Corrective Action Plans

Finding 393551 (2023-004)

Significant Deficiency 2023

NC

Eligibility Internal Control / Segregation of Duties

Finding: 2023-004 Name of contact person: Corrective action: Proposed completion date: Finding: 2023-005 Name of contact person: Corrective action: Proposed completion date: Shaneall Kollock, Medicaid Program Manager Adult and Family Medicaid Supervisors will train staff on the importance of enterin...

Finding: 2023-004 Name of contact person: Corrective action: Proposed completion date: Finding: 2023-005 Name of contact person: Corrective action: Proposed completion date: Shaneall Kollock, Medicaid Program Manager Adult and Family Medicaid Supervisors will train staff on the importance of entering the correct information, so that the case is processed correctly. Targeted reviews will be completed by both Medicaid Supervisors for 3 months, 2 reviews for each staff member. Section III - Federal Award Findings and Question Costs (continued) Shaneall Kollock, Medicaid Program Manager Adult Medicaid Supervisors will train staff on the importance of entering the correct information, so that the case is processed correctly. Targeted reviews will be completed by both Medicaid Supervisors for 3 months, 2 reviews for each staff member. Training was completed on 12/5/2023 for Adult Medicaid and 12/6/2023 for Family & Children's Medicaid. Training logs are availalbe. Targeted reviews began on 12/1/2023 and will end on 2/28/2024 if improvements are noted and no further errors noted. Review logs will document those targeted reviews. Quality Assurance staff will review findngs, recommendations, and make any adjustments needed to 2nd party forms. Training was completed on 12/5/2023 for Adult Medicaid. Training logs are availalbe. Targeted reviews began on 12/1/2023 and will end on 2/28/2024 if improvements are noted and no further errors noted. Review logs will document those targeted reviews. Quality Assurance staff will review findngs, recommendations, and make any adjustments needed to 2nd party forms.

View Audit 303698

Finding 393550 (2023-003)

Significant Deficiency 2023

Scotland County of North Carolina

NC

Eligibility Internal Control / Segregation of Duties

Finding: 2023-003 Name of contact person: Corrective action: Proposed completion date: Family Medicaid Supervisor has trained staff on when completing a child support referral is required. Targeted reviews will be completed by the Family Medicaid Supervisor for 3 months, 2 reviews for each staff mem...

Finding: 2023-003 Name of contact person: Corrective action: Proposed completion date: Family Medicaid Supervisor has trained staff on when completing a child support referral is required. Targeted reviews will be completed by the Family Medicaid Supervisor for 3 months, 2 reviews for each staff member. Section III - Federal Award Findings and Question Costs These errors and the finding were reviewed with the Family & Children's Medicaid staff. There will be no training as this requirement is currently not required per Admin Letter 13-23. Shaneall Kollock, Medicaid Program Manager

View Audit 303698

Finding 393496 (2023-004)

Significant Deficiency 2023

City of Elizabeth

NJ

Procurement, Suspension & Debarment § 200.317 § 200.327

The City recognizes the importance of internal controls and plans to enhance procedures to ensure that all purchases of goods and services under the federal award requiring a formal contract executes ones. The City believes it is prudent such awards have a contract to support purchase orders. Covid ...

The City recognizes the importance of internal controls and plans to enhance procedures to ensure that all purchases of goods and services under the federal award requiring a formal contract executes ones. The City believes it is prudent such awards have a contract to support purchase orders. Covid interruptions with related illnesses, early retirements, and hiring difficulties all contribute to a negative impact on productivity.

View Audit 303684

Finding 393495 (2023-003)

Material Weakness 2023

City of Elizabeth

NJ

Subrecipient Monitoring Procurement, Suspension & Debarment Reporting

The City recognizes the importance of internal controls and plans to enhance its procedures to ensure Project and Expenditure quarterly reports are prepared in accordance with governing requirements and will update those issues in the first quarter report for 2024. Covid interruptions with related i...

The City recognizes the importance of internal controls and plans to enhance its procedures to ensure Project and Expenditure quarterly reports are prepared in accordance with governing requirements and will update those issues in the first quarter report for 2024. Covid interruptions with related illnesses, early retirements, and hiring difficulties all contributed to a negative impact on productivity.

View Audit 303684

Finding 393494 (2023-007)

Significant Deficiency 2023

City of Elizabeth

NJ

Equipment & Real Property Management Procurement, Suspension & Debarment Internal Control / Segregation of Duties § 200.313

The City recognizes the importance of internal controls and plans to enhance procedures to ensure that all capital equipment is captured at time of purchase and receipt and properly entered in the property records. The City has actively reviewed its procedures of purchasing and disposition of fixed ...

