Corrective Action Plans

Finding 1191749 (2025-001)

Material Weakness 2025

New Jersey Coalition to End Domestic Violence, Inc.

NJ

Internal Control / Segregation of Duties

Identifying Number: 2025-001 Finding: The Coalition erroneously identified certain federal grants as state funded grants on the Schedules. Contact Person Responsible for Corrective Action: Nicole Morella, Co-Executive Director and Adreinne Gantz, Co-Executive Director Corrective Action Planned: The ...

Identifying Number: 2025-001 Finding: The Coalition erroneously identified certain federal grants as state funded grants on the Schedules. Contact Person Responsible for Corrective Action: Nicole Morella, Co-Executive Director and Adreinne Gantz, Co-Executive Director Corrective Action Planned: The Coalition acknowledges past issues with properly separating federal and state grant funds. As of July 1, 2025, the Coalition began fully segregating overlapping grants in its accounting system to ensure accurate allocation and monitoring, including separating FY26 RPE federal and state funds. The Coalition will thoroughly review each award’s conditions and funding streams to ensure all funds are correctly classified in the general ledger and monitored throughout the grant by all staff involved in the implementation, monitoring and reporting on the grant. Before year-end, the Coalition will review all received funds to ensure they are accurately reported in the Schedules. Anticipated Completion Date: June 30, 2026.

View Audit 395545

Finding 1191748 (2025-001)

Material Weakness 2025

Woodridge Nonprofit Corporation 044-11116

MI

Reporting Significant Deficiency Internal Control / Segregation of Duties

Condition: The Organization paid out management fees in excess of allowable amount per the Management Agent’s Certification agreement. Planned Corrective Action: The excess management fees will be reversed out of the Corporation for the year ended December 31, 2026, thus adjusting the fees to the al...

Condition: The Organization paid out management fees in excess of allowable amount per the Management Agent’s Certification agreement. Planned Corrective Action: The excess management fees will be reversed out of the Corporation for the year ended December 31, 2026, thus adjusting the fees to the allowable amount. Management acknowledges noncompliance in the current year and is currently reviewing internal controls related to management fees going forward. Contact person responsible for corrective action: Michael McMillan, Director of Finance / President Anticipated Completion Date: 12/31/2026

View Audit 395543

Finding 1191747 (2025-001)

Material Weakness 2025

Talbot County, Maryland

MD

Reporting

Response to Finding 2025-001 Timely Filing of SF-425, Federal Financial Report (FFR) (Federal Award Finding) An SF-425 annual report, covering the period ending September 30th, is due within 90 days of the reporting period for each open Airport Improvement Program (AIP) that receives funding from th...

Response to Finding 2025-001 Timely Filing of SF-425, Federal Financial Report (FFR) (Federal Award Finding) An SF-425 annual report, covering the period ending September 30th, is due within 90 days of the reporting period for each open Airport Improvement Program (AIP) that receives funding from the Federal Aviation Administration (FAA). Prior to submission, Talbot County ensures the accuracy of each financial report by reconciling amounts between various sources, including vendor invoices, SF-271 forms, Talbot County’s ERP/accounting system, and the FAA’s web-based electronic invoicing and grant payment portal system (Delphi). While this multi-step verification process supports the accuracy of financial reports, it remains highly manual and is constrained by increasing workloads, limited resources, and a lean workforce. This challenge has intensified and become more apparent over the last few years due to the recent surge in the number of open and active AIPs. Further compounding the issue were delayed responses from the FAA and the Federal government shutdown that occurred from October 1, 2025 to November 12, 2025. During this 43-day period, Talbot County staff were unable to effectively communicate with the FAA to verify essential financial data necessary to complete the SF-425 reports. Auditee’s Corrective Action Plan: Talbot County’s corrective action plan focuses on evaluating the current workflow to identify bottlenecks (points of constraint) and opportunities to leverage technology and improve efficiency. Ultimately, a clearly defined grant process will be implemented that establishes roles, responsibilities, and expectations for staff. Increasing the frequency of grant tracking and reconciliation activities throughout the year will be a key component, as this will mitigate the potential for reporting delays and minimize the burden on staff when SF- 425 reports are due subsequent to the Federal fiscal year ending each September 30th. The improved grant procedures will expand the role of Talbot County’s Finance Office and allow for the consistent timely filing of SF-425 reports. This is an evolving process that will show marked improvement for the 2026 Single Audit. Sincerely, Martha Darling Sparks Finance Director

View Audit 395539

Finding 1191738 (2025-002)

Material Weakness 2025

Siena Heights University

MI

Student Financial Aid

Condition: Of the 40 students selected for enrollment reporting testing, 2 students did not have their status change updated appropriately and 3 students did not have their Classification of Instructional Programs (CIP) code updated appropriately. Planned Corrective Action: The Director of Student F...

