Corrective Action Plans

The Department of Human Services (DHS) concurs with the finding. DHS will ensure that managers memorialize leave and overtime requests in writing in a manner that is best suited for the operational needs of the Department/Unit. Contact - Tania Mortensen, Chief Operating Officer, Marlene Akas, Human Resources Officer Estimated Completion Date - July 1, 2024 See Corrective Action Plan for chart/table

American Diabetes Association (ADA) is committed to ensuring the appropriate documentation is in place to adhere to federal regulations regarding activities allowed or unallowed and allowable costs. In response to the audit finding, ADA is taking the following corrective actions to address the audit recommendations: 1) Financial Services will communicate annual reminders of the existing policy relating toweekly completion and manager review of time records to all ADA team members. 2) Federal grant program management will perform weekly monitoring of all time recordsapplicable to federal awards to ensure that time is reviewed and approved by a manager with knowledge of staff activities so that ADA conforms to federal regulations regardingactivities allowed or unallowed and allowable costs. 3) Financial Services will execute a reimbursement request only once all time is reviewed and approved by a manager with knowledge of staff activities.

Recommendation: We recommend that controls be reviewed and revised to ensure that time and effort distribution records are prepared for staff who are charged to federal programs. These records should also be reviewed, approved, and maintained by administrative personnel. Action Taken: The Harrisburg Area YMCA's Compliance Officer has created a tracking sheet that will allow employees to keep track of their tasks and hours as related to grant programs. The employee will sign off on each sheet.

Findings Related to the Financial Statements Reported in Accordance with Government Auditing Standards None Findings Related to Federal Awards 2023-001 Activities Allowed or Unallowed and Allowable Costs/Cost Principles Federal Agency: U.S. Department of Homeland Security: Passed through the State of New Jersey, Department of Law and Public Safety Program Titles and Assistance Listing Numbers (ALN): Disaster Grants – Public Assistance (Presidentially Declared Disasters) – ALN 97.036 Federal Grant Numbers: State of New Jersey pass-through number: UH1WX, Project Worksheet #1822 – Award Year 2023 (Application 553330) Contact Person: Donna Wilser, Deputy Executive Director, 732-750-5300 Corrective Action: Management agrees with the finding. We are committed to strengthening our processes to ensure that all physical timesheets related to FEMA-declared disaster events are properly maintained and readily accessible. To achieve this, we will implement enhanced procedures and controls to ensure full compliance with the Uniform Guidance requirements. Anticipated Completion Date: December 1st, 2024

The payroll department will be trained on the proper calculation of salary and compensation rates.

The payroll department will be trained on the proper calculation of salary and compensation rates.

Allowable Activities and Costs – Assistance Listing No. 93.224/93.527 Recommendation: CLA recommends that the Organization consider completing time and effort attestation forms electronically to ensure none get lost or misplaced and are returned timely. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: Infinity Health’s current policy to support compliance with time and effort requirements is to obtain a statement from each employee with any time allocated for a grant, certifying the time spent on grant activities on a quarterly basis. Beginning 12/1/2023, Infinity Health has implemented a new electronic document management system which will improve our ability to track and monitor timely completion of time and effort statements each quarter. Name(s) of the contact person(s) responsible for corrective action: Kyle Ahlenstorf, CEO, and Michelle Leonard, CFO. Planned completion date for corrective action plan: June 30, 2024

The Alliance has reinstituted an hourly timesheet format in order to account for positions with multiple funding sources.

Grants and Finance Teams have already implemented tracking time and effort by actual hours versus budgeted allocated and reconcile each quarter before recording into our general ledger application. To compile with the finding recommendation will require combining two separate award periods for the HRSA HTC Grant to coincide with CIBD's fiscal reporting period.

Time and Effort sheets will be completed and maintained in personnel files and federal program records.

