Corrective Action Plans

Finding 1208253 (2021-001)

Material Weakness 2021

CORPORACION DEL FONDO DEL SEGURO DEL ESTADO

PR

Reporting Internal Control / Segregation of Duties Questioned Costs

As part of the preventive measures to file the Single Audit in a timely manner, an employee was selected to specifically dedicate time and effort related to auditing processes. Coordination of weekly meetings and phone calls with the external audit firm and the Programs has rendered immediate result...

As part of the preventive measures to file the Single Audit in a timely manner, an employee was selected to specifically dedicate time and effort related to auditing processes. Coordination of weekly meetings and phone calls with the external audit firm and the Programs has rendered immediate results to follow through with an established work plan. Therefore, time has been properly managed to collect the necessary information.

View Audit 399238

Finding 1205883 (2021-003)

Material Weakness 2021

City of Newark

NJ

Reporting

It is recommended that Management should ensure information is accessible and available for audit. Corrective Action and Explanation - The City of Newark will comply with the Auditor's recommendation. Implementation Date - December 31, 2023

View Audit 397668

Finding 1205748 (2021-003)

Material Weakness 2021

Rocky Mountain Tribal Leaders Council

MT

Reporting

RMTLC plans to learn the current government system for Federal Financial Report (FFR) reporting and accessing general ledger reports. The new system was implemented in 2025 under new administration and affected all previous funding prior to 2025. Therefore, some of those duties that we are dealing w...

RMTLC plans to learn the current government system for Federal Financial Report (FFR) reporting and accessing general ledger reports. The new system was implemented in 2025 under new administration and affected all previous funding prior to 2025. Therefore, some of those duties that we are dealing with, such as timely completion of financial close and the reporting process, has been lacking. The recently hired CPA has training and will help correct this issue.

View Audit 397476

Finding 1205746 (2021-002)

Material Weakness 2021

Rocky Mountain Tribal Leaders Council

MT

Questioned Costs Reporting

RMTLC hired a new CPA to help with the process of completing the audit on time in the future. Unfortunately, we are still in catch-up mode and have a learning curve for getting the audits completed on time. The COVID-19 situation also delayed the process for our finance team. This finding will conti...

RMTLC hired a new CPA to help with the process of completing the audit on time in the future. Unfortunately, we are still in catch-up mode and have a learning curve for getting the audits completed on time. The COVID-19 situation also delayed the process for our finance team. This finding will continue for the 2022 audit and several following years.

View Audit 397476

Finding 1181990 (2021-008)

Material Weakness 2021

Open Door Ministries of High Point, Inc.

NC

Questioned Costs Reporting Significant Deficiency § 200.303

Department of Veterans Affairs Federal Program Name: VA Homeless Providers Grant and Per Diem Program Assistance Listing Number: 64.024 Recommendation: We recommend the Organization design controls to ensure an adequate review process is in place to ensure that required reports are accurate and subm...

Department of Veterans Affairs Federal Program Name: VA Homeless Providers Grant and Per Diem Program Assistance Listing Number: 64.024 Recommendation: We recommend the Organization design controls to ensure an adequate review process is in place to ensure that required reports are accurate and submitted within the required timeframe. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: Management has implemented formal reporting controls to ensure all required reports are prepared accurately, reviewed appropriately, and submitted within the required timelines. These controls include a structured reporting calendar with submission deadlines, assignment of responsibility for report preparation and review, and a standardized review and approval process prior to submission. The Organization has also developed documentation procedures to retain evidence of supervisory review, validation of key data points, and confirmation of timely submission. These enhancements are intended to reduce risk of late submissions and improve the accuracy and consistency of program reporting. Name(s) of the contact person(s) responsible for corrective action: Ryan Ross, Executive Director Planned completion date for corrective action plan: March 31, 2026

View Audit 393351

Finding 1179948 (2021-003)

Material Weakness 2021

ADAMS COUNTY PUBLIC HOSPITAL DISTRICT #3 D/B/A OTHELLO COMMUNITY HOSPITAL

WA

Reporting Significant Deficiency Internal Control / Segregation of Duties

The District hired a new Chief Financial Officer in 2023 and was able to catch the District up on three years of financials statements and all missing audits. The new CFO made the following changes to ensure compliance: 1. Update internal controls and monitoring. The new CFO created a Federal Fundin...