The City recognizes the importance of internal controls and plans to enhance procedures to ensure that all capital equipment is captured at time of purchase and receipt and properly entered in the property records. The City has actively reviewed its procedures of purchasing and disposition of fixed assets and will make the necessary adjustments to ensure the fixed assets system remains up the date. Covid interruptions with related illnesses, early retirements, and hiring difficulties all contribute to a negative impact on productivity.

View Audit 303684

Finding 393492 (2023-006)

Material Weakness 2023

City of Elizabeth

NJ

Cash Management Reporting Internal Control / Segregation of Duties § 200.303

The City recognizes the importance of internal controls and plans to enhance procedures to ensure that the financial reports include amounts that have been incurred and paid and that they are reconciled to the general ledger in compliance with the requirements of the Uniform Guidance. Covid interrup...

The City recognizes the importance of internal controls and plans to enhance procedures to ensure that the financial reports include amounts that have been incurred and paid and that they are reconciled to the general ledger in compliance with the requirements of the Uniform Guidance. Covid interruptions with related illnesses, early retirements, and hiring difficulties all contribute to a negative impact on productivity.

View Audit 303684

Finding 393490 (2023-005)

Material Weakness 2023

City of Elizabeth

NJ

Questioned Costs Allowable Costs / Cost Principles Matching / Level of Effort / Earmarking § 200.430

The City recognizes the importance of internal controls and plans to enhance procedures to ensure payroll expenditures related to grants are properly captured, documented, and charged to that grant. Covid interruptions with related illnesses, early retirements, and hiring difficulties all contribut...

The City recognizes the importance of internal controls and plans to enhance procedures to ensure payroll expenditures related to grants are properly captured, documented, and charged to that grant. Covid interruptions with related illnesses, early retirements, and hiring difficulties all contribute to a negative impact on productivity.

View Audit 303684 Questioned Costs: $1

Finding 393486 (2023-001)

Material Weakness 2023

Town of Foster, Rhode Island

RI

Procurement, Suspension & Debarment

Town of Foster, Rhode Island Corrective Action Plan For the Fiscal Year Ended June 30, 2023 Section III-Federal Award Findings and Questioned Costs Finding: 2023-001 Corrective Action Plan - Management implemented a Corrective Action Plan for all future contracts awarded. These procedures include a...

Town of Foster, Rhode Island Corrective Action Plan For the Fiscal Year Ended June 30, 2023 Section III-Federal Award Findings and Questioned Costs Finding: 2023-001 Corrective Action Plan - Management implemented a Corrective Action Plan for all future contracts awarded. These procedures include adding the required contract language to all contracts and obtaining the professional’s certification that they are not suspended, debarred, or otherwise excluded from participating in the transaction at the time of contract award. In addition, prior to award, the entity confirms through the System for Award Management (SAM.gov) website that the contractor is not suspended, debarred, or otherwise excluded from participating in the transaction. This process was not implemented until late in the 2023 fiscal year. Anticipated Completion Date – Completed Contact Person – Kelli Russ, Finance Director

View Audit 303681

Finding 393456 (2023-003)

Material Weakness 2023

City of Cedar Rapids, Iowa

IA

Reporting

Identifying Number: 2023-003 Finding: The City previously recorded FEMA expenditures from Disaster Grants on their SEFA on the cash basis instead of the FEMA requirement of reporting the expenditures when the City has incurred an eligible expenditure and the project had been approved by FEMA. ...

Identifying Number: 2023-003 Finding: The City previously recorded FEMA expenditures from Disaster Grants on their SEFA on the cash basis instead of the FEMA requirement of reporting the expenditures when the City has incurred an eligible expenditure and the project had been approved by FEMA. Corrective action taken: Finance staff adjusted fiscal year 2023 accordingly and will review future Office of Management and Budget Compliance Supplements for the listing of changes each year. Anticipated completion date: June 30, 2024 Contact person: Andy Hoenig, General Accounting Manager

View Audit 303673

Finding 393445 (2023-001)

Significant Deficiency 2023

Community Resource Project, Inc.

CA

Questioned Costs Significant Deficiency Matching / Level of Effort / Earmarking

The agency agrees with the material finding on improper cutoff and depreciation. The agency was following advice from their previous auditors and now learning the correct way to record these items Community Resource Project, Inc. will strive to implement changes immediately. Going forward the agency...

