Corrective Action Plans

Finding 46208 (2022-002)

None 2022

WV

Special Tests & Provisions Eligibility Reporting

SPECIAL TESTS AND PROVISIONS ? ADP SYSTEM FOR SNAP Department of Health and Human Resources (DHHR) Assistance Listing Number 10.551, 10.561, COVID-19 10.561 Management within the DHHR appreciates and shares the auditors? concern with SNAP program integrity as it relates to the Recipient Automated P...

SPECIAL TESTS AND PROVISIONS ? ADP SYSTEM FOR SNAP Department of Health and Human Resources (DHHR) Assistance Listing Number 10.551, 10.561, COVID-19 10.561 Management within the DHHR appreciates and shares the auditors? concern with SNAP program integrity as it relates to the Recipient Automated Payment Information Data (RAPIDS) ADP system. DHHR would note that 7 CFR ? 272.10 begins with, ?(1) Purpose. All State agencies are required to sufficiently automate their SNAP operations and computerize systems for obtaining, maintaining, utilizing, and transmitting information concerning SNAP. Sufficient automation levels are those which result in effective programs or in cost effective reductions in errors and improvements in management efficiency, such as decreases in program administrative costs?? Within the RAPIDS ecosystem for SNAP administration, this automation includes data matching measures undertaken, in compliance with related federal rules as specified in 7 CFR ? 272.8, 7 CFR ? 272.16, etc., to automate the validation of client-provided, worker-input information while mitigating the additional administrative burden of secondary review for all worker interactions with a client?s case. Policy regarding state and federal data matching is laid out in Chapter 6 of the State?s Income Maintenance Manual (IMM), which is available at https://dhhr.wv.gov/bfa/policyplans/Documents/Binder4.pdf. The primary data exchange system detailed in IMM Chapter 6 that is applicable to SNAP is the Income and Eligibility Verification System (IEVS) required by 7 CFR ? 272.8. Systems mandated federally for inclusion in the IEVS include those operated by WorkForce WV, the Internal Revenue Service (IRS), and the U.S. Social Security Administration (SSA). A variety of other sources may also be queried for the purpose of validating client-provided information entered into RAPIDS by a worker, including Veterans Affairs (VA), Beneficiary and Earnings Data Exchange (BENDEX), Beneficiary Earnings and Exchange Record System (BEERS), National Directory of New Hires, and Prisoner Matching with the Department of Corrections as well as the Federal Data Services Hub (FSDH). IMM Chapter 6, page 2 describes the purpose of data matching through the IEVS as follows: Information obtained through IEVS is used for the following purposes: ? To verify the eligibility of the assistance group (AG) ? To verify the proper amount of benefits ? To determine if the AG received benefits that were not entitled ? To obtain information for use in criminal or civil prosecution based on receipt of benefits to which the AG was not entitled. IMM Chapter 6, pages 2-3 further detail the points at which a match with the IEVS must take place: A data exchange in the eligibility system occurs: ? When a new case is created; ? When a new person is added to a benefit; ? When a person?s demographic information is changed; and, ? On a periodic basis for all individuals in the eligibility system, depending on the type of benefit being received. Requirements for independent verification of information when automated data matches fail or report a discrepancy with client-provided, worker-input information are spelled out in IMM 6.4.4. The State believes that these automations, while perhaps not foolproof, are in keeping with both the wording and intent of 7 CFR ? 272.10, 7 CFR ? 272.8, 7 CFR ? 272.16, etc., which aim to automate processes in order to reduce administrative burden and associated costs, such as those that would be associated with a secondary review of all worker interactions with a client?s case. With that in mind, the State commits to working to bolster SNAP program integrity as it relates to the auditors? expressed concerns through completion of the USDA-FNS SNAP System Integrity Review Tool (SIRT) in alignment with USDA-FNS requirements and timelines to ensure that automated processes within RAPIDS continue to comport with federal requirements for ADP systems. The DHHR Bureau for Family Assistance, Division of Performance and Quality Improvement (DPQI), will continue its ongoing SNAP case reviews, as well as continue its efforts to report compliance with monthly requirements for expanded supervisor case reviews conducted and tracked through the Rushmore case review system, as mandated in a December 7, 2022 memorandum to supervisors. Furthermore, the Bureau for Family Assistance will develop additional worker training, to include the reinstatement of face-to-face Statewide Payment Accuracy Conferences, with an aim to ensure that client information is accurately captured in RAPIDS so the APD can perform its automated functions with integrity.

