Corrective Action Plans

Finding 1161620 (2025-002)

Material Weakness 2025

SC

Special Tests & Provisions Internal Control / Segregation of Duties

In Finding 2025-002, it was reported that the Organization did not properly apply sliding fee discounts for certain patients with visits to the Organization during the year ended May 31, 2025. Management recognizes the importance of complying with sliding fee guidelines. In response to Finding 2025-...

In Finding 2025-002, it was reported that the Organization did not properly apply sliding fee discounts for certain patients with visits to the Organization during the year ended May 31, 2025. Management recognizes the importance of complying with sliding fee guidelines. In response to Finding 2025-002, proper training will be given to employees and sliding fee discounts will be reviewed by a supervisor on a periodic basis to ensure compliance with the sliding fee scale.

View Audit 371474

Finding 1161616 (2025-001)

Material Weakness 2025

Rural Health Services, Inc.

SC

In Finding 2025-001, a condition was noted that a majority of the board members or their immediate family are not users of the health center services. Compliance conditions state that more than fifty percent of board members should “utilize the health center as their principal source of primary heal...

In Finding 2025-001, a condition was noted that a majority of the board members or their immediate family are not users of the health center services. Compliance conditions state that more than fifty percent of board members should “utilize the health center as their principal source of primary health care” in order for them to give substantive input into the Organization’s strategic direction and policy. Management recognizes the importance of complying with board member compliance guidelines. In response to Finding 2025-001, procedures have been established to ensure that more than 50 percent of the board members are users of the health center, and compliance is now achieved as of the date of this corrective action plan.

View Audit 371474

Finding 1161571 (2025-002)

Material Weakness 2025

Building Futures, Inc.

NE

HUD Housing Programs

Building Futures, Inc. will make deposits to the Residual Receipts account within 60 days of year-end if there is a cash surplus. The cash surplus for the year ended June 30, 2025 was made on September 11, 2025.

View Audit 371447

Finding 1161570 (2025-001)

Material Weakness 2025

Building Futures, Inc.

NE

HUD Housing Programs

Building Futures, Inc. will ensure monthly replacement reserve deposits are made or obtain approval from HUD to suspend deposits.

View Audit 371447

Finding 1161530 (2025-001)

Material Weakness 2025

Sj Senior Housing, Inc.

NJ

Questioned Costs Special Tests & Provisions HUD Housing Programs

Views of Responsible Official: We will make the deposit and ensure going forward all monthly payments are made.

View Audit 371429 Questioned Costs: $1

Finding 1161496 (2025-001)

Material Weakness 2025

Missouri Family Health Council, Inc.

MO

Recommendation: We recommend the Organization immediately open a general ledger account for the unrecorded bank account and implement and enforce a formal policy requiring all bank account to be approved by the Board of Directors and recorded in the general ledger immediately upon opening.

View Audit 371397

Finding 1161496 (2025-001)

Material Weakness 2025

Missouri Family Health Council, Inc.

MO

View of responsible officials and planned corrective actions: The Board concurs with the recommendation that the Organization establish a formal policy requiring all bank accounts be recorded in the general ledger immediately upon opening. The bank account was set up on the general ledger as soon as...

View of responsible officials and planned corrective actions: The Board concurs with the recommendation that the Organization establish a formal policy requiring all bank accounts be recorded in the general ledger immediately upon opening. The bank account was set up on the general ledger as soon as the finding was discussed with management and the outside accounting firm.

View Audit 371397

Finding 1161476 (2025-003)

Material Weakness 2025

Warner Pacific University

OR

Student Financial Aid

Student Financial Assistance Cluster – Assistance Listing No. Various Recommendation: We recommend the University review their current policies and procedures around credit balances and ensure the processes in place are sufficient to ensure student credit balances due to federal funds are refunded w...

