Corrective Action Plans

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Response: The Organization realized its Single Audit requirement in September of 2025 and immediately made plans to fulfill its requirements. Going forward, the Organization will track federal expenditures contemporaneously in order to determine when a reporting threshold is tripped. This should all...
Response: The Organization realized its Single Audit requirement in September of 2025 and immediately made plans to fulfill its requirements. Going forward, the Organization will track federal expenditures contemporaneously in order to determine when a reporting threshold is tripped. This should allow the Organization enough time to comply with the applicable laws and regulations.
Finding 1163310 (2024-001)
Material Weakness 2024
Heading Home management is in agreement with this finding. After years of turnover in key management positions steps have been taken to address staffing challenges and these positions have been successfully staffed with high-quality individuals who bring extensive knowledge and expertise to their ro...
Heading Home management is in agreement with this finding. After years of turnover in key management positions steps have been taken to address staffing challenges and these positions have been successfully staffed with high-quality individuals who bring extensive knowledge and expertise to their roles. These positions include a new Chief Executive Officer, Director of Operations, Chief Financial Officer, and Director of Human Services. To address challenges in accounting and finance Heading Home had contracted with a local CPA firm specializing in nonprofit accounting and financial reporting to assist the CFO with daily accounting tasks, the monthly close, financial reporting to management and the board of directors, and to facilitate and ensure audits are completed timely each year. The new management group is committed to maintaining a skilled and competent team in key financial roles. The FY23 audit was completed in May 2025 and the Heading Home’s accounting team anticipates the FY24 audit to be completed by November 2025. While this will once again result in a late filing, the new management team has made significant strides in a short amount of time and anticipates that the 2025 and all future audits will be submitted on or before the March 31st due date. Management anticipates the above corrective action plan to be fully implemented by November 30, 2025. Personnel responsible for ensuring implementation include Connie Chavez, Executive Director, and Debbie Brickman, Chief Financial Officer.
Finding 1163308 (2024-002)
Material Weakness 2024
Heading Home management is in agreement with this finding. After years of turnover in key management positions steps have been taken to address staffing challenges and these positions have been successfully staffed with high-quality individuals who bring extensive knowledge and expertise to their ro...
Heading Home management is in agreement with this finding. After years of turnover in key management positions steps have been taken to address staffing challenges and these positions have been successfully staffed with high-quality individuals who bring extensive knowledge and expertise to their roles. These positions include a new Chief Executive Officer, Director of Operations, Chief Financial Officer, and Director of Human Services. To address challenges in accounting and finance Heading Home had contracted with a local CPA firm specializing in nonprofit accounting and financial reporting to assist the CFO with daily accounting tasks, the monthly close, financial reporting to management and the board of directors, and to facilitate and ensure audits are completed timely each year. The new management group is committed to maintaining a skilled and competent team in key financial roles. Due to the backlog of billings at the opening of FY23, the billing submissions and quarterly reports for the first quarter were submitted late. With the new staff and assistance, these billings and quarterly reports were brought current as quickly as possible. They are now current and being submitted in a timely manner. Management’s corrective action plan was fully implemented by June 30, 2025, and anticipate that there will be no further issues. Personnel responsible for ensuring implementation include Connie Chavez, Executive Director, and Debbie Brickman, Chief Financial Officer.
Additional preventive internal control procedures will be implemented, designating a secondary individual responsible for submission should the primary individual leave or be terminated. These procedures and internal controls have been implemented as of the date of this report.
Additional preventive internal control procedures will be implemented, designating a secondary individual responsible for submission should the primary individual leave or be terminated. These procedures and internal controls have been implemented as of the date of this report.
1-Develop a reconciliation process for excess cash reserves to ensure compliance with loan agreements 2-Implement procedures to obtain and maintain documentation for qualifying low-income housing individuals. 3-Train staff on compliance requirements for loan agreements and reconciliation processes.
1-Develop a reconciliation process for excess cash reserves to ensure compliance with loan agreements 2-Implement procedures to obtain and maintain documentation for qualifying low-income housing individuals. 3-Train staff on compliance requirements for loan agreements and reconciliation processes.