View Audit 40967

Finding 46204 (2022-001)

Material Weakness 2022

State of West Virginia

WV

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

DHHR INFORMATION SYSTEM AND RELATED BUSINESS PROCESS CONTROLS Department of Health and Human Resources (DHHR) Assistance Listing Number 10.551, 10.561, COVID-19 10.561, 10.542, 93.558, COVID-19 93.558, 93.568, COVID-19 93.568, 93.575, 93.596, COVID-19 93.575, 93.658, 93.659, 93.767, 93.775, 93.777, ...

DHHR INFORMATION SYSTEM AND RELATED BUSINESS PROCESS CONTROLS Department of Health and Human Resources (DHHR) Assistance Listing Number 10.551, 10.561, COVID-19 10.561, 10.542, 93.558, COVID-19 93.558, 93.568, COVID-19 93.568, 93.575, 93.596, COVID-19 93.575, 93.658, 93.659, 93.767, 93.775, 93.777, COVID-19 93.777, 93.778, COVID-19 93.778, ARRA 93.778 Enhancing the Quality Control process (by adding other programs to the overall scope and expanding the populations for sampling to include payments that have case data that is initiated and approved by the same person as well as case data that is entered by one person without another level of approval) would prove costly for the DHHR due to the additional staff throughout the DHHR that would be required to accomplish such a task. Although enhancing the Quality Control process is still a possibility, upon further discussions within the DHHR, it was determined that prior to considering such an enhancement, the Bureau for Social Services, Bureau for Family Assistance, and other DHHR units should work together to perform the following: outline the existing internal controls over payments by payment type or program, determine the number of payments per month whereby one employee initiates and approves a payment (in relation to the population of all payments) and conclude on the risk of those payments being improper. Management can then identify areas of focus to conclude on the adequacy of the internal controls and make revisions to policies and procedures, if necessary. In short, although there are existing controls in place, the controls have not been documented and communicated to the State?s independent auditors in an effective manner.

View Audit 40967

Finding 46195 (2022-001)

Material Weakness 2022

Chehalis School District No. 302

WA

Subrecipient Monitoring Internal Control / Segregation of Duties Special Tests & Provisions

Finding ref number: 2022-001 Finding caption: The District did not have adequate internal controls for ensuring compliance with wage rate requirements. Name, address, and telephone of School District contact person: Heather C. Pinkerton 310 SW 16th St Chehalis, WA 98532 360-807-7207 Corrective actio...

Finding ref number: 2022-001 Finding caption: The District did not have adequate internal controls for ensuring compliance with wage rate requirements. Name, address, and telephone of School District contact person: Heather C. Pinkerton 310 SW 16th St Chehalis, WA 98532 360-807-7207 Corrective action the auditee plans to take in response to the finding: It is highly unusual for the district to utilize federal funds for construction projects; the Covid-19 Education Stabilization Funds were an anomaly. The District?s Director of Business and Operations was unaware that prevailing wage clauses are required to be included in all public works contracts over $2,000 that are paid with federal funds. She was aware that prevailing wages need to be paid. The audit finding does not dispute that prevailing wages were paid appropriately, just that the clauses were not included in the contracts. To be very clear, this finding is for not having required language in contracts. The District is now aware that inclusion of the clauses is a compliance requirement. Going forward, it is unlikely that federal funds will be used for construction projects; however, when federal funds are utilized for construction projects, the District will either include the required prevailing wage rate clauses in its contracts or will obtain a separate signed clause with the required prevailing wage rate information. Anticipated date to complete the corrective action: Immediately

View Audit 40903

Finding 46191 (2022-001)

Significant Deficiency 2022

Town of Westport, Conencticut

CT

Internal Control / Segregation of Duties Reporting Significant Deficiency

FINDING - FEDERAL AWARD PROGRAMS AUDIT United States Department of the Treasury 2022-001 COVID-19 American Rescue Plan Act Local Fiscal Recovery ? AL No. 21.027 Recommendation: We recommend that the Town implement a control for the Project and Expenditure Report to be reviewed by an individual ind...