The agency agrees with the material finding on improper cutoff and depreciation. The agency was following advice from their previous auditors and now learning the correct way to record these items Community Resource Project, Inc. will strive to implement changes immediately. Going forward the agency will implement a procedure to properly cutoff end-of-year expenses and have already begun recording depreciation for grant funded vehicles in the correct manner. Person(s) Responsible: Elizabeth Bianchi-Rossi, Finance Director Timing for Implementation: February 2024 – Once the agency learned of these errors, Community Resource Project, Inc. have already implemented a new procedure for the cutoff period at the end of the year and have changed our depreciation method to ensure the full value of the vehicle gets depreciated.

View Audit 303663 Questioned Costs: $1

Finding 393440 (2023-001)

Material Weakness 2023

Curtis V. Cooper Primary Health Care, Inc.

GA

Cash Management

In Finding 2023-001, a condition was noted that during the year, the Organization made five draws of federal funds that were not disbursed in a timely manner for program expenditures. Management recognizes the importance of the requirements to disburse federal funds in a timely manner. In respons...

In Finding 2023-001, a condition was noted that during the year, the Organization made five draws of federal funds that were not disbursed in a timely manner for program expenditures. Management recognizes the importance of the requirements to disburse federal funds in a timely manner. In response to Finding 2023-001, procedures will be established to minimize the time elapsing between the transfer of funds to the Organization from the U.S. Treasury and the issuance of payments for program purposes by the Organization.

View Audit 303660

Finding 393406 (2023-002)

Significant Deficiency 2023

Catholic Charities, INC

TN

Allowable Costs / Cost Principles

We are in the process of implementing the MACA method for allocating administrative costs going forward. As part of this process, we completed the MACA worksheet provided by SSVF using fiscal year 2023 data. The resulting allowable administrative costs were actually higher than the actual amounts ch...

We are in the process of implementing the MACA method for allocating administrative costs going forward. As part of this process, we completed the MACA worksheet provided by SSVF using fiscal year 2023 data. The resulting allowable administrative costs were actually higher than the actual amounts charged to the grant for fiscal year 2023. We will continue to work with the Veterans Administration to ensure the allocation methodology complies with the SSVF Program Guide.

View Audit 303656

Finding 393405 (2023-011)

Significant Deficiency 2023

Northampton County

NC

Eligibility Significant Deficiency

Finding 2023-011 Inaccurate Resources Entry Name of contact: Lisa Broady, Adult Medicaid Supervisor Corrective Action: Proposed Completion Date: Corrective Actions for finding 2023-008, 2023-009, 2023-010, and 2023-011 also apply to State Award findings. Section IV - State Award Findings and Questio...

Finding 2023-011 Inaccurate Resources Entry Name of contact: Lisa Broady, Adult Medicaid Supervisor Corrective Action: Proposed Completion Date: Corrective Actions for finding 2023-008, 2023-009, 2023-010, and 2023-011 also apply to State Award findings. Section IV - State Award Findings and Question Costs Unit meetings will be held during the week of March 4, 2024 with implementation effective immediately. Section III - Federal Award Findings and Question Costs (continued) Adult Medicaid supervisors will be meeting with staff to ensure that all resources have been updated, entered and documented correctly in NCFast and case files and NCFast are matching. A unit meeting will be scheduled to be held during the week of March 4, 2024 with implementation effective immediately.

View Audit 303645

Finding 393404 (2023-010)

Significant Deficiency 2023

Northampton County

NC

Eligibility Significant Deficiency

Finding 2023-008 IV-D Cooperation with Child Support Name of contact: Felicia Bullock, Family and Children’s Medicaid Supervisor Corrective Action: Proposed Completion Date: Finding 2023-009 Inaccurate Information Entry Name of contact: Corrective Action: Proposed Completion Date: Finding 2023-010 I...