Finding 1163275 (2024-002)
Material Weakness 2024
Corrective Action Plan For the Year Ended December 31, 2024 Contact Person(s): De Angelo Jones, Finance Director Deangelo.jones@youthcare.org Finding 2024-002 Significant deficiency in internal controls over compliance related to reporting. Explanation and specific reasons for disagreement with the ...
Corrective Action Plan For the Year Ended December 31, 2024 Contact Person(s): De Angelo Jones, Finance Director Deangelo.jones@youthcare.org Finding 2024-002 Significant deficiency in internal controls over compliance related to reporting. Explanation and specific reasons for disagreement with the audit finding or that corrective action is not required (if applicable): No disagreement. Corrective action planned:  Develop a contract expenditure compliance review process created with final review and approval by Finance Director. Anticipated completion date: Fixed January 1, 2025
Management will make sure the audited financial statements are filed into the REAC system 90 days after the fiscal year-end in future years.
Management will make sure the audited financial statements are filed into the REAC system 90 days after the fiscal year-end in future years.
View Audit 372786 Questioned Costs: $1
Management will deposit required amounts.
Management will deposit required amounts.
View Audit 372786 Questioned Costs: $1
THE AGENCY AGREES WITH THE FINDING AND IS IN THE PROCESS OF PROVIDING ADDITIONAL TRAINING FOR THE PROGRAM STAFF.
THE AGENCY AGREES WITH THE FINDING AND IS IN THE PROCESS OF PROVIDING ADDITIONAL TRAINING FOR THE PROGRAM STAFF.
THE AGENCY AGREES WITH THE FINDING AND IS IN THE PROCESS OF PROVIDING ADDITIONAL TRAINING FOR THE PROGRAM STAFF.
THE AGENCY AGREES WITH THE FINDING AND IS IN THE PROCESS OF PROVIDING ADDITIONAL TRAINING FOR THE PROGRAM STAFF.
Management agrees with the finding that sliding fee discounts must be applied consistently and in accordance with our approved policy. We are committed to ensuring access to care while maintaining compliance with HRSA program requirements. Planned Corrective Actions: To strengthen compliance with ou...
Management agrees with the finding that sliding fee discounts must be applied consistently and in accordance with our approved policy. We are committed to ensuring access to care while maintaining compliance with HRSA program requirements. Planned Corrective Actions: To strengthen compliance with our sliding fee discount policy, East Valley Community Health Center has implemented several corrective measures. Re-training for intake and billing staff began in April 2025 and is ongoing as part of our quarterly training cycle, In addition, we are currently reviewing our sliding fee discount policy and procedures to ensure they are clear, consistently applied, and aligned with HRSA guidance and the Health Center Program Compliance Manual. Monthly audits of patient encounters involving sliding fee adjustments began in October 2024 by the billing department and are now a permanent component of our internal compliance process. Audit results are reviewed by the Revenue Cycle Manager and shared with Clinic Managers, Front Office Leads, and Senior Leadership to ensure accountability and prompt corrective action when needed. The CFO is responsible for overseeing these processes and ensuring that all compliance measures are implemented effectively.
BFCAC made a change in personnel during 2024. Subsequently, BFCAC has emphasized the need to maintain supporting documentation for all charges, including changes to timesheets, and supporting documentation for manual adjustments. The Executive Director and the Finance Manager are responsible for thi...
BFCAC made a change in personnel during 2024. Subsequently, BFCAC has emphasized the need to maintain supporting documentation for all charges, including changes to timesheets, and supporting documentation for manual adjustments. The Executive Director and the Finance Manager are responsible for this corrective action.
View Audit 372721 Questioned Costs: $1
The Department of Health and Human Services/Centers for Disease Control and Prevention – Assistance Listing No. 93.495 Recommendation: We recommend the organization follow policies and procedures put in place in regard to the approval of cash disbursements. Explanation of disagreement with audit fin...
The Department of Health and Human Services/Centers for Disease Control and Prevention – Assistance Listing No. 93.495 Recommendation: We recommend the organization follow policies and procedures put in place in regard to the approval of cash disbursements. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: GHN has implemented policies and provided additional training to new staff to ensure compliance. Names of the contact persons responsible for corrective action: Jan Warren, Director of Finance & Amber Henderson, Chief Organization Excellence & Strategy Officer Planned completion date for corrective action plan: December 31, 2025
The Department of Health and Human Services/Centers for Disease Control and Prevention – Assistance Listing No. 93.945 Recommendation: We recommend that the Organization implements policies and procedures to perform subrecipient monitoring and that monitoring is formally documented and approved. Exp...