FINDING - FEDERAL AWARD PROGRAMS AUDIT United States Department of the Treasury 2022-001 COVID-19 American Rescue Plan Act Local Fiscal Recovery ? AL No. 21.027 Recommendation: We recommend that the Town implement a control for the Project and Expenditure Report to be reviewed by an individual independent of the preparation process prior to submission to the Treasury. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: Management agrees with this finding. Management further notes that a two-step review process has been implemented where the Controller will review the documents sign-off before the Finance Directors submits them through the State portal. The of the contact person responsible for corrective action: Sheila Carey Planned completion date for corrective action plan: March 30, 2023.

View Audit 40828

Finding 46189 (2022-006)

Significant Deficiency 2022

Northwest Iowa Mental Health Center D/b/a Seasons Center for Community

IA

Reporting Significant Deficiency § 200.303 § 200.328 § 200.329

Finding 2022-006: Reporting Federal Agency Name: Department of Health and Human Services CFDA #93.829 Program Name: Section 223 Demonstration Programs to Improve Community Mental Health Services Finding Summary: Through testing of one programmatic report, the number of adults and children served du...

Finding 2022-006: Reporting Federal Agency Name: Department of Health and Human Services CFDA #93.829 Program Name: Section 223 Demonstration Programs to Improve Community Mental Health Services Finding Summary: Through testing of one programmatic report, the number of adults and children served during the reporting period included six individuals twice. As a result of a software change during the grant year, management combined the listing of adults and children served from two electronic health record systems and did not identify these six individuals were duplicates in the listings. Responsible Individuals: Project Directors (Missy Martini, Rebecca McCrackin) and CEO (Dan Ries) Corrective Action Plan: CEO will review reports prior to submission and will do random testing of numbers included in the report to ensure numbers reported have supporting documentation. Documentation used to complete the required reports will be retained by the Center. Anticipated Completion Date: This process was implemented beginning January 2023.

View Audit 41794

Finding 46186 (2022-004)

Significant Deficiency 2022

Northwest Iowa Mental Health Center D/b/a Seasons Center for Community

IA

Reporting Significant Deficiency § 200.303 § 200.328 § 200.329

Finding 2022-004: Reporting Federal Agency Name: Department of Health and Human Services CFDA #93.087 Program Name: Enhance Safety of Children Affected by Substance Abuse Finding Summary: Through testing of one programmatic report, amounts reported did not agree to supporting documentation. Program...

Finding 2022-004: Reporting Federal Agency Name: Department of Health and Human Services CFDA #93.087 Program Name: Enhance Safety of Children Affected by Substance Abuse Finding Summary: Through testing of one programmatic report, amounts reported did not agree to supporting documentation. Programmatic information included within the report were included in the wrong category for services provided to adults and children and amounts were included in two categories for services in which no adults or children were provided services. The preparer of the report improperly input the case sizes within the incorrect column within the report and entered incorrect information in two instances. The report included programmatic information in the wrong categories for services provided and services not provided to adults and children. Responsible Individuals: Project Directors (Christina Eggink-Postma, Sarah Heinrichs) and CEO (Dan Ries) Corrective Action Plan: CEO will review reports prior to submission and will do random testing of numbers included in the report to ensure numbers reported have supporting documentation. Documentation used to complete the required reports will be retained by the Center. Anticipated Completion Date: This process was implemented beginning January 2023.

View Audit 41794

Finding 46184 (2022-001)

Material Weakness 2022

Caromont Health, Inc.

NC

Allowable Costs / Cost Principles Material Weakness Reporting

Finding 2022-001 Contact Person: Shari Reese Completion Date: March 13, 2023 Managements Response: Reporting Period 1: During Reporting Period 1, several subsidiaries of CaroMont Health, Inc. (?Parent?) received general distributions from the CARES Act Provider Relief Fund (?PRF?). Management ...

