Corrective Action Plans

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Allowable Activities and Costs, Cash Management, and Reporting Health Center Cluster – Assistance Listing No. 93.224 Recommendation: We recommend the Clinic develop and implement formal policies and procedures to ensure consistent review and approval over all applicable compliance requirements for f...
Allowable Activities and Costs, Cash Management, and Reporting Health Center Cluster – Assistance Listing No. 93.224 Recommendation: We recommend the Clinic develop and implement formal policies and procedures to ensure consistent review and approval over all applicable compliance requirements for federal programs. This should include but not limited to assigning responsibility for each compliance area, implementing documented review and approval controls (e.g., review of financial reports, cash drawdowns, and grant expenditures), and retaining evidence of review (e.g., sign-offs, checklists, or electronic approvals). Action taken in response to finding: The Clinic has implemented policies and procedures to ensure formal review and approval is documented for each compliance area. Name(s) of the contact person(s) responsible for corrective action: Kim Wieloch, Finance Director Planned completion date for corrective action plan: April 1, 2026.
Finding 1213592 (2025-001)
Material Weakness 2025
Management acknowledges the delay in submitting the audit report due to staff capacity limitations. To prevent recurrence, they have established a formal year-end audit planning calendar with interim documentation deadlines and have implemented a structured, pre-audit check-list process to ensure al...
Management acknowledges the delay in submitting the audit report due to staff capacity limitations. To prevent recurrence, they have established a formal year-end audit planning calendar with interim documentation deadlines and have implemented a structured, pre-audit check-list process to ensure all documentation is finalized and reviewed at least 30 days prior to the deadline.
2025-002 Single Audit Submission Planned Corrective Action Plan: The District will ensure all supporting documentation is prepared and ready for Auditors. In addition, audit services will be procured with sufficient time to submit the single audit by the required timeline. Anticipated Completion Dat...
2025-002 Single Audit Submission Planned Corrective Action Plan: The District will ensure all supporting documentation is prepared and ready for Auditors. In addition, audit services will be procured with sufficient time to submit the single audit by the required timeline. Anticipated Completion Date: June 30, 2026 Responsible Contact Person: Judy James, Business Manager
Finding 2025-001 – Eligibility (Significant Deficiency in Internal Control Over Compliance and Instance of Noncompliance) Planned Corrective Action: The Seattle Indian Health Board is implementing enhanced corrective actions to ensure full compliance with Indian Health Service eligibility requiremen...
Finding 2025-001 – Eligibility (Significant Deficiency in Internal Control Over Compliance and Instance of Noncompliance) Planned Corrective Action: The Seattle Indian Health Board is implementing enhanced corrective actions to ensure full compliance with Indian Health Service eligibility requirements, specifically related to documentation of Tribal enrollment. While prior corrective actions established foundational training and audit processes, management has identified the need for stronger front-end controls, clearer accountability, and system-based safeguards to prevent recurrence. Seattle Indian Health Board will implement the following actions: 1. Strengthen Front-End Eligibility Controls - Eligibility verification protocols will be updated to require complete Tribal enrollment documentation prior to scheduling non-urgent appointments. - A standardized eligibility checklist will be embedded into intake workflows to ensure all required documentation is identified and collected before services are rendered. 2. System Enhancement and Documentation Tracking - Electronic health record workflows will be enhanced to include required fields and alters for missing eligibility documentation, including Tribal enrollment. - Patients with incomplete eligibility records will be flagged, and services will be limited to allowable scenarios until documentation is obtained. 3. Targeted Training and Competency Validation - All registration and front desk staff will undergo mandatory retraining focused specifically on Tribal enrollment documentation requirements and compliance standards. - Staff competency will be validated through post-training assessments and periodic spot checks. 4. Enhanced Monitoring and Internal Audit - Monthly eligibility audits will be expanded to include a statistically valid sample size and documented review of Tribal enrollment verification. - Audit results will be formally reported to executive leadership, with identified deficiencies tracked through resolution. - Repeat errors or noncompliance will be addressed through corrective coaching and performance management, as appropriate. Management believes these enhanced corrective actions directly address the root cause of the finding by strengthening preventive controls, improving staff competency, and increasing oversight and accountability. Name of Responsible Party: Tempest Dawson, Director of Clinic Operations Anticipated Completion Date: December 31, 2026.
In response to the Auditor’s recommendations, the Municipality will establish formal procedures to ensure that all required forms, including Form 90-91, are properly completed, maintained, and submitted in accordance with applicable grant requirements. Additionally, all supporting documentation rela...