Condition: Of the 40 students selected for enrollment reporting testing, 2 students did not have their status change updated appropriately and 3 students did not have their Classification of Instructional Programs (CIP) code updated appropriately. Planned Corrective Action: The Director of Student Financial Services now oversees enrollment reporting to the third-party servicer. The director reviews enrollment reporting to the third party and also reviews reporting to the third-party servicer to ensure accurate and timely reporting to NSLDS. Contact person responsible for corrective action: Callie Zake, Director of Student Financial Aid Anticipated Completion Date: June 19, 2026

View Audit 395532

Finding 1191736 (2025-004)

Material Weakness 2025

Change, Inc.

MN

Procurement, Suspension & Debarment § 200.213

Finding 2025-004 Federal Departments: Corporation for National and Community Service Assistance Listing #: 17.274 Internal Controls Material Weakness Category of Finding – Procurement, Suspension, and Debarment Finding Summary: There was no observable control documentation to directly indicate that ...

Finding 2025-004 Federal Departments: Corporation for National and Community Service Assistance Listing #: 17.274 Internal Controls Material Weakness Category of Finding – Procurement, Suspension, and Debarment Finding Summary: There was no observable control documentation to directly indicate that a search for suspension and debarment was performed on vendors. Responsible Individuals: Jill Johnson, Executive Director Corrective Action Plan: Our Executive Director and Controller developed an updated procurement policy that went into place July 1, 2024. Our Operations Manager did not follow the policy. This staff member is no longer with the organization. We have implemented new training for managers and directors about the procurement policy to ensure proper execution going forward. Anticipated Completion Date: July 1, 2025

View Audit 395531

Finding 1191734 (2025-003)

Material Weakness 2025

Change, Inc.

MN

Reporting Significant Deficiency Internal Control / Segregation of Duties

Finding 2025-003 Significant Deficiency Medical Billing Revenue Recognition Internal Controls Finding Summary: Regular reconciliation between the medical billing system and the accounting system was not conducted throughout the year, leading to a significant discrepancy between the end of year trail...

Finding 2025-003 Significant Deficiency Medical Billing Revenue Recognition Internal Controls Finding Summary: Regular reconciliation between the medical billing system and the accounting system was not conducted throughout the year, leading to a significant discrepancy between the end of year trail balance and the billing software report. Responsible Individuals: Jill Johnson, Executive Director Corrective Action Plan: We are developing formal procedures to include monthly reconciliation between accounting and billing systems. Anticipated Completion Date: March 31, 2026

View Audit 395531

Finding 1191716 (2025-002)

Material Weakness 2025

Change, Inc.

MN

Allowable Costs / Cost Principles Material Weakness Reporting

Finding 2025-002 Material Weakness Inadequate Documentation and Training for CECL Calculation Process Finding Summary: The staff member responsible for the CECL calculation left during FY25. The replacement staff member did not have adequate understanding of the prior calculations or the supporting ...

Finding 2025-002 Material Weakness Inadequate Documentation and Training for CECL Calculation Process Finding Summary: The staff member responsible for the CECL calculation left during FY25. The replacement staff member did not have adequate understanding of the prior calculations or the supporting workpapers. Therefore, the CECL adjustment was not recorded at the beginning of the audit and required multiple attempts before a reasonable estimate was determined and recorded. Responsible Individuals: Jill Johnson, Executive Director Corrective Action Plan: We will capture detailed documentation of the CECL calculation process, including training and detailed written procedures. Anticipated Completion Date: January 1, 2026

View Audit 395531

Finding 1191698 (2025-001)

Material Weakness 2025

Change, Inc.

MN

Internal Control / Segregation of Duties Material Weakness

Finding 2025-001 Material Weakness Limited Segregation of Duties Over Cash Receipts Finding Summary: The person responsible for opening the mail, preparing the deposit summary, and depositing funds was granted full access to the accounting software, including the ability to enter, modify, and delete...

