Corrective Action Plans

Finding 1205449 (2025-002)

Material Weakness 2025

MD

Special Tests & Provisions Student Financial Aid Subrecipient Monitoring

Management Response The University concurs with this finding. Management has reviewed its processes for monitoring and issuing Title IV credit balance refunds and has implemented procedures to ensure refunds are processed within the required 14-day timeframe. The Financial Aid and Student Accounts o...

Management Response The University concurs with this finding. Management has reviewed its processes for monitoring and issuing Title IV credit balance refunds and has implemented procedures to ensure refunds are processed within the required 14-day timeframe. The Financial Aid and Student Accounts offices will review credit balance reports on a regular basis to identify students eligible for refunds and confirm timely disbursement. In addition, staff have been reminded of federal requirements related to credit balance refunds. Management will monitor this process periodically to ensure ongoing compliance. Corrective Action The University reviewed the federal requirements for refunds with applicable members of the Business Office and Financial Aid departments to ensure a thorough understanding of the refund rules. The University enhanced its weekly credit balance review process to require explicit review by the Controller and Director of Financial Aid if uncertainty exists on whether a student is eligible for a refund. This review must be completed within the 14 day period with either the refund issued or the loan removed from the student’s account. Contact Person Responsible Name – Richard Jones Title – Controller Phone – 410-532-5367 Email – rjones13@ndm.edu Anticipated Completion Date – April 30, 2026

View Audit 397132

Finding 1205443 (2025-001)

Material Weakness 2025

Marillac Community Health Centers

LA

Special Tests & Provisions Subrecipient Monitoring Eligibility

The organization has implemented additional levels of review and prescreening of slide patient data to ensure accuracy and that the data is complete. Routine reviews done by front desk supervisors will be further documented in order to provide additional training to staff as needed. Results of mont...

The organization has implemented additional levels of review and prescreening of slide patient data to ensure accuracy and that the data is complete. Routine reviews done by front desk supervisors will be further documented in order to provide additional training to staff as needed. Results of monthly audits performed by service line leaders will be reported to senior leadership. An internal audit will be done by the compliance team and presented to leadership on a quarterly basis. All appropriate admitting staff will go through training to reinforce our slide process and review procedures for all FQHC services.

View Audit 397122

Finding 1205427 (2025-103)

Material Weakness 2025

County of Yavapai

AZ

Subrecipient Monitoring § 200.344

Improve Controls over Subrecipient Monitoring Name of contact person: Connie DeKemper Anticipated completion date: 06/30/2026 Condition – During our audit, we noted the County did not complete the required monitoring until six months after the fiscal year end. Response - Subrecipient monitoring will...

Improve Controls over Subrecipient Monitoring Name of contact person: Connie DeKemper Anticipated completion date: 06/30/2026 Condition – During our audit, we noted the County did not complete the required monitoring until six months after the fiscal year end. Response - Subrecipient monitoring will be completed during the fiscal year.

View Audit 397094

Finding 1205424 (2025-102)

Material Weakness 2025

County of Yavapai

AZ

Matching / Level of Effort / Earmarking Subrecipient Monitoring

Improve Controls over Earmarking Name of contact person: Connie DeKemper Anticipated completion date: 06/30/2026 Condition – During our audit, we noted that the County utilized 74.4% of the expenditures on out-of-school youth, a deficiency of .6%. Furthermore, the County utilized 15.8% of youth expe...

Improve Controls over Earmarking Name of contact person: Connie DeKemper Anticipated completion date: 06/30/2026 Condition – During our audit, we noted that the County utilized 74.4% of the expenditures on out-of-school youth, a deficiency of .6%. Furthermore, the County utilized 15.8% of youth expenditures for paid and unpaid work experience, a 4.2% deficiency. Response - Expenditures will be reviewed on a monthly basis to ensure earmarking requirements are met. If not, a waiver for the earmarking requirements will be requested from the grantor.

View Audit 397094

Finding 1205421 (2025-101)

Material Weakness 2025

County of Yavapai

AZ

Subrecipient Monitoring Reporting § 200.327

Improve Internal Controls over Reporting Name of contact person: Connie DeKemper Anticipated completion date: 12/31/2026 Condition – During our audit, we noted the quarterly report ended March 31, 2025, was not filed. The expenditures for that period were included on the quarterly report ended June ...

Improve Internal Controls over Reporting Name of contact person: Connie DeKemper Anticipated completion date: 12/31/2026 Condition – During our audit, we noted the quarterly report ended March 31, 2025, was not filed. The expenditures for that period were included on the quarterly report ended June 30, 2025. Response - The County is in the process of reviewing the terms of the subrecipient agreement for reporting and is developing systems for timely reporting.