Finding 2022-001 Contact Person: Shari Reese Completion Date: March 13, 2023 Managements Response: Reporting Period 1: During Reporting Period 1, several subsidiaries of CaroMont Health, Inc. (?Parent?) received general distributions from the CARES Act Provider Relief Fund (?PRF?). Management reported all the general distributions received by the subsidiaries under the Parent entity in the portal, including the general distributions received by CaroMont Regional Medical Center (?Hospital?). Management listed the TINS of the subsidiaries, including the Hospital, in the Subsidiary Data section in the Parent?s portal. Management reported lost revenues utilizing option i, 2019 Actual Revenues, for the subsidiaries in the Parent?s portal. Reporting Period 2: During Reporting Period 2, the Hospital received both general and a targeted distributions (High Impact Area) from the CARES Act PRF. Management was unsure how to report so it contacted the HRSA Provider Support Line. HRSA opened case #00025470 and on January 18, 2022, Management had a phone conference with a representative of HRSA to discuss Period 2 reporting. HRSA advised management to report as follows: ? Hospital ? report the targeted distribution. Only report revenue, expenses, and data for the Hospital. ? Parent ? report general distributions. Don?t change any numbers from Period 1. Report revenue, expenses, and data for all subsidiary TINS listed in the portal. Management specifically remembers explaining to the HRSA representative that this approach would result in double counting of Total Unused Lost Revenues because Hospital revenues would be reported in both portals. The HRSA representative said that would be okay because Management answered YES to ?Is the parent entity reporting on your General Distribution payments?? in the Hospital portal, because the Hospital?s TIN is listed in the Subsidiary Information section in the Parent?s portal, and because the Parent?s TIN is listed in the Subsidiary Questionnaire section in the Hospital?s portal. Management documented these instructions in their notes made during the call. Management also specifically remembers asking the HRSA representative if the Hospital revenue should be removed from the prior quarters in the Parent portal when reporting Period 2 to which the representative replied, ?don?t change any numbers?. Management documented these instructions in their notes made during the call. Management filed the Period 2 reports for the Parent and the Hospital in accordance with HRSA?s instructions received during this phone conference. Management reported lost revenues under option i, 2019 Actual Revenues, for the listed subsidiaries in the Parent portal and for the Hospital in the Hospital portal. However, since Management was concerned this approach would result in double counting of unused lost revenues, they created a reconciliation spreadsheet on February 1, 2022. This spreadsheet documented unused lost revenues from the PRF Financial Reporting Summary Reporting pages in the Parent and Hospital portals for Period 1 and Period 2 and calculated the correct total unused lost revenues when the reports were combined and the double counting was eliminated. Management?s intent was to update this reconciliation during Period 4 reporting to ensure the remaining unused lost revenues in both the Parent and Hospital portals exceeded the combined reconciled lost revenue ? thereby ensuring there would be no double counting of lost revenues after all PRF reporting was completed. Reporting Period 4: During Report Period 4, several subsidiaries of the Parent received general distributions from the CARES Act PRF and targeted distributions from the American Rescue Plan (?ARP?). By the time the Portal Reporting opened for Period 4, CaroMont?s auditors were conducting the Single Audit for the year ended June 30, 2022, and reached out to Management to discuss their concerns about potential double counting of lost revenues in the Period 2 portal reporting. Management explained their process for reporting Period 2 and shared with the auditors their reconciliation spreadsheet that was created on February 1, 2022. The auditors had also performed a reconciliation that resulted in the same outcome. The auditors and management subsequently had several discussions on the different alternatives available to correct the Period 2 overstatement. Management evaluated the alternatives and ultimately decided to change its calculation of Lost Revenues in the Parent portal for Period 4 from option i, 2019 Actual Revenue, to option iii, Alternative Method of Calculating Lost Revenues Attributable to COVID-19. However, management continued to report lost revenues in the Hospital portal for Period 4 utilizing option i, 2019 Actual Revenue, as it had in Period 2. Management created another reconciliation spreadsheet on February 23, 2023 that demonstrated the Hospital revenue was excluded from the Parent?s lost revenue calculations in Period 4. This spreadsheet was uploaded as supporting documentation for option iii in the Parent?s portal. By changing from option i to option iii for lost revenues in the Parent portal for Period 4, management corrected the overstatement of lost revenues identified in the Audit of Federal Awards Performed in Accordance with U.S. Office of Management and Budget Uniform Guidance for the year ended June 30, 2022.

View Audit 41344

Finding 46182 (2022-002)

Significant Deficiency 2022

Cle Elum-Roslyn School District No. 404

WA

Questioned Costs Subrecipient Monitoring Internal Control / Segregation of Duties

The District concurs and will review current year?s indirect rates for ESSER reimbursements.

