Corrective Action Plans

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Finding 2022-1 & 2022-2 Control Activities, Information and Communication, Monitoring • Monthly reconciliation of all financial reports within the accounting system. • Dual review by Operations Manager and Board Treasurer at monthly finance committee meetings. • Use of accounting software tools and ...
Finding 2022-1 & 2022-2 Control Activities, Information and Communication, Monitoring • Monthly reconciliation of all financial reports within the accounting system. • Dual review by Operations Manager and Board Treasurer at monthly finance committee meetings. • Use of accounting software tools and training for accurate grant-based reporting. • Accounting software issues related to transition to cloud-based software have been problem solved as possible. • Due to unresolved system limitations, TLCHB will transition to QuickBooks in January 2026, per the recommendation of the independent auditor. STATUS: Implemented bullet 1-4, bullet 5 target January 2025 • Policy to ensure funds are expended within 30 days, with exceptions approved by senior leadership. STATUS: Implemented • Monthly bank reconciliations prepared by Finance Manager and reviewed by leadership, Finance committee. • Additional staff resources allocated to support reconciliation. STATUS: Reconciliations completed; ongoing compliance in place.
Finding 2022-1 & 2022-2 Control Activities, Information and Communication, Monitoring • Monthly reconciliation of all financial reports within the accounting system. • Dual review by Operations Manager and Board Treasurer at monthly finance committee meetings. • Use of accounting software tools and ...
Finding 2022-1 & 2022-2 Control Activities, Information and Communication, Monitoring • Monthly reconciliation of all financial reports within the accounting system. • Dual review by Operations Manager and Board Treasurer at monthly finance committee meetings. • Use of accounting software tools and training for accurate grant-based reporting. • Accounting software issues related to transition to cloud-based software have been problem solved as possible. • Due to unresolved system limitations, TLCHB will transition to QuickBooks in January 2026, per the recommendation of the independent auditor. STATUS: Implemented bullet 1-4, bullet 5 target January 2025 • Policy to ensure funds are expended within 30 days, with exceptions approved by senior leadership. STATUS: Implemented • Monthly bank reconciliations prepared by Finance Manager and reviewed by leadership, Finance committee. • Additional staff resources allocated to support reconciliation. STATUS: Reconciliations completed; ongoing compliance in place.
Finding 574044 (2022-003)
Significant Deficiency 2022
Audit Finding Reference: 2022-003 Corrective Action Taken or Planned: 1. Formal Documentation and Retention Procedures: Going forward, all report submissions will be accompanied by time and date-stamped confirmation of submission ( e.g., email confirmations, screenshots from the federal submission p...
Audit Finding Reference: 2022-003 Corrective Action Taken or Planned: 1. Formal Documentation and Retention Procedures: Going forward, all report submissions will be accompanied by time and date-stamped confirmation of submission ( e.g., email confirmations, screenshots from the federal submission portal, etc.). These confirmations will be retained in a designated compliance folder for each program. 2. Contingency Plan for System Errors: The County will develop a written contingency plan to address delays caused by system outages or data access issues. This plan will include communication protocols with software vendors, documentation of incidents, and immediate outreach to the granting agency when delays are anticipated. 3. Documenting Extensions and Agency Communication: In any case where a reporting deadline cannot be met, staff will immediately request written approval for extensions from the granting agency, and this correspondence will be retained as part of the official reporting record, as applicable and permitted. 4. Training for Program and Compliance Staff: Staff involved in federal reporting will receive training on reporting deadlines, documentation standards, and escalation protocols for delays. This training will be updated annually to reflect current guidance and program requirements. Anticipated Completion Date: October 15, 2025 Contact Person Responsible for Corrective Action: Charles Nickerson, Senior Director of Finance
Finding 574040 (2022-001)
Significant Deficiency 2022
Audit Finding Reference: 2022-001 Corrective Action Taken or Planned: At the time of compiling the Schedule of Expenditures of Federal Awards (SEF A), the County was unaware that the totals reported in Reports 2 and 3 submitted to the Health Resources and Services Administration (HRSA) were required...