View Audit 397094

Finding 1205414 (2025-002)

Material Weakness 2025

University of Maryland Medical System Corporation

MD

Allowable Costs / Cost Principles Cash Management Reporting

C. Cash Management; L. Reporting Evidence of Review and Approval of the Reported Expenditures Assistance Listing Assistance Listing 93.078 – Strengthening Emergency Care Delivery in the United States Healthcare System through Health Information and Promotion Assistance Listing 16.753 – Congressional...

C. Cash Management; L. Reporting Evidence of Review and Approval of the Reported Expenditures Assistance Listing Assistance Listing 93.078 – Strengthening Emergency Care Delivery in the United States Healthcare System through Health Information and Promotion Assistance Listing 16.753 – Congressionally Recommended Awards Federal Agency: Department of Health and Human Services Department of Justice Recommendation: Management should reassess the design of its controls to ensure documentation is retained that evidences the review and approval of expenditures submitted to the DOJ and DHHS for reimbursement. Explanation of disagreement with audit finding: There is no disagreement with the finding and recommendation. Action planned/taken in response to finding: The Corporation established a centralized UMMS Office for Research and Sponsored Programs Administration (ORSPA) department in December 2025. ORSPA and Corporate Financial Reporting are developing standard operating procedures and policies for the required review and reconciliation of grant expenditures per the accounting system to the financial submissions to the granting agency, including requirements for maintaining evidence of the review(s). A shared central repository for financial submissions was created. For each grant, this repository includes the financial submission and evidence of review and approval of the financial report submissions. The ORSPA and Corporate Financial Reporting will monitor the repository and work with grant managers to ensure evidence of financial submission review and approval is maintained. Anticipated Completion Date – June 30, 2027 Name(s) of the contact person(s) responsible for corrective action: Jeff Chadwick, Financial Reporting Director, jeff.chadwick@umm.edu

View Audit 397091

Finding 1205391 (2025-102)

Material Weakness 2025

Pima County

AZ

Cash Management Procurement, Suspension & Debarment Subrecipient Monitoring § 200.303 § 200.328 § 200.334

2025-102 The County did not develop internal control procedures over program reporting and cash management requirements, increasing risk of report errors to awarding agencies and wrongly receiving monies Cluster Name: Workforce Innovation and Opportunity Act (WIOA) Cluster Assistance Listings number...

2025-102 The County did not develop internal control procedures over program reporting and cash management requirements, increasing risk of report errors to awarding agencies and wrongly receiving monies Cluster Name: Workforce Innovation and Opportunity Act (WIOA) Cluster Assistance Listings numbers and program names: 17.258 WIOA Adult Program 17.259 WIOA Youth Activities 17.278 WIOA Dislocated Worker Formula Grants Award Numbers and years: IGA DI21-002286 July 1, 2024 through June 30, 2025 IGA DI23-002389 July 1, 2023 through June 28, 2028 Assistance Listings numbers and program name: 21.027 COVID-19—Coronavirus State and Local Fiscal Recovery Funds Award Numbers and years: 1505-0271 March 3, 2021 through December 31, 2024 CT-FM-22-149 October 1, 2024 through September 30, 2025 SLFRFP1962 January 5, 2023 through December 31, 2026 CTR069300 January 1, 2024 through December 30, 2026 GTAW-FM-23*123 October 3, 2022 through July 3, 2026 ACJC-VC-25-001A July 1, 2024 through December 31, 2024 Assistance Listings numbers and program name: 93.268 Immunization Cooperative Agreements Award numbers and years: CTR062571 July 1, 2022 through June 30, 2025 CTR059891 July 1, 2022 through June 30, 2027 Name of contact person: Art Cuaron, Director, Finance and Risk Management Anticipated completion date: June 30, 2027 The County recognizes the need to strengthen internal controls over federal reporting and cash management requirements. F&RM will complete the following actions to ensure compliance with 2 CFR Part 200: 1. Establish written internal control policies and procedures for federal program reporting. All federal financial reports will undergo an independently documented review before submission to ensure accuracy, allowability, and proper reporting periods. 2. Implement documentation standards requiring staff to retain supporting materials such as system reports, financial queries, screenshots, and reconciliations, in accordance with federal and County retention requirements. 3. Pima County has been working with each of its grant implementing entities to use Euna Grants calendaring and reminders to prompt the entities’ timely reporting activities. Grants Management and Innovation (GMI) Department sets the reminders schedule at the onset of the performance period. The reminders are then automatically emailed to the grants manager and the assigned accountant for each grant on a set schedule throughout the course of the grant. GMI and Finance – Grants will continue to work with grant implementing entities to use these reminders to trigger the necessary actions in a timely manner. Pima County was still in the process of institutionalizing this system during FY25. 4. Provide training for staff who prepare and review federal reports, focusing on reporting requirements, documentation standards, internal controls, and record retention. 5. Conduct periodic management oversight reviews to confirm that internal controls are followed and that reports are complete, accurate, and submitted on time. The County is also planning to implement the Workday Grants Module with an anticipated go-live of July 1, 2027. This solution will enhance our ability to manage the full fiscal lifecycle of grant awards and ensure compliance with federal reporting requirements. The Workday Grants Module is a native Workday solution, purpose-built to support the full fiscal grant lifecycle. The module supports the following financial grant objectives: • Grant setup and award and fiscal tracking • Cost allocation and allocability controls • Real-time grant financial reporting • Compliance with federal Uniform Guidance (2 CFR 200) • Integration with Workday Financial Management, Procurement and Human Capital Management (HCM) In addition, F&RM has submitted FY 2026/27 budget requests to fund three additional Accountant III positions in our Finance – Grants Division. These positions will expand our capacity to manage our grant portfolio and strengthen our reconciliation, billing and SEFA preparation processes. The contract for the Workday Grants Module is scheduled to go before the Board of Supervisors for approval in April. These new positions will be included in the County Administrator’s Recommended Budget and will be considered by the Board as part of the full budget adoption process in June.

