Corrective Action Plans

Finding 11921 (2021-007)

Significant Deficiency 2021

Redevelopment Authority of the County of Berks

PA

Reporting Significant Deficiency Internal Control / Segregation of Duties

The Authority contracted with Neighborly Software for a program to use with ERAP. At the beginning of ERAP, the Authority relied upon the data from the Neighborly program to generate its reports. By the 4th quarter of 2021, the Authority realized it could only utilize a portion of the Neighborly p...

The Authority contracted with Neighborly Software for a program to use with ERAP. At the beginning of ERAP, the Authority relied upon the data from the Neighborly program to generate its reports. By the 4th quarter of 2021, the Authority realized it could only utilize a portion of the Neighborly program for the data required for the reports and needed to supplement or add its own internal data. This method of utilizing Neighborly and internal data is now being used for reports.

View Audit 15886

Finding 11911 (2021-002)

Material Weakness 2021

Turning Point, Inc.

NC

Material Weakness Reporting Internal Control / Segregation of Duties § 200.501

Resolved

View Audit 15838

Finding 11910 (2021-001)

Material Weakness 2021

Turning Point, Inc.

NC

Material Weakness Reporting

Resolved

View Audit 15838

Finding 11848 (2021-005)

Material Weakness 2021

Arizona Immigrant and Refugee Services, INC

AZ

Reporting

The Organization will ensure to complete in an efficient and timely manner the submission of the audit within the required 9 month after fiscal year end as required by the Uniform Guidance and will work the audit firm to develop a schedule to ensure that future audits and single audits are completed...

The Organization will ensure to complete in an efficient and timely manner the submission of the audit within the required 9 month after fiscal year end as required by the Uniform Guidance and will work the audit firm to develop a schedule to ensure that future audits and single audits are completed timely and that the data collection reporting package is submitted to the federal audit clearinghouse by the due date for the year ended September 30, 2024 and future years.

View Audit 15688

Finding 11223 (2021-006)

Material Weakness 2021

Dewitt Hospital and Nursing Home, INC

AR

Questioned Costs Allowable Costs / Cost Principles Reporting

Finding 2021-006 The Hospital’s Provider Relief Fund portal reporting submission included cost deemed to be unallowable of $1,114,902. Also, the Hospital's portal reporting submission included errors in the lost revenue calculation resulting in lost revenues being overstated by $266,223. Comments ...

Finding 2021-006 The Hospital’s Provider Relief Fund portal reporting submission included cost deemed to be unallowable of $1,114,902. Also, the Hospital's portal reporting submission included errors in the lost revenue calculation resulting in lost revenues being overstated by $266,223. Comments on the Finding and Recommendation Management is in agreement with this finding and the related recommendation.

View Audit 15006 Questioned Costs: $1

Finding 11139 (2021-002)

Material Weakness 2021

Kama'aina Care, Inc.

HI

Reporting Internal Control / Segregation of Duties

We acknowledge the importance of updating the Policies and Procedures and ware dedicated to achieving and maintaining full compliance. We are committed to a comprehensive review and update of our manuals. Our goal is to ensure that all written polies and procedures are in compliance with the specifi...

We acknowledge the importance of updating the Policies and Procedures and ware dedicated to achieving and maintaining full compliance. We are committed to a comprehensive review and update of our manuals. Our goal is to ensure that all written polies and procedures are in compliance with the specified federal award requirements and reflect high standards of accountability and transparency. Due to the importance of adhering to federal regulations, we will work diligently to incorporate the necessary revisions under the guidance of our Chief Financial Officer.

View Audit 14921

Finding 11003 (2021-002)

Significant Deficiency 2021

Cornwall Manor

PA

Reporting Significant Deficiency Internal Control / Segregation of Duties

The Manor agrees with the finding and misinterpreted the guidance. The Manor agrees that they should have selected option iii as independent living revenues were not affected and personal care was undergoing renovations and thus the comparison of actual personal care revenues was not appropriate. ...