The District hired a new Chief Financial Officer in 2023 and was able to catch the District up on three years of financials statements and all missing audits. The new CFO made the following changes to ensure compliance: 1. Update internal controls and monitoring. The new CFO created a Federal Funding Monitoring and Reporting Policy that specifies that responsibilities over compliance, expenditures, and reporting. 2. Implement Process Improvements. The new CFO and Accounts Payable were able to identify grant fund expenditures and work closely to make sure all future grant expenditures are identified and tracked. 3. Communicate with External Audit Team. The new CFO communicates regularly with the external audit team to ensure they are aware of the grant funds received and the type of audit that is required and coordinate audits with plenty of time to complete the audit before deadlines.

View Audit 392296

Finding 1179947 (2021-002)

Material Weakness 2021

ADAMS COUNTY PUBLIC HOSPITAL DISTRICT #3 D/B/A OTHELLO COMMUNITY HOSPITAL

WA

Reporting Significant Deficiency § 200.512

The District hired a new Chief Financial Officer in 2023 and was able to catch the District up on three years of financials statements and all missing audits. The new CFO made the following changes to ensure compliance: 1. Update internal controls and monitoring. The new CFO created a Federal Fundin...

The District hired a new Chief Financial Officer in 2023 and was able to catch the District up on three years of financials statements and all missing audits. The new CFO made the following changes to ensure compliance: 1. Update internal controls and monitoring. The new CFO created a Federal Funding Monitoring and Reporting Policy that specifies that responsibilities over compliance, expenditures, and reporting. 2. Implement Process Improvements. The new CFO and Accounts Payable were able to identify grant fund expenditures and work closely to make sure all future grant expenditures are identified and tracked. 3. Communicate with External Audit Team. The new CFO communicates regularly with the external audit team to ensure they are aware of the grant funds received and the type of audit that is required and coordinate audits with plenty of time to complete the audit before deadlines.

View Audit 392296

Finding 1177796 (2021-012)

Material Weakness 2021

St. Croix Chippewa Housing Authority

CA

Subrecipient Monitoring Material Weakness Reporting § 200.302 § 200.327

2021-012 Financial Statement Reconciliations/Tie-In Procedures Material Weakness Recommendation: The Housing Authority should adopt written reconciliation and tie-in procedures into its financial policies and procedures manual. These policies should require timely reconciliations to take place as de...

2021-012 Financial Statement Reconciliations/Tie-In Procedures Material Weakness Recommendation: The Housing Authority should adopt written reconciliation and tie-in procedures into its financial policies and procedures manual. These policies should require timely reconciliations to take place as defined under policy. Action Taken: The Housing Authority agrees with this finding and will implement this recommendation within 120 days of this audit report.

View Audit 391158

Finding 1177795 (2021-011)

Material Weakness 2021

St. Croix Chippewa Housing Authority

CA

Matching / Level of Effort / Earmarking Subrecipient Monitoring Cash Management § 200.305

2021-011 Timely Grant Draws Material Weakness Recommendation: The Housing Authority should adopt written grant draw policies into its financial policies and procedures manual. Financials should be reviewed monthly, and drawdowns made as needed. Action Taken: The Housing Authority agrees with this fi...

2021-011 Timely Grant Draws Material Weakness Recommendation: The Housing Authority should adopt written grant draw policies into its financial policies and procedures manual. Financials should be reviewed monthly, and drawdowns made as needed. Action Taken: The Housing Authority agrees with this finding and will implement this recommendation within 120 days of this audit report.

View Audit 391158

Finding 1177793 (2021-009)

Material Weakness 2021

St. Croix Chippewa Housing Authority

CA

Reporting

2021-009 Late Audit Submission Material Weakness Recommendation: Ensure your books are closed in a timely fashion and schedule audit work to begin early enough so that your reporting package will be submitted on time. Action Taken: The Housing Authority agrees with this finding and will implement th...

2021-009 Late Audit Submission Material Weakness Recommendation: Ensure your books are closed in a timely fashion and schedule audit work to begin early enough so that your reporting package will be submitted on time. Action Taken: The Housing Authority agrees with this finding and will implement this recommendation within 120 days of this audit report.

