Corrective Action Plans

Finding 465 (2023-001)

Material Weakness 2023

Tmsa, Inc.

GA

Material Weakness Reporting Equipment & Real Property Management

September 29, 2023, Audit Period For the Year July 1, 2022 - June 30, 2023, Re: Request for Corrective Action Plan - Material Weakness, The Main Street Academy (TMSA) is in receipt of The Financial Statement Finding from Marshall Jones. TMSA responds as follows:Recommendation: Marshall Jones recomm...

September 29, 2023, Audit Period For the Year July 1, 2022 - June 30, 2023, Re: Request for Corrective Action Plan - Material Weakness, The Main Street Academy (TMSA) is in receipt of The Financial Statement Finding from Marshall Jones. TMSA responds as follows:Recommendation: Marshall Jones recommends that the School receive additional assistance in improving its financial reporting processes from individuals who are familiar with GAAP and governmental grant accounting. Marshall Jones also recommends that management establish policies and procedures to ensure that management-level reviews of monthly and annual financial information are performed on a timely basis. Views of Responsible Officials: The management of the School acknowledges the finding and concurs with the recommendation of Marshall Jones and provides the following Corrective Action Plan.Response of Responsible Officials: To continuously improve TMSA’s Accounting and Financial Reporting, workflows, and internal controls, TMSA transitioned back-office accounting providers mid-fiscal year (February 2023) due to various noted back-office operating weaknesses with the previous accounting provider. The previous back-office accounting provider did not set up the books well for continuation and transition. As a result, significant journal entries required correction by the new back-accounting provider to correct and strengthen the overall financials and back-office operating procedures of the organization. The management of the school and the current firm (Belay Accounting) have knowledge in the areas of both GASB and GAAP. The current back-office accounting provider and firm will continue with their existing monthly reviews of TMSA’s financials. The Chief Financial Officer (CFO) of the back-office firm Belay Accounting will work with the management of the school to continue to review the work of the back-office accounting staff monthly, specifically checking for adherence to GASB and GAAP standards. Following the transition from the previous back-office accounting provider to the current back-office accounting provider; the management of the school updated on February 10, 2023, its Financial & Accounting Control Policies & Procedures to further strengthen TMSA’s internal controls.Corrective Action Plan: The management of the school and the back-office accounting provider will continue to seek and attend training, in addition to receiving additional assistance to continue improving the financial reporting processes as recommended. Since the transition to the current back-office accounting provider and firm, monthly and annual financial reviews are currently being performed on a timely basis, which was not the case in the past with the previous back-office accounting provider. The management of the school will work with the CFO and back-office accounting staff to ensure that financial reviews and reporting continue to be performed on a timely basis. In partnership, Chaddrick Owes, Ed.D., Executive Director

View Audit 1010

Finding 462 (2023-002)

None 2023

Brescia University Inc.

KY

Special Tests & Provisions Student Financial Aid

The Director of Financial Aid reviewed all students who had withdrawn and determined that only two were impacted. These two students' refund calculations were reviewed and corrected, and appropriate funds were returned. The dates used in the R2T 4 calculation for the upcoming year have been reviewed...

The Director of Financial Aid reviewed all students who had withdrawn and determined that only two were impacted. These two students' refund calculations were reviewed and corrected, and appropriate funds were returned. The dates used in the R2T 4 calculation for the upcoming year have been reviewed by the Director of Financial Aid to verify the proper number of days will be used in the Title IV Refund calculations. The Assistant Registrar will review the academic calendar each semester to be used in the R2T4 calculations. The University implemented these procedures for the Fall 2023 semester.

View Audit 1009

Finding 458 (2023-001)

Significant Deficiency 2023

Brescia University Inc.

KY

Special Tests & Provisions Student Financial Aid Reporting

To prevent future errors and oversight in the preparation and review process, hard copies of the documents used to prepare the FI SAP will be cross-checked and verified by the Student Financial Aid Director. The documentation of the review then will be re-verified by the Vice President of Business &...