Audit Finding Reference: 2022-001 Corrective Action Taken or Planned: At the time of compiling the Schedule of Expenditures of Federal Awards (SEF A), the County was unaware that the totals reported in Reports 2 and 3 submitted to the Health Resources and Services Administration (HRSA) were required to be reported under Federal Assistance Listing Number (ALN) 93.498- COVID-19 - Provider Relief Fund. This resulted in an incomplete reporting of federal expenditures under the appropriate ALN. To address this issue, the County will implement the following corrective actions: 1. Training and Guidance: Staff responsible for SEF A preparation will receive additional training regarding federal reporting requirements, including how to align HRSA filings with SEFA reporting and the appropriate identification of Assistance Listing Numbers. 2. Improved Coordination: The County will establish closer coordination between the departments submitting reports to federal agencies (such as HRSA) and those compiling the SEFA to ensure consistency and completeness. 3. Periodic Reconciliations: The County will implement periodic reconciliations of its general ledger and departmental grant records against federal reporting requirements throughout the fiscal year, rather than waiting until year-end. This will support more timely and accurate SEFA preparation. Anticipated Completion Date: October 15, 2025 Contact Person Responsible for Corrective Action: Charles Nickerson, Senior Director of Finance
Corrective Action Plan Actions Planned in Response to Finding Authority will implement a monitoring procedure over reporting forms. Official Responsible for Ensuring CAP Implementation Kyle Christiansen, Executive Director Planned Completion of CAP December 31, 2023.
Corrective Action Plan Actions Planned in Response to Finding Authority will implement a monitoring procedure over reporting forms. Official Responsible for Ensuring CAP Implementation Kyle Christiansen, Executive Director Planned Completion of CAP December 31, 2023.
Corrective Action Plan Actions Planned in Response to Finding Authority staff will work with a third-part accountant on reconciling the balances and posting the proper year-end adjustments. The Authority will implement monitoring procedures over year-end accrual adjustments. Official Respons...
Corrective Action Plan Actions Planned in Response to Finding Authority staff will work with a third-part accountant on reconciling the balances and posting the proper year-end adjustments. The Authority will implement monitoring procedures over year-end accrual adjustments. Official Responsible for Ensuring CAP Implementation Kyle Christiansen, Executive Director Planned Completion of CAP December 31, 2024.
Finding 573717 (2022-010)
Significant Deficiency 2022
The Board of County Commissioners, with the cooperation and participation of all elected officials, reviews, develops and implements policies and procedures to create a strong internal control environment. The Board of County Commissioners will work with all elected officials, the third-party admini...
The Board of County Commissioners, with the cooperation and participation of all elected officials, reviews, develops and implements policies and procedures to create a strong internal control environment. The Board of County Commissioners will work with all elected officials, the third-party administrator, and federal, state and local partners to develop policies, procedures, and internal controls designed to accurately track grants, including the application process, verification, oversight, and reporting of grant requirements. To assist in this process, the Board of County Commissioners engaged a third-party administrator to oversee the grant process, including application, eligibility, review, requirements, contracting, recipient tracking and oversight, and documentation and reporting. The Board of County Commissioners will work with the third-party administrator to ensure proper grant administration.
Finding 573712 (2022-004)
Material Weakness 2022
The Board of County Commissioners, with the cooperation of all elected officials and officers responsible for the receipt or expenditure of federal funds, will evaluate the processes and procedures currently in place to ensure the accuracy of SEFA reporting and detect potential inaccuracies and/or m...
The Board of County Commissioners, with the cooperation of all elected officials and officers responsible for the receipt or expenditure of federal funds, will evaluate the processes and procedures currently in place to ensure the accuracy of SEFA reporting and detect potential inaccuracies and/or misstatements.
Finding 573379 (2022-003)
Significant Deficiency 2022
Management concurs with the finding and will ensure that records are maintained to indicate timely submission of reports.
Management concurs with the finding and will ensure that records are maintained to indicate timely submission of reports.
Management concurs with the finding and will implement a proper expenditure reporting process, reconciled monthly, to avoid recurrence during future audits.
Management concurs with the finding and will implement a proper expenditure reporting process, reconciled monthly, to avoid recurrence during future audits.
The City will review the process for identifying federal awards to minimize the likelihood of errors in preparing the schedule of expenditures of federal awards to minimize the likelihood of errors in preparing the schedule of expenditures of federal awards. This will include inquiries of the Engine...