Finding 2023-008 IV-D Cooperation with Child Support Name of contact: Felicia Bullock, Family and Children’s Medicaid Supervisor Corrective Action: Proposed Completion Date: Finding 2023-009 Inaccurate Information Entry Name of contact: Corrective Action: Proposed Completion Date: Finding 2023-010 Inadequate Request for Information Name of contact: Corrective Action: Family and Children's Medicaid with staff on making sure TWN and OVS is ran on every application and recert as well as paying attention to other information received. Adult Medicaid supervisors will meet with staff to ensure that the TWN is being run in NCFast for all applications/recerts and that all case files include online verifications and case documentation of all resources countable and non-countable for vehicles and property. Section III - Federal Award Findings and Question Costs Family and Children's Medicaid supervisors will be meeting with staff to ensure they are receiving correct information, counting and entering correct information into NCF. Supervisor will randomly check at least 10 cases a month to assure accuracy. Adult Medicaid supervisors will be meeting with staff to ensure that they are imputing and listing income correctly in NCFast on all applications/recerts. Also, will ensure that prior to case terminations, clients have been evaluated properly for all AMA programs and proper procedures have been followed before terminating a case. Unit meetings will be held during the week of March 4, 2024 with implementation effective immediately. Supervisor will continue to review 10 cases each month to assure correct information has been keyed and correct procedures has been done prior to case termination. Family and Children's Medicaid supervisors will meet with staff on IV-D referrals and discuss when to key them. A unit meeting with staff during the week of March 4, 2024.

View Audit 303645

Finding 393403 (2023-009)

Significant Deficiency 2023

Northampton County

NC

Eligibility Significant Deficiency Internal Control / Segregation of Duties

Finding 2023-008 IV-D Cooperation with Child Support Name of contact: Felicia Bullock, Family and Children’s Medicaid Supervisor Corrective Action: Proposed Completion Date: Finding 2023-009 Inaccurate Information Entry Name of contact: Corrective Action: Proposed Completion Date: Finding 2023-010 I...

Finding 2023-008 IV-D Cooperation with Child Support Name of contact: Felicia Bullock, Family and Children’s Medicaid Supervisor Corrective Action: Proposed Completion Date: Finding 2023-009 Inaccurate Information Entry Name of contact: Corrective Action: Proposed Completion Date: Finding 2023-010 Inadequate Request for Information Name of contact: Corrective Action: Family and Children's Medicaid with staff on making sure TWN and OVS is ran on every application and recert as well as paying attention to other information received. Adult Medicaid supervisors will meet with staff to ensure that the TWN is being run in NCFast for all applications/recerts and that all case files include online verifications and case documentation of all resources countable and non-countable for vehicles and property. Section III - Federal Award Findings and Question Costs Family and Children's Medicaid supervisors will be meeting with staff to ensure they are receiving correct information, counting and entering correct information into NCF. Supervisor will randomly check at least 10 cases a month to assure accuracy. Adult Medicaid supervisors will be meeting with staff to ensure that they are imputing and listing income correctly in NCFast on all applications/recerts. Also, will ensure that prior to case terminations, clients have been evaluated properly for all AMA programs and proper procedures have been followed before terminating a case. Unit meetings will be held during the week of March 4, 2024 with implementation effective immediately. Supervisor will continue to review 10 cases each month to assure correct information has been keyed and correct procedures has been done prior to case termination. Family and Children's Medicaid supervisors will meet with staff on IV-D referrals and discuss when to key them. A unit meeting with staff during the week of March 4, 2024.

View Audit 303645

Finding 393402 (2023-008)

Significant Deficiency 2023

Northampton County

NC

Eligibility Significant Deficiency

Finding 2023-008 IV-D Cooperation with Child Support Name of contact: Felicia Bullock, Family and Children’s Medicaid Supervisor Corrective Action: Proposed Completion Date: Finding 2023-009 Inaccurate Information Entry Name of contact: Corrective Action: Proposed Completion Date: Finding 2023-010 I...

Finding 2023-008 IV-D Cooperation with Child Support Name of contact: Felicia Bullock, Family and Children’s Medicaid Supervisor Corrective Action: Proposed Completion Date: Finding 2023-009 Inaccurate Information Entry Name of contact: Corrective Action: Proposed Completion Date: Finding 2023-010 Inadequate Request for Information Name of contact: Corrective Action: Family and Children's Medicaid with staff on making sure TWN and OVS is ran on every application and recert as well as paying attention to other information received. Adult Medicaid supervisors will meet with staff to ensure that the TWN is being run in NCFast for all applications/recerts and that all case files include online verifications and case documentation of all resources countable and non-countable for vehicles and property. Section III - Federal Award Findings and Question Costs Family and Children's Medicaid supervisors will be meeting with staff to ensure they are receiving correct information, counting and entering correct information into NCF. Supervisor will randomly check at least 10 cases a month to assure accuracy. Adult Medicaid supervisors will be meeting with staff to ensure that they are imputing and listing income correctly in NCFast on all applications/recerts. Also, will ensure that prior to case terminations, clients have been evaluated properly for all AMA programs and proper procedures have been followed before terminating a case. Unit meetings will be held during the week of March 4, 2024 with implementation effective immediately. Supervisor will continue to review 10 cases each month to assure correct information has been keyed and correct procedures has been done prior to case termination. Family and Children's Medicaid supervisors will meet with staff on IV-D referrals and discuss when to key them. A unit meeting with staff during the week of March 4, 2024.