To prevent future errors and oversight in the preparation and review process, hard copies of the documents used to prepare the FI SAP will be cross-checked and verified by the Student Financial Aid Director. The documentation of the review then will be re-verified by the Vice President of Business & Finance. The University implemented these procedures for the FI SAP due October 1, 2023.

View Audit 1009

Finding 456 (2023-001)

None 2023

Nlh 5

NM

Questioned Costs HUD Housing Programs Reporting

FINDING 2023-001 - Special Tests and Provisions - Reserve for Replacement Criteria: Total cash of $5,022 was required to be deposited into the Reserve for Replacement account by June 30,2023 Statement of Condition: As of June 30, 2023, the Reserve for Replacement only had $4,604 deposited during the...

FINDING 2023-001 - Special Tests and Provisions - Reserve for Replacement Criteria: Total cash of $5,022 was required to be deposited into the Reserve for Replacement account by June 30,2023 Statement of Condition: As of June 30, 2023, the Reserve for Replacement only had $4,604 deposited during the year. Cause: Management did not perform the Reserve for Replacement deposit for one month. Effect or Potential Effect: The project was not in compliance with the Capital Advance and current HUD regulations, the project’s Reserve for Replacement was under-funded for the current year by $418. Auditor Non-Compliance Code: B Questioned Costs: $418 Reporting Views of Responsible Officials: Management agrees with the Reserve for Replacement calculations and is aware of the current deposit required to the Reserve for Replacement. Auditor's Recommendations: Management should implement internal controls to make any required deposits before the year-end deadline. Action Plan: Money was transferred to the Replacement Reserve account in July 2023.

View Audit 1002 Questioned Costs: $1

Finding 450 (2023-003)

Material Weakness 2023

Pine River-Backus Public Schools Independent School District No. 2174

MN

Procurement, Suspension & Debarment Internal Control / Segregation of Duties

2023-003 Eligibility and Reporting Federal Agency: U.S. Department of Agriculture Federal Program Name: Child Nutrition Cluster Assistance Listing Number: 10.553 and 10.555 Federal Award Identification Number and Year: 212MN061N1199 - 2023 Pass-Through Agency: Minnesota Department of Education Pass...

2023-003 Eligibility and Reporting Federal Agency: U.S. Department of Agriculture Federal Program Name: Child Nutrition Cluster Assistance Listing Number: 10.553 and 10.555 Federal Award Identification Number and Year: 212MN061N1199 - 2023 Pass-Through Agency: Minnesota Department of Education Pass-Through Number(s): 1-2174-000 Award Period: July 1, 2022 - June 30, 2023 Type of Finding: • Material Weakness in Internal Control over Compliance Recommendation: We recommend the District review and approve the CLiCS meals counts timely before they are submitted, review the paper applications, and implement procedures to ensure vendors are not suspended or debarred. Explanation of Disagreement with Audit Finding: There is no disagreement with the audit finding. Action Taken in Response to Finding: Management will work on implementing procedures and controls to ensure meal counts are accurate and reviewed prior to submission, paper applications are reviewed and approved, and proper documentation is retained to ensure vendors are not suspended or debarred. Name of the Contact Person Responsible for Corrective Action Plan: Jolene Bengtson, Business Manager Planned Completion Date for Corrective Action Plan: June 30, 2024

View Audit 987

Finding 439 (2023-003)

Material Weakness 2023

Housing Authority of the City of Imperial, Nebraska

NE

Internal Control / Segregation of Duties Special Tests & Provisions Eligibility

Finding 2023-003 The Authority agrees with the finding and responds by stating that our project is relatively small with only one administrative staff. The Board has reviewed this issue and determined there are no additional procedures which can reasonably be done to eliminate these deficiencies a...

Finding 2023-003 The Authority agrees with the finding and responds by stating that our project is relatively small with only one administrative staff. The Board has reviewed this issue and determined there are no additional procedures which can reasonably be done to eliminate these deficiencies and accepts them.

