Corrective Action Plans

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Finding 2024-008:Special Tests and Provisions: Personnel Requirements (Title V, CFDA 93.U01) Significant Deficiency (New Finding) Condition: Of ten employees tested under Title V personnel requirements (Public Law 101-630, Indian Child Protection and Family Violence Prevention Act), background check...
Finding 2024-008:Special Tests and Provisions: Personnel Requirements (Title V, CFDA 93.U01) Significant Deficiency (New Finding) Condition: Of ten employees tested under Title V personnel requirements (Public Law 101-630, Indian Child Protection and Family Violence Prevention Act), background check documentation was missingfor two employees and a signed confidentialityagreement was missingfor one employee. Corrective Action: Obtain and file the missing background check documentation and confidentiality agreement for the identified employees. Implement a personnel compliance checklist requiring completed background checks and signed confidentiality agreements before any employee begins duties involving contact with or control over Indian children. Assign HR sign-off responsibility confirming checklist completion, retained in each personnel file. Conduct a one-time look-back review of all current Title V-relevant personnel files to confirm completeness. Responsible Party: Human Resources/ Chief Executive Officer Anticipated Completion Date: Checklist process in effect by October 15, 2026
Finding2024-007:Equipment and Real Property Management (Title V, CFDA 93.U01) Material Weakness (Repeat Finding: 2023-007) Condition: The Organization lacked a system to identify, mark, record, or maintain equipment and real property purchased with federalfunds; no periodic physical inventory was pe...
Finding2024-007:Equipment and Real Property Management (Title V, CFDA 93.U01) Material Weakness (Repeat Finding: 2023-007) Condition: The Organization lacked a system to identify, mark, record, or maintain equipment and real property purchased with federalfunds; no periodic physical inventory was performed; and there was no process to obtain prior written approval for capital expenditures of $10,000 or more, as required by 2 CFR §200.310 through §200.314 and §200.407. Corrective Action: • Establish a property/equipment ledger recording description, acquisition cost, funding source, acquisition date, location, and disposition for all federally funded equipment and real property. • Implement a physical inventory at least once every two years, reconciled to the property ledger, per 2 CFR §200.313(d). • Implement a prior-written-approvalworkflow requiring awarding agency/pass-through approval before purchasing or leasing equipment ($10,000+ per unit), land, or buildings with federal funds. • Apply the GLrestructuring from Finding 2024-003 so capital purchases under Title V are individually identifiable. Responsible Party: Chief Financial Officer Anticipated Completion Date: Property ledger established concurrent with the Blackbaud implementation, kickoff August 13, 2026; complete by March 31, 2027; first physical inventory completed by June 30, 2027
Finding 2024-006: Preparation of the Schedule of Expenditures of Federal Awards (SEFA) Repeat Finding (2021-007, 2022-006, 2023-006) Condition: Controls were not adequate to ensure the SEFA accurately reflected each award's federal agency and Assistance Listing Number; differences existed between th...
Finding 2024-006: Preparation of the Schedule of Expenditures of Federal Awards (SEFA) Repeat Finding (2021-007, 2022-006, 2023-006) Condition: Controls were not adequate to ensure the SEFA accurately reflected each award's federal agency and Assistance Listing Number; differences existed between the SEFA and the underlying grant agreements/compliance supplements, requiring adjustment. Corrective Action: • Develop a standard SEFA preparation workpaper, to be used jointly with the Organization's outsourced accounting firm, that reconciles each federal award line to the general ledger and to the executed grant agreement/Notice of Award. • Establish a defined handoff process with the outsourced accounting firm sothe CFO receives the draft SEFA with sufficient lead time to review it internally before submission to the auditor. • Verify federal agency name and Assistance Listing Number for each award directly against grant documentation before submission. • Require a documented second-level review of the SEFA by the CFO, in addition to the outsourced firm's preparation, prior to issuance to the auditor. • Provide trainingto both the outsourced firm's preparer and internalfinance staff on Uniform Guidance §200.510 SEFA requirements. Responsible Party: Chief Financial Officer (in coordination with the Organization's outsourced accounting firm) Anticipated Completion Date: SEFA preparation workpaper and CFO review process adopted by December 1, 2026; in effect for the FY25 SEFA
Finding 2024-005: Reporting (Title V, CFDA 93.U01) Material Weakness (Repeat Finding: 2021-005, 2022-005, 2023-005) Condition: The Organization could not provide required Title Vreports, including the financial report, activity narrative, third-party income report, GPRA/GPRAMA, urban data standards ...