The Manor agrees with the finding and misinterpreted the guidance. The Manor agrees that they should have selected option iii as independent living revenues were not affected and personal care was undergoing renovations and thus the comparison of actual personal care revenues was not appropriate. Management will correct the error in future filings.

View Audit 14852

Finding 10971 (2021-001)

Material Weakness 2021

Oregon Coalition Against Domestic & Sexual Violence

OR

Subrecipient Monitoring Allowable Costs / Cost Principles Internal Control / Segregation of Duties § 200.414 § 200.68

Contact person(s) responsible: Executive Director Vanessa Timmons; Associate Director Keri Moran Kuhn; Accounting Manager Linda Koonce. Corrective action planned: OCADSV added an Administrative Cost Center to its General Ledger effective 10-01-22, the beginning of FY23, and began costing administ...

Contact person(s) responsible: Executive Director Vanessa Timmons; Associate Director Keri Moran Kuhn; Accounting Manager Linda Koonce. Corrective action planned: OCADSV added an Administrative Cost Center to its General Ledger effective 10-01-22, the beginning of FY23, and began costing administrative payroll costs to that cost center. Additionally, the organization re-trained administrative staff on direct cost-allowable activities vs. administrative activities relative to timekeeping and timesheet preparation and the necessity of daily work descriptions supporting the hourly allocation. The payroll policy that requires supervisors to review and sign off on timesheets and hourly allocations to cost centers was also reviewed. OCADSV is developing a formal cost allocation plan to recover direct and indirect costs using the 10% de minimis of Modified Total Direct Cost. The allocation will be applied monthly and incorporated into the annual budgeting process. Anticipated completion date: Effective 6-21-23 and ongoing

View Audit 14814

Finding 10970 (2021-006)

Significant Deficiency 2021

Oregon Coalition Against Domestic & Sexual Violence

OR

Internal Control / Segregation of Duties Subrecipient Monitoring Reporting § 200.512

Contact person(s) responsible: Executive Director Vanessa Timmons; Associate Director Keri Moran-Kuhn; Accounting Manager Linda Koonce Corrective Action Planned: During this time OCADSV went through several temporary fiscal staff and one permanent hired staff that had made mistakes, with the effect ...

Contact person(s) responsible: Executive Director Vanessa Timmons; Associate Director Keri Moran-Kuhn; Accounting Manager Linda Koonce Corrective Action Planned: During this time OCADSV went through several temporary fiscal staff and one permanent hired staff that had made mistakes, with the effect of having to make adjustments in order to attempt to close accounting records. Controls have been put into place and permanent accounting manager is in place. Anticipated Date of Completion: 01-24-2022

View Audit 14814

Finding 10680 (2021-010)

Material Weakness 2021

Town of Princeville

NC

Subrecipient Monitoring Cash Management Material Weakness

Name of Contact Person: Dr. Glenda Knight, Town Manager Corrective Action Plan: Management will ensure that remaining FEMA projects are closed out on a timely basis. Anticipated Completion Date: Management will implement the above procedure immediately.

View Audit 14355

Finding 10534 (2021-003)

Significant Deficiency 2021

Crotona Estates Housing Development Fund Company, Inc.

NY

Reporting

Recommendation: We recommend that the electronic submission to REAC be filed as soon as possible. Action Taken: Oversight of the filing process is being reviewed and adjusted to ensure the electronic submission to REAC will be filed as soon as possible and on a timely basis going forward.

View Audit 14259

Finding 10405 (2021-005)

Material Weakness 2021

Dunseith Public School District No. 1

ND

Reporting School Nutrition Programs

2021-005 Contact Person Evan Peltier Planned Corrective Action Dunseith Public School Dist. #1 will implement the recommendation from Brady Martz. Planned Completion Date The planned completion date will be the start of FY-24.