View Audit 966

Finding 437 (2023-002)

None 2023

Howard Payne University

TX

Incorrect Summer Pell Calculation Planned Corrective Action: PELL grant was incorrectly calculated on some students. We have been, and still are, working with our software provider to determine the issue. Until this matter is resolved, all summer PELL disbursements will be reviewed and recalculat...

Incorrect Summer Pell Calculation Planned Corrective Action: PELL grant was incorrectly calculated on some students. We have been, and still are, working with our software provider to determine the issue. Until this matter is resolved, all summer PELL disbursements will be reviewed and recalculated manually to ensure accuracy. Person Responsible for Corrective Action Plan: Karen LaQuey, Director, Student Financial aid Anticipated Date of Completion: ASAP

View Audit 959

Finding 436 (2023-001)

None 2023

Howard Payne University

TX

Reporting Student Financial Aid Eligibility

Enrollment Reporting to National Student Loan Data System (NSLDS) Planned Corrective Action: A review is being completed by the Registrar’s Office to determine if something is in the student record that may prevent a student from being reported correctly. If a common factor can be determined, then ...

Enrollment Reporting to National Student Loan Data System (NSLDS) Planned Corrective Action: A review is being completed by the Registrar’s Office to determine if something is in the student record that may prevent a student from being reported correctly. If a common factor can be determined, then it will be corrected. Until then, Enrollment reporting to NSC will be reviewed twice. Follow up will be done regarding last date of attendance reporting for those students who do fail to complete the semester. Person Responsible for Corrective Action Plan: Karen LaQuey, Director, Student Financial Aid Director; Wendy McNeeley, previous Registrar; Kristina Penland, Registrar Anticipated Date of Completion: 12/12/2023

View Audit 959

Finding 435 (2023-001)

Significant Deficiency 2023

Northeast Ohio Medical University

OH

Subrecipient Monitoring Reporting Significant Deficiency

Finding Number: 2023-001 Anticipated Completion Date: October 16, 2023 Responsible Contact Person: Bianka Hernandez, Director of Grants Accounting Planned Corrective Action: All FFATA reporting will be entered onto the FSRS website immediately after full execution. The report will be saved and sub...

Finding Number: 2023-001 Anticipated Completion Date: October 16, 2023 Responsible Contact Person: Bianka Hernandez, Director of Grants Accounting Planned Corrective Action: All FFATA reporting will be entered onto the FSRS website immediately after full execution. The report will be saved and submitted monthly as new subaward agreements are fully executed. The FFATA report will be monitored and reviewed three business days before the end of the current month, so that the report may be submitted in a timely manner.

View Audit 953

Finding 434 (2023-001)

Significant Deficiency 2023

South Pointe Housing, Inc.

LA

Subrecipient Monitoring HUD Housing Programs Reporting

At the end of July, 2023, security deposits held on behalf of tenants were $9,206 and funds held in reserve at the bank were $9,442.80. August security deposits held on behalf of tenants were again $9,206 and funds held in reserve at the bank were $9,442.80. We will continue to monitor this on a mo...

At the end of July, 2023, security deposits held on behalf of tenants were $9,206 and funds held in reserve at the bank were $9,442.80. August security deposits held on behalf of tenants were again $9,206 and funds held in reserve at the bank were $9,442.80. We will continue to monitor this on a monthly basis.

View Audit 947

Finding 432 (2023-001)

None 2023

Corporacion De Servicios Educativos De Yabucoa

PR

Reporting

COSEY did not receive on a timely manner, the information from the previous auditor's firm. In the past recent years this has been our first finding. However, in order to comply and address the matter we have submitted the Single Audit reporting package on time for this period. Also, we have establi...

COSEY did not receive on a timely manner, the information from the previous auditor's firm. In the past recent years this has been our first finding. However, in order to comply and address the matter we have submitted the Single Audit reporting package on time for this period. Also, we have established quarterly follow ups to the consultants in charge of performing statements.

View Audit 932

Finding 425 (2023-001)

Significant Deficiency 2023

Shands Jacksonville Medical Center, INC

FL

Allowable Costs / Cost Principles Cash Management Eligibility

Views of responsible officials and planned corrective actions: The Financial and Data Analytics Director conducts spot testing of each bi-weekly payroll expenditure report received from Human Resources for eligible PRF reporting. Evidence of testing is retained. Responsible Officials: Dean C. Cocchi...