View Audit 303645

Finding 393392 (2023-003)

Significant Deficiency 2023

Chippewa Hills School District

MI

Allowable Costs / Cost Principles § 200.402

Finding 2023-003 - Corrective Action Plan CHSD - 2022-2023 Audit Findings Finding 2023-003 – ACTIVITIES ALLOWED OR UNALLOWED / ALLOWABLE COST/COST PRINCIPLES Type: Significant Deficiency in Internal Control Program: COVID 19 Education Stabilization Fund (ALN 84.425D– ESSER II Formula, and ALN 84.425...

Finding 2023-003 - Corrective Action Plan CHSD - 2022-2023 Audit Findings Finding 2023-003 – ACTIVITIES ALLOWED OR UNALLOWED / ALLOWABLE COST/COST PRINCIPLES Type: Significant Deficiency in Internal Control Program: COVID 19 Education Stabilization Fund (ALN 84.425D– ESSER II Formula, and ALN 84.425U – ESSER III Formula) Condition: Expenditures charged to the grant were not authorized by the grant. Criteria: As detailed by 2 CFR 200.402, “the total cost of a Federal award is the sum of the allowable direct and allocable indirect costs less any applicable credits”. Cause: Management’s misunderstanding of costs allowed under this grant. Effect: Unallowed costs Corrective action to be taken: 1. District enlisted the services of an outside consultant to work with the Finance Director to address the training, knowledge, and experience (TKE) shortfalls in his skill set. The scope of work was specified to include addressing the grant funding processes, proper public school audit practices, and the proper methods for grant application, grant budgeting, budget implementation, amending budgetary elements as permissible, and reconciling grant funding. 2. The Finance Director will effectively apply the provided TKE skills to CHSD Grant Funding processes to ensure compliance with the budgetary guidelines and constraints of each grant funding opportunity awarded to the CHSD. 3. In the event a need or opportunity arises, whereby a requested transaction exceeds a budgetary constraint of an approved grant budget, the Finance Director will ensure a Grant Budget Amendment or variance request is reviewed and approved by the issuing Agency/Department prior to authorizing or posting the transaction which would create the budget variance. The corrective action timeline is as follows: The corrective action is effective immediately and applicable to all stakeholders with data entry access to the CHSD financial accounting software platform. District Leader Responsible for Corrective Action Plan: The Finance Director will be responsible for ensuring compliance with this corrective action. Respectfully submitted, Marc Forrest, Director of Finance

View Audit 303635

Finding 393391 (2023-002)

Material Weakness 2023

Chippewa Hills School District

MI

Equipment & Real Property Management § 200.313

Finding 2023-002 - Corrective Action Plan CHSD - 2022-2023 Audit Findings Finding 2023-002 – EQUIPMENT Type: Material Weakness in Internal Control / Noncompliance Program: COVID 19 Education Stabilization Fund (ALN 84.425D – ESSER II Formula) Condition: The District was unable to locate all Chromebo...