In response to the Auditor’s recommendations, the Municipality will establish formal procedures to ensure that all required forms, including Form 90-91, are properly completed, maintained, and submitted in accordance with applicable grant requirements. Additionally, all supporting documentation related to the period of performance for each project will be identified, organized, and maintained, including approved project worksheets, grant award documentation, and related financial records. Furthermore, monitoring mechanisms and periodic reviews will be implemented to ensure ongoing compliance with applicable requirements and the timely availability of required documentation for audit and monitoring purposes.
The Municipality shall establish procedures, training programs, and internal controls to ensure compliance with the preparation and timely submission of the Single Audit Report to the Federal Audit Clearinghouse, as required by the OMB Super Circular Uniform Guidance and in accordance with the nine-...
The Municipality shall establish procedures, training programs, and internal controls to ensure compliance with the preparation and timely submission of the Single Audit Report to the Federal Audit Clearinghouse, as required by the OMB Super Circular Uniform Guidance and in accordance with the nine-month deadline established therein. In addition, the Department of Finance will monitor the progress of the work, including the preparation of financial statements, as well as the external audit and the single audit, so that for the fiscal year ending June 30, 2026, the reports are submitted by the established deadline of no later than March 31, 2027.
Finding 1211188 (2025-002)
Material Weakness 2025
Syntiro
ME
We agree with the finding and we will be reviewing and implementing the recommendations accordingly. We are committed to ensuring no duplication of costs across reporting periods and compliance with allocability requirements under Uniform Guidance on a prospective basis. This corrective action plan ...
We agree with the finding and we will be reviewing and implementing the recommendations accordingly. We are committed to ensuring no duplication of costs across reporting periods and compliance with allocability requirements under Uniform Guidance on a prospective basis. This corrective action plan will be implemented by June 30, 2026.
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.
Our program leadership are playing a more active role in reporting and compliance and are actively involving directors of programs in the process of reporting.
Our program leadership are playing a more active role in reporting and compliance and are actively involving directors of programs in the process of reporting.
CLS agrees with the finding. Notifications from the Legal Services Corporation regarding report due dates, including the TIG semiannual progress reports, will be forwarded to the responsible party. The responsible party will set a reminder one week before the due date on their calendar, as well as t...
CLS agrees with the finding. Notifications from the Legal Services Corporation regarding report due dates, including the TIG semiannual progress reports, will be forwarded to the responsible party. The responsible party will set a reminder one week before the due date on their calendar, as well as the due date. Due dates for all reports, including the TIG semi-annual progress reports, will be placed on the Operations Grant calendar. An agenda item will be added to the Operations Unit meeting to review the due dates for all reports due the following month.
Corrective Action Plan: A new procurement policy was developed, reviewed, and formally approved by the Board of Directors on January 20, 2026. The policy establishes procurement procedures aligned with industry best practices and strengthens internal controls to ensure transparency, accountability, ...
Corrective Action Plan: A new procurement policy was developed, reviewed, and formally approved by the Board of Directors on January 20, 2026. The policy establishes procurement procedures aligned with industry best practices and strengthens internal controls to ensure transparency, accountability, and compliance with applicable requirements. Individual(s) Responsible: Yolanda Adams Completion Date: Policy was voted on by the board and put into place subsequent to year end.
Corrective Action Plan: Training and ongoing education initiatives have been implemented to ensure reports are completed and submitted in accordance with established deadlines. The new Chief Financial Officer is actively monitoring report status and accuracy to ensure timely compliance. A defined re...
Corrective Action Plan: Training and ongoing education initiatives have been implemented to ensure reports are completed and submitted in accordance with established deadlines. The new Chief Financial Officer is actively monitoring report status and accuracy to ensure timely compliance. A defined reporting structure has been established to strengthen oversight, accountability, and adherence to all reporting requirements. Individual(s) Responsible: Yolanda Adams Completion Date: Plan has been implemented as of date of audit submission.
Federal Agency Name: Department of Housing and Urban Development Program Name: Section 242 – Mortgage Insurance - Hospitals Federal Financial Assistance Listing #: CFDA #14.128 Compliance Requirement: Special Tests and Provisions Finding Summary: During the fiscal year, the Organization entered into...
