November 15, 2022. The period between our month end close procedures and the report deadlines is to short considering an AUP needs to be performed before each submission. However, we have taken some actions to advance some of the program information to comply. The report scheduled for January 2024 was submitted on time. Corrective Action Plan:  Management has been reviewing the procedures and identifying steps that can be performed before month end closing.  A formal extension request will be submitted at the renewal of the award. Contact Person: Roxana Rivera Manuel Joglar Team: Fiscal Manager, Fiscal Agent, Program leaders. Anticipated Completion Date: Next report deadline May 17, 2024
The Authority will perform an internal review of the toll credits usage Excel spreadsheet and will reconcile all credits used by the projects with a starting date in FY 2023 and later with the last version of the Federal-Aid Project Agreement approved by FHWA. Also, the credits summary will be deliv...
The Authority will perform an internal review of the toll credits usage Excel spreadsheet and will reconcile all credits used by the projects with a starting date in FY 2023 and later with the last version of the Federal-Aid Project Agreement approved by FHWA. Also, the credits summary will be delivered on a quarterly basis to the Executive Staff for the approval process. For the fiscal year 2024, the manual process of reconciling toll credits balance of the new projects with a starting date of January 2024 and later will be changed to an automated process with the PMIS Program, as agreed in Section II of the Memorandum of Understanding (MOU) signed in February 2016 between FHWA and the Authority. In addition, current toll credits tracking, reconciliation, and approval processes are reviewed by FHWA PR Division for compliance. Responsible: Mr. Enrique J. Rosa Torres, Budget Office Auxiliary Director Status: In process. Expected to be completed on or before June 30, 2025.
Corrective Action Plan: The Authority assigned an Analyst and a Supervisor the responsibility to monitor compliance with all related Federal requirements for the reporting process of these funds. Also, an adequate training was provided to the personnel involved in the administration of this program....
Corrective Action Plan: The Authority assigned an Analyst and a Supervisor the responsibility to monitor compliance with all related Federal requirements for the reporting process of these funds. Also, an adequate training was provided to the personnel involved in the administration of this program. Responsible: Mr. Ramon L. Rivera Rivera, Analyst Mr. Enrique J. Rosa Torres, Budget Office Auxiliary Director Status: Completed on June 30, 2023.
Corrective Action Plan: The Authority will develop a new procedure to ensure compliance with these reporting requirements. All personnel involved in the administration of these programs for which federal funds are expended should receive adequate training about federal compliance and reporting requi...
Corrective Action Plan: The Authority will develop a new procedure to ensure compliance with these reporting requirements. All personnel involved in the administration of these programs for which federal funds are expended should receive adequate training about federal compliance and reporting requirements related to such programs. In addition, an individual should be assigned with the responsibility to monitor compliance with all related federal requirements. These procedures will also include a quarterly reconciliation of amounts reported between the Schedule of Federal Awards with the trial balance. Responsible: Mr. Angel M. Felix Cruz, Finance Office Auxiliary Director Ms. Maria Del R. Ramos Ocasio, Accounting and Finance Manager Status: In process. Expected to be completed on or before December 31, 2024.
Management’s response - New management in place starting in February 2023 will ensure that the Town reviews and correctly separates these items going forward.
Management’s response - New management in place starting in February 2023 will ensure that the Town reviews and correctly separates these items going forward.
Management’s response - New management in place starting in February 2023 will ensure that the Town reviews and correctly reports federal expenditures on the Schedule of Expenditures of Federal Awards moving forward.
Management’s response - New management in place starting in February 2023 will ensure that the Town reviews and correctly reports federal expenditures on the Schedule of Expenditures of Federal Awards moving forward.
Material Weakness in Internal Control over Compliance Condition: The Town did not submit the required SLFRF Project and Expenditure Report Due April 30, 2023 on time. Recommendation: The Town review grant award documents thoroughly and set up processes and procedures in place to ensure reporting r...
Material Weakness in Internal Control over Compliance Condition: The Town did not submit the required SLFRF Project and Expenditure Report Due April 30, 2023 on time. Recommendation: The Town review grant award documents thoroughly and set up processes and procedures in place to ensure reporting requirements to the awarding agency are completely accurately and timely based on grant requirements. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: The Town has begun a full review of all grants, especially those received in prior administrations and pre-hire of the current CFO, to assure the compliance of reporting requirements are complete accurate and will be timely reported as stated in the grant requirements. Contact person: Dawn Norton Responsible for corrective action: Dawn Norton, CFO Planned completion date for corrective action plan: March 2024
Finding 391171 (2023-004)
Significant Deficiency 2023
Finding 2023-004 Reporting Identification of the federal program: Federal Grantor: United States Department of Homeland Security Pass-Through Grantor: State of Missouri, State Emergency Management Agency Assistance Listing No.: 97.036, COVID-19 Disaster Grants – Public Assistance (Presidentially D...