The City will review the process for identifying federal awards to minimize the likelihood of errors in preparing the schedule of expenditures of federal awards to minimize the likelihood of errors in preparing the schedule of expenditures of federal awards. This will include inquiries of the Engineer’s Office.
All FFR and PPR reporting requirements for all federal grants and agreements are tracked in a master spreadsheet, with reminders to all program and project managers at least 2 weeks in advance of reporting due dates.
All FFR and PPR reporting requirements for all federal grants and agreements are tracked in a master spreadsheet, with reminders to all program and project managers at least 2 weeks in advance of reporting due dates.
MANAGEMENT OF TASK FORCE ON DOMESTIC VIOLENCE, HOPE, INC. WILL TAKE THE NECESSARY STEPS TO ENSURE THAT YEAR-END FINANCIAL STATEMENTS ARE PREPARED TIMELY SO THAT THE REPORTING PACKAGE AND DATA COLLECTION FORM CAN BE SUBMITTED AS REQUIRED BY UNIFORM GUIDANCE.
MANAGEMENT OF TASK FORCE ON DOMESTIC VIOLENCE, HOPE, INC. WILL TAKE THE NECESSARY STEPS TO ENSURE THAT YEAR-END FINANCIAL STATEMENTS ARE PREPARED TIMELY SO THAT THE REPORTING PACKAGE AND DATA COLLECTION FORM CAN BE SUBMITTED AS REQUIRED BY UNIFORM GUIDANCE.
Managements Corrective Action Plan Year Ending – December 31, 2022 Schedule of finding and Questioned Costs: Section II – Financial Statement Findings: 2022-001 – Internal Control over Patient Accounts Receivable Financial Close and Reporting Section III – Federal Award Findings: 2022-002 - Reportin...
Managements Corrective Action Plan Year Ending – December 31, 2022 Schedule of finding and Questioned Costs: Section II – Financial Statement Findings: 2022-001 – Internal Control over Patient Accounts Receivable Financial Close and Reporting Section III – Federal Award Findings: 2022-002 - Reporting ALN #93.217 Contact: Jennifer Moore Title: Controller Completion Date – September 2024 Corrective Action – Planned Parenthood Great Northwest, Hawai’i, Indiana, Kentucky has implemented a process improvement plan in 2024 that addresses each of the findings:  We have redefined the allowance calculation methodology, relying on historical analysis and improved reporting that more accurately determines the doubtful receivables.  In 2024, a new team has taken over the reporting and filing process for our grant awards, including federal. This team is responsible for submitting the reporting and draws by the designated timeline, and it is confirmed as part of the month-end close process.
Planned Corrective Action The Town has evaluated the resources needed to produce timely financial information and ensure timely completion of records needed to complete annual audits by their due dates. As a result of the evaluation the town has contracted a Finance Director and adequate staff. Cont...
Planned Corrective Action The Town has evaluated the resources needed to produce timely financial information and ensure timely completion of records needed to complete annual audits by their due dates. As a result of the evaluation the town has contracted a Finance Director and adequate staff. Contact Person Responsible for Corrective Action David Gonzalez Anticipated Completion Date June 30, 2025
Finding 572959 (2022-001)
Material Weakness 2022
Management has retained additional personnel to assist in performing these duties and is in the process of implementing additional policies and procedures. GBAPP is in the process of supplementing its accounting personnel with a consultant with suitable skills, knowledge and experience in financial,...
Management has retained additional personnel to assist in performing these duties and is in the process of implementing additional policies and procedures. GBAPP is in the process of supplementing its accounting personnel with a consultant with suitable skills, knowledge and experience in financial, governmental and grants management reporting.
Great Falls Development Authority Corrective Action Plan: During the pandemic, separation of staff, rapid growth, and increased complexity of our organization proved that some of our procedural systems were no longer adequate. We relied too much on single team members being solely responsible for r...