Finding 2025-001 Material Weakness Limited Segregation of Duties Over Cash Receipts Finding Summary: The person responsible for opening the mail, preparing the deposit summary, and depositing funds was granted full access to the accounting software, including the ability to enter, modify, and delete transactions. While it is not this person’s responsibility to record deposits in the accounting system, they have the ability to do so. Responsible Individuals: Jill Johnson, Executive Director Corrective Action Plan: Our process has been updated to ensure the person opening mail, preparing the deposit summary, and depositing funds do not have access to the accounting software. Anticipated Completion Date: January 1, 2026

View Audit 395531

Finding 1191680 (2025-001)

Material Weakness 2025

Discovery Science Center of Orange County and Subsidiaries

CA

Subrecipient Monitoring Reporting Internal Control / Segregation of Duties § 200.329

Management’s Plan for Corrective Action: Management agrees with the finding and plans to implement procedures to ensure timely submission of required performance reports. We will ensure that the grant administrator develops processes for a reporting calendar, preparing required reports, and document...

Management’s Plan for Corrective Action: Management agrees with the finding and plans to implement procedures to ensure timely submission of required performance reports. We will ensure that the grant administrator develops processes for a reporting calendar, preparing required reports, and documenting submission. Management expects these procedures to be implemented beginning in the next reporting cycle. Management has subsequently completed and submitted all of the required performance reports to remedy the identified deficiency.

View Audit 395528

Finding 1191678 (2025-003)

Material Weakness 2025

M. Carter Plaza

OR

HUD Housing Programs Special Tests & Provisions Subrecipient Monitoring

Finding no.: 2025-003 Contact person(s) responsible: Kymberly Horner, Executive Director for PCRI and Matthew Wrigley, Accounting Financial and Audit Manager for Cascade Management Corrective action planned: The monthly deposits to the replacement reserve account have been reinstated after the lapse...

Finding no.: 2025-003 Contact person(s) responsible: Kymberly Horner, Executive Director for PCRI and Matthew Wrigley, Accounting Financial and Audit Manager for Cascade Management Corrective action planned: The monthly deposits to the replacement reserve account have been reinstated after the lapse which was due to a period of transition of management in the property management department. The funding processes have been reestablished and procedures are in place to ensure there are no unplanned lapses in funding the reserve going forward. Anticipated completion date: February 2026

View Audit 395527

Finding 1191677 (2025-002)

Material Weakness 2025

M. Carter Plaza

OR

HUD Housing Programs Special Tests & Provisions

Finding no.: 2025-002 Contact person(s) responsible: Kymberly Horner, Executive Director for PCRI and Matthew Wrigley, Accounting Financial and Audit Manager for Cascade Management Corrective action planned: The improvements in processes mentioned in the plan to address Fining no. 2025-001 will serv...

Finding no.: 2025-002 Contact person(s) responsible: Kymberly Horner, Executive Director for PCRI and Matthew Wrigley, Accounting Financial and Audit Manager for Cascade Management Corrective action planned: The improvements in processes mentioned in the plan to address Fining no. 2025-001 will serve to accelerate closing procedures and help the audit to be completed on schedule allowing for the required calculation and deposit of the residual receipt reserve funds within the required time frame. Anticipated completion date: October 2026

View Audit 395527

Finding 1191676 (2025-001)

Material Weakness 2025

M. Carter Plaza

OR

Internal Control / Segregation of Duties Subrecipient Monitoring HUD Housing Programs § 200.512

Finding no.: 2025-001 Contact person(s) responsible: Kymberly Horner, Executive Director for PCRI and Matthew Wrigley, Accounting Financial and Audit Manager for Cascade Management Corrective action planned: The closing of books and preparation for audit procedures is being addressed via improvement...