Finding 2024-005: Reporting (Title V, CFDA 93.U01) Material Weakness (Repeat Finding: 2021-005, 2022-005, 2023-005) Condition: The Organization could not provide required Title Vreports, including the financial report, activity narrative, third-party income report, GPRA/GPRAMA, urban data standards report, and property inventory. Corrective Action: • Build a federal reportingcalendar listing every required Title Vreport, its due date, data source, and responsible preparer. • Assign a designated preparer and a second-level reviewer for each report prior to submission. • Retain a copy of each submitted report, with the submission confirmation, in a centralized compliance file. • Provide staff training on Title V reporting obligations and the underlying contract requirements. Responsible Party: Chief Financial Officer/ Grant Director Anticipated Completion Date: Reporting calendar in place by October 15, 2026; first fully compliant reporting cycle Q1 2027
Finding 2024-004: Procurement and Suspension and Debarment (Title V, CFDA 93.U01) Material Weakness (Repeat Finding: 2021-004, 2022-004, 2023-004)Condition: Because Title V expenditures lacked transaction-level detail, the auditor could not select procurement transactions for testing or verify that ...
Finding 2024-004: Procurement and Suspension and Debarment (Title V, CFDA 93.U01) Material Weakness (Repeat Finding: 2021-004, 2022-004, 2023-004)Condition: Because Title V expenditures lacked transaction-level detail, the auditor could not select procurement transactions for testing or verify that vendors were screened for suspension/debarment prior to contract award. Corrective Action: • Adopt a written procurement policy aligned with Uniform Guidance thresholds (micro-purchase, simplified acquisition, formalprocurement); this policy is in progress and pendingboard approval. • Require and document a System for Award Management (SAM.gov) check, or an equivalent vendor certification, before anyfederally funded contract or purchase order is issued. • Retain SAM.gov screening printouts/certifications with the procurement file for each Title V vendor. • Apply the GLrestructuring from Finding 2024-003 so procurement transactions are individually identifiable for testing. Responsible Party: Chief Financial Officer Anticipated Completion Date: Procurement policy adopted by November 15, 2026; SAM screening process in effect for all new Title V vendors by December 1, 2026
Finding 2024-003: Activities Allowed and Unallowed, Allowable Costs, Period of Performance (Title V, C FDA 93. U0 1) Material Weakness (Repeat Finding: 2021-003, 2022-003, 2023-003) Condition: Title V expenditures were recorded through summary journal entries without transactionlevel detail, prevent...
Finding 2024-003: Activities Allowed and Unallowed, Allowable Costs, Period of Performance (Title V, C FDA 93. U0 1) Material Weakness (Repeat Finding: 2021-003, 2022-003, 2023-003) Condition: Title V expenditures were recorded through summary journal entries without transactionlevel detail, preventing the auditor from selecting a valid sample or testing compliance. A disclaimed opinion on compliance was issued for this major program. Questioned costs are undetermined due to scope limitation. Corrective Action: • Restructure the chart of accounts/ GL coding so every Title V transaction is individually recorded and traceable to source documentation, rather than aggregated into journal entries. • Require program/grant coding at the point of transaction entry (accounts payable, payroll allocation, purchasing) rather than after the fact. • Implement a quarterly internal review reconciling Title V ledger detail to the approved Title V budget and contract terms. • Provide finance staff training on Uniform Guidance recordkeeping requirements (2 CFR §200.302, §200.333) specific to federal award transactions. Responsible Party: Chief Financial Officer Anticipated Completion Date: GL restructuring to be implemented concurrent with the Organization's new fund accounting system (Blackbaud Financial Edge NXT), implementation kickoff August 13, 2026; complete by March 31, 2027, with the first fully traceable Title V transaction month in April 2027
Audit Finding Reference: 2024-004 Timely Filing of Single Audit Report Planned Corrective Action: Faster turn around time from Audit firm Planned Implementation Date of Corrective Action: Immediately upon notification, June 09, 2025. Person Responsible for Corrective Action: County Administrator and...