Student Financial Assistance Cluster – Assistance Listing No. Various Recommendation: We recommend the University review their current policies and procedures around credit balances and ensure the processes in place are sufficient to ensure student credit balances due to federal funds are refunded within 14 days. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: The Controller and the Assistant Director of Student Accounts will review credit balances due to federal funds on a weekly basis to determine the balances that need to be refunded. All credit balances that are identified as valid and owed to the student will now be refunded as part of the weekly refund process. Name of the contact person responsible for corrective action: Douglas Wade, Executive Vice President and CFO Warner Pacific University 2219 SE 68th Ave Portland OR 97215 dswade@warnerpacific.edu Office Phone 503-517-1043 Cell Phone 661-706-8379 Planned completion date for corrective action plan: April 30, 2025

View Audit 371379

Finding 1161470 (2025-002)

Material Weakness 2025

Warner Pacific University

OR

Student Financial Aid

Student Financial Assistance Cluster – Assistance Listing No. Various Recommendation: We recommend the University review its reporting procedures to ensure the students’ statuses are accurately and timely reported to NSLDS as required by regulations. Explanation of disagreement with audit finding: T...

Student Financial Assistance Cluster – Assistance Listing No. Various Recommendation: We recommend the University review its reporting procedures to ensure the students’ statuses are accurately and timely reported to NSLDS as required by regulations. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: WPU will form an internal committee to meet, review the existing procedures and reporting schedule, and update the procedures and reporting schedule as needed to ensure the students’ statuses are accurately and timely reported to NSLDS as required by regulations. The committee will consist of the Registrar, the Senior Associate Registrar, the Director of Student Finance, and representative(s) from the Controller’s Office. The committee will meet as many times as needed in Fall 2025 to fully review the procedures and reporting schedule, including reviewing any audit findings and making sure that the procedures have been properly updated to prevent the identified issue(s) from recurring in the future. Moving forward, the committee will meet at least once per year to review and update the procedures and reporting schedule, and can meet more frequently if needed to respond to individual situations.

View Audit 371379

Finding 1161464 (2025-001)

Material Weakness 2025

Warner Pacific University

OR

Student Financial Aid Allowable Costs / Cost Principles Significant Deficiency

Student Financial Assistance Cluster – Assistance Listing No. 84.033 – Federal Work Study Program Recommendation: We recommend that the University establish procedures to ensure that at least 7% of Federal Work Study allocation is used for community service jobs, or successfully receive a waiver as ...

Student Financial Assistance Cluster – Assistance Listing No. 84.033 – Federal Work Study Program Recommendation: We recommend that the University establish procedures to ensure that at least 7% of Federal Work Study allocation is used for community service jobs, or successfully receive a waiver as had happened in previous years. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: The Director of Financial Aid will monitor the progress of establishing partnerships and FWS community service opportunities, as well as review usage of FWS funds in the community service sector. The Director of Financial Aid will provide status updates to, and seek guidance from, the Vice President of Enrollment and Student Success and Engagement at least two times per term to ensure that WPU is on target to reach the federal requirements around the FWS community service rules. At the end of each award year, the University will evaluate student satisfaction in the community service positions and adjust placements accordingly for the upcoming award year.

View Audit 371379

Finding 1161457 (2025-001)

Material Weakness 2025

Cornerstone Housing North, Inc.

NH

HUD Housing Programs Cash Management

Plan: Residual Funds Return Process All residual funds identified for return to HUD must be submitted to the Fiscal Department along with the following: • HUD Form HUD-9250 • A completed check request Once both documents are received: 1. The Fiscal Department will initiate a bank transfer from the R...