Finding 2023-002 Material weakness in internal controls over compliance and instances of noncompliance related to allowable costs. Repeat Finding Yes. 2022-04 Contact Person(s): Beth Mizushima, Chief Operating Officer, mizushimab@crhn.org Explanation and specific reasons for disagreement with the audit finding or that corrective action is not required (if applicable): Not applicable. Corrective action planned: We agree that all awards should be charged the actual allocation percentages of time and effort. It is our assessment that staffing turnover did contribute to challenges with the set-up and deployment of Paylocity in Fall of 2022. We are committed to improving our time and effort system. Currently, we are in the process of migrating accounting and payroll functions to new systems. Additionally, we have dedicated a fiscal staff member’s time to review all payroll expenditures and adjust as needed prior to our next draw. Anticipated completion date: April 30, 2024.

CORRECTIVE ACTION PLAN April 1, 2024 Victim/Witness Assistance Progam respectfully submits the following corrective action plan for the year ended December 31, 2023. Cognizant or Oversight Agency for Audit: Commonwealth of Pennsylvania Commission on Crime and Delinquency Name and address of independent public accounting firm: Hamilton & Musser, PC 176 Cumberland Parkway Mechanicsburg, PA 17055 Audit Period: January 1, 2023 – December 31, 2023 The finding from the December 31, 2023 schedule of findings and questioned costs is discussed below. The finding is numbered consistently with the numbers assigned in the schedule. Findings – Financial Statement Audit #2023-001 – Significant Deficiency – Authorization and Approval Procedural Controls Recommendation We recommend delegating the approval of the Executive Director’s timesheet to another member of management involved in regular office procedures. View of responsible officials and planned corrective action Effective immediately, the Assistant Director signs the biweekly timesheets of the Executive Director. Findings – Federal Award Programs Audit See Finding 2023-001 If the Commonwealth of Pennsylvania Commission on Crime and Delinquency has questions regarding this plan, please call Victim/Witness Assistance Program Executive Director Amy Rosenberry at 717-780-7078. Sincerely, Amy Rosenberry Executive Director

Human Resources educated the leadership team on February 28, 2024 on ADP timesheets and stressed the importance of getting the proper timesheet approvals, as well as additional training on the ADP payroll system and barriers that can effect timely approvals. HR will be doing an additional check on Fridays of timesheet weeks to make sure employees are submitting timesheets to their supervisors on time. Any instance of approvals not being done will result in the employee's paycheck being held until proper approvals are submitted. HR will also provide individual education sessions with the timecard supervisor and/or employee to those that didn't submit approvals on time. Person(s) Responsible: Human Resources, Crystal Harting Timing for Implementation: Effective immediately as of 5/31/2024

Personnel Responsible for the Corrective Action: Steven Rosenzweig, Chief Financial Officer Anticipated Completion Date: Prior to the beginning of the next federal grant program Corrective Action Plan: Senior leadership will design a system to track the actual hours worked by staff that are specific to each separate federal grant program. The time tracking data will be periodically reviewed and approved by the senior leader, who will ensure the data is maintained in organizational records to support the final report of the federal grant program expenditures.

Name of Responsible Individual: Tyler Hosey, Senior Accountant Corrective Action: The University acknowledges that the records to substantiate the payroll costs were insufficient and lacking internal controls. Going forward the University plans to implement a strategic process to document time and effort associated with research and development cluster and it’s federal grants. All employees that work with the Challenger Learning Center will continue to have their hours worked documented in the Paycom payroll software. Payroll is processed on a biweekly basis, and therefore on biweekly basis the payroll costs from the Challenger Learning Center will be reimbursed to the University from the various Challenger Learning Center bank accounts. This will be done as a percentage of time worked for the NIH Grant, the NASA Grant, and the general Challenger Learning Center functions. Anticipated Completion Date: June 2024

Views of Responsibte Officials and Planned Corrective Actions: The School District will immediately begin collecting the time and effort documentation for the impacted grants for the current fiscal year (FY24) and into future periods as required. lf the Oversight Agency has questions regarding this plan, please call Amanda Dupont, lnternal Auditor, at 978-674-2102