Audit Finding Reference: 2024-004 Timely Filing of Single Audit Report Planned Corrective Action: Faster turn around time from Audit firm Planned Implementation Date of Corrective Action: Immediately upon notification, June 09, 2025. Person Responsible for Corrective Action: County Administrator and Finance Director
Audit Finding Reference: 2024-003 Internal Controls Over Reporting Planned Corrective Action: A Finance Director will review quarterly report prior to submission. Planned Implementation Date of Corrective Action: Immediately upon notification, June 09, 2025. Person Responsible for Corrective Action:...
Audit Finding Reference: 2024-003 Internal Controls Over Reporting Planned Corrective Action: A Finance Director will review quarterly report prior to submission. Planned Implementation Date of Corrective Action: Immediately upon notification, June 09, 2025. Person Responsible for Corrective Action: County Administrator and Finance Director
Audit Finding Reference: 2024-002 Document Policies and Procedures Over Federal Awards Planned Corrective Action: A Uniform Guidance policy and Procedure document has been adopted. Planned Implementation Date of Corrective Action: The policy was effective 03/21/2025. Person Responsible for Correctiv...
Audit Finding Reference: 2024-002 Document Policies and Procedures Over Federal Awards Planned Corrective Action: A Uniform Guidance policy and Procedure document has been adopted. Planned Implementation Date of Corrective Action: The policy was effective 03/21/2025. Person Responsible for Corrective Action: Finance Director
Year Ended: October 31, 2024 Contact person responsible for corrective action: Erling Juel, District Manager Anticipated completion date: by the end of the grant period The following is Greenfields Irrigation District’s corrective action plan for audit finding 2024-001. Corrective Action Plan 2024-0...
Year Ended: October 31, 2024 Contact person responsible for corrective action: Erling Juel, District Manager Anticipated completion date: by the end of the grant period The following is Greenfields Irrigation District’s corrective action plan for audit finding 2024-001. Corrective Action Plan 2024-001: Greenfields Irrigation District (District) is aware of this imbalance. The District needed to order project materials in advance and make progress payments before construction began. Because work had not yet started, recipient expenditures temporarily exceeded the proportional cost share. As the project progresses and additional eligible costs are incurred, the federal and recipient shares will align with the required cost-share requirements.
Planned Corrective Action: The Organization has a procurement policy within the Organization’s Internal Controls. The Organization has a procurement process within the Organization’s Operations Manual. However, they are missing key elements required in federal procurement. Both of these will be revi...
Planned Corrective Action: The Organization has a procurement policy within the Organization’s Internal Controls. The Organization has a procurement process within the Organization’s Operations Manual. However, they are missing key elements required in federal procurement. Both of these will be reviewed to ensure they align with CFR standards for federal procurement. Planned Implementation Date of Corrective Action: June 12, 2025 Name of Contact Person: Melinda Lequin, Executive Finance Director
Planned Corrective Action: While the Organization’s existing internal controls address management of invoices and payments, there was no written process within the organization’s internal controls that identified the required documentation, workpapers, review, and approval for federal grant reimburs...
Planned Corrective Action: While the Organization’s existing internal controls address management of invoices and payments, there was no written process within the organization’s internal controls that identified the required documentation, workpapers, review, and approval for federal grant reimbursements. Planned Implementation Date of Corrective Action: October 1, 2025 Name of Contact Person: Melinda Lequin, Executive Finance Director
Planned Corrective Action: There was no written process within the Organization’s Internal Controls that identified the requirements for federal grant management and subrecipient oversight. The draft for these internal controls has been updated to include a subrecipient monitoring / risk assessment ...