View Audit 14076

Finding 10111 (2021-005)

Material Weakness 2021

Hill & Dales General Hospital and Subsidiary

MI

Questioned Costs Allowable Costs / Cost Principles Material Weakness § 200.303

Finding 2021-005 Federal Agency Name: Department of Health and Human Services Program Name: COVID-19 Provider Relief Fund and American Rescue Plan Federal Financial Assistance Listing: #93.498 Finding Summary: The Organization claimed expenses that were reimbursed by other funding sources. These exp...

Finding 2021-005 Federal Agency Name: Department of Health and Human Services Program Name: COVID-19 Provider Relief Fund and American Rescue Plan Federal Financial Assistance Listing: #93.498 Finding Summary: The Organization claimed expenses that were reimbursed by other funding sources. These expenses were improperly included in the HHS Special Report which caused the report to be inaccurate. Responsible Individuals: Renee Henry, Director of Finance Corrective Action Plan: The Organization will implement internal control policies to ensure all amounts reimbursed by other funding sources are adequately documented and reduced from the eligible expenditure listing and ensure are properly recorded in the report required to be submitted to the federal agency. The Organization will also implement a review process 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: March 31, 2024

View Audit 13756 Questioned Costs: $1

Finding 10110 (2021-004)

Material Weakness 2021

Hill & Dales General Hospital and Subsidiary

MI

Subrecipient Monitoring Material Weakness Reporting § 200.303

Finding 2021-004 Federal Agency Name: Department of Health and Human Services Program Name: COVID-19 Provider Relief Fund and American Rescue Plan Federal Financial Assistance Listing: #93.498 Finding Summary: The Organization’s final lost revenue calculation identified as eligible and claimed under...

Finding 2021-004 Federal Agency Name: Department of Health and Human Services Program Name: COVID-19 Provider Relief Fund and American Rescue Plan Federal Financial Assistance Listing: #93.498 Finding Summary: The Organization’s final lost revenue calculation identified as eligible and claimed under the Provider Relief Fund program did not agree to the amount claimed in the report submitted to the Department of Health and Human Services for Period 1. Responsible Individuals: Renee Henry, Director of Finance Corrective Action Plan: Management will implement a control process and policy which includes monitoring over amounts reported relating to lost revenue amounts and the related calculation. Anticipated Completion Date: March 31, 2024

View Audit 13756

Finding 10109 (2021-003)

Material Weakness 2021

Hill & Dales General Hospital and Subsidiary

MI

Allowable Costs / Cost Principles Eligibility Material Weakness § 200.303

Finding 2021-003 Federal Agency Name: Department of Health and Human Services Program Name: COVID-19 Provider Relief Fund and American Rescue Plan Federal Financial Assistance Listing: #93.498 Finding Summary: The Organization did not have an adequate internal control policy in place to ensure revie...

Finding 2021-003 Federal Agency Name: Department of Health and Human Services Program Name: COVID-19 Provider Relief Fund and American Rescue Plan Federal Financial Assistance Listing: #93.498 Finding Summary: The Organization did not have an adequate internal control policy in place to ensure review and approval of the lost revenue calculation and report submitted to the Department of Health and Human Services for Period 1. Responsible Individuals: Renee Henry, Director of Finance Corrective Action Plan: Management will implement a control process and policy which includes a secondary review and approval of any future lost revenue calculation and report submitted under the federal program. Anticipated Completion Date: March 31, 2024

View Audit 13756

Finding 9575 (2021-001)

Material Weakness 2021

Cascadia Behavioral Healthcare, Inc.

OR

Reporting

In accordance with OMB Uniform Guidance, we have provided below Cascadia Behavioral Healthcare, Inc. and Affiliates’ response and corrective action plan addressing the findings in the “Report on Federal Awards in Accordance with the OMB Uniform Guidance” for the fiscal year that ended June 30, 2021....