Federal Agency Name: Department of Housing and Urban Development Program Name: Section 242 – Mortgage Insurance - Hospitals Federal Financial Assistance Listing #: CFDA #14.128 Compliance Requirement: Special Tests and Provisions Finding Summary: During the fiscal year, the Organization entered into two new short term loans. A new loan is identified in the Mortgage Note Insured by HUD as the incurrence of additional indebtedness which, by terms of the agreement, should be approved by HUD in advance of entering into the loan agreement unless the loan meets certain requirements. If those requirements are met, then the Organization just needs to inform HUD of the new loan agreement. Responsible Individuals: Jay Hodges, Chief Financial Officer Corrective Action Plan: Management will enhance internal controls to ensure additional indebtedness is approved by HUD in advance of incurring such indebtedness. Anticipated Completion Date: April 29, 2026
Finding 2025-003: ALN 20.106 ABIA FAA, 3-48-0359-067-2021, 3-48-0359-071-2022, 3-48-0359-074-2024, 3-48-0359-073-2024, 3-48-0359-075-2024, 3-48-0359-077-2025, 3-48-0359-078-2025, 3-48-0359-079-2025, U.S. Department of Transportation — Significant Deficiency in Internal Control over Reporting and Fin...
Finding 2025-003: ALN 20.106 ABIA FAA, 3-48-0359-067-2021, 3-48-0359-071-2022, 3-48-0359-074-2024, 3-48-0359-073-2024, 3-48-0359-075-2024, 3-48-0359-077-2025, 3-48-0359-078-2025, 3-48-0359-079-2025, U.S. Department of Transportation — Significant Deficiency in Internal Control over Reporting and Finding of Non-compliance Contact Person – Lyn Estabrook, Deputy Chief, Airport Development Management Response – Concur. The Aviation Department has completed a thorough internal review of its FAA Airport Improvement Program (AIP) and other FAA grant reporting practices in response to the audit’s draft finding. This evaluation saw gaps in documentation and deadline management that contributed to delays and inconsistencies in required FAA performance reporting. While project updates were regularly communicated during monthly ADO coordination meetings and with Airport program wide written monthly reports these updates did not meet the FAA’s formal submission requirement for their written performance reports within 30 days of the close of each reporting period. To address these issues comprehensively and sustainably, the Department has already implemented significant process improvements, including the assignment of a dedicated Project Coordinator, formalization of reporting workflows, and establishment of a centralized reporting repository. The Division has also issued a fully documented FAA Grant Reporting Procedure and implemented annual mandatory training to ensure staff knowledge, consistency, and long-term compliance. These corrective actions are designed to prevent recurrence, enhance accountability, and ensure all future performance reports are completed, submitted, and documented in accordance with FAA requirements. See below write up of the Corrective Action Taken and Planned: 1. Project Coordinator Assigned: A dedicated Project Coordinator (PC) now manages report tracking, deadlines, and documentation control. 2. Annual Mandatory Training: • Training held February 5, 2026 • Annually recurring every October (new fiscal year) • Covers: o FAA forms o Deadlines o Submission requirements o Documentation standards 3. Formal 30 Day Reporting Controls: • Tracker auto calculates deadlines • PMs receive calendar invites and reminders at 21, 14, 7, and 3 days • FAA submissions now require CC to: o Project Coordinator o Airport Deputy Chief (Lyn Estabrook) o CIP Finance Manager (Cathy Brown) • Evidence of sent email placed in centralized repository 4. Centralized Evidence Repository: • All submitted forms, sent emails, and FAA acknowledgments stored in one location • Reduces risk of buried project files • Supports complete, auditable documentation 5. Procedure Issued: The FAA Grant Reporting Procedure has been issued and is now mandatory Division policy. 6. Timeline & Monitoring: • Immediate: Controls implemented in March 2026 • Next 90 Days: Review effectiveness after full quarterly cycle • Ongoing: o Annual training at beginning of the fiscal year o Quarterly internal reviews o Annual procedure update aligned to any FAA changes Estimated Completion – June 30, 2026.
National Student Loan Data System (NSLDS) Enrollment Reporting Recommendation: We recommend the University review its reporting procedures to ensure the students’ statuses are accurately and timely reported to NSLDS as required by regulations. Explanation of disagreement with audit finding: There is...