Finding Number: 2023-003 – Procurement/Full and open competition Anticipated Completion Date: April 2024 Responsible Contact Person: Jocelyn Lombardozzi Planned Corrective Action: In response to this finding, an analysis of 2023 labor charged to awards was conducted. The results of the analysis revealed that a net amount of $35,238 more could have been charged to the awards which the Company will not pursue charging to the awards. An analysis of labor charged to awards active in the first quarter of 2024 has also been performed to ensure that active awards are being charged according to employee’s actual pay. As of April 1, 2024, the Company has transitioned to a new accounting system. This system is configured to require employees working on sponsored projects to utilize percentage of effort and effort certification functionality for tracking actual time and actual labor costs to awards. Budgeted labor rates are no longer being used as of April 1, 2024.

At this time, the Foundation can confirm all employees have rate of pay documentation in their employee files. The Foundation is working to adopt stronger policies around contractors engaged with the organization with oversight to contractors’ pay provided by the staffed CEO.

The Organization will implement policies and procedures to ensure payroll costs charged to federal programs are based on timesheets that reflect the actual work performed. The timesheets will be signed by employees and approved by a supervisor prior to allocation of payroll cost to the federal program.Effective April 26, 2024 – all staff will submit timesheets for the two week period ending on April 26, 2024 and will continue to do so. Anticipated Completion date - April 26,2024 Responsible Contact Person -Joe Diamond, Executive Director

Upon review of the finding, we acknowledge the importance of accurately documenting personnel expenses by the requirements outlined in the cited regulation. We recognize that charges to Federal awards for salaries and wages must be based on records that accurately reflect the work performed and that these records must support the distribution of an employee's salary or wages among specific activities or cost objectives when applicable. In response to this finding, we will take the following actions: 1. Review and strengthen our current procedures for documenting personnel expenses to ensure compliance with Section 2 CFR Part 200.430 (i). 2. Provide additional training and guidance to relevant personnel responsible for documenting time and effort across different activities or cost objectives. 3. Implement enhanced monitoring mechanisms to regularly assess and validate the completeness of personnel expense documentation. 4. Designate a responsible individual or team to oversee and coordinate the implementation of these corrective actions. We are fully committed to addressing this finding promptly and effectively to ensure ongoing compliance with federal regulations. We welcome any further guidance or assistance from your team to facilitate this process.

The District will require a PAR form from any employee covering a shift in Child Nutrition whose main job is not in the Child Nutrition Department. • The Director of Child Nutrition, Syed Zaidi, will identify and provide a PAR form for those employees providing services to the Child Nutrition Department in a substitute situation. To be established as of 6/30/2024.

Views of Responsible Officials: Management will develop appropriate documentation to support when an employee charges a program that is funded by various donors. A consistent and reasonably methodology which may be based on awards budgets should be the basis of the ending allocation. This corrective action will also be included in an updated time allocation policy.

The Department of Human Services (DHS), Central Office Payroll group will run reports biweekly to determine if any employees are on a leave without pay status greater than 10 days. This added reporting function will ensure that all DHS employees who are on a leave of absence without pay beyond 10 days have their PMIS histories updated upon each extension and return to work. COMPLETION DATE/ CONTACT PERSON March 26, 2024 Maureen Taylor (609) 292-6106 Maureen.Taylor@dhs.nj.gov

Recommendation: We recommend that controls be reviewed and revised to ensure that time and effort distribution records are prepared for staff who are charged to federal programs. These records should also be reviewed, approved, and maintained by administrative personnel. Action Taken: The Harrisburg Area YMCA's Compliance Officer has created a tracking sheet that will allow employees to keep track of their tasks and hours as related to grant programs. The employee will sign off on each sheet.

Person Responsible: Chief Operating Officer, Deirdre Bagley, will coordinate with the finance team Implementation Date: By August 30, 2024 Management’s response: In response to the recommendation that the Organization apply salaries on each of its Federal awards, based on actual time spent on each award per employee, as supported by timesheets and other records, we concur with the recommendation and are in the process of creating a single, succinct schedule so that the auditors can easily test and reconcile the salary amounts to the supporting payroll and other records.