Corrective Action Plans

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Tuerk House, Inc. recognizes the importance of maintaining compliance with federal grant requirements related to allowable costs and documentation standards. The Organization acknowledges the continued deficiencies identified in the areas of time and effort reporting and supporting documentation for...
Tuerk House, Inc. recognizes the importance of maintaining compliance with federal grant requirements related to allowable costs and documentation standards. The Organization acknowledges the continued deficiencies identified in the areas of time and effort reporting and supporting documentation for expenditures charged to grant programs and reaffirms its commitment to achieving full compliance. To address this repeat finding, Tuerk House has implemented or is continuing to implement the following corrective actions: • Implemented a formal time and effort certification process requiring employees to certify actual time worked on federal grant activities on a regular basis, rather than relying on budgeted allocations. • Developed a standardized cost allocation methodology that aligns with actual grant activity and is supported by verifiable documentation. • Required that all expenditures charged to federal awards be supported by complete and accurate source documentation, including vendor invoices, timesheets, and approvals. • Established a document retention policy consistent with 2 CFR § 200.334 to ensure all supporting records are retained for the required period and readily accessible for audit or review. Training sessions for program and finance staff have been conducted, and ongoing training will continue to ensure consistent understanding and application of these updated policies and procedures. Organization Contact Person Responsible for Corrective Action – Kisun Peters, Director of Finance Anticipated Completion Date – June 30, 2026
Delivering Evidence-Led inTerventions in Arkansas to Advance Healthy Equity and Access in Diabetes Care (DELTA AHEAD) Recommendation: We recommend the Organization review its policies and procedures during the check signing process to ensure all approvals are obtained as required by the Organization...
Delivering Evidence-Led inTerventions in Arkansas to Advance Healthy Equity and Access in Diabetes Care (DELTA AHEAD) Recommendation: We recommend the Organization review its policies and procedures during the check signing process to ensure all approvals are obtained as required by the Organization's internal control policy. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: Accounting staff will review the policies, procedures, and workflow with ADCES and grant-focused staff to ensure there is a common understanding across the organization. Name of the contact person responsible for corrective action: Matthew Biecker, Chief Financial Officer Planned completion date for corrective action plan: Immediately
A procurement checklist will be developed to require proper documentation if utilizing Federal Funds. The checklist will list specific thresholds for procurement based on funding type, and whether the procurement is construction related and list requirements and thresholds for the construction activ...
A procurement checklist will be developed to require proper documentation if utilizing Federal Funds. The checklist will list specific thresholds for procurement based on funding type, and whether the procurement is construction related and list requirements and thresholds for the construction activity. A new vendor checklist will also be developed to ensure that the vendor is not debarred and/or suspended prior to conducting business with them. The checklist will also list other relevant documents that will be needed prior to first payment. The anticipated completion date will be 9/30/2026.
The supervisor of registration employees will oversee quarterly patient file reviews of patients registered as beneficiaries to ensure that the required documentation is acquired from the patients. Patient files that lack the required documentation, will be flagged in a way that will be noticeable b...
The supervisor of registration employees will oversee quarterly patient file reviews of patients registered as beneficiaries to ensure that the required documentation is acquired from the patients. Patient files that lack the required documentation, will be flagged in a way that will be noticeable by anyone that has access to the files. The clinic will also consider an outside department like PRC which also validates beneficiary information could get involved in a mid-fiscal year review of the beneficiary patient files to provide a secondary review of the files. The anticipated completion date will be 9/30/2026.
Condition: Multiple students were incorrectly coded as free and reduced meal status when they should have been switched to paid status. Plan: The District will ensure the direct certification list is properly maintained and put new processes in place to verify students’ meal status year over year. A...
Condition: Multiple students were incorrectly coded as free and reduced meal status when they should have been switched to paid status. Plan: The District will ensure the direct certification list is properly maintained and put new processes in place to verify students’ meal status year over year. Anticipated Date of Completion: The District will correct this for the 2025-2026 school year. Name of Contact Person: Nathan Knitt, Director of Business Services Management Response: The School District of Fort Atkinson accepts the plan for the Corrective Action listed above and does not dispute anything.
Condition: Supporting documentation for the monthly food service meals provided did not align with the claims reported for reimbursement by free, reduced, and paid categories. Plan: The District will review supporting documentation for meals to ensure all meals are accounted for. Anticipated Date of...