Views of responsible officials and planned corrective actions: The Financial and Data Analytics Director conducts spot testing of each bi-weekly payroll expenditure report received from Human Resources for eligible PRF reporting. Evidence of testing is retained. Responsible Officials: Dean C. Cocchi, Vice President and CFO Completion Date: March 31, 2022

View Audit 896

Finding 424 (2023-002)

Significant Deficiency 2023

Housing Authority for the City of Freeport

IL

HUD Housing Programs

Going forward the HA will follow the HUD compliance supplement and obligate the capital funds transferred to operations the same day the voucher request is submitted in LOCCS.

View Audit 891

Finding 423 (2023-001)

Significant Deficiency 2023

Housing Authority for the City of Freeport

IL

HUD Housing Programs

Recently, HACF has hired a new Assistant Property Manager who will receive Public Housing Occupancy, Eligibility, Income and Rent Calculation (PHOEIR) training from NAHRO. This training will provide knowledge and accurate rent calculation guidance to the HACF’s staff. Additionally, HACF will conduct...

Recently, HACF has hired a new Assistant Property Manager who will receive Public Housing Occupancy, Eligibility, Income and Rent Calculation (PHOEIR) training from NAHRO. This training will provide knowledge and accurate rent calculation guidance to the HACF’s staff. Additionally, HACF will conduct and review up to 20 files bi-annually and will document file errors and needed corrections. All audit files will be signed off by the Property Operations Manager and the staff. Property management staff will receive ongoing training on reviewing income, assets, and rent calculations, tenant record keeping and recertification requirements.

View Audit 891

Finding 422 (2023-001)

None 2023

Columbia Catholic Housing for the Elderly, Inc. - Trinity House Apartments

PA

Special Tests & Provisions HUD Housing Programs

IN THE FUTURE, THE PROJECT MANAGER WILL PERFORM ALL UNIT INSPECTIONS AT THE TIME OF ANNUAL RECERTIFICATION TO ENSURE INSPECTIONS ARE NOT MISSED. THE REGIONAL MANAGER WILL REVIEW ALL UNIT INSPECTIONS ON A MONTHLY BASIS.

View Audit 889

Finding 416 (2023-001)

Significant Deficiency 2023

National Crime Victim Law Institute

OR

Allowable Costs / Cost Principles Significant Deficiency

National Crime Victim Law Institute respectfully submits the following corrective action plan for the year ended May 31, 2023. Contact Person of National Crime Victim Law Institute: Julie Hester, Director of Administration and Operations 1130 SW Morrison Street, Suite 240, Portland, Oregon 97205 N...

National Crime Victim Law Institute respectfully submits the following corrective action plan for the year ended May 31, 2023. Contact Person of National Crime Victim Law Institute: Julie Hester, Director of Administration and Operations 1130 SW Morrison Street, Suite 240, Portland, Oregon 97205 Name and Address of Independent Public Accounting Firm: McDonald Jacobs, P.C. 520 SW Yamhill, Suite 500, Portland, Oregon 97204 Audit Period: June 1, 2022 through May 31, 2023. The finding from the May 31, 2023 schedule of findings and questioned costs is discussed below. The finding is numbered consistently with the number assigned in the schedule. Finding # 2023-001 Type: Federal award, Significant deficiency regarding allowable costs Finding For three months tested, amounts charged to the grant for allocated rent expenses were inaccurate or did not agree to the accounting records, resulting in insignificant over and under billings. Recommendation: Contract billings should be reconciled to the accounting records and a review of the reconciliation should be completed before invoicing the government agency. Corrective Action: NCVLI has engaged the services of a contract accounting firm for fiscal year 2023-24. This accounting firm will assist with monthly financial transactions, maintaining accounting records and assisting with billings. This firm will work closely with the Director of Administration & Operations (DAO). Among the benefits of this additional layer of support for accounting work is a new process for rent allocations which ensures calculations are reviewed and affirmed by multiple people. Rent allocations are generated by the accounting firm and reviewed by the DAO prior to generation of billings. Billings will then be generated by the DAO with assistance from the accounting firm and will continue to be reviewed and approved by the Executive Director prior to submission to federal agencies. As an additional check, regular internal review of monthly payroll and rent allocations will be conducted by a member of the management team other than the DAO to ensure supporting documentation and reports from accounting system align and support allocations. Anticipated Completion Date: September 2023