Finding no.: 2025-001 Contact person(s) responsible: Kymberly Horner, Executive Director for PCRI and Matthew Wrigley, Accounting Financial and Audit Manager for Cascade Management Corrective action planned: The closing of books and preparation for audit procedures is being addressed via improvements in internal controls related to property accounting, month and year end closing procedures which include a new property management accounting software package. It is also being addressed via the hiring of more experienced staff during fiscal year 2024-2025. The organization anticipates that these improvements will allow for the audit to be completed within the required timeframe in the upcoming cycle. Anticipated completion date: October 2026

View Audit 395527

Finding 1191675 (2025-004)

Material Weakness 2025

Kalamazoo Valley Community College

MI

Student Financial Aid Subrecipient Monitoring Reporting

Condition: Of the 40 students selected for enrollment reporting, the College did not update the student enrollment information for 3 students accurately. Planned Corrective Action: The College will modify its process and update its documented procedures to include periodically running an Enrollment ...

Condition: Of the 40 students selected for enrollment reporting, the College did not update the student enrollment information for 3 students accurately. Planned Corrective Action: The College will modify its process and update its documented procedures to include periodically running an Enrollment Reporting Graduated/Withdrawn Report from NLSDS and review for accuracy and make timely corrections, if necessary. Contact person responsible for corrective action: Director of Financial Aid Anticipated Completion Date: June 30, 2026

View Audit 395523

Finding 1191673 (2025-003)

Material Weakness 2025

Kalamazoo Valley Community College

MI

Student Financial Aid Subrecipient Monitoring Reporting

Condition: The College did not have appropriate segregation of duties in place to ensure the reporting to COD is being reviewed by an individual separate from the process of preparing the reconciliations. Planned Corrective Action: The College will modify its process and update its documented proced...

Condition: The College did not have appropriate segregation of duties in place to ensure the reporting to COD is being reviewed by an individual separate from the process of preparing the reconciliations. Planned Corrective Action: The College will modify its process and update its documented procedures to include an appropriate review of the reconciliation by an individual separate from the process of preparing the reconciliations. Contact person responsible for corrective action: Director of Financial Aid Anticipated Completion Date: June 30, 2026

View Audit 395523

Finding 1191671 (2025-002)

Material Weakness 2025

Kalamazoo Valley Community College

MI

Student Financial Aid Subrecipient Monitoring Significant Deficiency

Condition: The College did not provide notifications to certain students related to direct loan disbursements. Planned Corrective Action: The Director of Financial Aid will work with our information technology department to ensure the criteria used for triggering the notification emails is correct a...

Condition: The College did not provide notifications to certain students related to direct loan disbursements. Planned Corrective Action: The Director of Financial Aid will work with our information technology department to ensure the criteria used for triggering the notification emails is correct and capturing all the necessary students. Additionally, an exception report will be created to identify students who have not been sent the notification email for the financial aid department to review and then send the appropriate notification. The department procedures will be updated to reflect these changes in process. Contact person responsible for corrective action: Director of Financial Aid Anticipated Completion Date: March 31, 2026

View Audit 395523

Finding 1191669 (2025-001)

Material Weakness 2025

Kalamazoo Valley Community College

MI

Student Financial Aid Subrecipient Monitoring Material Weakness

Condition: Out of 60 students tested for return to Title IV, we identified 4 students whose calculations were performed outside of the required time frame. Planned Corrective Action: The College will work with its Director of Financial Aid to ensure the semester end procedures include steps to ident...

Condition: Out of 60 students tested for return to Title IV, we identified 4 students whose calculations were performed outside of the required time frame. Planned Corrective Action: The College will work with its Director of Financial Aid to ensure the semester end procedures include steps to identify those students who unofficially withdrew. Once the students are identified, individuals with appropriate skills and knowledge will be able to determine if a return of Title IV calculation is necessary and appropriately return any funds, as necessary. Contact person responsible for corrective action: Director of Financial Aid Anticipated Completion Date: March 31, 2026

View Audit 395523

Finding 1191659 (2025-001)

Material Weakness 2025

Asian University for Women (auw) Support Foundation

MA

Reporting Internal Control / Segregation of Duties § 200.303 § 200.510

Finding: 2025-001 Reimbursable federal grant revenue Responsible Person: Cecilia Frerotte Title: Contract CFO Phone Number: 617-261-8186 Anticipated Completion Date: June 30, 2026 Corrective Action: Management will enhance grant review and reconciliation procedures to ensure that reimbursable expend...