Planned Corrective Action: There was no written process within the Organization’s Internal Controls that identified the requirements for federal grant management and subrecipient oversight. The draft for these internal controls has been updated to include a subrecipient monitoring / risk assessment process. Planned Implementation Date of Corrective Action: October 1, 2025 Name of Contact Person: Melinda Lequin, Executive Finance Director
Management has implemented a standardized monthly grant reconciliation process requiring that all reimbursement requests be fully reconciled to the general ledger, grant cost centers, payroll records, and supporting documentation before submission to the granting agency. Payroll-related expenditures...
Management has implemented a standardized monthly grant reconciliation process requiring that all reimbursement requests be fully reconciled to the general ledger, grant cost centers, payroll records, and supporting documentation before submission to the granting agency. Payroll-related expenditures and fringe benefit allocations are now based solely on actual allowable costs incurred and recorded in the general ledger. Budgeted amounts are no longer utilized when calculating reimbursement requests if actual expenditure information is available. As part of the Organization's standardized monthly financial close process, payroll costs, employer payroll taxes, employee benefits, workers' compensation, and other fringe benefit expenditures are reconciled to the general ledger and supporting documentation before reimbursement requests are prepared. Management has also implemented documented supervisory review procedures requiring verification that reimbursement requests reconcile to the accounting records and comply with the Organization's cost allocation methodology and applicable federal grant requirements before submission. Management has completed a review of prior reimbursement reporting, reconciled identified differences to the underlying accounting records, and corrected identified reporting discrepancies. These reconciliation procedures have been incorporated into the Organization's ongoing grant compliance process to strengthen internal controls over federal reimbursement requests and promote continued compliance with 2 CFR Part 200. The corrective actions identified above were substantially implemented during the fourth quarter of 2025 and have been incorporated into the Organization's standardized monthly financial close and grant reimbursement processes. Management continues to monitor the effectiveness and consistent application of these controls, including reconciliation of fringe benefit expenditures to actual costs recorded in the general ledger and documented supervisory review before submission of reimbursement requests. Full formalization and documentation of the enhanced grant reconciliation and compliance procedures are expected by February 28, 2027.
Management has strengthened its monthly grant reporting procedures by requiring that all shared occupancy costs be calculated using the actual rent and utility expenses incurred for the reporting period in accordance with the Organization's documented cost allocation methodology. Budgeted amounts ar...
Management has strengthened its monthly grant reporting procedures by requiring that all shared occupancy costs be calculated using the actual rent and utility expenses incurred for the reporting period in accordance with the Organization's documented cost allocation methodology. Budgeted amounts are not utilized in determining costs charged to federal or State grant programs when actual expenditures are available. Supporting documentation for occupancy costs is reconciled to the general ledger and source documentation before preparation of each grant reimbursement request. In addition, management has implemented a documented supervisory review requiring verification of allocation calculations, supporting schedules, actual source documentation, and applicable cost allocation percentages before expenditures are charged to federal and State grant programs. These procedures have been incorporated into the Organization's standardized monthly financial close process and grant reporting procedures to promote consistent application of federal cost principles, strengthen management oversight, and ensure compliance with 2 CFR Part 200 and applicable grant requirements. The corrective actions identified above were implemented during the fourth quarter of 2025 and incorporated into the Organization's monthly grant reporting procedures. Management continues to monitor the consistent application of these controls as part of its ongoing grant compliance and financial reporting processes. Responsible Parties: CaTrice Monik, Finance Administrator; Susan Manuel, Internal Audit/Accounting; and Andre Thomas, Executive Director/CEO. CaTrice Monik is responsible for preparing grant reimbursement requests using actual recorded occupancy costs and maintaining the related supporting documentation; Susan Manuel is responsible for reconciliation and supervisory review of allocation calculations, supporting schedules, and underlying accounting records; and Andre Thomas provides management oversight and final approval, as applicable. Implementation Status: Fully implemented as of December 31, 2025. The related control procedures remain in effect as part of management's ongoing grant compliance and financial reporting processes.
Management has implemented procedures requiring executive compensation to be formally authorized by the Board of Directors or its designated representative, documented within the Organization's governance records, and maintained within the Executive Director's personnel file. Supporting documentatio...