View Audit 868

Finding 412 (2023-001)

Significant Deficiency 2023

Rye City School District

NY

The District will implement a system of internal controls to ensure that all certifications are completed in accordance with the percentage of time worked (ie. monthly or semiannually) and that they are completed timely. The implementation of this system will occur within 30 days of receiving the au...

The District will implement a system of internal controls to ensure that all certifications are completed in accordance with the percentage of time worked (ie. monthly or semiannually) and that they are completed timely. The implementation of this system will occur within 30 days of receiving the auditor’s report.

View Audit 863

Finding 405 (2023-001)

None 2023

Worthington Senior Housing, Inc.

MN

Auditor Recommendation Recommendation: We recommend that the Organization ensure that the required deposit to the reserve for replacements account be made on a timely basis. Corrective Action Plan (CAP) 1. Explanation of Disagreement with Audit Finding There is no disagreement with the audit findi...

Auditor Recommendation Recommendation: We recommend that the Organization ensure that the required deposit to the reserve for replacements account be made on a timely basis. Corrective Action Plan (CAP) 1. Explanation of Disagreement with Audit Finding There is no disagreement with the audit finding. 2. Action Planned in Response to Finding Sara Wohlers (management agent) will ensure that deposits to reserve for replacements account are made on a timely basis when cash allows. The remaining deposit for the June 30, 2023 fiscal year was deposited on August 2, 2023. 3. Official Responsible for Insuring CAP Sara Wohlers is the official responsible for ensuring corrective action of the deficiency. 4. Planned Completion Date for CAP This plan will be implemented for the June 30, 2024 audit. 5. Plan to Monitor Completion of CAP Chuck Reuter (Accounting Manager) and Sara Wohlers will be monitoring this plan.

View Audit 848

Finding 404 (2023-007)

Material Weakness 2023

Community Unit School District No. 1

IL

§ 200.302

FINDINGS- MAJOR FEDERAL AWARD PROGRAMS AUDIT Material Weakness U.S. Department of Education- Education Stabilization Fund Under the Coronavirus Aid, Relief and Economic Security Act- AL 84.425 Finding No.: 2023-007 Condition: The District did not maintain adequate financial reocrds in accord...

FINDINGS- MAJOR FEDERAL AWARD PROGRAMS AUDIT Material Weakness U.S. Department of Education- Education Stabilization Fund Under the Coronavirus Aid, Relief and Economic Security Act- AL 84.425 Finding No.: 2023-007 Condition: The District did not maintain adequate financial reocrds in accordance with 2 CFR 200.302(b)(3). Recommendation: The District should maintain adequate financial reocrds capable of adequately identifying the source and application of grant funds in accordance with 2 CFR 200.302(b)(3). Action Taken: The District concurs with the recommendation. The District will work to maintain records capable of adequately identifying the source and application of grant funds.

View Audit 845

Finding 403 (2023-006)

Material Weakness 2023

Community Unit School District No. 1

IL

Internal Control / Segregation of Duties

FINDINGS- MAJOR FEDERAL AWARD PROGRAMS AUDIT Material Weakness U.S. Department of Education- Education Stabilization Fund Under the Coronavirus Aid, Relief and Economic Security Act- AL 84.425 Finding No.: 2023-006 Condition: The District's accounting function is controlled by a limited numb...

