Corrective Action Plans

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Finding 561271 (2024-001)
Significant Deficiency 2024
Corrective Action Plan Emory University Office of Financial Aid Prepared by John Leach, Assoc Ve Prov/Dir, Univ Fin Aid, Office of Financial Aid Federal Program: Federal Direct Student Loans (ALN 84.268} CFR 200.303/685.300(b)(S0) Federal Award Year: September 1, 2023 to August 31, 2024 Federal Agen...
Corrective Action Plan Emory University Office of Financial Aid Prepared by John Leach, Assoc Ve Prov/Dir, Univ Fin Aid, Office of Financial Aid Federal Program: Federal Direct Student Loans (ALN 84.268} CFR 200.303/685.300(b)(S0) Federal Award Year: September 1, 2023 to August 31, 2024 Federal Agency: U.S. Department of Education Finding 2024-001: Cash Management The reconciliation between ED's records (School Account Statements) and the school's financial and business records were prepared timely throughout the year; however, the differences identified in the reconciliation were not accounted for and no review or segregation of duties was documented as part of that process. Management Response and Corrective Action Plan: The finding was primarily caused by an unforeseen staff shortage. This led to one person being the preparer and reviewer with no segregation of duties. Although the differences were identified, they were not documented on the reconciliation form. To resolve this finding, the Office of Financial Aid {OFA) has hired new employees and implemented a new process. The Financial Operations Team is now fully staffed with two senior accountants and one senior director. As part of our ongoing efforts to strengthen internal controls and ensure the integrity of our processes, we have implemented a segregation of duties framework. This approach will help us clearly define roles and responsibilities, ensuring that critical tasks are divided among different individuals. By doing so, we will meet compliance requirements, reduce errors, and promote accountability within our office. One senior accountant will prepare the monthly reconciliation by the 10th of the following month. The senior director will review the monthly reconciliation by the 15th of the following month. In the absence of the initial preparer/reviewer, the executive director of OFA will take on the reviewer role. We understand that proper documentation is crucial for clarity, tracking, and future troubleshooting. The differences/discrepancies that are identified in the reconciliation process will be accounted for through proper documentation on the reconciliation form, which will be reviewed/investigated by a second reviewer. The Financial Operations Team within the OFA will continue to create timely and accurate monthly Federal Direct Student Loan reconciliations that compare OPUS (Emory), General Ledger (Emory), Student Account Statement-SAS (U.S. Department of Education), and GS (U.S. Department of Education). Anticipated Completion Date The corrective action plan was implemented for FY 24-25 (September 1, 2024). Responsible Department: Office of Financial Aid John B. Leach, Associate Vice Provost for Enrollment and University Financial Aid Suite 300 Boisfeuillet Jones Center 200 Dowman Drive Atlanta, Georgia 30322
The Authority obtained answers from USDA to questions specific to the Authority's operations after the due date of the semiannual report. The Authority will be proactivt to follow up with USDA when questions and information are submitted for preliminary review. Reports will be prepared and submitted...
The Authority obtained answers from USDA to questions specific to the Authority's operations after the due date of the semiannual report. The Authority will be proactivt to follow up with USDA when questions and information are submitted for preliminary review. Reports will be prepared and submitted in a timely manner.
The Housing Authority will implement a standardized process for documenting rent reasonableness across all tenant files, including those from the Emery County merger, and will explore automated tools to streamline the determination and documentation process. Staff will also receive training to ensur...
The Housing Authority will implement a standardized process for documenting rent reasonableness across all tenant files, including those from the Emery County merger, and will explore automated tools to streamline the determination and documentation process. Staff will also receive training to ensure compliance with the requirements moving forward.
Corrective Action Plan Assistance Listing Number 21.029 COVID-19 Coronavirus Capital Projects Fund U.S. Department of the Treasury Missouri Department of Economic Development Program Year 2024 Condition – The Cooperative was unable to provide evidence that vendors used in covered transactions wer...
Corrective Action Plan Assistance Listing Number 21.029 COVID-19 Coronavirus Capital Projects Fund U.S. Department of the Treasury Missouri Department of Economic Development Program Year 2024 Condition – The Cooperative was unable to provide evidence that vendors used in covered transactions were not suspended, debarred, or otherwise excluded. Due to the current year finding, management set a goal to ensure the Missouri ARPA Broadband Infrastructure Grant Program guidelines related to debarred or suspended vendors are being met. To meet these guidelines management has compared the current vendor list to Excluded Parties List System found on SAM.GOV and found none of the currently used vendors on the list. Management has added this verification step to its new vendor process and will conduct annual self-assessment to ensure vendor eligibility documentation is current and up to date. Responsible Official: Jay Wallace, Manager of Accounting & Finance Implementation Date: April 25, 2025
Finding 561264 (2024-003)
Significant Deficiency 2024
SD 2024‐003 SUBRECIPIENT MONITORING Recommendations: If the most recent subrecipient audit report is not yet available, management should request the prior fiscal year if not already obtained. Management’s Response: The IRL Council put controls in place to be more effective at subrecipient monitori...