View Audit 41236 Questioned Costs: $1

Finding 46163 (2022-002)

Significant Deficiency 2022

Shepherd Public School District

MI

Cash Management Reporting School Nutrition Programs

Finding 2022-002 ? REPORTING Type: Significant Deficiency in Internal Control! Noncompliance ? Reporting Program: Child Nutrition Cluster (ALN 10.553, 10.555 and 10.559) Condition: Meals claimed were not supported by count sheets for lunch for one of the two months meals were tested. Criteria: The D...

Finding 2022-002 ? REPORTING Type: Significant Deficiency in Internal Control! Noncompliance ? Reporting Program: Child Nutrition Cluster (ALN 10.553, 10.555 and 10.559) Condition: Meals claimed were not supported by count sheets for lunch for one of the two months meals were tested. Criteria: The District is required to claim meals served, by category, based on reports provided from individual meal serve counts. Cause: This condition was caused by an insufficient internal control process for comparison of supporting documentation of meal counts to meal claims. Effect: Based on a comparison of meals claimed to reports provided from individual meal serve counts, the District has underclaimed reimbursement for the year by an immaterial amount. Questioned Costs: None. Recommendation: We recommend that the District review their process of meal claims and make necessary changes to ensure that all meals claimed, by category, agree to supporting documentation. Corrective Action Plan: Shepherd Public Schools Food Service Department will implement internal control review process to ensure that individual meal serve counts match identically the meals claimed by reviewing original count sheets at the time of certification of meal claims. Either the food service director or assigned designee will verify counts at the end of each month. This internal control review process will begin effective with the October 2022 claims report.

View Audit 41016

Finding 46161 (2022-006)

Significant Deficiency 2022

Waushara County

WI

Reporting Significant Deficiency Internal Control / Segregation of Duties

U.S. Department of Health and Human Services and Wisconsin Department of Health Services (DHS) 2022-006 WIMCR Reporting Medical Assistance Program ? Assistance Listing No. 93.778 Recommendation: CLA recommends the County develop and implement a process to require review and approval of the WIMCR re...

U.S. Department of Health and Human Services and Wisconsin Department of Health Services (DHS) 2022-006 WIMCR Reporting Medical Assistance Program ? Assistance Listing No. 93.778 Recommendation: CLA recommends the County develop and implement a process to require review and approval of the WIMCR reports prior to the submission of the report to the state to help ensure that the data reported are accurate, complete and supporting documentation is retained. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: Annual WIMCR reporting to be completed by Waushara County DHS Finance team; Financial Manager and/or Financial Assistant. If both positions are fully employed both positions need to review and sign off on data prior to submission. If one of the positions is vacant a second review of data and sign-off needs to be done by someone else within DHS ? likely the DHS Director. Name(s) of the contact person(s) responsible for corrective action: Peder Culver, Finance Manager, Clara Voigtlander, DHS Director Planned completion date for corrective action plan: 2022 WIMCR has been submitted. Action plan will be in place for 2023 reporting or sooner, if 2022 WIMCR is re-opened.

View Audit 40814

Finding 46155 (2022-002)

Significant Deficiency 2022

Pickaway County

OH

Subrecipient Monitoring Reporting

We will correct our reporting issues with the next required report. July 31, 2023 County Administrator 740-474-6093

View Audit 40211

Finding 46151 (2022-001)

None 2022

Essex County College

NJ

Student Financial Aid Reporting

2022-001 Student Financial Assistance NSLDS Enrollment Reporting Recommendation: We recommend the College continue to follow the corrective action plan as it relates to enrollment and program status reporting to NSLDS to ensure all status changes are reported timely with the correct effective dates...