View Audit 397080

Finding 1205372 (2025-003)

Material Weakness 2025

South Carolina State University

SC

Subrecipient Monitoring Procurement, Suspension & Debarment § 200.303

Finding 2025-003 – Reporting – Special Reports for Federal Funding Accountability and Transparency Act (“FFATA”) Corrective Action Plan I. Overview and Acknowledgment The University acknowledges Finding 2025-003 regarding noncompliance with reporting requirements under the Federal Funding Accountabi...

Finding 2025-003 – Reporting – Special Reports for Federal Funding Accountability and Transparency Act (“FFATA”) Corrective Action Plan I. Overview and Acknowledgment The University acknowledges Finding 2025-003 regarding noncompliance with reporting requirements under the Federal Funding Accountability and Transparency Act. Specifically, the University did not submit a first-tier subaward agreement/amendment/modification within the required timeframe to the System for Award Management (SAM.gov). The University concurs with the findings and is committed to strengthening its internal controls, procedures, and oversight mechanisms to ensure full compliance with all FFATA reporting requirements moving forward. II. Criteria Under FFATA requirements: • Recipients of federal grants or cooperative agreements must report first-tier subawards of $30,000 or more to SAM.gov. • Reporting must be completed timely and accurately in accordance with federal guidelines. • Institutions must maintain sufficient internal controls to ensure that all reportable subawards are identified, tracked, and submitted within required deadlines. III. Condition The audit determined that a subaward agreement, amendment, or modification meeting FFATA reporting thresholds was not submitted within the required timeframe. This reflects a lapse in the University’s internal processes governing subrecipient monitoring and reporting compliance. IV. Root Cause Analysis The University has identified the following contributing factors: • Inadequate tracking mechanisms for subaward reporting deadlines • Insufficient coordination between Grants Administration and responsible program personnel • Lack of automated alerts and centralized monitoring systems • Gaps in internal review and approval workflows prior to submission • Limited oversight to ensure timely compliance with FFATA requirements V. Corrective Actions and Implementation Plan The University will implement the following corrective measures effective immediately: 1. Internal Audit Oversight and Governance • The Internal Audit function will assume leadership responsibility for overseeing FFATA compliance and subrecipient reporting processes. • Quarterly compliance reports will be prepared and submitted directly to the Vice President and Chief Finance Officer until sustained compliance is achieved. • Internal Audit will conduct periodic reviews and testing of subaward reporting to ensure adherence to federal requirements. 2. Enhanced Tracking and Monitoring Systems • A centralized tracking system will be implemented to monitor all subawards, including thresholds, reporting deadlines, and submission status. • Automated alerts and reminders will be established to notify responsible personnel of upcoming reporting deadlines. 3. Strengthening Policies and Procedures • Standard Operating Procedures (“SOPs”) for FFATA reporting will be updated and formally documented. • Procedures will clearly define roles, responsibilities, timelines, and escalation protocols for noncompliance. • A compliance checklist will be required prior to execution and modification of all subaward agreements. 4. Improved Interdepartmental Coordination • Formal communication protocols will be established between Grants Administration, Principal Investigators, and Finance to ensure timely identification and reporting of subawards. • Designated compliance liaisons will be assigned to ensure accountability across departments. 5. Training and Capacity Building • Mandatory training will be conducted for all staff involved in grants management and subrecipient oversight. • Training will focus on FFATA requirements, reporting timelines, system usage, and compliance expectations. 6. Pre-Submission Review and Quality Assurance • A secondary review process will be implemented prior to submission to SAM.gov to ensure accuracy and completeness. • Documentation supporting all submissions will be retained in a centralized repository for audit and compliance purposes. VI. Timeline for Implementation • Immediate: o Initiate Internal Audit oversight o Implement interim tracking and reporting processes o Begin staff training • Short-Term: o Deploy centralized tracking system and automated alerts o Finalize and implement updated SOPs o Begin quarterly reporting to the Vice President and Chief Finance Officer • Long-Term (Ongoing): o Conduct continuous monitoring and compliance reviews o Maintain quarterly reporting until full and sustained compliance is achieved VII. Monitoring and Ongoing Compliance The Internal Audit function will provide ongoing monitoring and validation of FFATA reporting compliance. Quarterly reports will include status updates, identified issues, corrective actions, and recommendations for continuous improvement. VIII. Conclusion The University is committed to addressing the deficiencies identified in Finding 2025-003 through enhanced oversight, improved processes, and strengthened internal controls. These actions will ensure timely and accurate subaward reporting, uphold compliance with FFATA requirements, and reinforce the University’s commitment to transparency and accountability in federal grant management. Anticipated Completion Date: September 1, 2026