Finding 2023-004 Reporting Identification of the federal program: Federal Grantor: United States Department of Homeland Security Pass-Through Grantor: State of Missouri, State Emergency Management Agency Assistance Listing No.: 97.036, COVID-19 Disaster Grants – Public Assistance (Presidentially Declared Disasters) (“FEMA”) Pass-Through Award Numbers: Project# 699963 P/W# 624; Project# 185883 P/W# 529; and Project# 150136 P/W# 171 Condition: Timeliness and submission of the quarterly reports required by the State of Missouri could not be verified. Views of Responsible Officials and Planned Corrective Actions: The state of Missouri requires all quarterly reports be mailed. While we did send in our quarterly reports to the state of Missouri as required, we do not have proof of submissions as we did not send by certified mail. All future quarterly reporting will be documented with an email to our State SEMA representative when we send out quarterly reports so there is documentation for our records. Responsible Party: Emily Bruening, Director – Finance Date of Completion: This will be implemented for our next round of quarterly reporting, due in April 2024.
Finding 391169 (2023-002)
Significant Deficiency 2023
Finding 2023-002 Reporting Information on the federal program: Federal Grantor: United States Department of Health and Human Services (HHS), Health Resources and Services Administration (HRSA) Assistance Listing No.: 93.498, COVID-19 Provider Relief Fund and American Rescue Plan (ARP) Rural Distrib...
Finding 2023-002 Reporting Information on the federal program: Federal Grantor: United States Department of Health and Human Services (HHS), Health Resources and Services Administration (HRSA) Assistance Listing No.: 93.498, COVID-19 Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution (“PRF”) Payment Received Period: 01/01/2020–12/31/2022 (Period 4) and 01/01/2020–06/30/2023 (Period 5) Condition: For one of the sampled PRF reports (Mercy Hospital South Period 5 PRF Report), the amount reported for net patient service revenue (NPSR) for calendar year 2023 quarter 2 (CY2023 Q2) was incorrect for one reporting tax identification number (TIN). Views of Responsible Officials and Planned Corrective Actions: One cost report adjustment for the current year was inaccurately labeled as a prior year adjustment. This was an isolated oversight by our revenue analysis team. We will perform additional review of cost report adjustments used for PRF funding to ensure the amounts reported are accurate and in compliance with the terms of the agreement. Responsible Party: Kathryn Stecich, Executive Director, Revenue Cycle Date of Completion: By 6/30/24
FINDING 2023-8- Untimely Enrollment Status Reporting The Institute had not processed May 1 roster by the 5/15/23 deadline. A.Comments on Findings and Recommendations: The Institute agrees with the finding and Auditor's recommendation. B.Actions Taken or Planned OIAH has now moved to a new SIS system...
FINDING 2023-8- Untimely Enrollment Status Reporting The Institute had not processed May 1 roster by the 5/15/23 deadline. A.Comments on Findings and Recommendations: The Institute agrees with the finding and Auditor's recommendation. B.Actions Taken or Planned OIAH has now moved to a new SIS system that is able to batch upload under the NSLDS ERR report. This system has been in effect since 9/2023. crediting $3,569 to the students' accounts that were affected. Signed Betsy Bremke, Administrative Campus Director Date: _3/29/2024__
FINDING 2023-4- Untimely Paid and Unpaid Credit Balances The Institute had Untimely Paid and Unpaid Credit Balances while Participating under the Zone Alternative and the Heightened Cash Monitoring 1 Payment Method A.Comments on Findings and Recommendations: The Institute agrees with the finding and...
FINDING 2023-4- Untimely Paid and Unpaid Credit Balances The Institute had Untimely Paid and Unpaid Credit Balances while Participating under the Zone Alternative and the Heightened Cash Monitoring 1 Payment Method A.Comments on Findings and Recommendations: The Institute agrees with the finding and Auditor's recommendation. B.Actions Taken or Planned We have revised the process of student stipends ofdisbursements. Each student whose account receives a disbursement whom results in a credit balance, will be given stipend prior to any draw down. We shall also make process and procedures with new third-party servicer to ensure stipend is sent prior to drawdown. Signed Betsy Bremke, Administrative Campus Director Date: _3/29/2024__
View Audit 301753 Questioned Costs: $1
Finding 391130 (2023-002)
Significant Deficiency 2023
Finding Reference Number: SA2023-002 - Federal Funding Accountability and Transparency Act (FFATA) Reporting Assistance Listing Number: 14.218 Assistance Listing Title: Community Development Block Grant – Entitlement Grant COVID-19 - Community Development Block Grants/ Entitlement Grants-CV ...
Finding Reference Number: SA2023-002 - Federal Funding Accountability and Transparency Act (FFATA) Reporting Assistance Listing Number: 14.218 Assistance Listing Title: Community Development Block Grant – Entitlement Grant COVID-19 - Community Development Block Grants/ Entitlement Grants-CV Name of Federal Agency: Department of Housing and Urban Development Federal Award Identification Number: B-22-MC-06-0009 COVID-19 – B-20-MW-06-0009 • Fiscal Year of Initial Finding: 2022 • Name(s) of the contact person: Leng Powers • Corrective Action Plan: In April 2023, City staff received training on the FFATA website and reporting requirements. After review of the website, the website's requirements, and the FFATA reporting requirements, City staff assigned reporting roles to individuals in Housing and Finance to report within 30 days of executing agreements of $30,000 with sub-recipients. During Fiscal Year 2022/23, the City entered into contract with (3) sub-recipients for awards over $30,000. These contracts were officially executed in December2022/January 2023. The City has been working to obtain the UEI and other miscellaneous reporting information from the sub-recipients in order to complete the required FFATA report for FY2022-23. Going forward, the City will require the FFATA information to be included in the sub-awardee prior to executing the grant award. • Anticipated Completion Date: June 30, 2024
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