Great Falls Development Authority Corrective Action Plan: During the pandemic, separation of staff, rapid growth, and increased complexity of our organization proved that some of our procedural systems were no longer adequate. We relied too much on single team members being solely responsible for reporting on some grants or contracts. We have put in place three measures to ensure that all reports are submitted as required and that all reports are filed with each grant or contract. First, each grant or contract now has at least three staff team members responsible for report submittal and filing, the grant or contract manager, their direct supervisor, and our CFO. Second, all documents concerning each grant or contract will be stored electronically on our server and on our Sharepoint. Third, we have put in place a more robust management structure to handle our rapid growth, have created an Executive Assistant position, and are creating an Accounting Assistant position to properly manage the increased administrative workload. Our senior management team — Brett Doney, CEO, Jolene Schalper, Executive Vice President, Jana Williams, CFO, and Jill Kohles, Senior Vice President — are responsible for implementing the above corrective action. We anticipate completion of implementation of the corrective action by December 31, 2025.
Criteria: The Uniform Guidance requires the auditee to prepare a SEFA for the period covered by the auditee's financial statement. It is the responsibility of the auditee's management to design and implement internal controls that provide reasonable assurance over the completeness and accuracy of th...
Criteria: The Uniform Guidance requires the auditee to prepare a SEFA for the period covered by the auditee's financial statement. It is the responsibility of the auditee's management to design and implement internal controls that provide reasonable assurance over the completeness and accuracy of the SEFA. The SEFA is the basis for the auditor's identification of major programs. Condition: The City's initial SEFA provided for the audit was incomplete and contained inaccurate program expenditure amounts. In particular, there were multiple federal programs that were not identified, or had inaccurate amounts reported, on the initial SEFA for the year under audit: ALN 16.554 National Criminal History Improvement Program (NCHIP) ALN 20.600 State and Community Highway Safety ALN 66.458 Capitalization Grants for Clean Water State Revolving Funds ALN 93.568 Low-Income Home Energy Assistance ALN 97.044 Assistance to Firefighters Grant ALN 97.067 Homeland Security Grant Program Cause: The City does not have a method to accurately track the related expenditures for reporting. Effect or Potential Effect: A Uniform Guidance compliance audit is based on the premise that management must comply with federal statutes, regulations and the terms and conditions of the federal awards it received. Without identifying the funds as federal, the auditee may not have complied with those requirements. In addition, there is increased risk regarding the accurate reporting of grant expenditures and noncompliance with policies and procedures surrounding the recording of federal awards. Questioned Costs: None Context: The City was aware of the requirement to prepare a SEFA prior to the audit; however, they were not able to accumulate the appropriate records to correctly identify the source of funding for all ongoing projects. In addition, management was unable to accurately determine the amounts to be reported on the SEFA in accordance with 2 CFR §200.502. The adjustments to the SEFA amounted to an increase in Total Federal Expenditures reported of $892,160. Repeat Finding: This is a repeat finding; it was previously finding 2021-006 and 2021-007. Recommendation: We recommend the City develop and implement procedures to ensure that information related to all federal awards is accumulated to assist in the preparation of the SEFA. In addition, we recommend management of the City verify the completeness and accuracy of the amounts reported on the SEFA. Response: The City agrees with the finding, and will develop a method for accurately tracking federal expenditures. Anticipated Completed Date: June 30, 2025 Responsible Contact Person: Elizabeth Greenwood, Director of Administration & Finance City of Cortland, 25 Court Street, Cortland, NY 13045 (607) 758-8373
Criteria: Under the requirements of the Coronavirus State and Local Fiscal Recovery Funds (CSLFRF) program as codified in 31 CFR Part 35 Subpart A, recipients are required to provide periodic reports providing detailed accounting of the use of funds, modifications to a State or Territory's tax reven...