Finding 2023-002 - Corrective Action Plan CHSD - 2022-2023 Audit Findings Finding 2023-002 – EQUIPMENT Type: Material Weakness in Internal Control / Noncompliance Program: COVID 19 Education Stabilization Fund (ALN 84.425D – ESSER II Formula) Condition: The District was unable to locate all Chromebooks selected for testing that were purchased with ESSER II Formula funds. Also, some Chromebooks that were located did not have adequate identification tags Corrective action to be taken: A. Improved device inventory management – to include ESSER Funded Chromebooks: Consistent with the goal of improved technology device tracking, CHSD will expand the scope of end-user identification information collected and monitored via existing Technology Management Systems. By leveraging and expanding the use of available resources within our Google Administrative Console and GoGuardian, including deployment of a GoGuardian check-in/check-out functionality, CHSD will possess the details and tracking information necessary to provide improved device management and tracking in real time. The following actions, consistent with the goal of this CAP, will be executed as part of the expanded device monitoring project deployment:  Complete a full review of CHSD Technology Device inventory.  Decommission and/or disable any lost, damaged, stolen, or broken Technology Devices (to include Chromebooks) and document the outcome of each event (i.e. unsalvageable, returned to use, lost/stolen, etc.) prior to recycling or further deployment.  Perform routine internal audits of device inventory: o Per trimester o Annual summer audit. B. Proper identification tags on Chromebooks: This is an ongoing corrective action to address devices which were deployed prior to the purchase of an etching device for the District. Deficient devices are in the process of being identified, pulled from operations, properly asset tagged via laser engraving, and returned to operations as time and resources are available. The full review of CHSD Technology Device Inventory, noted in the first bullet of Section A above, will serve as a secondary compliance review opportunity to ensure the current efforts provided full compliance with the asset tag requirements. Additionally, with the purchase of the laser engraver, new Chromebooks/devices are required to have their asset ID and funding source etched as part of the device set up process which is completed prior to deployment. The corrective action timeline is as follows: A. Improved device inventory management – to include ESSER Funded Chromebooks – Noted corrective actions are scheduled to be in place and complete by September 1, 2024. B. Proper identification tags on Chromebooks - Noted corrective action regarding proper Asset Tag being applied to deficient devices is scheduled to be complete by June 30, 2024. District Leader Responsible for Corrective Action Plan: The Technology Administrator will be responsible for ensuring compliance with this corrective action and will provide the results of the noted routine internal inventory and audit events to the Superintendent for review and data warehousing. Respectfully submitted, Marc Forrest, Director of Finance

View Audit 303635

Finding 393390 (2023-001)

Material Weakness 2023

Chippewa Hills School District

MI

Allowable Costs / Cost Principles § 200.430

Finding 2023-001 - Corrective Action Plan CHSD - 2022-2023 Audit Findings Finding 2023-001 - ACTIVITIES ALLOWED OR UNALLOWED / ALLOWABLE COSTS/COST PRINCIPLES Type: Material Weakness in Internal Control / Noncompliance Program: COVID 19 Education Stabilization Fund (ALN 84.425D – ESSER II Formula, E...

Finding 2023-001 - Corrective Action Plan CHSD - 2022-2023 Audit Findings Finding 2023-001 - ACTIVITIES ALLOWED OR UNALLOWED / ALLOWABLE COSTS/COST PRINCIPLES Type: Material Weakness in Internal Control / Noncompliance Program: COVID 19 Education Stabilization Fund (ALN 84.425D – ESSER II Formula, ESSER II Section 98c Learning Loss, ALN 84.425U – ESSER III Formula) Condition: The District was unable to provide documentation that identified wages, by employee, that were charged to Education Stabilization Fund grants. Corrective action to be taken: Payroll transactions will be recorded at the most granular level to ensure accuracy and transparency in the resulting outcomes. The issue at hand was a result of an overarching labor transfer at the top level of the labor expense accounts. The errant transfer neglected to properly align the underlying transactions, at the employee weekly payroll level, with the correlating expense totals being transferred between grants (i.e. each individual employee expense of the same General Ledger expense code structure comprising the total expense of the given General Ledger) and resulted in the disparity noted in the finding. Adherence to this corrective action will ensure strengthened internal control(s) and future grant compliance. Corrective action timeline: The corrective action is effective immediately and applicable to all stakeholders with data entry access to the CHSD financial accounting software platform. District leader responsible for Corrective Action Plan: The Finance Director will be responsible for ensuring compliance with this corrective action and work product of the Finance Director will have a similarly robust check and balance via transaction review and verification by a knowledgeable second source, normally the Account Payable Administrator or the Superintendent. Respectfully submitted, Marc Forrest, Director of Finance

View Audit 303635

Finding 393379 (2023-004)

Significant Deficiency 2023

Chippewa Hills School District

MI

Cash Management School Nutrition Programs Special Tests & Provisions

Finding 2023-004 - Corrective Action Plan CHSD - 2022-2023 Audit Findings Finding 2023-004 – SPECIAL TESTS AND PROVISIONS (repeat comment) Type: Significant Deficiency in Internal Control / Noncompliance Program: Child Nutrition Cluster (ALN 10.553, 10.555 and 10.559) Condition: As of year-end the D...