Condition: Supporting documentation for the monthly food service meals provided did not align with the claims reported for reimbursement by free, reduced, and paid categories. Plan: The District will review supporting documentation for meals to ensure all meals are accounted for. Anticipated Date of Completion: The District will correct this for the 2025-2026 school year. Name of Contact Person: Nathan Knitt, Director of Business Services Management Response: The School District of Fort Atkinson accepts the plan for the Corrective Action listed above and does not dispute anything.
Finding caption: The District did not have adequate internal controls and did not comply with federal suspension and debarment requirements Name, address, and telephone of School District contact person: Heather Judd 217 S Hofstetter Colville, WA 99114 (509) 684-7856 Corrective action the auditee pl...
Finding caption: The District did not have adequate internal controls and did not comply with federal suspension and debarment requirements Name, address, and telephone of School District contact person: Heather Judd 217 S Hofstetter Colville, WA 99114 (509) 684-7856 Corrective action the auditee plans to take in response to the finding: (If the auditee does not concur with the finding, the auditee must list the reasons for disagreement). The District will strengthen internal controls over suspension and debarment compliance for Nutrition Services vendors. Effective immediately, all vendors expected to meet or exceed the $25,000 federal threshold will require documented suspension and debarment verification prior to contract execution or renewal. The Nutrition Services Director will be responsible for completing and maintaining documentation of the verification; however, the Business Office will implement an annual review each September 1 to ensure all required checks are completed, properly documented, and retained. Additionally, procedures will be updated to require submission of all debarment and suspension documentation to the Business Office for centralized recordkeeping, with periodic monitoring throughout the year to ensure compliance despite staff turnover. Anticipated date to complete the corrective action: 9/1/26
2025-005 - Reporting Corrective Action Plan: Management agrees with the finding and has committed the resources giving rise to the finding. Person(s) Responsible: M. Michael Garza Timing for Implementation: June 30, 2026.
2025-005 - Reporting Corrective Action Plan: Management agrees with the finding and has committed the resources giving rise to the finding. Person(s) Responsible: M. Michael Garza Timing for Implementation: June 30, 2026.
Finding ref number: 2025-001 Finding caption: The District did not have adequate internal controls for ensuring compliance with federal procurement requirements. Name, address, and telephone of District contact person: Tom Hitt, Purchasing and Compliance Manager 1215 W. Lewis Street Pasco, WA 99301 ...
Finding ref number: 2025-001 Finding caption: The District did not have adequate internal controls for ensuring compliance with federal procurement requirements. Name, address, and telephone of District contact person: Tom Hitt, Purchasing and Compliance Manager 1215 W. Lewis Street Pasco, WA 99301 Phone: (509) 543-6700 Corrective action the auditee plans to take in response to the finding: Pasco School District concurs with the audit finding. The District has evaluated the circumstances surrounding this issue and determined that the root cause was a lack of specific procedural controls and staff training related to cooperative (“piggyback”) procurement requirements, particularly regarding vendor regional assignments under Department of Enterprise Services (DES) contracts. As noted in the audit, staff were not aware that contractors were assigned to specific geographic regions, which resulted in the selection of a vendor outside the District’s designated region. The District recognizes that the selected vendor in question was local to the District, and following the DES contract requires the District to instead order from a Spokane company, which is 2-3 hours away. The District places a strong emphasis on supporting local businesses as part of its commitment to the community, and this priority was a contributing factor in procurement decisions in this instance. However, the District recognizes that all procurement activities involving federal funds must strictly adhere to applicable federal, state, and contract requirements. Upon discovery of the issue during the audit process, Nutrition Services immediately initiated corrective action. The department transitioned to the appropriately assigned vendor, and within a short timeframe completed all necessary onboarding, ordering, and delivery processes. Procurement activities are now aligned with DES contract requirements. Additionally, while the District had been utilizing a vendor outside of the assigned DES contract region for these purchases, that vendor is an approved provider under the Office of Superintendent of Public Instruction’s Department of Defense (DoD) Fresh Produce Program. The District will continue to utilize that vendor when procuring produce through DoD-funded programs, where appropriate. To prevent recurrence, the District will implement the following corrective actions: 1. Staff Training and Capacity Building Provide training on federal procurement requirements and DES contracts Reinforce that local preference cannot override compliance requirements 2. Ongoing Monitoring and Internal Controls Conduct periodic internal reviews of procurement activity Perform documentation audits and provide corrective feedback 3. Coordination with DES and OSPI Guidance Require staff to reference DES and OSPI guidance when utilizing cooperative contracts Through these actions, the District will strengthen internal controls and ensure compliance with federal procurement requirements moving forward. Anticipated date to complete the corrective action: June 30, 2026
Recommendation: We recommend that First Rising Mount Zion Baptist Church Housing Corporation, Inc. design and implement controls to prevent non-compliance with HUD requirements surrounding surplus cash deposits such as recalculating surplus cash at the end of the year after all transactions have bee...