In accordance with OMB Uniform Guidance, we have provided below Cascadia Behavioral Healthcare, Inc. and Affiliates’ response and corrective action plan addressing the findings in the “Report on Federal Awards in Accordance with the OMB Uniform Guidance” for the fiscal year that ended June 30, 2021. Finding 2021-001: Schedule of Expenditures of Federal Awards (SEFA) – Material Weakness in Internal Control over Compliance Management agrees with the finding and the auditor’s recommendation. Contact Person responsible for corrective action: Ryan Wilson Ryan.wilson@cascadiahealth.org Corrective Action Planned: For the year ended June 30, 2022, additional procedures were incorporated into our SEFA preparation process including steps to identify contracts containing federal award amounts. These steps included 1) additional layers of review by the revenue management team, 2) additional internal review of any confirmations received from state and local agencies indicating federal funding, and 3) additional review of the draft SEFA for completeness. Anticipated Completion Date: Management has resolved this matter.

View Audit 13243

Finding 9523 (2021-002)

Significant Deficiency 2021

Women's Coalition of St. Croix

VI

Reporting

The STOP Annual Subgrantee award was filed two-weeks late in FY2021 due to transitions in staff. In the future, WCSC’s Executive Director will ensure to file this report within thirty days of the end of the calendar year. She will work with program staff to collect the necessary statistics for the ...

The STOP Annual Subgrantee award was filed two-weeks late in FY2021 due to transitions in staff. In the future, WCSC’s Executive Director will ensure to file this report within thirty days of the end of the calendar year. She will work with program staff to collect the necessary statistics for the report beginning in December of each year, ensuring that there is ample time to prepare and submit the report. If there are any anticipated delays to filing this report, the Executive Director will obtain written permission for an extension from the grantor. Estimated Completion Date: Fiscal Year 2022

View Audit 13179

Finding 9521 (2021-001)

None 2021

Women's Coalition of St. Croix

VI

Reporting § 200.512

Transitions in WCSC financial personnel during and after year-end resulted delays to the audit process for this audit period (FY2021) and the subsequent audit period ending September 30, 2022. To address this problem, WCSC hired a fiscal consultant in August 2022 to oversee the fiscal office, prepar...

Transitions in WCSC financial personnel during and after year-end resulted delays to the audit process for this audit period (FY2021) and the subsequent audit period ending September 30, 2022. To address this problem, WCSC hired a fiscal consultant in August 2022 to oversee the fiscal office, prepare and complete all grant reports, and to coordinate all fiscal audits. WCSC also hired a full-time bookkeeper in October 2022 to conduct day-to-day financial transactions and to assist with audit and grant reporting. WCSC has already engaged its Auditors to conduct the FY2022 audit, which will commence immediately following the completion of the FY2021 audit. This would put WCSC on track to complete the FY2023 audit by June 2024, thus meeting the requirement to submit the audit to the Federal Audit Clearing House within nine months after year-end. The timeline for the completion of the two subsequent audits is as follows: Estimated Completion Date: June 30, 2024

View Audit 13179

Finding 9478 (2021-002)

Significant Deficiency 2021

County of Stephens

TX

Subrecipient Monitoring Reporting

The County will begin to track grant receipts and expenditures through the County Judge's office and put checks and balances in place with duplicate tracking by the County Treasurer. Grants will be tracked in an excel spreadsheet by State and Federal grant expenditures to ensure that the County is o...

The County will begin to track grant receipts and expenditures through the County Judge's office and put checks and balances in place with duplicate tracking by the County Treasurer. Grants will be tracked in an excel spreadsheet by State and Federal grant expenditures to ensure that the County is overseeing grants in a way that it will be prepared in the event that a siingle audit is triggered in any given year.

View Audit 12996

Finding 9284 (2021-005)

None 2021

Gary Chicago International Airport Authority

IN

Reporting

Audit Finding: Late Issuance of the 2021 Single Audit Reporting Package. Corrective Action Taken: We have taken the necessary steps to ensure timeliness of the financial close each year moving forward. Due to multiple restatements from the 2020 audit as well as adjustments/corrections to the financi...