2022-001 Student Financial Assistance NSLDS Enrollment Reporting Recommendation: We recommend the College continue to follow the corrective action plan as it relates to enrollment and program status reporting to NSLDS to ensure all status changes are reported timely with the correct effective dates. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: A cross-disciplinary group of institutional staff meets to discuss and continue remediation efforts. The Director of Enrollment Services obtains and reviews internal data reports to inform further assessment. Once the review of specific cases was completed, the Director of Enrollment Services performed a full file review for the 21-22 year, making changes necessary as a result of that review. The Director of Enrollment Services engaged in a review of policy and procedures and individuals responsible for enrollment reporting to the NSLDS including, but not restricted to, 1) review of the institution?s data in the BANNER system; 2) the institution?s set up and interface with the National Student Clearinghouse, and 3) internal staff policy and procedure for staff engaged and responsible for enrollment reporting to the NSLDS for the institution. The Director of Enrollment Services consults with personnel and continues to assess appropriate protocols. In addition, the Director of Enrollment Services directs personnel on needed training including, but not restricted to, FSA conference sessions, FSA Training portal suite pedagogy, and the National Student Clearinghouse Academy. Name(s) of the contact person(s) responsible for corrective action: Renee Ojo-Ohikuare, Director of Enrollment Services. Planned completion date for corrective action plan: June 30, 2023 If the Department of Education or the Office of the Secretary of Higher Education have questions regarding the documented plans above, please call Evens Wagnac at 973-877-3040.

View Audit 40198

Finding 46150 (2022-003)

Significant Deficiency 2022

Signature Theatre, Inc.

VA

Allowable Costs / Cost Principles Reporting Significant Deficiency

2022-003 200 CFR Subpart F Audit Requirements Views of Responsible Officials and Corrective Action Plan: Responsible Officials: Maggie Boland, Managing Director Valerie Bunns, Director of Finance and Administration Corrective Action Plan: Signature will incorporate federal grant compliance training ...

2022-003 200 CFR Subpart F Audit Requirements Views of Responsible Officials and Corrective Action Plan: Responsible Officials: Maggie Boland, Managing Director Valerie Bunns, Director of Finance and Administration Corrective Action Plan: Signature will incorporate federal grant compliance training for appropriate personnel.

View Audit 40745

Finding 46137 (2022-001)

Material Weakness 2022

Oglesby Esd No. 125

IL

Internal Control / Segregation of Duties Reporting

Familiarize staff with financial reporting requirements and segregate duties to the extent possible. The cost of training or adding personnel will be considered, if cost effective.

View Audit 40647

Finding 46134 (2022-004)

Significant Deficiency 2022

Freeborn County

MN

Internal Control / Segregation of Duties Special Tests & Provisions Reporting § 200.303

2022-004 SPECIAL PROVISIONS Medical Assistance Program ? Assistance Listing No. 93.778 Recommendation: We recommend that the County enact policies to ensure that Collaborative reports are reviewed prior to submission in a timely manner. Explanation of disagreement with audit finding: There is no dis...

2022-004 SPECIAL PROVISIONS Medical Assistance Program ? Assistance Listing No. 93.778 Recommendation: We recommend that the County enact policies to ensure that Collaborative reports are reviewed prior to submission 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 will implement procedures to ensure that all reports are reviewed prior to submission. Name of the contact person responsible for corrective action: Pat Paquin, Finance Manager Planned completion date for corrective action plan: December 31, 2023

View Audit 40299

Finding 46133 (2022-003)

Significant Deficiency 2022

Freeborn County

MN

Internal Control / Segregation of Duties Reporting Significant Deficiency § 200.303

2022-003 REPORTING Medical Assistance Program ? Assistance Listing No. 93.778 Recommendation: We recommend that the County enact policies to ensure that reports are reviewed prior to submission in a timely manner. Explanation of disagreement with audit finding: There is no disagreement with the audi...

2022-003 REPORTING Medical Assistance Program ? Assistance Listing No. 93.778 Recommendation: We recommend that the County enact policies to ensure that reports are reviewed prior to submission 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 will implement procedures to ensure that all reports are reviewed prior to submission. Names of the contact person responsible for corrective action: Pat Paquin, Finance Manager Planned completion date for corrective action plan: December 31, 2023

View Audit 40299

Finding 46123 (2022-001)

None 2022

Milestone Recovery and Subsidiaries

ME

Reporting Internal Control / Segregation of Duties

Views of responsible officials and planned corrective action: We are in agreement with the finding. We are taking steps to create an updated process to ensure compliance with this requirement moving forward.