View Audit 397073

Finding 1205370 (2025-101)

Material Weakness 2025

Cochise County

AZ

Subrecipient Monitoring Eligibility Procurement, Suspension & Debarment § 200.303

Cochise County Corrective Action Plan Year ended June 30, 2025 2025-101 Assistance Listings number and name: 10.557 WIC Special Supplemental Nutrition Program for Women, Infants, and Children Award number and years: CTR067930, October 1, 2023 through September 30, 2028 Federal agency: U.S. Departmen...

Cochise County Corrective Action Plan Year ended June 30, 2025 2025-101 Assistance Listings number and name: 10.557 WIC Special Supplemental Nutrition Program for Women, Infants, and Children Award number and years: CTR067930, October 1, 2023 through September 30, 2028 Federal agency: U.S. Department of Agriculture Pass-through grantor: Arizona Department of Health Services Compliance requirement: Eligibility Questioned costs: Unknown The County did not perform eligibility certification requirements, resulting in an increased risk of program participants receiving benefits they are not eligible to receive Contact: Barbara Lang Completion date: March 2026 Corrective Action: Cochise County WIC leadership and staff are committed to full adherence with WIC policy and will continue to implement training, monitoring, and communication to ensure compliance with federal and state regulation. This audit timeframe produced findings primarily related to issues that have already been corrected through the departure of staff that contributed to the findings (to include the previous Directors), hiring of new staff with a more thorough and comprehensive training plan implemented, and staff effort to retroactively collect all required signatures at subsequent appointments to ensure all WIC clients have current signatures and understanding of Rights & Obligations and Consents for their certification period. We recognize that these new processes were not put into plan until June 2025, due to the timing of the previous audit, and therefore did not reflect on the July 1, 2024 – June 30, 2025 audit period. In addition to the above resolved issues, a new WIC director was hired in September 2025 and new policies and procedures were immediately developed and put into place. These new policies and procedures that serve as our already implemented corrective action plan are as follows: Staff Training a. All staff are required to complete the full ADHS WIC-sponsored live cohort training courses upon hire, and every 3 years of their employment to ensure competencies are maintained over time. b. All staff complete their annual Civil Rights, Conflict of Interest, and Confidentiality upon hire and annually. Last annual training was completed Fall 2025. c. A staff dedicated as Training Coordinator monitors training logs and ensure all training requirements are met, with additional oversight by the WIC Director and the ADHS WIC State office. d. In-person staff meetings are held monthly, with a significant portion of time dedicated to staff training on programmatic expectations to ensure all staff obtain the same information so that tasks are carried out in a standardized method. e. Weekly team huddles to review any timely findings or discuss issues as a group. f. Weekly 1:1’s with each staff to discuss areas where the employee may need additional training or to discuss any deficiencies the WIC manager has noticed, (i.e. note-taking/documentation, single income verifications, chart review findings, etc.). Separation of Duties g. Cert List for Audits report run every 2 weeks for each clinic/staff person to review adherence to Separation of Duties. i. Follow up with certain percentage of clients per policy to assess how the certification went and verify client information. ii. Follow up with staff if any issues are identified. h. Staff have been training on during staff meetings in July 2025, August 2025, October 2025, and during new employee training on how to properly use the HANDS system to ensure the system accurately records who completed the 2nd income verification. i. Revision of Separation of Duties policy and implementation of new “protected time” procedure to ensure there is a staff person available at almost all times of day to complete the 2nd IV. *Since approval of this policy the ADHS WIC state office on 1/5/2026 and implementation of this policy/procedure, the Cert List for Audit report of single-income verifications has decreased substantially (from 60 in 2 weeks, to 5), all with documented reasons why 2nd IV was unable to be obtained during certification appointment and notes verifying 2nd IV was completed on another date. Rights and Obligations and Consent Forms a. All staff received a refresher training on 8/26/25, will be retrained annually, and are regularly reminded to obtain both required signatures at certification b. If staff are unable to obtain digital signatures due to tech issues, they are required to obtain e-document signatures via the clients email, or written signatures the staff then scans into the client file c. Chart reviews and staff observations are completed on a monthly-bimonthly basis to ensure ongoing staff compliance with policy and procedure