Finding 2023-004 - Corrective Action Plan CHSD - 2022-2023 Audit Findings Finding 2023-004 – SPECIAL TESTS AND PROVISIONS (repeat comment) Type: Significant Deficiency in Internal Control / Noncompliance Program: Child Nutrition Cluster (ALN 10.553, 10.555 and 10.559) Condition: As of year-end the District had a fund balance in the non-profit food service fund in excess of three months’ operating expenses by approximately $157,881. Criteria: The USDA requires that the District limit its net cash resources to an amount that does not exceed 3 months average expenditures of the non-profit food service fund per requirements in 7 CFR Part 210.14(b). Cause: This condition was caused by the meal claims increasing and having more reimbursements come in than anticipated. Corrective action to be taken: Over the 2023-2024 school year, the District will continue to leverage the excess fund balance to improve the quality of the food service program. Efforts to address the ongoing excess fund balance condition are ongoing and, while planning started in the 2022-2023 school year, an aggressive food service capital reinvestment project is scheduled to be completed in the 2023-2024 school year. This $220,000+ project will address equipment replacement and student service improvements in both the High School and the Middle School. The spend down associated with this project is anticipated to offset the excess fund balance on June 30, 2023, as noted in this finding. However, anticipating the potential for continued Food Service Program funding support at a state and federal level, the CHSD food service department will continue to monitor the fund balance with the goal of proactively managing any forecasted excess balance by continuing to offer more new food choices and improve the quality of the food served (including more fresh produce and better-quality ingredients). These improvements will continue to be in conjunction with the Michigan Department of Education's Office of School Support Services which will again approve the spending plan. The corrective action timeline is as follows: The corrective action is effective immediately and encompasses the ongoing efforts on the part of the District to comply with program criteria while balancing unpredictable statutory revenue streams against spending forecasts in the highly volatile food service market conditions. The District anticipates compliance with the Fund Balance condition set forth in the program by 6-30-2024. District Leader Responsible for Corrective Action Plan: The Food Service Administrator will be responsible for ensuring compliance with this corrective action. Respectfully submitted, Marc Forrest, Director of Finance

View Audit 303635

Finding 393378 (2023-002)

Significant Deficiency 2023

Mi Residential Community, Inc. 023-11147

MA

Equipment & Real Property Management Internal Control / Segregation of Duties

U.S. Department of Housing and Urban Development, passed through the Massachusetts Housing Finance Agency Section 8 Housing Assistance Payments Program – Assistance Listing No. 14.195 Significant Deficiencies 2023...

U.S. Department of Housing and Urban Development, passed through the Massachusetts Housing Finance Agency Section 8 Housing Assistance Payments Program – Assistance Listing No. 14.195 Significant Deficiencies 2023-002 Condition: 8 of the 40 required annual housing quality inspections selected for testing had not been completed within one year of the previous inspection. Auditor's Recommendation: We recommend that an internal control procedure to ensure that the required annual housing inspections are performed within one year of the previous inspection be implemented. Action Taken: Management will continue to work consistently to comply with performing unit inspections on at least an annual basis to determine whether the appliances and equipment in the units are functioning properly. Management will ensure that annual inspections commence in April 2024 to ensure that all units are inspected within 365 days of the last unit inspection.

View Audit 303633

Finding 393377 (2023-001)

Significant Deficiency 2023

Mi Residential Community, Inc. 023-11147

MA

HUD Housing Programs Eligibility Reporting

U.S. Department of Housing and Urban Development, passed through the Massachusetts Housing Finance Agency Section 8 Housing Assistance Payments Program – Assistance Listing No. 14.195 Significant Deficiencies 2023-001 Condition: 1) Housing assistance and tenant payments for 2 of the 40 tenant file...