Recommendation: We recommend that First Rising Mount Zion Baptist Church Housing Corporation, Inc. design and implement controls to prevent non-compliance with HUD requirements surrounding surplus cash deposits such as recalculating surplus cash at the end of the year after all transactions have been posted. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: First Rising Mount Zion Baptist Church Housing Corporation, Inc. T/A Gibson Plaza Apartments will implement enhanced internal controls to ensure compliance with HUD requirements related to surplus cash calculations and deposits. Specifically: - Management will perform a final recalculation of surplus cash at year-end after all accounting transactions have been recorded and reviewed. - A standardized checklist will be developed and utilized to ensure that all required steps in the surplus cash calculation process are completed accurately. - The surplus cash calculation will be reviewed and approved by a secondary individual independent of the preparer to ensure accuracy and compliance. Name(s) of the contact person(s) responsible for corrective action: Asa Ewings Planned completion date for corrective action plan: 5/31/2026
RE: Funding 2025-001 – Incorrect student status, Corrective Action Plan To whom it may concern: Student Financial Assistance Cluster (ALNs: 84.063 and 84.268) Management concurs with the findings. Management acknowledges that the condition identified is primarily attributable to staff turnover assoc...
RE: Funding 2025-001 – Incorrect student status, Corrective Action Plan To whom it may concern: Student Financial Assistance Cluster (ALNs: 84.063 and 84.268) Management concurs with the findings. Management acknowledges that the condition identified is primarily attributable to staff turnover associated with the closure of the school, which resulted in disruptions to established processes and reduced the effectiveness of controls over the determination and documentation of student eligibility. Management has ensured the appropriate reporting has now been made to the NSLDS. The SFA program has been terminated and therefore will not impact future audits. Leadership Responsible: Colleen Walsh Dean, Student and Alumni Services Lawrence Memorial/Regis College (781) 979-3000 Anticipated Completion date: May 30, 2026
Federal Procurement Regulations Planned Corrective Action: During the audit period, HAH experienced significant organizational transition, including separation from its parent organization, turnover in key administrative and finance positions, and the rebuilding of internal financial operations and ...
Federal Procurement Regulations Planned Corrective Action: During the audit period, HAH experienced significant organizational transition, including separation from its parent organization, turnover in key administrative and finance positions, and the rebuilding of internal financial operations and controls. These circumstances contributed to inconsistent application and documentation of procurement procedures. To address this deficiency and prevent recurrence, HAH worked with HRSA Technical Assistance resources to develop an enhanced procurement policy and procedure, which is scheduled for Board approval in May 2026. In the interim, HAH has reinforced procurement requirements through staff training and communication regarding federal procurement standards. Additionally,management has implemented ongoing monitoring and compliance reviews of procurement activities to ensure adherence to policy requirements, including appropriate bid documentation and sole source justification when applicable Person Responsible for Corrective Action Plan: Donald McGruder, CFO Anticipated Date of Completion: Resolved
Management’s Response Community Council of Idaho, Inc. acknowledges the finding related to untimely reconciliations, material audit adjustments, and delayed financial statement issuance. Management agrees that improvements are necessary to strengthen internal controls over financial reporting, ensur...