Plan: Residual Funds Return Process All residual funds identified for return to HUD must be submitted to the Fiscal Department along with the following: • HUD Form HUD-9250 • A completed check request Once both documents are received: 1. The Fiscal Department will initiate a bank transfer from the Residual Checking Account to the General Checking Account. 2. After the internal transfer is completed, the check request will be processed, and payment will be submitted to HUD. Note: The Program Director is responsible for submitting both the HUD-9250 form and the check request. Funds will not be transferred from the Residual Account to General Checking unless both documents have been received. The Fiscal Department will manage the internal transfer, issue the payment, and mail payment to HUD. Contact: Christina Morin, Program Director Anticipated completion date: October 1, 2025

View Audit 371368

Finding 1161439 (2025-001)

Material Weakness 2025

Morrison Institute of Technology

IL

Procurement, Suspension & Debarment

Condition - The Institute did not have proper internal controls in place to verify that contractors are not suspended or debarred prior to entering into contracts. The Institute entered into a contract for construction activities totaling $499,814 and did not verify that the contractor was not suspe...

Condition - The Institute did not have proper internal controls in place to verify that contractors are not suspended or debarred prior to entering into contracts. The Institute entered into a contract for construction activities totaling $499,814 and did not verify that the contractor was not suspended or debarred prior to entering into the contract. Subsequent to auditor inquiry, the Institute performed a search for the contractor on the SAM exclusion list and noted the contractor was not listed as suspended or debarred. Corrective Action Plan - Contingent on board approval, the administration and staff of Morrison Institute of Technology will implement a practice whereas certification regarding debarment, suspension, and ineligibility are included with any contract or expenditure that meets or exceeds the threshold of $50,000. Contact Person, Title and Phone Number - Chris Scott, President, (815)-772-7218, Ext. 212 Anticipated Completion Date - October 30, 2025

View Audit 371305

Finding 1161419 (2025-001)

Material Weakness 2025

William James College, Inc. & Affiliates

MA

Student Financial Aid Special Tests & Provisions Eligibility

Finding – Special Tests and Provisions: Enrollment Reporting – Federal Direct Student Loan Program, Assistance Listing Number 84.268; May 31, 2025 Award Year; U.S. Department of Education Criteria or Specific Requirement Enrollment information, including the effective date of separation from the ins...

Finding – Special Tests and Provisions: Enrollment Reporting – Federal Direct Student Loan Program, Assistance Listing Number 84.268; May 31, 2025 Award Year; U.S. Department of Education Criteria or Specific Requirement Enrollment information, including the effective date of separation from the institution, must be accurately reported within 30 days whenever attendance changes for a student, unless a roster will be submitted within 60 days. The changes include reductions or increases in attendance levels, withdrawals, graduations, and approved leaves of absence. It is the institution’s responsibility, as a participant in the Title IV aid programs, to monitor and report these changes to the National Student Loan Data System (“NSLDS”). (NSLDS Enrollment Reporting Guide November 2022, and 34 CFR 685.309(b)) Condition Of the nine students selected for enrollment reporting testing, two students within the sample were reported to NSLDS outside the maximum 60-day window. This was not a statistically valid sample. Views of Responsible Officials and Planned Corrective Actions The College concurs with the finding. The College will continue to remain vigilant in its oversight over timely communication of enrollment reporting detail to NSLDS. In both instances, the data we had sent to the National Student Clearinghouse (NSC) was not received by NSLDS in a timely fashion. We will review our reporting schedule and make the appropriate changes to our reporting timeline to ensure the data we report to the NSC is subsequently received by NSLDS within regulations. Names of Contact Person Responsible for Corrective Action: Anna Lyons, Associate Registrar Anticipated Completion Date: September 1, 2025

View Audit 371288

Finding 1161383 (2025-001)

Material Weakness 2025

Uncompahgre Combined Clinics Dba Uncompahgre Medical Center

CO

Internal Control / Segregation of Duties Subrecipient Monitoring HUD Housing Programs

Federal Program: Consolidated Health Centers Grant Assistance Listing No. 93.224 & 93.527 Recommendation: Our auditors recommended the Organization to review internal controls in regards to the determination, recording, and monitoring of the sliding fee process to ensure that appropriate sliding fee...