Management has implemented procedures requiring executive compensation to be formally authorized by the Board of Directors or its designated representative, documented within the Organization's governance records, and maintained within the Executive Director's personnel file. Supporting documentation will include Board approval of executive compensation, salary authorization, compensation adjustments, employment-related documentation, and any other records necessary to demonstrate proper authorization and compliance with applicable grant and payroll requirements. In addition, executive personnel files will be reviewed annually as part of the year-end financial reporting process to verify that all required payroll and personnel documentation is complete, current, properly authorized, and retained in accordance with the Organization's record retention policies and applicable federal and State grant requirements. The corrective actions identified above have been partially implemented. Full implementation and formalization of the executive compensation documentation and annual personnel file review procedures are expected by December 31, 2026. Following implementation, these procedures will remain ongoing components of the Organization's governance, payroll, and annual financial reporting processes. Responsible Parties: Andre Thomas, Executive Director/CEO; Susan Manuel, Internal Audit/Accounting; and the Board of Directors or its designated representative, as applicable. The Board of Directors or its designated representative is responsible for formal authorization of executive compensation; the Executive Director/CEO is responsible for ensuring that required employmentrelated documentation is maintained; and Internal Audit/Accounting is responsible for verifying that compensation authorization and related supporting documentation are complete and available for financial reporting, grant compliance, and audit purposes. Implementation Status: Partially implemented; full implementation and formalization expected by December 31, 2026.
This matter was previously identified through DHS monitoring of the Organization's grant reporting. In response, management implemented a standardized monthly grant reporting process during 2025 that includes internal preparation deadlines established in advance of the grantor's due date, reconcilia...
This matter was previously identified through DHS monitoring of the Organization's grant reporting. In response, management implemented a standardized monthly grant reporting process during 2025 that includes internal preparation deadlines established in advance of the grantor's due date, reconciliation of grant expenditures to the accounting records, supervisory review of monthly reimbursement requests, and monitoring of submission deadlines through the Organization's grant compliance process. These procedures provide sufficient time for preparation, reconciliation, supervisory review, resolution of identified discrepancies, and submission of the Periodic Financial Reports within the timeframes established by IDHS. The revised procedures were incorporated into the Organization's standard monthly grant reporting process during 2025 and remain an ongoing component of the Organization's grant compliance and financial reporting procedures. Responsible Parties: CaTrice Monik, Finance Administrator, is responsible for preparation and timely completion of the Periodic Financial Reports; Susan Manuel, Internal Audit/Accounting, is responsible for reconciliation and review of the underlying financial information and monitoring compliance with applicable reporting deadlines; and Andre Thomas, Executive Director/CEO, provides management oversight and final approval, as applicable. Implementation Status: Fully implemented as of December 31, 2025.
Management has implemented a formal compliance calendar that identifies reporting deadlines associated with federal and State grants, including audit submission requirements under Uniform Guidance and GATA. Reporting deadlines and related audit milestones are monitored throughout the year, and manag...
Management has implemented a formal compliance calendar that identifies reporting deadlines associated with federal and State grants, including audit submission requirements under Uniform Guidance and GATA. Reporting deadlines and related audit milestones are monitored throughout the year, and management performs periodic reviews to ensure that required financial reports, audit deliverables, and regulatory filings remain on schedule. Delays or missed internal milestones will be identified and addressed promptly to minimize the risk of noncompliance with external reporting deadlines. 21 Integrity & Fidelity NFP. 403 W. Lincoln Highway, Chicago, IL. 60411 integrityandfidelity.org Andre Thomas (773) 756-6806 In addition, management has established earlier internal target dates for year-end closing procedures, financial statement preparation, audit support, and review of audit deliverables to provide adequate time for completion of required regulatory filings before applicable deadlines. Management will continue to monitor audit progress throughout each engagement and maintain ongoing communication with the independent auditors to facilitate timely completion of future audits and regulatory submissions. The corrective actions identified above have been partially implemented, including enhanced monitoring of regulatory reporting requirements and coordination of audit-related deliverables. Full implementation and formalization of the compliance calendar, internal audit completion milestones, and related management review procedures are expected by February 28, 2027. These procedures will remain ongoing components of the Organization's annual financial reporting and regulatory compliance process. Responsible Parties: Susan Manuel, Internal Audit/Accounting, with oversight and final approval by Andre Thomas, Executive Director/CEO. Responsibilities include monitoring applicable federal and State reporting deadlines, coordinating financial information and audit deliverables, monitoring progress against established internal deadlines, and ensuring required reports are submitted to the appropriate regulatory portals within prescribed timeframes. Implementation Status: Partially implemented; full implementation and formalization expected by February 28, 2027
Identifying Number: 2024-002 Finding: There was a lack of segregation of duties in preparing and reviewing the quarterly Project and Expenditure Reports. Corrective Actions Taken or Planned: The Town has established policy and related procedures to ensure proper segregation of duties in preparing an...