View Audit 40960

Finding 46118 (2022-001)

Material Weakness 2022

Lubbock Christian University

TX

Student Financial Aid Matching / Level of Effort / Earmarking Subrecipient Monitoring

Finding 2022-001 Enrollment Reporting Views of Responsible Officials The University agrees with the auditor?s findings and recommendations. Corrective Action Plan The University has implemented additional training for this compliance requirement to ensure that changes in enrollment status are record...

Finding 2022-001 Enrollment Reporting Views of Responsible Officials The University agrees with the auditor?s findings and recommendations. Corrective Action Plan The University has implemented additional training for this compliance requirement to ensure that changes in enrollment status are recorded correctly in the system and reported accurately. Additionally, the University will resolve status change discrepancies and review status change reporting output monthly to ensure that changes are reported accurately. Implementation Date Immediate Individual(s) Responsible Yvonne Harwood, Vice President of Institutional Effectiveness and Becky Wilson, Assistance Vice President of Financial Assistance

View Audit 41496

Finding 46104 (2022-003)

Material Weakness 2022

Southwestern Wisconsin Community School District

WI

Material Weakness Reporting Internal Control / Segregation of Duties

Finding #2022-003- Material Adjustments Condition: Johnson Block and Company, Inc. proposed numerous adjusting journal entries. We deem these entries to be significant in relation to the financial statements. Since the District did not make these adjustments in its accounting system prior to the au...

Finding #2022-003- Material Adjustments Condition: Johnson Block and Company, Inc. proposed numerous adjusting journal entries. We deem these entries to be significant in relation to the financial statements. Since the District did not make these adjustments in its accounting system prior to the audit, a material weakness exists in the District?s internal controls. Effect: This means that the proper recording and reporting of financial information may not occur within a timely manner. Cause: Financial information was not recorded in a timely manner and material adjustments were needed in order to correct various transactions. Criteria: Material adjusting journal entries not prepared by the District before the audit are considered an internal control weakness. Recommendation: Policies and procedures should be implemented to ensure account balances are properly recorded in a timely manner. Response: The District will work to establish policies and procedures to reduce the number of adjusting journal entries proposed by the auditor. Contact Person: John Costello Anticipated Completion: June 30, 2023

View Audit 40958

Finding 46102 (2022-002)

None 2022

Crf Xii, Inc. Dba Prov. Place of Bloomington Apartments

IN

Reporting Matching / Level of Effort / Earmarking

Findings - Federal Award Programs Audit: U.S. Department of Housing and Urban Development Finding 2022-002: Section 223(f) Loan Program, CFDA 14.157 Recommendation: The management agent should ensure the Project is properly maintained. Action Taken: Management is in the process of addressing the ...

Findings - Federal Award Programs Audit: U.S. Department of Housing and Urban Development Finding 2022-002: Section 223(f) Loan Program, CFDA 14.157 Recommendation: The management agent should ensure the Project is properly maintained. Action Taken: Management is in the process of addressing the various items noted in the REAC inspection report.

View Audit 41495

Finding 46101 (2022-001)

None 2022

Crf Xii, Inc. Dba Prov. Place of Bloomington Apartments

IN

Cash Management HUD Housing Programs Reporting

Findings - Federal Award Programs Audit: U.S. Department of Housing and Urban Development Finding 2022-001: Section 223(f) Loan Program, CFDA 14.157 Recommendation: Make the deposit to the residual receipts account as required and ensure that all future residual receipts amounts are deposited with...

Findings - Federal Award Programs Audit: U.S. Department of Housing and Urban Development Finding 2022-001: Section 223(f) Loan Program, CFDA 14.157 Recommendation: Make the deposit to the residual receipts account as required and ensure that all future residual receipts amounts are deposited within 90 days after year end. Action Taken: Management will make the required residual receipts deposit as soon as possible and will ensure compliance in the future.

View Audit 41495

Finding 46096 (2022-003)

Significant Deficiency 2022

Eastern New Mexico University

NM

Student Financial Aid Eligibility Reporting

Corrective Action: (SSS): SSS will verify student?s low-income levels for those with a FAFSA on file by having the University?s Financial Aid Department confirm that the student?s income is low-level per the Student Aid Report and FAFSA University?s Financial Aid Department confirm that the st...