The Department of Health and Human Services/Centers for Disease Control and Prevention – Assistance Listing No. 93.945 Recommendation: We recommend that the Organization implements policies and procedures to perform subrecipient monitoring and that monitoring is formally documented and approved. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: We will implement policies and procedures to implement subrecipient monitoring. Names of the contact persons responsible for corrective action: Jan Warren, Director of Finance & Amber Henderson, Chief Organization Excellence & Strategy Officer Planned completion date for corrective action plan: December 31. 2025.
The Department of Health and Human Services/Centers for Disease Control and Prevention – Assistance Listing No. 93.495 Recommendation: We recommend the organization create and or update policies and procedures to ensure all required reports are submitted timely and accurately. Explanation of disagre...
The Department of Health and Human Services/Centers for Disease Control and Prevention – Assistance Listing No. 93.495 Recommendation: We recommend the organization create and or update policies and procedures to ensure all required reports are submitted timely and accurately. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: GHN has developed and is in the process of implementing a tracking system for compliance deadlines, including report submissions. Name of the contact person responsible for corrective action: Amber Henderson, Chief Organization Excellence & Strategy Officer Planned completion date for corrective action plan: December 31, 2025
The Department of Health and Human Services/Centers for Disease Control and Prevention – Assistance Listing No. 93.495 Recommendation: We recommend the organization create proper policies and procedures to ensure indirect costs are properly calculated and tracked. Explanation of disagreement with au...
The Department of Health and Human Services/Centers for Disease Control and Prevention – Assistance Listing No. 93.495 Recommendation: We recommend the organization create proper policies and procedures to ensure indirect costs are properly calculated and tracked. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: GHN has developed a procedure as well as hired additional staff to correctly track, calculate, and review indirect costs. Names of the contact persons responsible for corrective action: Jan Warren, Director of Finance & Amber Henderson, Chief Organization Excellence & Strategy Officer Planned completion date for corrective action plan: December 31, 2025
The Department of Health and Human Services/Centers for Disease Control and Prevention – Assistance Listing No. 93.495 Recommendation: We recommend that the Organization’s procurement policy is followed and that procurement procedures are documented, reviewed and approved. Explanation of disagreemen...
The Department of Health and Human Services/Centers for Disease Control and Prevention – Assistance Listing No. 93.495 Recommendation: We recommend that the Organization’s procurement policy is followed and that procurement procedures are documented, reviewed and approved. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: We are reviewing our current policies and procedures in these areas to determine if any changes should be implemented. Greater Health Now has increased trainings for staff members in terms of the documentation required to purchase goods and services with grant funds. Furthermore, to strengthen our oversight of sole-source contracts awarded with program and non-program funds, we will introduce stringent measures requiring thorough documentation of the vendor’s or contractor’s qualifications. Names of the contact persons responsible for corrective action: Jan Warren, Director of Finance & Amber Henderson, Chief Organization Excellence & Strategy Officer Planned completion date for corrective action plan: December 31, 2025
The Department of Health and Human Services/Centers for Disease Control and Prevention – Assistance Listing No. 93.495 Recommendation: We recommend that the Organization implement policies and procedures to ensure subrecipients are paid within 30 days of when the billing is received. If the request ...
The Department of Health and Human Services/Centers for Disease Control and Prevention – Assistance Listing No. 93.495 Recommendation: We recommend that the Organization implement policies and procedures to ensure subrecipients are paid within 30 days of when the billing is received. If the request is believed to be improper, support for the delay in payment should be maintained. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: We have established a process to review and track accounts payable, including monthly reviews of outstanding bills, partner invoices, and partner compliance. Furthermore, we have added additional accounting staff focused on disbursements for subrecipients involved in federal grant programs. Finally, we have a process in place to document the receipt of partner invoices submitted to GHN for payment as well as a record of payment approval and/or revisions necessary. Names of the contact persons responsible for corrective action: Jan Warren, Director of Finance & Amber Henderson, Chief Organization Excellence & Strategy Officer Planned completion date for corrective action plan: December 31, 2025
Recommendation: We recommend that the Organization put controls in place to ensure timely filing of the audit package to the Federal Audit Clearinghouse. Organization's Response: The Organization agrees with the auditors' recommendation.