FINDINGS- MAJOR FEDERAL AWARD PROGRAMS AUDIT Material Weakness U.S. Department of Education- Education Stabilization Fund Under the Coronavirus Aid, Relief and Economic Security Act- AL 84.425 Finding No.: 2023-006 Condition: The District's accounting function is controlled by a limited number of individuals resulting in the inadequate segregation of duties. Recommendation: The District should segregate duties where possible. The Board should be ware of this problem and closely review and approve all financial related information. Action Taken: The District concurs with the recommendation. The District has reviewed and continues to review its financial policies and procedures to better segregate duties where possible. The Superintendent continually reminds the Board of their responsibility in regards to review and approving financial items and asking questions. It is not cost feasible to hire additional personnel.

View Audit 845

Finding 401 (2023-001)

Significant Deficiency 2023

Community Health Care, Inc.

IA

Allowable Costs / Cost Principles Reporting

CHC agrees it did not allocate its Iowa Medicaid Wrap-Around payments to the Dental and Pediatric Services lines correctly. As the additional context states in the audit report, CHC agrees the departmental allocation did not affect its overall financial statements for the 2020, 2021, and 2022 quart...

CHC agrees it did not allocate its Iowa Medicaid Wrap-Around payments to the Dental and Pediatric Services lines correctly. As the additional context states in the audit report, CHC agrees the departmental allocation did not affect its overall financial statements for the 2020, 2021, and 2022 quarters and did not affect its ability to fully obligate the distributed funds, with its corrected lost revenues reflecting $2,589,831 in lost revenues. CHC has a strong record of grant compliance demonstrated by its consistent compliance with its financial statement audits and its clean record of compliance with its HRSA surveyors. We take our grant compliance seriously and have adequate internal controls in place to maintain current and future federal grants. We will strengthen our departmental allocation methodology of the Iowa Medicaid wrap-around payments with the following: • Re-educating its current accounting staff on the correct allocation methodology for Iowa Medicaid wrap-around payments. • Ensuring its dental payor wraparound payments are allocated correctly to its internal dental departments. This process will be monitored and completed through its monthly account reconciliation process and quarterly departmental reporting processes. • Ensuring its medical payor wraparound payments are allocated correctly to its internal medical departments. This will be done by utilizing a consistent allocation methodology based upon patient visits. This process will be monitored and completed through its monthly account reconciliation process and quarterly departmental reporting processes. The timing of the implemented corrective actions began in 2023 and has been re-enforced with its accounting staff in the first 2 quarters of 2023. As CHC has been able to fill its open accounting positions and train appropriately, I do not anticipate further Iowa Medicaid wrap allocation deficiencies. As such I consider all remediation steps to be implemented and complete.

View Audit 836

Finding 399 (2023-001)

Significant Deficiency 2023

Okemos Public Schools

MI

Subrecipient Monitoring School Nutrition Programs Significant Deficiency

OKEMOS PUBLIC SCHOOLS FOR THE YEAR ENDED JUNE 30, 2023 Okemos Public Schools respectfully submits the following corrective action plan for the year ended June 30, 2023. Auditor: Maner Costerisan 2425 E. Grand River Avenue, Suite 1 Lansing, MI 48912 Audit Period Year ended June 30, 2023 District Con...

OKEMOS PUBLIC SCHOOLS FOR THE YEAR ENDED JUNE 30, 2023 Okemos Public Schools respectfully submits the following corrective action plan for the year ended June 30, 2023. Auditor: Maner Costerisan 2425 E. Grand River Avenue, Suite 1 Lansing, MI 48912 Audit Period Year ended June 30, 2023 District Contact Person: Liz Lentz, Executive Director of Finance Finding 2023-001: Considered a significant deficiency in internal control over compliance. Recommendation: The District should consistently utilize a point-of-sale system to track and claim the number of meals served. Action to be Taken: Management agrees with the finding and had already changed procedures during the school year to better track and claim meals.

View Audit 830

Finding 390 (2023-001)

Significant Deficiency 2023

Texoma Council of Governments

TX

Questioned Costs

Corrective Action Plan: Federal regulations, Title 2 U.S. Code of Federal Regulations §200.511 states, “At the

View Audit 819 Questioned Costs: $1

Finding 390 (2023-001)

Significant Deficiency 2023

Texoma Council of Governments

TX