National Student Loan Data System (NSLDS) Enrollment Reporting Recommendation: We recommend the University review its reporting procedures to ensure the students’ statuses are accurately and timely reported to NSLDS as required by regulations. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: The reporting data wasn’t being sent timely to NSLDS, as a result of process and procedural changes at the University. With new personnel in positions and changing processes, management is confident in data feeding NSLDS within the 60 day period after thorough review of the process overall. This includes a remediation effort of IT data feeds to the NSLDS and the compilation of data. As the enrollment data is not sent on a daily/frequent basis, the next reporting cycle (coming month), the process will be investigated and triaged as necessary. Names of the contact persons responsible for corrective action: Josh Perkins, AVP – Finance/Admin; Kevin Klawonn, Director - IT Planned completion date for corrective action plan: 6/1/2026
Common Origination & Disbursement (COD) Reporting Recommendation: We recommend the University establish a process to ensure that all disbursement information is accurately reported to the COD system. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Act...
Common Origination & Disbursement (COD) Reporting Recommendation: We recommend the University establish a process to ensure that all disbursement information is accurately reported to the COD system. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: The finding was ultimately caused by a syncing error of a batch job process that sends disbursement data to COD from our legacy (now retired) system that has since been replaced, as of October 2025. This was viewed as a one-off occurrence, not a broader systematic issue. The new system is better configured to accurately report disbursement information accurately. Further, Management has undergone a review of findings, and confirmed batch information is configured to send COD information accurately as of the finding notification date. Names of the contact persons responsible for corrective action: Josh Perkins, AVP – Finance/Admin; Kevin Klawonn, Director - IT Planned completion date for corrective action plan: April 30, 2026
In order to avoid recurrence of such errors in future years, LSNC is implementing a checklist for integrity reports (a draft of which is attached to this memo) and a mid-year programwide integrity report process to identify and correct errors. The checklist of integrity reports will be used and reta...
In order to avoid recurrence of such errors in future years, LSNC is implementing a checklist for integrity reports (a draft of which is attached to this memo) and a mid-year programwide integrity report process to identify and correct errors. The checklist of integrity reports will be used and retained by the executive assistant and the interim executive director to verify that all necessary reports are run and reviewed twice each year. A copy of each report will be retained with the checklist as an additional verification measure. The mid-year review will occur in June or July and will include income and asset eligibility checks on closed cases - using a report of all closed cases that shows the household composition, asset amount and the LSC eligibility selection for each case. The interim executive director and the executive assistant responsible for programwide integrity reports will both review the report and examine any cases that exceed the asset limit for the case household size. Ineligible cases will be corrected to indicate they are not LSC-eligible, meaning that they will not be reported. If LSC funds were used to support the case, those time entries will be changed to charge appropriate funds and staff will prepare revised timesheets. The same review will be repeated at the end of the calendar year, before case data is reported to LSC (and prior to the self-inspection process). This additional review should further strengthen the processes already in place. This process is not time limited. It will be added to LSNC's regular compliance activities. If you have any questions or concerns about LSNC's proposed plan, please contact me at (916) 551-2179 or via email at jaguilar@lsnc.net.
Finding 2025-002 – Significant Deficiency AL Nos: 20.507 and 20.526, 20.205 Federal Grantor: U.S. Department of Transportation, Federal Transit Administration, Federal Transit Cluster - Direct Award Compliance Requirement: Other Compliance Requirements Award Nos: All awards under Assistance Listing ...
Finding 2025-002 – Significant Deficiency AL Nos: 20.507 and 20.526, 20.205 Federal Grantor: U.S. Department of Transportation, Federal Transit Administration, Federal Transit Cluster - Direct Award Compliance Requirement: Other Compliance Requirements Award Nos: All awards under Assistance Listing (AL) Numbers 20.507, 20.526, and 20.205 Condition: Several changes were made to the schedule of expenditures of federal awards (SEFA) after the single audit began, including: - The periods of performance had to be updated on several grants. - Missing criteria, such as the award date, had to be added for new grants. - The assistance listing number was corrected for two grants. - A grant amount immaterial to the major program was removed from the SEFA after the single audit began. - Adjustments were made to the SEFA after the audit began to claim current year expenses for disallowed 2024 costs to fully implement the recommendation made in the 2024 single audit. - Qualified expenses were shifted between eligible routes for one grant on the SEFA. Criteria: 2 CFR Part 200, Subpart E (Uniform Guidance) Section 200.303 states that “The nonfederal entity must: (a) Establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non-Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award.” Cause: Grant management procedures are not documented, a complete schedule of all available grants to use when reconciling expenses for inclusion on the SEFA and accruing grant revenue was a work in progress and not all necessary changes were identified by the District’s review procedures. Effect: Expenses were omitted from the SEFA and other expenses were included on the SEFA that were already reported in the prior