Corrective Action: (SSS): SSS will verify student?s low-income levels for those with a FAFSA on file by having the University?s Financial Aid Department confirm that the student?s income is low-level per the Student Aid Report and FAFSA University?s Financial Aid Department confirm that the student?s income is low-level per the Student Aid Report and FAFSA. The EFC that is listed at $0 is information that is derived from the institution?s Financial Aid Department that is uploaded into Banner once the department verifies the information which comes from the FAFSA and parent/student taxes. (TS): Students in question were offered allowable activities (e.g., tutoring, career/college exploration) by TS program staff. However, these eight students elected to forgo involvement in permissible activities. During the audited period, the former TS program director retired and a new program director was hired. There was no overlap between the former and new program director. The TRIO Tracking Specialist reviewed, signed, and initialed documents in the absence of the TS Director. The applications audited show evidence of the initials of the TRIO Tracking Specialist which was intended to provide evidence of internal program control. Timeline of Corrective Action: 1. The above processes will be put in place by December 31, 2022. 2. A review of related TRIO grant processes and eligibility requirements for students currently involved in the programs will be conducted by June 30, 2023. 3. In addition to the above steps, the Roswell campus is in the process of reviewing the job description for a grants director to oversee federal grants. This position would include oversight of compliance with federal rules, regulations, guidelines, and campus policies. The ENMU-Roswell Campus HR office reviewed the grants director job description and started the process of posting this position on October 24, 2022. It is anticipated this position will be filled by January 31, 2023. 4. Additional compliance discussion sessions and grant requirement reviews for the involved TRIO grant program directors will take place in November 2022 with the campus senior leadership. Responsible Party(ies): Roswell Campus; Assistant Vice President of Student Affairs

View Audit 41471

Finding 46091 (2022-002)

Significant Deficiency 2022

Eastern New Mexico University

NM

Matching / Level of Effort / Earmarking Student Financial Aid Reporting

Corrective Action: Management agrees that students were not properly reported to the Clearinghouse or NSLDS again and that all of the proposed corrective action in FY 21 did not occur. The registrar did not utilize NSLDS access until October 2022 and was not able to verify the submissions. Timeli...

Corrective Action: Management agrees that students were not properly reported to the Clearinghouse or NSLDS again and that all of the proposed corrective action in FY 21 did not occur. The registrar did not utilize NSLDS access until October 2022 and was not able to verify the submissions. Timeline of Corrective Action: Immediate. The registrar now has access to NSLDS as well as the Clearinghouse and has established procedures to verify the submission after every upload. The Financial Aid and Registrar Offices have agreed to meet quarterly to review submissions and to include Roswell offices in the meetings too. Responsible Party(ies): Registrar; Portales Campus

View Audit 41471

Finding 46090 (2022-003)

Material Weakness 2022

Total Health Care, Inc.

MD

Questioned Costs Allowable Costs / Cost Principles Reporting

Views of Responsible Officials and Planned Corrective Actions - Management has updated its PRF documentation to include a lost revenue calculation in accordance with PRF guidance. The calculation fully supports the PRF funding received. Future reporting submissions will be prepared with oversight b...

Views of Responsible Officials and Planned Corrective Actions - Management has updated its PRF documentation to include a lost revenue calculation in accordance with PRF guidance. The calculation fully supports the PRF funding received. Future reporting submissions will be prepared with oversight by the parent organization. Organization contact persons responsible for corrective action: Richard Greene, CFO Anticipated completion date: Correction action has been completed and is awaiting feedback from HRSA on how to submit updated lost revenue calculation.

View Audit 40855 Questioned Costs: $1

Finding 46089 (2022-002)

Material Weakness 2022

Total Health Care, Inc.

MD

Reporting

Views of Responsible Officials and Planned Corrective Actions ? The Organization submitted the report within the allowable time granted by HRSA and the information provided on the report was accurate at the time the report was prepared and submitted to HRSA. An updated report with additional lost re...

Views of Responsible Officials and Planned Corrective Actions ? The Organization submitted the report within the allowable time granted by HRSA and the information provided on the report was accurate at the time the report was prepared and submitted to HRSA. An updated report with additional lost revenues, if required, will be provided to HRSA. Organization contact persons responsible for corrective action: Richard Greene, CFO Anticipated completion date: Correction action has been completed and is awaiting feedback from HRSA on how to submit updated lost revenue calculation.

View Audit 40855

Corrective Action Plans

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