View Audit 397064

Finding 1205366 (2025-005)

Material Weakness 2025

City of Alexandria

VA

Subrecipient Monitoring § 200.303 § 200.332 § 200.414

Home Investment Partnerships Program Assistance Listing No. 14.239 Recommendation: The City should review and enhance its internal controls and procedures to ensure that all required information is included in subawards at the time of issuance and maintained in subsequent modifications. Explanation ...

Home Investment Partnerships Program Assistance Listing No. 14.239 Recommendation: The City should review and enhance its internal controls and procedures to ensure that all required information is included in subawards at the time of issuance and maintained in subsequent modifications. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: The City will undertake additional training for departments in FY 2026, to include providing departments with a grants responsibility checklist. Name(s) of the contact person(s) responsible for corrective action: Kevin Greenlief, Director of Finance. Planned completion date for corrective action plan: Q2, 2026.

View Audit 397053

Finding 1205363 (2025-004)

Material Weakness 2025

City of Alexandria

VA

Procurement, Suspension & Debarment Subrecipient Monitoring § 200.303

Highway Planning and Construction Assistance Listing No. 20.205 Recommendation: We recommend that the City review and enhance current procedures to ensure that the vendor's suspension and debarment status is documented prior to contracting with the vendor. Explanation of disagreement with audit find...

Highway Planning and Construction Assistance Listing No. 20.205 Recommendation: We recommend that the City review and enhance current procedures to ensure that the vendor's suspension and debarment status is documented prior to contracting with the vendor. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: The City's Transporation Department erroneously thought the City's Purchasing Department performed the suspension and debarment check. Purchasing reported that since we were riding the contract of another jurisdiction that they rely on that jurisdiction to check for debarment and the other jurisdiction confirmed that they only award contracts to active vendors on the State's eVA system, hence an indication of no debarment). Regardless, the City will conduct additional training in this area for prime award recipients and for Purchasing staff. The City will also check for suspensions and debarment even if riding contracts from other jurisdictions. Name(s) of the contact person(s) responsible for corrective action: Davidia Thompson, Wynndell Bishop, Department of Finance. Planned completion date for corrective action plan: Q2, 2026.

View Audit 397053

Finding 1205361 (2025-003)

Material Weakness 2025

City of Alexandria

VA

Subrecipient Monitoring Reporting Significant Deficiency § 200.303

HeadStart Assistance Listing No. 93.600 Recommendation: We recommend that DCHS review procedures and internal controls to ensure that the required subawards are reported timely and accurately to FSRS no later than the end of the month following the month of issuance of each subaward. Documentation o...

HeadStart Assistance Listing No. 93.600 Recommendation: We recommend that DCHS review procedures and internal controls to ensure that the required subawards are reported timely and accurately to FSRS no later than the end of the month following the month of issuance of each subaward. Documentation of supporting compliance should be readily available for review. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: The reporting has been completed. New employees will be trained in the procedures and internal controls to ensure that the required subawards are reported timely and accurately to FSRS no later than the end of the month following the month of issuance of each subaward. Documentation will be available for review during the audit period. Name(s) of the contact person(s) responsible for corrective action: Noah Abraham, DCHS Operations Director. Planned completion date for corrective action plan: Complete

View Audit 397053

Finding 1205360 (2025-003)

Material Weakness 2025

Lincoln County Health Department

MO

Procurement, Suspension & Debarment Internal Control / Segregation of Duties Subrecipient Monitoring

2025-003 Material Weakness Internal Control – Special Tests / Prevailing wages C. Comments on Findings and Recommendations: We concur with the auditor’s suggestions for obtaining certified payrolls as needed in conjunction with construction projects. D. Actions Taken or Planned: Management will requ...

2025-003 Material Weakness Internal Control – Special Tests / Prevailing wages C. Comments on Findings and Recommendations: We concur with the auditor’s suggestions for obtaining certified payrolls as needed in conjunction with construction projects. D. Actions Taken or Planned: Management will request certified payrolls for any future construction contracts as required by federal regulation. Anticipated completion date: Already implemented, ongoing Contact information for this finding: Michelle Walsh, 636-528-6117

View Audit 397052

Finding 1205359 (2025-002)

Material Weakness 2025

Lincoln County Health Department

MO

Procurement, Suspension & Debarment Subrecipient Monitoring Material Weakness

2025-002 Material Weakness Internal Control / Noncompliance – Reporting A. Comments on Findings and Recommendations: We concur with the auditor’s suggestions for reporting program personnel cost. B. Actions Taken or Planned: Management will continue to evaluate their controls with respect to current...