year. The SEFA had to be revised, which delayed the audit testing and major program determination process. Context: The number of grants has increased since the pandemic due to new pandemic related grants becoming available that delayed the use of the District’s regular federal grants. This caused grants to be combined by grantors with different allowable expenses, areas of service, and periods of performance and caused grants to be extended, causing significant complexity. The dollar amount of auditor changes made to the SEFA were immaterial and the SEFA was not relied upon by the District to ensure compliance with compliance requirements so the changes to the SEFA did not result in noncompliance with other compliance requirements. The District staff made a significant effort to bill all qualifying expenses during the audit, which will help reduce the complexity of remaining grants in future years. Recommendation: We recommend the District develop written procedures to allocate expenses to routes and purposes under federal grants that document the timing of the preparation and review of the allocation schedule. A summary tab should be added to the allocation schedule to reconcile amounts for each route/purpose to total operating expenses, preventive maintenance, insurance, communications and other expenses allocated to the population of expenses in the general ledger. We also recommend the District develop a schedule to summarize all approved and pending grants that includes the amounts available under each grant, each route/purpose within each grant, periods of performance for each amount available, the last date to submit invoices, and amounts claimed and still available for each grant by route/purpose. The District should re-evaluate budgets if changes or delays occur to federal grants and ensure a new federal or local funding source is identified and claimed for the expenses. The SEFA should be prepared after expenses are reconciled to the general ledger at the invoice/paycheck level by route/purpose and the allocation schedule is thoroughly reviewed. The SEFA should be reviewed by a knowledgeable member of management to ensure completeness and accuracy. We also recommend the District claim expenses more quickly to allow the granting agency time to review and approve the claims before the audit begins. We recommend the District reconcile expenses within 30 days of quarter end and prepare claims within 45 days of quarter end. If the District is unsure about the period of performance dates or other restrictions on a grant, staff should contact the granting agency for clarification. Finally, we recommend the District request the grants be made available for general operating expenses rather than for individual routes, times etc. to reduce complexity wherever possible. 2025-002 Views of Responsible Officials and Planned Corrective Actions: Management agrees with the recommendation and recognizes the importance of maintaining strong procedures for the monitoring, allocation and claiming of federal grant expenses. Over the past year, the District has made significant progress addressing the complexity created by the increase in federal grants following the pandemic, including reviewing prior year grant activity, resolving overclaims, coordinating closely with Federal Transit Administration (FTA), and amending grants where necessary. During this process, the District delayed certain claims while prior year matters were being resolved to ensure that expenses were claimed appropriately and in accordance with grant requirements. Staff also developed improved internal worksheets and summary schedules to track grant activity and allocations across funding sources. As the District moves beyond the review and resolution of older grant issues, management expects continued improvement in the monitoring, management, and reconciliation of federal funding sources. The District will continue strengthening internal procedures, including developing more formal written documentation of allocation methodologies, reconciliation schedules, and review procedures. These efforts are expected to further improve timeliness, accuracy, and oversight of grant reporting and claiming activities. Responsible Party: Director of Finance & Administration Implementation Date: Ongoing; full implementation expected by December 31, 2026 YCTD Contact Person Responsible for the Correction Actions; Chas Ann Fadrigo.
Management of CWA agrees with this finding and intends to develop and implement written internal control policies and procedures by December 31, 2026. Applicable employees will be trained in these policies and procedures by December 31, 2026.
Management of CWA agrees with this finding and intends to develop and implement written internal control policies and procedures by December 31, 2026. Applicable employees will be trained in these policies and procedures by December 31, 2026.
Recommendation: We recommend that management notify LSC prior to entering into any lease with an accessibility certification. Explanation of disagreement with audit finding: There is no disagreement with this finding Action taken in response to finding: Legal Aid Chicago’s new office space is fully ...
Recommendation: We recommend that management notify LSC prior to entering into any lease with an accessibility certification. Explanation of disagreement with audit finding: There is no disagreement with this finding Action taken in response to finding: Legal Aid Chicago’s new office space is fully ADA accessible. The current lease runs through February 28, 2041. Should Legal Aid Chicago choose to not extend the existing lease and relocate to a new location upon its expiration, we will be sure to provide formal notification and confirmation of ADA accessibility prior to lease execution. Name of the contact person responsible for corrective action: Teresa Sullivan, Deputy Director / General Counsel Planned completion date for corrective action plan: December 31, 2040
Recommendation: We recommend that management implement a control to ensure complete documentation is maintained for all cases that require retainer agreement. Explanation of disagreement with audit finding: There is no disagreement with this finding. Action taken in response to finding: Legal Aid Ch...