SD 2024‐003 SUBRECIPIENT MONITORING Recommendations: If the most recent subrecipient audit report is not yet available, management should request the prior fiscal year if not already obtained. Management’s Response: The IRL Council put controls in place to be more effective at subrecipient monitoring following the FY 2023 finding which included the following actions: The IRL Council reviewed all projects and activities currently allocated and funded by federal sources to ensure the Uniform Guidance was in place within their respective agreements, and they were amended as needed. All new subrecipient agreements funded by federal sources were not executed until the respective federal award was in place and the Uniform Guidance language was included. The IRL Council did request audit reports from subrecipients and made statements on them, however for the ones who had not completed their FY 2024 audit, a prior year audit report was not immediately requested and statements for those subrecipients had not yet been made. The IRL Council will implement a control to request prior year Financial Statements/audit reports from subrecipients who have not yet completed their report for the year being requested during the Council’s monitoring. Responsible Party: Daniel Kolodny, COO Anticipated Completion Date: June 1, 2025.
Finding 561261 (2024-002)
Significant Deficiency 2024
SD 2024‐002 SUSPENSION AND DEBARMENT Recommendation: We recommend the Council continue with the controls that were implemented in late 2024 to ensure the Council does not enter a subaward or other covered transaction with a party that is suspended, debarred or otherwise excluded from participating i...
SD 2024‐002 SUSPENSION AND DEBARMENT Recommendation: We recommend the Council continue with the controls that were implemented in late 2024 to ensure the Council does not enter a subaward or other covered transaction with a party that is suspended, debarred or otherwise excluded from participating in federal awards. As the control was not in place for the majority of 2024, it is a repeat finding. Management’s Response: The IRL Council amended its Operating Procedures following the FY 2023 finding to include suspension and debarment procedures into procurement methods for activities that are federally funded. The IRL Council Chief Operating Officer, immediately checked all current vendors for compliance within SAM.gov and all new or amended agreements have since been checked in SAM.gov for compliance. As noted by Carr, Riggs, and Ingram there were no instances of exception in their testing. Due to the timing of the FY 2023 finding, FY 2024 would also be considered a finding regardless of any corrective action taken. Anticipated Completion Date: Remedial action completed on December 31, 2024.
Finding 561258 (2024-001)
Material Weakness 2024
MW 2024‐001 REPORTING Recommendation: The Chief Operating Officer should obtain in writing any adjustments or clarifications to the grant awards to ensure the requested reports are prepared and reviewed. Management’s Response: EPA has never requested the SF425 (Federal Financial Reporting Form) from...
MW 2024‐001 REPORTING Recommendation: The Chief Operating Officer should obtain in writing any adjustments or clarifications to the grant awards to ensure the requested reports are prepared and reviewed. Management’s Response: EPA has never requested the SF425 (Federal Financial Reporting Form) from year’s prior and we were told verbally that we were only required to submit them at grant closeout. During a current EPA OIG audit, we were informed that the procedural process we were following was incorrect and that yearly reports were required to be submitted. To bring the IRL Council back into compliance with all federal awards, the Chief Operating Officer completed the FY 2024 forms and submitted them to EPA on March 10, 2025. Responsible Party: Daniel Kolodny, Chief Operating Officer Anticipated Completion Date: Remedial action completed on March 10, 2025.
FFATA reporting for all existing and future subawards will be implemented immediately. All SAWC staff involved in the writing and granting of subawards will be briefed on FFATA reporting requirements, and FFATA reporting will be included as a required step in any materials guiding the subaward grant...
FFATA reporting for all existing and future subawards will be implemented immediately. All SAWC staff involved in the writing and granting of subawards will be briefed on FFATA reporting requirements, and FFATA reporting will be included as a required step in any materials guiding the subaward granting process going forward.
All new contracts and subawards will contain a suspension and debarment clause or condition. For existing contracts and subawards, SAWC will amend with this clause where possible or otherwise verify that the contractor/subrecipient is not suspended or debarred and retain documentation of this verifi...
All new contracts and subawards will contain a suspension and debarment clause or condition. For existing contracts and subawards, SAWC will amend with this clause where possible or otherwise verify that the contractor/subrecipient is not suspended or debarred and retain documentation of this verification in our records.
Department of Health and Human Services 2024-001 Procurement Recommendation: We recommend that the Organization develop a written procurement policy that meets the requirements noted in Section 200.318 of the Code of Federal Regulations. Explanation of disagreement with audit finding: There is no...