Finding: 2025-001 Reimbursable federal grant revenue Responsible Person: Cecilia Frerotte Title: Contract CFO Phone Number: 617-261-8186 Anticipated Completion Date: June 30, 2026 Corrective Action: Management will enhance grant review and reconciliation procedures to ensure that reimbursable expenditures incurred under cost-reimbursement grants are properly recognized as contribution revenue and federal expenditures in the appropriate period. These procedures will include a grant-by-grant reconciliation of reimbursement requests, refundable advances, award terms, general ledger balances, amounts reported on the Schedule of Expenditures of Federal Awards (SEFA) and amounts reported in all other grant-related compliance reports, as applicable. Management will also formalize and expand supervisory review and approval controls over all grant compliance reporting and year end financial reporting, including the SEFA. In addition, the Board plans to increase the size of the Audit Committee to include members with substantial experience in auditing and grant program oversight. The Audit Committee will meet regularly with both the external auditors and the outsourced accounting firm to provide enhanced governance and oversight of grant accounting and compliance matters.

View Audit 395510

Finding 1191656 (2025-003)

Material Weakness 2025

Isd 115 Cass Lake-Bena

MN

Allowable Costs / Cost Principles HUD Housing Programs School Nutrition Programs

Contact Person – Sue Chase, Superintendent Corrective Action Plan – The District should implement policies and procedures to ensure only allowable activities/costs are being charged against grants. Completion Date – March 31, 2026

View Audit 395508

Finding 1191655 (2025-001)

Material Weakness 2025

Heber-Overgaard Unified School District No. 6

AZ

Allowable Costs / Cost Principles § 200.430

Finding Number: 2025‐001 Program Names/Assistance Listing Titles: Assistance Listing Numbers: Title I Grants to Local Educational Agencies 84.010 Forest Service Schools and Roads Cluster 10.665 Contact Person: Andrea Despain Anticipated Completion Date: June 30, 2026 Planned Corrective Action: The D...

Finding Number: 2025‐001 Program Names/Assistance Listing Titles: Assistance Listing Numbers: Title I Grants to Local Educational Agencies 84.010 Forest Service Schools and Roads Cluster 10.665 Contact Person: Andrea Despain Anticipated Completion Date: June 30, 2026 Planned Corrective Action: The District will collaborate with all grant stakeholders to strengthen internal controls by ensuring strict adherence to payroll procedures. Oversight will be reinforced through regular grant management meetings and funding reviews conducted by the Business Manager. To enhance accuracy and documentation practices, staff will receive targeted training on compliance requirements with payroll and grants. Additionally, recordkeeping processes will be standardized, with periodic reviews to verify adherence and improve efficiency. These corrective actions have been implemented and will be continuously supported through ongoing reviews.

View Audit 395504

Finding 1191653 (2025-004)

Material Weakness 2025

Hawaii Pacific University

HI

Special Tests & Provisions Student Financial Aid

The officials responsible for Student Accounts acknowledge that certain student financial aid refunds were processed outside the 14-day federal deadline, primarily due to insufficient Title IV training during the initial transfer of responsibilities to Student Accounts. While a standard operating pr...

The officials responsible for Student Accounts acknowledge that certain student financial aid refunds were processed outside the 14-day federal deadline, primarily due to insufficient Title IV training during the initial transfer of responsibilities to Student Accounts. While a standard operating procedures (SOP) exists within the current refunds training, it is limited, focusing primarily on the reports and some of federal requirements but does not provide sufficient detail on regulations, reviews, approvals, and timelines. Student Accounts has already taken steps to address and correct the misinformation, but additional improvements are still needed. The SOP for refunds is currently in progress to fully incorporate all necessary items to ensure better and clearer training guidelines. Mandatory Title IV refund training will be provided to all Refund Representatives and included in onboarding for new hire. We shall set established expectations set for all individuals involved in the process, including their delegates, to ensure accountability and consistent application of procedures. Ongoing collaboration with Financial Aid will ensure procedures are consistently applied, questions are addressed, and staff remain current with requirements. These actions are expected to ensure compliance with the 14-day federal requirement, strengthen staff competency, and support continuous improvement in refund processing. Person(s) Responsible: Student Accounts Manager (training), Associate Vice President & Controller Targeted Correction Date: June 30, 2026

View Audit 395499

Finding 1191652 (2025-003)

Material Weakness 2025

Hawaii Pacific University

HI

Student Financial Aid Special Tests & Provisions Reporting

At the end of the 2023–24 award year, responsibility for generating Return of Title IV (R2T4) withdrawal lists transitioned from the Business Office to the Financial Aid Office. The Financial Aid Office began producing both official withdrawal and unofficial (non-passing grade) reports through Elluc...