View Audit 391158

Finding 1176727 (2021-001)

Material Weakness 2021

Chuloonawick Native Village

AK

Allowable Costs / Cost Principles Reporting

Chuloonawick Native Village agrees with the finding and will retain documentation supporting its expenditures for subsequent audits and train all new staff correct filing procedures.

View Audit 390654

Finding 1176708 (2021-005)

Material Weakness 2021

Beartooth Billings Clinic

MT

Allowable Costs / Cost Principles Questioned Costs Cash Management

Following the Period 1 submission, the Organization identified that the patient revenue figures used in the lost revenue calculation did not reconcile to the audited financial statements. The lost revenue model was subsequently re performed using audited patient revenue data, and the corrected calcu...

Following the Period 1 submission, the Organization identified that the patient revenue figures used in the lost revenue calculation did not reconcile to the audited financial statements. The lost revenue model was subsequently re performed using audited patient revenue data, and the corrected calculation was incorporated into the Period 4 PRF submission. To prevent recurrence, the Organization has strengthened its internal review protocols for reporting, including mandatory reconciliation of all revenue inputs to audited financial statements and secondary review by the Regional Controller prior to submission. These enhanced controls ensure that future lost revenue calculations are accurate, supportable, and compliant with HRSA reporting requirements.

View Audit 390602

Finding 1176707 (2021-004)

Material Weakness 2021

Beartooth Billings Clinic

MT

Allowable Costs / Cost Principles Questioned Costs Cash Management

Capital expenditures charged to the PRF program were allowable; however, at June 30, 2021, HHS had not yet issued clear technical guidance indicating that capital costs must be fully completed or received within the Period of Availability, therefore causing the expenditures to be out of period. Defi...

Capital expenditures charged to the PRF program were allowable; however, at June 30, 2021, HHS had not yet issued clear technical guidance indicating that capital costs must be fully completed or received within the Period of Availability, therefore causing the expenditures to be out of period. Definitive guidance clarifying this requirement was not released until August 2021, after the close of the reporting period. As a result, the Organization applied the best available interpretation at the time of close. To prevent similar issues, the Organization will incorporate ongoing monitoring of updated directives, strengthen pre submission technical reviews, and consult with external advisors to validate compliance with period of availability rules prior to future filings.

View Audit 390602

Finding 1176706 (2021-003)

Material Weakness 2021

Beartooth Billings Clinic

MT

Allowable Costs / Cost Principles Questioned Costs Cash Management

The keying error in the original Period 1 submission was corrected in the Period 4 PRF report, and additional review controls have been implemented to prevent manual data-entry inaccuracies. G&A expenses, initially allocated based on limited guidance, are now supported by a standardized methodology ...

The keying error in the original Period 1 submission was corrected in the Period 4 PRF report, and additional review controls have been implemented to prevent manual data-entry inaccuracies. G&A expenses, initially allocated based on limited guidance, are now supported by a standardized methodology with full underlying documentation in line with PRF reporting requirements.

View Audit 390602

Finding 1176174 (2021-003)

Material Weakness 2021

City of Chester

PA

Eligibility Material Weakness Reporting

The City agrees with the finding. Starting in the summer of 2024, procedures were implemented to begin monthly financial statements leading to being prepared for more timely year-end closings. These procedures included expenditure and revenue reports being prepared and reviewed, as well as checklist...

The City agrees with the finding. Starting in the summer of 2024, procedures were implemented to begin monthly financial statements leading to being prepared for more timely year-end closings. These procedures included expenditure and revenue reports being prepared and reviewed, as well as checklists and reconciliations being prepared and reviewed. Retroactive review processes are underway regarding 2022 and 2023 years to be audited.

View Audit 389991

Finding 1171351 (2021-002)

Material Weakness 2021

Ekentucky Advanced Manufacturing Institute INC

KY

Allowable Costs / Cost Principles Reporting Internal Control / Segregation of Duties § 200.512

We concur with the recommendation. The required filings are done in conjunction with the audits of the organization's financial statements. The organization is actively working to get the audits and the required filings current. The organization will submit the infomrntion lo the audit firm for 2022...

We concur with the recommendation. The required filings are done in conjunction with the audits of the organization's financial statements. The organization is actively working to get the audits and the required filings current. The organization will submit the infomrntion lo the audit firm for 2022 by January 3 1, 2026. The information for audits of the subsequent years' financial statements will be submitted within 30 days of the completion of the prior year audit. The organization expects to be current on the audits and filings by December 31, 2027.