Management’s Response Community Council of Idaho, Inc. acknowledges the finding related to untimely reconciliations, material audit adjustments, and delayed financial statement issuance. Management agrees that improvements are necessary to strengthen internal controls over financial reporting, ensure timely account reconciliations, and improve the overall financial close and audit preparation process. Management recognizes that turnover within the business office during the audit year significantly impacted continuity, institutional knowledge, and the timely completion of reconciliations and closing procedures. Subsequent to year end, management has initiated corrective actions designed to improve financial reporting accuracy, accountability, and timeliness. Corrective Actions to Be Implemented 1. Implementation of Formal Monthly Closing Procedures Management will implement a standardized monthly financial close process with defined timelines, responsibilities, and review procedures. The monthly close process will include: Completion of all balance sheet reconciliations, Review of grant and contract revenue accounts, Review of property and equipment activity, Reconciliation of debt schedules, Reconciliation of pharmaceutical inventory balances, Recording of depreciation and interest expense, and Verification that all material journal entries are posted timely. A monthly close checklist will be developed and maintained to ensure consistency and accountability. 2. Timely Reconciliation of Grant and Contract Accounts Management will strengthen procedures surrounding grant and contract accounting to ensure receivables and revenue are reconciled monthly and supported by appropriate documentation. Actions include: Reconciling grant receivable balances to supporting reimbursement requests and funding agency records, Reviewing deferred revenue and earned revenue calculations monthly, Investigating and resolving variances timely, and Implementing supervisory review of grant reconciliations. 3. Enhanced Review and Oversight Controls Management will implement additional review controls over financial reporting and account reconciliations. These controls will include: Documented supervisory review and approval of reconciliations, Review of significant or unusual journal entries, Periodic review of financial statements and supporting schedules by senior finance leadership, and Earlier audit preparation and interim review procedures to identify issues prior to year end. 4. Strengthening Staffing and Organizational Structure Management and executive leadership have evaluated the operational needs of the business office and have taken steps to improve staffing stability and oversight capacity. Actions include: Clarifying accounting roles and responsibilities, Enhancing cross-training within the finance department, Providing additional training related to grant accounting and reconciliations, Utilizing external resources or consultants, as needed, to support complex accounting areas and transition periods. 5. Improvement of Clinic Reporting Processes Management will continue evaluating clinic reporting systems and procedures to ensure operational growth is adequately supported by accounting and financial reporting processes. This includes: Improving coordination between clinic operations and accounting, Standardizing reporting procedures, Evaluating system-generated reports for accuracy and completeness, and Implementing additional reconciliation and review controls related to clinic financial activity. 6. Audit Readiness and Timeliness Improvements Management will establish an audit preparation timeline with interim deadlines to support timely completion of the annual audit and compliance with federal reporting deadlines. The organization will: Prepare schedules and reconciliations in advance of audit fieldwork, Conduct periodic internal reviews of audit support documentation, Improve coordination with external auditors throughout the year, and Monitor progress toward required reporting deadlines. Contact Person Responsible for Corrective Action: Implementation oversight will be shared among executive leadership, finance management, program leadership, and those charged with governance. Anticipated Completion Date: Corrective actions began subsequent to year end and are expected to be substantially implemented during fiscal year 2026, with ongoing monitoring and refinement thereafter.
Significant Deficiency, Nonmaterial Non-Compliance Finding 2025-005: Name of Contact Person: Bill Bradley The Town did not have a system of internal controls in place to ensure cash management compliance requirements were met. Auditor’s review indicated that a reimbursement request #4 was drawn and ...
Significant Deficiency, Nonmaterial Non-Compliance Finding 2025-005: Name of Contact Person: Bill Bradley The Town did not have a system of internal controls in place to ensure cash management compliance requirements were met. Auditor’s review indicated that a reimbursement request #4 was drawn and received in August yet the Town did not disburse the funds, until September. Therefore, the monies were not paid to the vendor within the three (3) day required compliance period. Corrective Action: With the new Town Manager and Finance Director the Town fully expects to comply with the three (3) day compliance requirement Proposed Completion Date: Immediately.
The corrective action plan was documented in our response to the auditor's comment. See the Schedule of Findings and Questioned costs.
The corrective action plan was documented in our response to the auditor's comment. See the Schedule of Findings and Questioned costs.
The corrective action plan was documented in our response to the auditor's comment. See the Schedule of Findings and Questioned costs.
The corrective action plan was documented in our response to the auditor's comment. See the Schedule of Findings and Questioned costs.
The District will ensure that a semi-annual certification is completed at least twice a year and signed by a knowledgeable supervisor or the employee, confirming those employees who worked solely on a single federal program or cost objective.
The District will ensure that a semi-annual certification is completed at least twice a year and signed by a knowledgeable supervisor or the employee, confirming those employees who worked solely on a single federal program or cost objective.
Views of Responsible Officials: The Foundation will retroactively receive the FFATA reports for their sub-recipients, and going forward will ensure that the FFATA reports are received and submitted for all sub-recipients.
Views of Responsible Officials: The Foundation will retroactively receive the FFATA reports for their sub-recipients, and going forward will ensure that the FFATA reports are received and submitted for all sub-recipients.
Views of Responsible Officials: The Foundation will retroactively perform a risk assessment of all subrecipients for FY26. Going forward, a pre-award risk assessment will be performed prior to awarding a subrecipient and appropriate monitoring procedures over sub-recipients will be implemented.