At the end of the 2023–24 award year, responsibility for generating Return of Title IV (R2T4) withdrawal lists transitioned from the Business Office to the Financial Aid Office. The Financial Aid Office began producing both official withdrawal and unofficial (non-passing grade) reports through Ellucian Banner. Because the two reports produced nearly identical student listings, it was assumed that the Banner-generated unofficial withdrawal report was effectively identifying all students who had received non-passing grades.During an internal audit conducted at the end of the Spring 2025 semester, the University identified one student who had failed all courses and was not included on either of the R2T4 lists. Upon further review, the issue was traced to a reporting limitation within Banner that excluded some students with all failing grades from the population used for R2T4 review. To resolve this, the Financial Aid Office coordinated with the Registrar’s Office to obtain a complete list of students who officially withdrew and students with all non-passing grades once final grades were submitted. R2T4 calculations were subsequently performed for applicable students identified in this additional list. Since Spring 2025, the University has institutionalized this revised procedure. The Registrar’s Office now provides the Financial Aid Office with a list of all students with non-passing grades at the end of each semester once grades are submitted. The Financial Aid Office reviews both reports to identify potential unofficial withdrawals and performs R2T4 calculations as required. To strengthen oversight and prevent future omissions during staffing transitions or process changes, the University will: • Document the revised R2T4 identification and review process in the Financial Aid operations manual. • Clearly assign responsibility for report generation, review, and follow-up between the Registrar’s Office and Financial Aid Office. • Implement a quarterly internal cross-check to confirm all required R2T4 reviews are completed. Person(s) Responsible: Associate Director of Financial Aid and Director of Financial Aid. Correction Date: January 31, 2026. This issue is resolved.

View Audit 395499

Finding 1191651 (2025-002)

Material Weakness 2025

Hawaii Pacific University

HI

Subrecipient Monitoring Student Financial Aid Reporting

The University has made substantial progress toward completing the remaining elements required under the Gramm-Leach-Bliley Act (GLBA) and aligning its program with the FTC Safeguards Rule. Full implementation timelines are primarily constrained by current staffing capacity within ITS/Cybersecurity ...

The University has made substantial progress toward completing the remaining elements required under the Gramm-Leach-Bliley Act (GLBA) and aligning its program with the FTC Safeguards Rule. Full implementation timelines are primarily constrained by current staffing capacity within ITS/Cybersecurity and Legal, as well as certain technical tool limitations (e.g., data discovery and validation). Despite these constraints, notable progress has been achieved across the required FTC Safeguards Program elements as summarized below: • Element 1 – Designate a Qualified Individual: Completed. Qualified individual appointed to implement and supervise the company’s information security program; reporting mechanisms to the Board established. Completion is confirmed based on oversight and execution of subsequent program elements. • Element 2 – Conduct a Risk Assessment: Completed. Initial risk assessment conducted to identify reasonably foreseeable threats; controls and priorities for Elements 3–9 is being guided by this assessment. • Element 3 – Access Controls & Data Classification: 70% complete. Policies finalized; multi- factor authentication (MFA) implemented; initial asset inventory completed. Data owner assignments and detailed access reviews are in progress. • Element 4 – Vulnerability Management: Complete. Latest penetration testing identified no critical findings. • Element 5 – Information Security Policies: Drafted and pending Legal review; Board acceptance scheduled for March 2026. • Element 6 – Third-Party Oversight: 70% complete. Policy and workflow developed; Board acceptance scheduled for March 2026. • Element 7 – Periodic Risk Assessments: 80% complete. Updated risk assessment currently in progress. • Element 8 – Incident Response Plan: 90% complete. Final reporting and approval scheduled for March 2026. • Element 9 – Qualified Individual & Board Reporting: 90% complete. Annual report scheduled for March 2026. • Red Flags Rule (Identity Theft Prevention): 50% complete. Policy drafted, complete comprehensive program, formal procedures and additional trainings still required. Next Steps: Remaining actions will be completed as Legal and Board approvals are obtained and staffing capacity allows. HPU will continue to develop and retain documentation supporting the completion and implementation of each safeguard element, as prescribed by GLBA. Periodic internal assessments of the Information Security Program will be scheduled following full implementation, with consideration given to engaging an independent third party for future reviews. Person(s) Responsible: Information Security Officer; Vice President of Operations and Chief Information Officer. Targeted Correction Date: March 31, 2026.