Federal Program: Consolidated Health Centers Grant Assistance Listing No. 93.224 & 93.527 Recommendation: Our auditors recommended the Organization to review internal controls in regards to the determination, recording, and monitoring of the sliding fee process to ensure that appropriate sliding fee rates/categories are utilized for each sliding fee encounter and that the support for the sliding fee discounts is retained. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: The Organization has recognized the deficiency of internal controls regarding this determination, recording, and monitoring of the sliding fee process from application through making the adjustment. The Organization has implemented a comprehensive input and verification process that applies to both the initial application and the subsequent adjustment phases. This includes enhanced checks to ensure accuracy in data entry and calculation, as well as verification of application information. If the U.S. Department of Health and Human Services has questions regarding this plan, please call Tricia Lippert, Comptroller at 970-327-0537.

View Audit 371259

Finding 1161367 (2025-003)

Material Weakness 2025

Augsburg University

MN

Questioned Costs Allowable Costs / Cost Principles Period of Performance § 200.403 § 200.405

Research and Development Cluster— Assistance Listing Nos. Various Recommendation: We recommend that the University review its procedures around review and approval of R&D expenditures to ensure that only valid expenditures are reported. Explanation of disagreement with audit finding: There is no dis...

Research and Development Cluster— Assistance Listing Nos. Various Recommendation: We recommend that the University review its procedures around review and approval of R&D expenditures to ensure that only valid expenditures are reported. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: The University does have existing internal control processes over its federal grants. The principal investigators code, approve, and submit expenditures for payment. In addition, principal investigators receive periodic grant reports which include the detail of all transactions charged to their grants for review. The University will add an additional control step to review coding of research and development payment requests in the ERP system prior to payment. Names of the contact persons responsible for corrective action: Gerri Stepanek and Carole Kampf Planned completion date for corrective action plan: September 1, 2025

View Audit 371249 Questioned Costs: $1

Finding 1161359 (2025-002)

Material Weakness 2025

Augsburg University

MN

Significant Deficiency Internal Control / Segregation of Duties

Student Financial Assistance Cluster— Assistance Listing Nos. 84.007, 84.033, 84.063, 84.268 Recommendation: We recommend that the University review the updated GLBA requirements and ensure their WISP includes all required elements. Explanation of disagreement with audit finding: There is no disagre...

Student Financial Assistance Cluster— Assistance Listing Nos. 84.007, 84.033, 84.063, 84.268 Recommendation: We recommend that the University review the updated GLBA requirements and ensure their WISP includes all required elements. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: Augsburg University will update its Written Information Security Program to: * More fully document the processes and procedures to dispose of customer information securely * Maintain a log of authorized users’ activity and keep an eye out for unauthorized access. Names of the contact persons responsible for corrective action: Scott Krajewski Planned completion date for corrective action plan: May 31, 2026

View Audit 371249

Finding 1161353 (2025-001)

Material Weakness 2025

Augsburg University

MN

Student Financial Aid Reporting Significant Deficiency

Student Financial Assistance Cluster— Assistance Listing Nos. 84.007, 84.033, 84.063, 84.268 Recommendation: We recommend the University review its reporting procedures to ensure that students’ statuses are accurately and timely reported to NSLDS as required by regulations. Explanation of disagreeme...

Student Financial Assistance Cluster— Assistance Listing Nos. 84.007, 84.033, 84.063, 84.268 Recommendation: We recommend the University review its reporting procedures to ensure that students’ statuses are accurately and timely reported to NSLDS as required by regulations. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: Student Financial Services is working with the Registrar to update our reporting practices for students with student teaching requirements. The registrar has connected with the Clearinghouse to confirm and utilize a separate file type for this population, which should resolve the reporting date issue. Name of the contact person responsible for corrective action: Catherine Maun Planned completion date for corrective action plan: May 31, 2026

View Audit 371249

Finding 1161342 (2025-001)

Material Weakness 2025

King University

TN

Questioned Costs Student Financial Aid Reporting

2025‐001 Significant Deficiency: Working During Scheduled Class Time (U.S. Department of Education, Federal Work Study Program, ALN #84.033) Responsible Officials: Christin Mustard, Director of Financial Aid, is responsible for overseeing campus-based funding, and Melissa Tolbert, Financial Aid Offi...