Recommendation: We recommend that management implement a control to ensure complete documentation is maintained for all cases that require retainer agreement. Explanation of disagreement with audit finding: There is no disagreement with this finding. Action taken in response to finding: Legal Aid Chicago's Deputy Director/General Counsel has already contacted the employees who made the errors with respect to missing retainers and has included their supervisors in the communication to ensure compliance on a forward-looking basis. The Deputy Director/General Counsel will also hold a compliance training for staff covering LSC regulations by the end of Q3 2026. Name of the contact person responsible for corrective action: Teresa Sullivan, Deputy Director / General Counsel Planned completion date for corrective action plan: September 30, 2026
Recommendation: We recommend that management implement a control to review PAI time entries to ensure they are accurate. Explanation of disagreement with audit finding: There is no disagreement with this finding. Action taken in response to finding: While issues with PAI time for non-case activity w...
Recommendation: We recommend that management implement a control to review PAI time entries to ensure they are accurate. Explanation of disagreement with audit finding: There is no disagreement with this finding. Action taken in response to finding: While issues with PAI time for non-case activity were successfully remediated with the implementation of a required drop-down activity description field in the LegalServer case management system, the two erroneous entries in 2025 involved case time and resulted from cases that were opened as PAI “Yes” due to the intake occurring at a volunteer clinic and the expectation of volunteer attorney involvement that did not ultimately occur. Legal Aid Chicago's Deputy Director/General Counsel has already contacted the employees who made the errors with respect to PAI time and has included their supervisors in the communication to ensure compliance on a forward-looking basis. The Deputy Director/General Counsel will also hold a compliance training for staff covering LSC regulations by the end of Q3 2026. Name of the contact person responsible for corrective action: Teresa Sullivan, Deputy Director / General Counsel Planned completion date for corrective action plan: September 30, 2026
Formula Grants for Rural Areas – Assistance Listing No. 20.509 Recommendation: We recommend the Organization revise the conflict of interest policy to align with federal requirements and regulations. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Act...
Formula Grants for Rural Areas – Assistance Listing No. 20.509 Recommendation: We recommend the Organization revise the conflict of interest policy to align with federal requirements and regulations. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: The Organization will review and update the conflict of interest policy. Names of the contact persons responsible for corrective action: Garry Hart, Executive Director, and Kris Burkey, Finance Manager Planned completion date for corrective action plan: Ongoing
Formula Grants for Rural Areas – Assistance Listing No. 20.509 Recommendation: We recommend the Organization implement a process to verify employee pay rates are properly entered into the payroll system. Explanation of disagreement with audit finding: There is no disagreement with the audit finding....
Formula Grants for Rural Areas – Assistance Listing No. 20.509 Recommendation: We recommend the Organization implement a process to verify employee pay rates are properly entered into the payroll system. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: The Organization will implement a process for the HR department to review the payroll change report after accounting enters new pay rates. Names of the contact persons responsible for corrective action: Garry Hart, Executive Director, and Kris Burkey, Finance Manager Planned completion date for corrective action plan: Ongoing
LSC Grants (Basic and Native American) – Assistance Listing No. 09.742018 Recommendation: The Organization should review its policy manual and ensure that required provisions of 45 CFR 1610 are fully incorporated to ensure compliance with LSC requirements. Explanation of disagreement with audit find...
LSC Grants (Basic and Native American) – Assistance Listing No. 09.742018 Recommendation: The Organization should review its policy manual and ensure that required provisions of 45 CFR 1610 are fully incorporated to ensure compliance with LSC requirements. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: The Organization will conduct a comprehensive policy review and update to ensure full incorporation of all required provisions of 45 CFR 1610. This will include: • A section-by-section comparison of current policies against regulatory requirements. • Revision of the Organization’s policy manual to explicitly address permissible use of non-LSC funds and required accounting and segregation practices. • Integration of updated language into the accounting manual and related compliance policies. • Internal review by leadership to ensure alignment with LSC guidance and audit expectations. Submission of draft policy to LSC for review along with the revisions in the Accounting Manual. • Presentation of revised policies to the Board of Directors for approval, as appropriate Updated policies will be disseminated to staff with accompanying guidance to ensure consistent implementation. Name(s) of the contact person(s) responsible for corrective action: William Sulik, Interim Executive Director and Lori Stanford, Deputy Director Planned completion date for corrective action plan: July 31, 2026
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