Recommendation: We recommend that the Organization put controls in place to ensure timely filing of the audit package to the Federal Audit Clearinghouse. Organization's Response: The Organization agrees with the auditors' recommendation.
Management concurs with the finding. Procedures have been implemented to enhance year-end review of grant activity, including reconciliation of grant expenditures and receivables to the SEFA and general ledger prior to issuance. The Departments’ will continue to monitor these processes to ensure com...
Management concurs with the finding. Procedures have been implemented to enhance year-end review of grant activity, including reconciliation of grant expenditures and receivables to the SEFA and general ledger prior to issuance. The Departments’ will continue to monitor these processes to ensure compliance with the Uniform Guidance reporting requirements. Anticipated Completion Date: October 31, 2025
CORRECTIVE ACTION PLAN August 13, 2024 U.S. DEPARTMENT OF EDUCATION U.S. DEPT. OF AGRICULTURE Purdy School District R-II respectfully submits the following corrective action plan for the year ended June 30, 2024. Contact information for the individual responsible for the corrective action: Dr Travis...
CORRECTIVE ACTION PLAN August 13, 2024 U.S. DEPARTMENT OF EDUCATION U.S. DEPT. OF AGRICULTURE Purdy School District R-II respectfully submits the following corrective action plan for the year ended June 30, 2024. Contact information for the individual responsible for the corrective action: Dr Travis Graham, Superintendent Purdy School District R-II 201 Gabby Gibbons Dr Purdy, MO 65734 (417) 442-3215 Independent Public Accounting Firm: The CPA Group, PC, 217 4th Street, Monett, MO 65708 Audit Period: Year ended June 30, 2024 The findings from the June 30, 2024, Schedule of Findings and Questioned Costs are discussed below. The findings are numbered consistently with the numbers assigned in the schedule. FINDINGS – FINANCIAL STATEMENT AUDIT Material Weakness – Internal Control over Financial Reporting - Segregation of duties Finding 2024-001 Recommendation: We realize Because of limited resources and personnel, management may not be able to achieve a proper segregation of duties; however, our professional standards require that we bring this lack of segregation of duties to your attention in this report. Action Taken: The limited number of available personnel prohibits segregation of incompatible duties and the District does not have the resources to hire additional accounting personnel. Completion Date: Not applicable Sincerely, Dr Travis Graham, Superintendent Purdy School District R-II
As documented in our response to the auditor's com­ment, we plan to monitor and segregate duties as efficiently as possible.
As documented in our response to the auditor's com­ment, we plan to monitor and segregate duties as efficiently as possible.
Share Food Program will obtain verification of reportable amounts where pass-through activity is applicable. This amount will be reconciled to the amounts and disclosures in the financial statements. This was implemented for finanical reporting for the fiscal year ended June 30, 2025.
Share Food Program will obtain verification of reportable amounts where pass-through activity is applicable. This amount will be reconciled to the amounts and disclosures in the financial statements. This was implemented for finanical reporting for the fiscal year ended June 30, 2025.
Share Food Program has developed procedures and processes to manage, maintain, and reconcile the Financial Statements to the Schedule of Expenditures of Federal Awards as part of our year end closing procedures. This was implemented, and it is expected that the June 30, 2025 reporting will be timely...
Share Food Program has developed procedures and processes to manage, maintain, and reconcile the Financial Statements to the Schedule of Expenditures of Federal Awards as part of our year end closing procedures. This was implemented, and it is expected that the June 30, 2025 reporting will be timely and accurate.
Management accepts the recommendation and will ensure compliance with the procurement standards in 2 CFR §§ 200.318–200.327 for all federally funded purchases by either conducting a competitive bidding process or documenting and obtaining approval for a sole source procurement as allowed under 2CFR ...
Management accepts the recommendation and will ensure compliance with the procurement standards in 2 CFR §§ 200.318–200.327 for all federally funded purchases by either conducting a competitive bidding process or documenting and obtaining approval for a sole source procurement as allowed under 2CFR §200.320(c)
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