2025‐001 Significant Deficiency: Working During Scheduled Class Time (U.S. Department of Education, Federal Work Study Program, ALN #84.033) Responsible Officials: Christin Mustard, Director of Financial Aid, is responsible for overseeing campus-based funding, and Melissa Tolbert, Financial Aid Office Manager, manages the work study contracts and training with supervisors and students. Kelly Pennington, Payroll and Benefits Supervisor, is responsible for paying work study students. Summary of Finding: During the audit, it was noted that a student appears to have been paid for Federal Work Study hours logged and submitted for time the student was scheduled to be in class without acceptable exemption, which contradicts guidance provided by the 2024-2025 Federal Student Aid Handbook, resulting in an over-payment of $11. Corrective Action Plan: King University has implemented a new mandatory training module for both work study students and supervisors. This training must be completed before a student is cleared to begin working, and this step will be an annual requirement for all new and returning students and supervisors. The training includes key points from the Work Study Handbook and an assessment test that must be passed in order to be cleared for work. Our Work Study Coordinator is completing individual training with all new supervisors as well as refresher training with returning supervisors. Supervisors are informed of their responsibility to verify the accuracy of all timesheets submitted and to ensure that clocked hours do not overlap with scheduled class time. They are required to meet with their work study students in advance to review the policies and expectations outlined in the Work Study Handbook. Both the student and supervisor must sign a document acknowledging that they have read the handbook. Timely communications and reminders will be sent throughout the academic year to supervisors and students as well. As an added safeguard, our IT department has created a report that compares student timesheets to their class schedules to ensure there is no overlap with class time. This report will be run by payroll or financial aid staff prior to each pay cycle to verify compliance. Anticipated Completion Date: King University has returned the overpayment of $11 to the Department via G6 in September 2025.

View Audit 371237 Questioned Costs: $1

Finding 1161299 (2025-002)

Material Weakness 2025

Sarasota Housing Authority

FL

HUD Housing Programs Internal Control / Segregation of Duties

Views of Responsible Officials and Planned Corrective Action: The Authority agrees with the recommendation of the auditor and has processed the required correction to the tenantâ€™s HUD-50058 form. The Authority will increase oversight in the Housing Voucher Cluster to ensure that established intern...

Views of Responsible Officials and Planned Corrective Action: The Authority agrees with the recommendation of the auditor and has processed the required correction to the tenantâ€™s HUD-50058 form. The Authority will increase oversight in the Housing Voucher Cluster to ensure that established internal control policies are being followed accurately and on a timely basis. William Russell, Chief Executive Officer, will be responsible to implement this corrective action by March 31, 2026.

View Audit 371221

Finding 1161290 (2025-001)

Material Weakness 2025

Presbyterian Homes

IL

Allowable Costs / Cost Principles Cash Management Significant Deficiency

Coordinated with Illinois Emergency Management Agency to correct duplicate line items in grant cost summary. Cost summary was corrected before closing out grant. Management has implemented controls in the future to prevent duplicate invoices from being submitted.

View Audit 371213

Finding 1161282 (2025-001)

Material Weakness 2025

South Fork Retirement Center, Inc.

IN

Reporting

Finding 2025-001 – Filing Annual Reports Timely Finding Resolution Status: In process. Information on Universe and Population Size: This is not applicable. Sample Size Information: This is not applicable. Noncompliance Information: This is not applicable. Statement of Condition: South Fork violated ...