2025-002 Material Weakness Internal Control / Noncompliance – Reporting A. Comments on Findings and Recommendations: We concur with the auditor’s suggestions for reporting program personnel cost. B. Actions Taken or Planned: Management will continue to evaluate their controls with respect to current federal awards and requirements to insure accurate information captured and reported in accordance with the required timelines by implementing additional oversight. Anticipated completion date: Already implemented, ongoing Contact information for this finding: Michelle Walsh, 636-528-6117

View Audit 397052

Finding 1205357 (2025-001)

Material Weakness 2025

Lincoln County Health Department

MO

Eligibility Subrecipient Monitoring Material Weakness

2025-001 Material Weakness Internal Control / Noncompliance – Eligibility A. Comments on Findings and Recommendations: We concur with the auditor’s suggestions for maintaining supporting documentation to provide evidence of LCHD’s compliance with requirements applicable to each program funded under ...

2025-001 Material Weakness Internal Control / Noncompliance – Eligibility A. Comments on Findings and Recommendations: We concur with the auditor’s suggestions for maintaining supporting documentation to provide evidence of LCHD’s compliance with requirements applicable to each program funded under Uniform Guidance requirements. B. Actions Taken or Planned: Management implemented changes to the capturing and files maintained for documenting a participant’s eligibility for participation in program services. Management will continue to evaluate their controls with respect to current federal awards and requirements to ensure accurate information captured, reported and maintained. Anticipated completion date: Already implemented, ongoing Contact information for this finding: Michelle Walsh, 636-528-6117

View Audit 397052

Finding 1205356 (2025-003)

Material Weakness 2025

Health Resources in Action, INC

MA

Internal Control / Segregation of Duties Subrecipient Monitoring Reporting

2025-003 Program Name: Environmental Justice Thriving Communities Grantmaking Program; Assistance Listing Number: 64.615 Compliance Requirement Affected: Reporting: Recommendation: HRIA should improve controls/processes around reporting to ensure documentation is retained related to procurements mad...

2025-003 Program Name: Environmental Justice Thriving Communities Grantmaking Program; Assistance Listing Number: 64.615 Compliance Requirement Affected: Reporting: Recommendation: HRIA should improve controls/processes around reporting to ensure documentation is retained related to procurements made with federal funds. Disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: Management has implemented additional controls to ensure that each program has documented procedures to submit required reports timely and accurately. The untimely filing of reports in fiscal year 2025 resulted from a change in personnel. During fiscal year 2026, management identified all applicable reporting requirements and assigned responsibility to appropriate personnel. Additional procedures were implemented to ensure reports are reviewed and submitted in accordance with required deadlines. Name of the contact person responsible for corrective action: Beth Doreian, CFO Planned completion date for corrective action plan: March 1, 2026

View Audit 397051

Finding 1205354 (2025-002)

Material Weakness 2025

Health Resources in Action, INC

MA

Internal Control / Segregation of Duties Subrecipient Monitoring Reporting

2025-002 Program Name: Community-Based Violence Intervention and Prevention Initiative; Assistance Listing Number: 16.045 Compliance Requirement Affected: Reporting: Recommendation: HRIA should improve controls/processes around reporting to ensure documentation is retained related to procurements ma...

2025-002 Program Name: Community-Based Violence Intervention and Prevention Initiative; Assistance Listing Number: 16.045 Compliance Requirement Affected: Reporting: Recommendation: HRIA should improve controls/processes around reporting to ensure documentation is retained related to procurements made with federal funds. Disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: Management has implemented additional controls to ensure that each program has documented procedures to submit required reports timely and accurately. The untimely filing of reports in fiscal year 2025 resulted from a change in personnel. During fiscal year 2026, management identified all applicable reporting requirements and assigned responsibility to appropriate personnel. Additional procedures were implemented to ensure reports are reviewed and submitted in accordance with required deadlines. Name of the contact person responsible for corrective action: Beth Doreian, CFO Planned completion date for corrective action plan: March 1, 2026

View Audit 397051

Finding 1205329 (2025-003)

Material Weakness 2025

Washington Adventist University

MD

Student Financial Aid Subrecipient Monitoring Significant Deficiency

Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: WAU agrees with the recommendation to update our formal process to identify and maintain an inventory of data, devices, and systems that support or process customer f...

Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: WAU agrees with the recommendation to update our formal process to identify and maintain an inventory of data, devices, and systems that support or process customer financial aid information. While we currently use the Spiceworks Inventory System to track hardware and software assets and Google Workspace to manage user cloud access and data storage, we acknowledge that a formal, documented inventory process covering all required categories has not yet been fully established. The IT Director has been assigned to develop and document this process within 30 days. We acknowledge this finding and the associated risk arising from the absence of an independent risk assessment. As of March 25, 2026, the University has engaged TeamLogic Cybersecurity to strengthen our managerial, technical, and operational controls and to (1) develop and document a formal, GLBA aligned risk assessment process; (2) conduct annual independent, comprehensive risk assessment of our information systems and data environment; and (3) provide written findings and recommendations. Based on these results, we will implement appropriate safeguards, and institutionalize an annual risk assessment cycle to ensure that risks are consistently identified, assessed, mitigated, and monitored in accordance with GLBA requirements. Name(s) of the contact person(s) responsible for corrective action: Rosalee Pedapudi, IT Director, Information Technology Services Planned completion date for corrective action plan: April 26, 2026

View Audit 397028

Finding 1205305 (2025-002)

Material Weakness 2025

County of Luzerne, Pennsylvania

PA

Subrecipient Monitoring Reporting Significant Deficiency

Condition: The Program's Single Audit and reporting package was delayed for the year ended June 30, 2024 beyond the nine-month due date, as a result of turnover and delays in reconciling federal and state award activity with the Commonwealth. Criteria: Pursuant to the provisions of the Uniform Guida...

Condition: The Program's Single Audit and reporting package was delayed for the year ended June 30, 2024 beyond the nine-month due date, as a result of turnover and delays in reconciling federal and state award activity with the Commonwealth. Criteria: Pursuant to the provisions of the Uniform Guidance, under §200.512(a), the Program is required to complete and submit its Single Audit and related Data Collection Form within nine months of the end of its fiscal period (March 31) of the following year. Root Cause Analysis: The audit for the period ending June 30, 2024 was started in January 2025 and was completed and submitted in June 2025. In accordance with Uniform Guidance, the deadline is March 31st annually to have the audit completed and submitted. To meet this deadline, the year-end close and audit process needs to begin at least two months sooner to achieve this deadline. To address finding 2024-002, we began the audit in October 2025, one month ahead of schedule. Planned Corrective Action Steps: 1. Annually, begin the year-end close in September and start the audit in October. Responsible Party: MHDS Fiscal Director and MHDS Fiscal Unit Timeline for Completion: 1. Action Step #1 – September-November 2026

View Audit 397008

Finding 1205276 (2025-002)

Material Weakness 2025

Zane Trace Local School District

OH

Matching / Level of Effort / Earmarking Subrecipient Monitoring Cash Management

The District will work with the contractors to get the proper payroll records to meet the prevailing wage requirements agreed upon in the contract.

View Audit 396991

Finding 1205275 (2025-007)

Material Weakness 2025

Roof Above, Inc.

NC

Subrecipient Monitoring Reporting Significant Deficiency

Corrective Action Plan Reporting Finding 2025-007 Roof Above will ensure the review of all grant invoices is documented through the signature of the reviewer on the grant cover sheet. Roof Above will institute a policy that grant invoices will not be submitted without the corresponding review signat...

Corrective Action Plan Reporting Finding 2025-007 Roof Above will ensure the review of all grant invoices is documented through the signature of the reviewer on the grant cover sheet. Roof Above will institute a policy that grant invoices will not be submitted without the corresponding review signature. Contact person responsible for corrective action: Tonya Frye, Chief Financial Officer Anticipated completion date: September 30, 2026

View Audit 396990

Finding 1205264 (2025-003)

Material Weakness 2025

Roof Above, Inc.

NC

Subrecipient Monitoring Significant Deficiency Matching / Level of Effort / Earmarking

Corrective Action Plan Special Tests: Housing Quality Standards Finding 2025-003 Roof Above will document review of the inspection by sending an email to the grants administrator stating the inspection has been reviewed. Contact person responsible for corrective action: Katie Church, Vice President ...

Corrective Action Plan Special Tests: Housing Quality Standards Finding 2025-003 Roof Above will document review of the inspection by sending an email to the grants administrator stating the inspection has been reviewed. Contact person responsible for corrective action: Katie Church, Vice President of Scattered Site Housing Anticipated completion date: June 30, 2026

View Audit 396990

Finding 1205262 (2025-002)

Material Weakness 2025

Roof Above, Inc.

NC

Subrecipient Monitoring Eligibility Material Weakness

Corrective Action Plan Eligibility Finding 2025-002 Roof Above will add signature lines to current client eligibility checklist, to include the name, signature and date for both the person preparing and the person reviewing tenant eligibility. Contact person responsible for corrective action: Katie ...