View Audit 384645

Finding 1170873 (2021-001)

Material Weakness 2021

RTC Industries, Inc.

OH

Questioned Costs Reporting § 200.512

Corrective Action Plan Agency: Department of Transportation, passed through Ohio Department of Transportation Audit Period: 2021 Audit Finding Number: 2021-01 Audit Finding Title: Noncompliance with Audit Submission Requirements Corrective Action Plan: Management concurs with the finding. Management...

Corrective Action Plan Agency: Department of Transportation, passed through Ohio Department of Transportation Audit Period: 2021 Audit Finding Number: 2021-01 Audit Finding Title: Noncompliance with Audit Submission Requirements Corrective Action Plan: Management concurs with the finding. Management has engaged a new audit service provider and has implemented plans to complete the required audits and submit the required Reporting package and Data Collection Forms. Anticipated Completion Date: With the hiring of new auditors, the corrective action plan is substantially completed even though the work is ongoing. Contact Person Responsible: Tina Burrey, Finance Director

View Audit 384180

Finding 1168971 (2021-002)

Material Weakness 2021

Alabama Rural Coalition for the Homeless INC

AL

Reporting

Management agrees with this finding. Management will take the appropriate actions to ensure that its Single Audit Reporting Package is submitted to the Federal Audit Clearinghouse no later than nine months after fiscal year end.

View Audit 381641

Finding 1168770 (2021-004)

Material Weakness 2021

VALLEY CITY PUBLIC SCHOOL DISTRICT

ND

Questioned Costs Material Weakness Reporting

Contact Person Jackie Cordie, Business Manager Corrective Action Plan The District plans to implement the auditor's recommendation. Planned Completion Date for CAP Fiscal year beginning July 1, 2024

View Audit 380881

Finding 1167847 (2021-003)

Material Weakness 2021

Northern Marianas Housing Corporation

FM

HUD Housing Programs Reporting

Corrective Action: NMHC will strengthen controls over compliance with applicable Uniform Financial Reporting Standards reporting requirements and the timely reconciliation of its general ledger accounts. NMHC will make sure to distinguish the reporting between the VMS and FDS for reporting purposes ...

Corrective Action: NMHC will strengthen controls over compliance with applicable Uniform Financial Reporting Standards reporting requirements and the timely reconciliation of its general ledger accounts. NMHC will make sure to distinguish the reporting between the VMS and FDS for reporting purposes only.

View Audit 379196

Finding 1165510 (2021-001)

Material Weakness 2021

New Directions, Inc.

CA

Internal Control / Segregation of Duties Questioned Costs Subrecipient Monitoring

Management concurs that there were staffing and turnover challenges for the Organization. Adequate policies and procedures are in place to ensure timeliness of data requested. Additionally, we will establish milestones to ensure future audits progress within the Uniform Guidance timeline.

View Audit 376224

Finding 1165037 (2021-009)

Material Weakness 2021

Pima Council on Aging

AZ

Questioned Costs Material Weakness Reporting

Finding Number 2021-009: No Internal Review of SEFA Prior to Submission (Internal Controls), July 1, 2020 through June 30,2021. Statement of Condition: PCOA did not complete an internal review of SEFA prior to submission PCOA personnel responsible for enacting corrective action plan: Jay Huffstutler...

Finding Number 2021-009: No Internal Review of SEFA Prior to Submission (Internal Controls), July 1, 2020 through June 30,2021. Statement of Condition: PCOA did not complete an internal review of SEFA prior to submission PCOA personnel responsible for enacting corrective action plan: Jay Huffstutler, Finance Director, jhuffstutler@pcoa.org The corrective action plan:  PCOA has instituted an internal review and approval process for the Schedule of Expenditures of Federal Awards (SEFA), which now requires sign-off by the Finance Director prior to submission to the auditors.  The third-party accounting firm prepared and reconciled the SEFA in collaboration with internal staff  Technical hires are being made to ensure continued compliance and review capacity during year-end closing. Completion Date: July 31, 2025

View Audit 375125

Finding 1165036 (2021-008)

Material Weakness 2021

Pima Council on Aging

AZ

Questioned Costs Material Weakness Reporting

Finding Number 2021-008 : Noncompliance with Federal Reporting Requirements (Reporting), July 1, 2020 through June 30,2021. Statement of Condition: PCOA did not comply with Federal Reporting Requirements PCOA personnel responsible for enacting corrective action plan: Jay Huffstutler, Finance Directo...