Criteria: Under the requirements of the Coronavirus State and Local Fiscal Recovery Funds (CSLFRF) program as codified in 31 CFR Part 35 Subpart A, recipients are required to provide periodic reports providing detailed accounting of the use of funds, modifications to a State or Territory's tax revenue sources, and such other information as may be required (31 CFR 35.4(c)). Under this same requirement, non-entitlement units of local government were required to submit a Project and Expenditure Report (the Report) by April 30, 2022 and then annually thereafter. Cause/Condition: The City did not have a method to accurately track the related expenditures for reporting. Therefore, the City did not file one of one Reports. Effect: The entity is not in compliance with federal regulations regarding reporting. Questioned Costs: None. Context: The City was aware of the reporting requirement prior to the single audit, however, they were not able to accurately and appropriately certify the report. Recommendation: We recommend the City ensure all required reports are filed, and filed in a timely manner. In addition, we recommend the City completes and files the required Report as soon as practicable. Response: The City agrees with the finding and has already implemented a detailed tracking guide and is prepared to meet future reporting requirements for this funding. Corrective Action Plan: Expenses to date were reconciled in late July 2023. In addition, Common Council adopted an allocation plan for remaining funds in August 2023 to help direct and track remaining projects utilizing American Rescue Plan Act funds. Common Council will receive updated reporting on American Rescue Plan Act funds at a minimum of twice per year. Anticipated Completed Date: April 15, 2024. Responsible Contact Person: Elizabeth Greenwood, Director of Administration & Finance City of Cortland, 25 Court Street, Cortland, NY 13045 (607) 758-8373
Criteria: Under the Single Audit Act of 1996 and Title 2 U.S. Code of Federal Regulations Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (Uniform Guidance), §200.512, Report Submission, the Single audit reporting package is required to be fi...
Criteria: Under the Single Audit Act of 1996 and Title 2 U.S. Code of Federal Regulations Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (Uniform Guidance), §200.512, Report Submission, the Single audit reporting package is required to be filed within the earlier of 30 calendar days after receipt of the auditors' report, or 9 months after the end of the audit period. Cause/Condition: Staffing shortages caused the delays in financial reporting. This deadline was not met on a timely basis for the year ended December 31, 2022. Effect: As a result, the entity is not in compliance with §200.512 of the Uniform Guidance. Repeat Finding: This is a repeat finding, it was previously reported as 2021-004. Recommendation: We recommend the requirements of §200.512 of the Uniform guidance be adhered to by striving to have all information required for the audit available on a timely basis. This will help to ensure timely audit report issuance and compliance with the filing deadline. Response: The City is still facing staffing shortages and is working to get the subsequent financial statements completed. It is expected the 2024 reporting package will be filed on time. Corrective Action Plan: The City has hired a full complement of staff in the Finance department, and anticipates timely filings going forward. Anticipated Completed Date: September 30, 2025. Responsible Contact Person: Elizabeth Greenwood, Director of Administration & Finance City of Cortland, 25 Court Street, Cortland, NY 13045 (607) 758-8373
Management has been in contact with their funders regarding the late submission and no action is expected. Management will arrange for future audits and submissions to be performed timely
Management has been in contact with their funders regarding the late submission and no action is expected. Management will arrange for future audits and submissions to be performed timely
Finding 571393 (2022-003)
Significant Deficiency 2022
Management is aware of reporting requirements and has committed the resources to ensure timely filing for future reports.
Management is aware of reporting requirements and has committed the resources to ensure timely filing for future reports.
FINDINGS- FINANCIAL STATEMENT AUDIT SIGNFICANT DEFICIENCY Finding 2022-001 - Reporting : The U.S. Economic Development Administration ALN # 11 .307 require reports to the appropriate federal agency for revolving loan funds and grants. Response to Audit Finding 2022-001 : Background: In March of 2022...
FINDINGS- FINANCIAL STATEMENT AUDIT SIGNFICANT DEFICIENCY Finding 2022-001 - Reporting : The U.S. Economic Development Administration ALN # 11 .307 require reports to the appropriate federal agency for revolving loan funds and grants. Response to Audit Finding 2022-001 : Background: In March of 2022 , NARCOG had a transition of leadership in the Finance Department. The new Finance Director had to be set up as an authorized representative for the organization before reporting could be submitted, which caused a delay in reporting in a timely manner. The Finance Director is still learning the process and requirements of the financial data for the reporting. Conclusion: Going forward NARCOG will have a three-member team to ensure that reporting is submitted in a timely manner. The Finance Director, Executive Director, and Planning Director will all have the capability of completing and submitting reports.
The omission of occurred as a result of timing of receipt of award and not knowing all unsolicited funding had to be reported on SEFA schedule. The error has been corrected. Management did perform a review however there was no documentation maintained of this process. There are specific ledger codes...
The omission of occurred as a result of timing of receipt of award and not knowing all unsolicited funding had to be reported on SEFA schedule. The error has been corrected. Management did perform a review however there was no documentation maintained of this process. There are specific ledger codes used to track all grants. The SEFA will be prepared by the Controller and signed off on by the CFO.
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