Corrective Action Plan Eligibility Finding 2025-002 Roof Above will add signature lines to current client eligibility checklist, to include the name, signature and date for both the person preparing and the person reviewing tenant eligibility. Contact person responsible for corrective action: Katie Church, Vice President of Scattered Site Housing Anticipated completion date: June 30, 2026

View Audit 396990

Finding 1205260 (2025-002)

Material Weakness 2025

City of McCall, Idaho

ID

Subrecipient Monitoring Internal Control / Segregation of Duties § 200.303

THE CITY WILL IMPROVE GRANT EXPENDITURES RECORDKEEPING BY USING CASELLE, OUR ENTERPRISE GENERAL LEDGER (GL) SYSTEM, AS THE PRIMARY SYSTEM OF RECORD FOR TRACKING ALL GRANT-RELATED REVENUE, EXPENDITURES, AND PROJECT ACTIVITY. THE CITY WILL UTILIZE THE CASELLE PROJECT ACCOUNTING MODULE AS THE OFFICIAL ...

THE CITY WILL IMPROVE GRANT EXPENDITURES RECORDKEEPING BY USING CASELLE, OUR ENTERPRISE GENERAL LEDGER (GL) SYSTEM, AS THE PRIMARY SYSTEM OF RECORD FOR TRACKING ALL GRANT-RELATED REVENUE, EXPENDITURES, AND PROJECT ACTIVITY. THE CITY WILL UTILIZE THE CASELLE PROJECT ACCOUNTING MODULE AS THE OFFICIAL GRANT/PROJECT TRACKING MECHANISM AND WILL FORMALIZE A CONSISTENT GRANT ACCOUNTING STRUCTURE WITHIN CASELLE (INCLUDING APPROPRIATE FUND/PROJECT/GRANT CODES AND EXPENDITURE ACCOUNTS) SO THAT GRANT TRANSACTIONS ARE CLEARLY IDENTIFIED, ACCURATELY CODED, AND FULLY SUPPORTED BY DOCUMENTATION. TO ENSURE THE ONGOING ACCURACY OF THE GENERAL LEDGER AND PROJECT RECORDS, THE CITY WILL IMPLEMENT ROUTINE RECONCILIATION AND REVIEW PROCEDURES THAT TIE AMOUNTS RECORDED IN CASELLE (INCLUDING PROJECT ACCOUNTING ACTIVITY) TO SUPPORTING DOCUMENTATION AND REIMBURSEMENT ACTIVITY AND WILL CORRECT ANY MISCODING OR OMISSIONS PROMPTLY. THE CITY WILL ALSO UPDATE WRITTEN GRANT ACCOUNTING PROCEDURES AND PROVIDE TRAINING TO STAFF INVOLVED IN PURCHASING, ACCOUNTS PAYABLE, AND GRANT ADMINISTRATION TO REINFORCE CODING REQUIREMENTS, DOCUMENTATION STANDARDS, AND REVIEW RESPONSIBILITIES.

View Audit 396984

Finding 1205259 (2025-001)

Material Weakness 2025

District School Board of Pinellas County

FL

Student Financial Aid Special Tests & Provisions Subrecipient Monitoring § 200.303

Corrective Action Plan Fiscal Year 2025 Finding Number: 2025-001 – Pell Grant Special Tests and Provisions – NSLDS Reporting The District acknowledges the findings related to NSLDS enrollment reporting and has conducted an internal review of processes, systems, and oversight structures contributing ...

Corrective Action Plan Fiscal Year 2025 Finding Number: 2025-001 – Pell Grant Special Tests and Provisions – NSLDS Reporting The District acknowledges the findings related to NSLDS enrollment reporting and has conducted an internal review of processes, systems, and oversight structures contributing to the finding. To ensure compliance with federal reporting requirements, the District will implement the following corrective actions: 1. Enhanced Review Procedures: The District will strengthen internal controls over enrollment reporting by implementing procedures to ensure all enrollment status changes are accurately recorded, reconciled between internal systems and third-party servicer reports, and submitted to NSLDS within required time frames. Additionally, The District is actively restructuring internal systems and workflows within the department to strengthen oversight, improve accuracy, and ensure timely reporting of enrollment status changes. 2. Training: The District recognizes that staff turnover and inconsistent training contributed to the finding. To address this, the District will implement a comprehensive training plan in partnership with the third-party servicer. 3. Monitoring Controls: The District will formally reestablish expectations with its third-party servicer to ensure all contracted services are implemented. Implementation Timeline: • Enhanced review procedures will be implemented immediately. • The District will implement an ongoing comprehensive training plan in partnership with third-party servicer. • Staff will meet with third-party servicer to re-establish expectations and to ensure compliance with federal reporting requirements before fiscal year-end. Responsible Party: Dr. Dywayne B. Hinds, Sr., Area Superintendent, Dr. Jakub Prokop, Director, PTC- Clearwater, and Dr. Jason Shedrick, Director, PTC-St. Petersburg Anticipated Completion Date: June 30, 2026 Dywayne B. Hinds, Sr., Ed.D. Area Superintendent, Area 3

View Audit 396974

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