View Audit 395499

Finding 1191632 (2025-001)

Material Weakness 2025

City of Pittsburg

CA

Procurement, Suspension & Debarment

Financial Closing and Audit Preparedness – Significant Deficiency Responsible Official: Isaac Williams, Financial Analyst Corrective Action Plan: The City will ensure suspension and debarment verification is performed and documented, including saving the full SAM.gov record and updating procedures a...

Financial Closing and Audit Preparedness – Significant Deficiency Responsible Official: Isaac Williams, Financial Analyst Corrective Action Plan: The City will ensure suspension and debarment verification is performed and documented, including saving the full SAM.gov record and updating procedures and checklists. Finance will provide citywide training to inform responsible staff of the requirements. Anticipation Completion Date: Fiscal Year 2025-26

View Audit 395494

Finding 1191631 (2025-003)

Material Weakness 2025

Aleutian Pribilof Islands Association, Inc.

AK

Eligibility Material Weakness Internal Control / Segregation of Duties

Finding 2025-003: Material Weakness in Internal Control over Compliance and Noncompliance – Eligibility Program: 64.055 Staff Sergeant Parker Gordon Fox Suicide Prevention Grant Program Planned Corrective Action: To address the identified material weakness and ensure future compliance with SSG Fox S...

Finding 2025-003: Material Weakness in Internal Control over Compliance and Noncompliance – Eligibility Program: 64.055 Staff Sergeant Parker Gordon Fox Suicide Prevention Grant Program Planned Corrective Action: To address the identified material weakness and ensure future compliance with SSG Fox SPGP eligibility and documentation requirements, the organization has implemented the following systemic enhancements: • Standardized Eligibility Controls: The organization has developed and deployed a mandatory Case File Compliance Checklist for all program participants. This control ensures that all federally mandated documentation—including signed program agreements, grievance procedures, religious protections, individualized service plans, and all five required baseline mental health screenings—is present and verified for every file. • Enhanced Management Oversight: To ensure the effectiveness of these controls, the Department Director has implemented a Monthly Quality Assurance (QA) Review. On a monthly basis, the Director will perform a formal audit of active case files to verify compliance. This review will be documented via a formal sign-off, providing a clear audit trail of supervisory oversight. • Records Retention & Security: Management oversight has been expanded to include specific verification of Data Integrity and Retention. Monthly reviews will ensure that all required documentation is maintained in accordance with 2 CFR § 200 standards—ensuring records are secure, unalterable, and readily accessible for future audits. • Continuous Professional Development: The organization has institutionalized a Mandatory Training Curriculum. All relevant staff will undergo initial onboarding and recurring periodic training focused on SSG Fox SPGP compliance standards, participant eligibility, and rigorous documentation procedures. • Personnel Realignment: The organization has undergone a restructuring of the program staff to ensure that all personnel are fully aligned with the agency's internal control environment and commitment to federal compliance. Anticipated completion date: April 30, 2026 Contact Information: Louise Chikigak, Chief Financial Officer, (907) 222-4250

View Audit 395488

Finding 1191630 (2025-002)

Material Weakness 2025

Aleutian Pribilof Islands Association, Inc.

AK

Reporting Significant Deficiency Internal Control / Segregation of Duties

Finding 2025-002: Significant Deficiency in Internal Control over Compliance and Other Matters – Application of Indirect Cost Rates Programs: 93.224 and 93.527 Health Centers Program Cluster 64.055 Staff Sergeant Parker Gordon Fox Suicide Prevention Grant Program Planned Corrective Action: See above...

Finding 2025-002: Significant Deficiency in Internal Control over Compliance and Other Matters – Application of Indirect Cost Rates Programs: 93.224 and 93.527 Health Centers Program Cluster 64.055 Staff Sergeant Parker Gordon Fox Suicide Prevention Grant Program Planned Corrective Action: See above Anticipated completion date: April 30, 2026 Contact Information: Louise Chikigak, Chief Financial Officer, (907) 222-4250

View Audit 395488

Corrective Action Plans

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