U.S. Department of Housing and Urban Development, passed through the Massachusetts Housing Finance Agency Section 8 Housing Assistance Payments Program – Assistance Listing No. 14.195 Significant Deficiencies 2023-001 Condition: 1) Housing assistance and tenant payments for 2 of the 40 tenant files selected for testing were calculated incorrectly due to errors in the amounts used for income. 2) The asset values for 10 of the 40 tenant files and the interest income for 3 of the 40 tenant files selected for testing were not reported correctly on Form HUD-50059. This had no impact on the housing assistance and tenant payments. 3) There were no sufficient documentation for 2 of the 40 tenant files selected for testing to support the asset values reported on Form HUD-50059. 4) 1 of the 40 tenant files selected for testing was missing an Existing Tenant Search report. 5) The Existing Tenant Search report for 2 of the 40 tenant files selected for testing stated that the tenants may be receiving rental assistance at another housing agency, however there was no evidence to show that the Community had followed up with the tenant and/or the housing agency to avoid a double subsidy. Auditor's Recommendation: We recommend that an internal control procedure be implemented to ensure that all HUD-50059 forms are completed accurately and all required information is obtained and maintained within the tenant files. Action Taken: 1) Management will meet with tenants to properly investigate causation for the finding above. Management will correct the audited annual recertification with the expectation of correcting the income used to tabulate the tenants’ level of rental assistance. For the file where the tenant was overcharged, the tenant will be reimbursed for administrative error. For the file where the rental subsidy was being overcharged, HUD will be reimbursed for the subsidy accordingly. 2) Management will correct all audited annual recertifications with correct asset values and/or interest income. Management will also insert file clarification notes to all files that are edited to ensure transparency and notate that the corrected asset values and/or interest income will not affect the tenants’ level of rental assistance. Management will implement internal control procedures to ensure that all asset and interest income values are reported correctly in the future. 3) Management will meet with tenants to properly investigate causation for the finding above. Management will correct annual recertification reporting and properly document tenant files accordingly. Management will implement internal control procedures to ensure that staff is only accepting proper verifications per the HUD handbook in the future. 4) Management will ensure that the tenant has an Existing Tenant Search report in the file. Management has removed all tenant information that does not correspond to this tenant file. Management will implement internal control procedures to ensure that documents are not being misfiled. 5) Management will meet with tenants to properly investigate causation for the finding above. Management will determine if possible double subsidies exist. Management will follow up with respective PHA or owner if necessary to confirm if the tenant is being assisted at the other location. Management will properly document all contacts made or information obtained to determine if a household is receiving multiple subsidies or not. When the tenants’ multiple subsidies are discussed and resolved, management will ensure that all evidence is included within the tenant file.

View Audit 303633

Finding 393376 (2023-002)

Material Weakness 2023

Iron County Housing Commission

MI

Special Tests & Provisions HUD Housing Programs Internal Control / Segregation of Duties

Action Taken: Management has updated its utility allowance effective beginning in November 2023. Anticipated Completion Date of Action: November 2023

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Finding 393375 (2023-001)

Material Weakness 2023

Iron County Housing Commission

MI

Special Tests & Provisions HUD Housing Programs Internal Control / Segregation of Duties

Action Taken: Management is still in the process of implementing policies and procedures to ensure all inspections are performed in a timely manner and all re-inspections are performed within the required timeframe. Anticipated Completion Date of Action: Ongoing

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Finding 393374 (2023-001)

Significant Deficiency 2023

Community Health & Wellness Partners of Logan County

OH

Subrecipient Monitoring Reporting Internal Control / Segregation of Duties

Federal program and specific federal award U.S. Department of Health and Human Services (HHS) 93.498 Provider Relief Fund and American Rescue Plan Rural Distribution Specific requirement Special Reporting of Provider Relief Funds (PRF) Reporting Portal Condition Under the terms and conditions of t...

Federal program and specific federal award U.S. Department of Health and Human Services (HHS) 93.498 Provider Relief Fund and American Rescue Plan Rural Distribution Specific requirement Special Reporting of Provider Relief Funds (PRF) Reporting Portal Condition Under the terms and conditions of the Provider Relief Funds “option 2” for calculation of lost revenue using budgeted revenue compared to actual revenue, the amounts used for the budget must be based on a board approved budget prior to March 27, 2020, which covers the period of availability. The Organization utilized a budget for the period November 1, 2019, through October 31, 2020 that was board approved prior to March 27, 2020; however, the budget periods of November 1, 2020 through October 31, 2021 and November 1, 2021 through October 31, 2022 were not board approved prior to March 27, 2020. Accordingly, option 3 should have been indicated in the PRF reporting portal. In addition, it was noted that there was not a separate review of the information submitted to the reporting portal. Cause Due to the complexity of the PRF Reporting Requirements, the Organization made an error in selecting option 2 as the reporting method and there was not a second review of the information reported in the PRF reporting portal before submission. Effect or potential effect Option 2 verses Option 3 was selected on PRF reporting portal. Questioned costs None Repeat finding No Recommendation We recommend that management further review terms and conditions of grant reporting requirements and include others within the Organization to provide monitoring and oversight of reporting submissions. Corrective action We agreed with the above comment and will include the involvement of the CEO or a Finance Committee member to review reporting submissions for all grant awards. Due to the unusual nature of the PRF reporting, we believe this issue of noncompliance is isolated. Questions regarding this corrective action plan should be addressed to Tara Bair, President/CEO at (937)599-1411.

View Audit 303631

Corrective Action Plans

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