Audit Finding: Late Issuance of the 2021 Single Audit Reporting Package. Corrective Action Taken: We have taken the necessary steps to ensure timeliness of the financial close each year moving forward. Due to multiple restatements from the 2020 audit as well as adjustments/corrections to the financials, it delayed the completion and issuance of the 2021 single audit. The authority understands and takes accountability for moving the audit forward in a timely manner. The late issuance of the 2021 audit will also effective the issuance of the 2022 audit however, we are confident that the 2023 audit will close timely and subsequent single audit filings. Responsible Parties: Dasha Chandler-Thompson, Finance Manage and Daniel Vicari, Executive Director. Anticipated Completion Date: 09/30/2024

View Audit 12719

Finding 9231 (2021-003)

Significant Deficiency 2021

400-408 Housing Development Fund Company INC

NY

Subrecipient Monitoring Reporting Significant Deficiency

Management has acknowledged a breach in protocol and is in the process of transferring the tenants' security deposits collected and held in the operating bank account to a segregated bank account.

View Audit 12646

Finding 9230 (2021-002)

Significant Deficiency 2021

400-408 Housing Development Fund Company INC

NY

HUD Housing Programs Cash Management Reporting

Management has acknowledged a breach in protocol and deposited the current year’s surplus cash on December 2, 2021.

View Audit 12646

Finding 9191 (2021-003)

Material Weakness 2021

Women's Center of East Texas

TX

Allowable Costs / Cost Principles Cash Management Material Weakness

A policy has been implemented that requires the HR Director (whome processed payroll) to submit biweekly payroll to the Executive Director to review and approve prior to payroll being issued. An electronic approval is saved for each pay period. Further, the Finance Director and Executive Director ha...

A policy has been implemented that requires the HR Director (whome processed payroll) to submit biweekly payroll to the Executive Director to review and approve prior to payroll being issued. An electronic approval is saved for each pay period. Further, the Finance Director and Executive Director have implemented frequent payroll allocation reviews to ensure that employees are properly allocating their time between funding sources. Secondly, when preparing invoices, the Grant Administrator submits drafts to the Finance Director and Executive Director to review and approve, and any billings that the Finance Director prepares are reviewed and approved by the Executive Director.

View Audit 12563

Finding 9188 (2021-001)

Material Weakness 2021

Women's Center of East Texas

TX

Allowable Costs / Cost Principles Cash Management Material Weakness

A policy has been implemented that requires the HR Director (whome processed payroll) to submit biweekly payroll to the Executive Director to review and approve prior to payroll being issued. An electronic approval is saved for each pay period. Further, the Finance Director and Executive Director ha...

A policy has been implemented that requires the HR Director (whome processed payroll) to submit biweekly payroll to the Executive Director to review and approve prior to payroll being issued. An electronic approval is saved for each pay period. Further, the Finance Director and Executive Director have implemented frequent payroll allocation reviews to ensure that employees are properly allocating their time between funding sources. Secondly, when preparing invoices, the Grant Administrator submits drafts to the Finance Director and Executive Director to review and approve, and any billings that the Finance Director prepares are reviewed and approved by the Executive Director.

View Audit 12563

Finding 8725 (2021-002)

Significant Deficiency 2021

City of Port Arthur

TX

Reporting Cash Management Significant Deficiency

Finding: 2021-002: Untimely and Inaccurate Reporting Corrective Action Plan Internal control policies and procedures surrounding reporting will be reviewed and updated, if necessary, to ensure that future reports are submitted accurately and timely. Person(s) Responsible Director of Finance Con...

Finding: 2021-002: Untimely and Inaccurate Reporting Corrective Action Plan Internal control policies and procedures surrounding reporting will be reviewed and updated, if necessary, to ensure that future reports are submitted accurately and timely. Person(s) Responsible Director of Finance Controller Anticipated Completion Date An updated policy manual was approved by the City Council on January 17,2023. New policies and procedures are expected to be fully implemented by March 31, 2024.

View Audit 11871

Corrective Action Plans

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