Finding Number 2021-008 : Noncompliance with Federal Reporting Requirements (Reporting), July 1, 2020 through June 30,2021. Statement of Condition: PCOA did not comply with Federal Reporting Requirements PCOA personnel responsible for enacting corrective action plan: Jay Huffstutler, Finance Director, jhuffstutler@pcoa.org The corrective action plan:  PCOA, with the assistance of DES, has created a grant compliance tracking system.  PCOA has also implemented oversight procedures to ensure all federal reports are submitted accurately and on time.  The Finance Director will assist in structuring these controls around the training program and finance staff.  The Finance Director oversees this process, and their capacity to do so has been strengthened through targeted hiring of experienced finance professionals.

View Audit 375125

Finding 1165031 (2021-003)

Material Weakness 2021

Pima Council on Aging

AZ

Allowable Costs / Cost Principles Cash Management Reporting

Finding Number 2021-003: Lack of Review of Meal Sign-In Sheets (Allowable Costs/Cost Principles) , July 1, 2020 through June 30,2021. Statement of Condition: The Meal Sign-in Sheets were not regularly and consistently attached to proper documentation. PCOA personnel responsible for enacting correcti...

Finding Number 2021-003: Lack of Review of Meal Sign-In Sheets (Allowable Costs/Cost Principles) , July 1, 2020 through June 30,2021. Statement of Condition: The Meal Sign-in Sheets were not regularly and consistently attached to proper documentation. PCOA personnel responsible for enacting corrective action plan: Francine McGetrick, Contracts Director, Fmcgetrick@pcoa.org The corrective action plan: 1. PCOA has implemented procedures requiring internal review of all client sign-in sheets related to meals billed for reimbursement. 2. While the required sign-in documentation was completed and retained, it was stored in the contracts area and not submitted with the DES files. A new process has been established to ensure that sign-in sheets are filed along with the corresponding summary information at the time of submission. 3. PCOA has designed the updated process and trained staff to ensure proper documentation is verified prior to billing. 4. Ongoing compliance is now overseen by the Director of Contracts, and operational staff have been re-trained to ensure consistent execution. Completion Date: June 30th, 2025

View Audit 375125

Finding 1165030 (2021-002)

Material Weakness 2021

Pima Council on Aging

AZ

Questioned Costs Material Weakness Reporting

Finding Number 2021-002: – Late Filing of Uniform Guidance Audit, July 1, 2020 through June 30,2021. Statement of Condition: PCOA did not file the Uniform Guidance Audit before the established deadline PCOA personnel responsible for enacting corrective action plan: Jay Huffstutler, Finance Director,...

Finding Number 2021-002: – Late Filing of Uniform Guidance Audit, July 1, 2020 through June 30,2021. Statement of Condition: PCOA did not file the Uniform Guidance Audit before the established deadline PCOA personnel responsible for enacting corrective action plan: Jay Huffstutler, Finance Director, jhuffstutler@pcoa.org The corrective action plan: Background: Prior to fiscal year 2021, PCOA consistently completed and submitted its Uniform Guidance audits on time. The delay in filing for fiscal year 2020–2021 was primarily due to a change in executive leadership, which significantly impacted internal capacity and oversight during that period. PCOA acknowledges the missed filing deadline and has since taken corrective action, including hiring a new Finance Director and engaging a third-party accounting firm to support the finance team during the transition and assist in bringing all outstanding audits current. These measures have been implemented to ensure timely and compliant audit submissions moving forward. 1. A finance compliance calendar has been established, and oversight of reporting deadlines will be completed by the newly hired Finance Director. 2. The third-party accounting firm supports timely preparation and review of audit materials. 3. New accounting staff are also being hired to ensure workload coverage and continuity during critical reporting periods. 4. In addition, ongoing training and cross-training of staff will continue under the direction of the Finance Director to strengthen internal capacity and mitigate future risks. Completion Date: June 30, 2025

View Audit 375125

Corrective Action Plans

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