Finding 2025-001 – Filing Annual Reports Timely Finding Resolution Status: In process. Information on Universe and Population Size: This is not applicable. Sample Size Information: This is not applicable. Noncompliance Information: This is not applicable. Statement of Condition: South Fork violated the single audit requirements by not filing the Single Audit Data Collection Form (SF-SAC) to the Federal Audit Clearinghouse in a timely manner. South Fork assumed that filing the audited financials to Real Estate Assessment Center (REAC) was sufficient in being in compliance. Criteria: When there are federal expenditures that exceed the amount of $750,000, the SF-SAC must be filed in a timely manner to ensure compliance with reporting requirements. Effect or Potential Effect: South Fork is in violation with the Federal Audit Clearinghouse guidelines. Cause: Unaware of Federal Audit Clearinghouse filing requirements. South Fork was only aware of filing the audited financial statements to REAC. Recommendation: South Fork will file the current year audited financials with the SF-SAC to the Federal Audit Clearinghouse. Auditor Noncompliance Information: Z – Other. Questioned Costs: $0 Reporting Views of Responsible Officials: South Fork filed the 2025 audited financial statements with the Federal Audit Clearinghouse to be back in compliance. Concur or Do Not Concur with This Finding: Concur. Agree or Disagree with Auditor Recommendations: Agree. Completion Date: June 30, 2025 Actions Taken or Plan on the Finding: South Fork filed the 2025 audited financial statements with the Federal Audit Clearinghouse and will continue to do so when required.

View Audit 371202

Finding 1161281 (2025-002)

Material Weakness 2025

Taylor Housing Commission

MI

Questioned Costs HUD Housing Programs

We concur with this finding and the Auditor's recommendation. We will increase staff training, and bring on additional HCV staff, to ensure Greater oversight in Eligibility compliance.

View Audit 371201 Questioned Costs: $1

Finding 1161280 (2025-001)

Material Weakness 2025

Taylor Housing Commission

MI

Questioned Costs HUD Housing Programs

We concur with this finding and the Auditor's recommendation. We will review the Admin Plan and policies related to the calculation of TTP. The THC's HCV staff have undergone additional NELROD - "Rent Calculation" training as of 10-10-2025, and management will implement procedures to clear this find...

We concur with this finding and the Auditor's recommendation. We will review the Admin Plan and policies related to the calculation of TTP. The THC's HCV staff have undergone additional NELROD - "Rent Calculation" training as of 10-10-2025, and management will implement procedures to clear this finding in FY 2025.

View Audit 371201 Questioned Costs: $1

Finding 1161274 (2025-004)

Material Weakness 2025

MacAlester College

MN

Procurement, Suspension & Debarment Significant Deficiency

Research & Development Cluster – CFDA No. 47.050 Recommendation: We recommend that the Grants Accounting team implement a control to ensure that suspension and debarment checks are both performed and formally documented prior to processing payments of $25,000 or more. Explanation of disagreement wit...

Research & Development Cluster – CFDA No. 47.050 Recommendation: We recommend that the Grants Accounting team implement a control to ensure that suspension and debarment checks are both performed and formally documented prior to processing payments of $25,000 or more. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: The College has amended its procedures for approving federal grant expenditures to ensure that review for suspension and debarment is formally documented prior to payments of $25,000 or more. Name of the contact person responsible for corrective action: Matthew Walters, Director of Accounting Planned completion date for corrective action plan: October 31, 2025

View Audit 371195

Finding 1161273 (2025-003)

Material Weakness 2025

MacAlester College

MN

Student Financial Aid Significant Deficiency Matching / Level of Effort / Earmarking

Student Financial Assistance Cluster – CFDA No. 84.038 Recommendation: We recommend that the College review all retired/assigned Perkins loan files to ensure MPNs are present and properly retained. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Actio...

Student Financial Assistance Cluster – CFDA No. 84.038 Recommendation: We recommend that the College review all retired/assigned Perkins loan files to ensure MPNs are present and properly retained. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: The College will review assigned and retired files for the Master Promissory Notes. Name of the contact person responsible for corrective action: Deb Schmidt, Director of Student Accounts Planned completion date for corrective action plan: February 28, 2026

View Audit 371195

Corrective Action Plans

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