Views of Responsible Officials: The Foundation will retroactively perform a risk assessment of all subrecipients for FY26. Going forward, a pre-award risk assessment will be performed prior to awarding a subrecipient and appropriate monitoring procedures over sub-recipients will be implemented.
Views of Responsible Officials: All the Foundation's employees now complete an excel timesheet that is then submitted to their supervisor for review and approval. Payroll is processed only after all employee timesheets are approved and received by the Senior Accountant who processes payroll.
Views of Responsible Officials: All the Foundation's employees now complete an excel timesheet that is then submitted to their supervisor for review and approval. Payroll is processed only after all employee timesheets are approved and received by the Senior Accountant who processes payroll.
Views of Responsible Officials: In March 2026, the Foundation hired a staff accountant that replaced a role that was previously held by a consultant. The Foundation's Board President, in the absence of the vacant Executive Director position, is approving the reports. The reports are being submitted ...
Views of Responsible Officials: In March 2026, the Foundation hired a staff accountant that replaced a role that was previously held by a consultant. The Foundation's Board President, in the absence of the vacant Executive Director position, is approving the reports. The reports are being submitted on a timely basis.
Views of Responsible Officials: Each screening is uploaded with the first payment request to any vendor, supplier, or consultant. The Foundation will retroactively document the date the screening was conducted, the date the screening was reviewed, as well as the name of the person performing the rev...
Views of Responsible Officials: Each screening is uploaded with the first payment request to any vendor, supplier, or consultant. The Foundation will retroactively document the date the screening was conducted, the date the screening was reviewed, as well as the name of the person performing the review of the screening for all vendors, suppliers, or consultants that were paid during FY26. Going forward, the date the screening was performed, along with the person reviewing the screening and the date of that review, will be documented. The Foundation performs new screenings annually for all vendors, suppliers and consultants at the beginning of the fiscal year.
The City originally scheduled time for completion of the audit for the year ended June 30, 2025, in January 2026. However, an audit procedure requiring reconciliation of occupational tax revenues to the Georgetown-Scott County Revenue Commission audit report was delayed until February when a draft o...
The City originally scheduled time for completion of the audit for the year ended June 30, 2025, in January 2026. However, an audit procedure requiring reconciliation of occupational tax revenues to the Georgetown-Scott County Revenue Commission audit report was delayed until February when a draft of that agency’s report became available to the City. Thus, the City received a draft of its audit report on February 24, 2026, for review and completion of final audit items. Due to staff workload in the month of March, final audit items were not completed until April. Staff was not aware that a late submission would result in a finding, whereas it had not in the past due to deadline extensions by the FAC or past audit firm policy as applied to this deadline. The City will review staffing levels and create more stringent reminders and timelines for completion of audit items in the future now that they are aware that the submission deadline is not automatically extended each year.
S3800-090 Auditor's Summary of the Auditee's Comments on the Findings and Recommendations: Concur S3800-130 Response Indicator: Agree S3800-140 Completion Date: April 20, 2026 S3800-150 Response: The Project deposited $2,000 to the security deposit account to increase the balance so that it will mee...
S3800-090 Auditor's Summary of the Auditee's Comments on the Findings and Recommendations: Concur S3800-130 Response Indicator: Agree S3800-140 Completion Date: April 20, 2026 S3800-150 Response: The Project deposited $2,000 to the security deposit account to increase the balance so that it will meet the requirement of maintaining the security deposit account at a balance equal to or more than the security deposit liability account as of April 20, 2026. S3800-160 Contact Person - First Name: Dawn S3800-180 Contact Person - Last Name: Kleinschrodt
S3800-090 Auditor's Summary of the Auditee's Comments on the Findings and Recommendations: Concur S3800-130 Response Indicator: Agree S3800-140 Completion Date: April 30, 2026 S3800-150 Response: The Project will make the necessary catch-up deposits to the replacement reserve to cover the identified...
S3800-090 Auditor's Summary of the Auditee's Comments on the Findings and Recommendations: Concur S3800-130 Response Indicator: Agree S3800-140 Completion Date: April 30, 2026 S3800-150 Response: The Project will make the necessary catch-up deposits to the replacement reserve to cover the identified shortfall once the amount is confirmed with the lender/escrow holder. The Project has updated its processes to reflect the increased monthly deposit for replacement reserves. S3800-160 Contact Person - First Name: Dawn S3800-180 Contact Person - Last Name: Kleinschrodt
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