Identifying Number: 2024-002 Finding: There was a lack of segregation of duties in preparing and reviewing the quarterly Project and Expenditure Reports. Corrective Actions Taken or Planned: The Town has established policy and related procedures to ensure proper segregation of duties in preparing and reviewing the quarterly Project and Expenditure Reports. Contact person(s): Anthony Genovese, Director of Finance Anticipated Completion Date: July 2026
Recommendation: The federal single audit report must be submitted to the FAC in accordance with the deadlines set forth in the federal guidelines.
Recommendation: The federal single audit report must be submitted to the FAC in accordance with the deadlines set forth in the federal guidelines.
Documentation to perform a Single Audit of State FY 2025, which ended June 30, 2025, is already submitted to the auditors. There are working on control test of the data submitted and expect to finish the Single Audit Report on March 31, 2027.
Documentation to perform a Single Audit of State FY 2025, which ended June 30, 2025, is already submitted to the auditors. There are working on control test of the data submitted and expect to finish the Single Audit Report on March 31, 2027.
Recommendation: We recommend that the City implement controls over USDA reports to ensure that they are reviewed prior to submission. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action planned in response to finding: The City will work to ensure t...
Recommendation: We recommend that the City implement controls over USDA reports to ensure that they are reviewed prior to submission. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action planned in response to finding: The City will work to ensure that the management reports are reviewed prior to submission. Name of the contact person responsible for corrective action: Christina Regas, City Administrator Planned completion date for corrective action plan: December 31, 2025.
Reporting Requirements for Federally Funded Projects – U.S. Department of Agriculture Community Facilities Loans and Grants, (Assistance Listing #10.766) Name of the Contact Person Responsible for the Corrective Action Plan: Willis Lott, Director of Finance. Corrective Action Plan: We concur. We wil...
Reporting Requirements for Federally Funded Projects – U.S. Department of Agriculture Community Facilities Loans and Grants, (Assistance Listing #10.766) Name of the Contact Person Responsible for the Corrective Action Plan: Willis Lott, Director of Finance. Corrective Action Plan: We concur. We will continue to review and improve policies and procedures in an effort to eliminate error and identify deficiencies from both operational and financial perspectives. Anticipated Completion Date: August 31, 2025
Reporting Requirements for Federally Funded Projects – U.S. Department of Treasury Coronavirus State and Local Fiscal Recovery Funds, (Assistance Listing #21.027) Name of the Contact Person Responsible for the Corrective Action Plan: Willis Lott, Director of Finance. Corrective Action Plan: We concu...
Reporting Requirements for Federally Funded Projects – U.S. Department of Treasury Coronavirus State and Local Fiscal Recovery Funds, (Assistance Listing #21.027) Name of the Contact Person Responsible for the Corrective Action Plan: Willis Lott, Director of Finance. Corrective Action Plan: We concur. We will continue to review and improve policies and procedures in an effort to eliminate error and identify deficiencies from both operational and financial perspectives. Anticipated Completion Date: August 31, 2025
Management agrees with the auditors' finding and will take action to implement controlling procedures over federal programs.
Management agrees with the auditors' finding and will take action to implement controlling procedures over federal programs.
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