Department of Health and Human Services 2024-001 Procurement Recommendation: We recommend that the Organization develop a written procurement policy that meets the requirements noted in Section 200.318 of the Code of Federal Regulations. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: While the Organization had a procurement policy in place for the entire year, until October 1, 2024 it was noncompliant with the requirements of Title 2, Subtitle A, Chapter 2 Part 200, Subpart D, section 200.318 of the Code of Federal Regulations. The new policy was implemented on October 1, 2024 and there were no instances of noncompliance after this date. It is the opinion of the organization that this finding has therefore already been resolved. Name(s) of the contact person(s) responsible for corrective action: Erica Vogt, CFO Planned completion date for corrective action plan: Already resolved
Finding 561212 (2024-003)
Significant Deficiency 2024
Federal Agency Name: US Department of Treasury Program Name: Coronavirus State and Local Fiscal Recovery Funds CFDA # 21.027 H4HRG23166 and H4HRGP23180, 2024 Finding Summary: The Organization did not have a formal tracking and monitoring process in place to accumulate total matching expenditures inc...
Federal Agency Name: US Department of Treasury Program Name: Coronavirus State and Local Fiscal Recovery Funds CFDA # 21.027 H4HRG23166 and H4HRGP23180, 2024 Finding Summary: The Organization did not have a formal tracking and monitoring process in place to accumulate total matching expenditures incurred toward the requirement for each award. Responsible Individuals: Lara Blair, Finance Manager Corrective Action Plan: The Organization will implement a tracking process by award detail to clearly identify and track qualifying expenditures by award to ensure that all matching requirements are achieved and appropriately documented. Anticipated Completion Date: June 30, 2025
College Place Public Schools will take the following steps to prevent future noncompliance with time-and-effort documentation requirements: 1. Clarify Procedures: District leadership has revised internal protocols for documenting staff funded by federal grants, including fixed-schedule and semiannua...
College Place Public Schools will take the following steps to prevent future noncompliance with time-and-effort documentation requirements: 1. Clarify Procedures: District leadership has revised internal protocols for documenting staff funded by federal grants, including fixed-schedule and semiannual reporting procedures. (Already corrected effective September 2024) 2. Staff Training: Business office and program staff will be retrained in by July 31, 2025 on federal documentation standards, including OSPI Bulletin 048-17. (Completion by July 31, 2025) 3. Internal Review: A quarterly review process is now in place to ensure proper documentation is collected and retained for all federally funded personnel. (Already corrected effective September 2024) Grant Transition Oversight: All funding transitions (e.g., ESSER to TFCCLC) will now require a pre-transition compliance review by Director of Business Services and CPPS Payroll Specialist to avoid misaligned timelines and documentation gaps. (Completion by July 31, 2025)
Finding No, 2024-002 DATA COLLECTION FORM DUE DATES We acknowledge the audit finding regarding the untimely submission of the Data Collection Form (DCF). We recognize the importance of timely filing in compliance with federal requirements and are committed to addressing this issue. To ensure the DCF...
Finding No, 2024-002 DATA COLLECTION FORM DUE DATES We acknowledge the audit finding regarding the untimely submission of the Data Collection Form (DCF). We recognize the importance of timely filing in compliance with federal requirements and are committed to addressing this issue. To ensure the DCF is filed on time in the future, we will implement improved communication and coordination between our finance team, external auditors, and relevant stakeholders. Specifically, we will: • Establish an internal timeline aligned with federal deadlines, • Schedule earlier engagement and planning meetings with the audit team, • Assign clear roles and responsibilities to team members, and • Monitor progress regularly to ensure timely completion of audit-related tasks.
Finding No. 2024-001 NONCOMPLIANCE WITH US GAAP – VARIABLE INTEREST ENTITIES (VIE) We acknowledge the audit finding and appreciate the auditor’s diligence in identifying the issue. After evaluating the matter, we agree that the effect on the consolidated financial statements is immaterial and does n...
Finding No. 2024-001 NONCOMPLIANCE WITH US GAAP – VARIABLE INTEREST ENTITIES (VIE) We acknowledge the audit finding and appreciate the auditor’s diligence in identifying the issue. After evaluating the matter, we agree that the effect on the consolidated financial statements is immaterial and does not impact the fair presentation of our financial position, results of operations, or cash flows. Additionally, after assessing the costs and benefits of remediation, we have determined that the corrective action required to fully address this issue is not cost-effective at this time. The resources required would outweigh the potential benefits, particularly given the immaterial nature of the issue and the lack of impact on users of the financial statements. We, will continue to monitor this area as part of our internal controls framework and will reassess if conditions change or if the issue becomes material in future periods.
Although there was a procedure in place for timely reporting of withdrawals, an employee retirement caused the lapse in reporting. As a safeguard in the future, we have updated the documents procedures to indicate that all documents will be sent digitally to the registrar’s office, rather than a com...
Although there was a procedure in place for timely reporting of withdrawals, an employee retirement caused the lapse in reporting. As a safeguard in the future, we have updated the documents procedures to indicate that all documents will be sent digitally to the registrar’s office, rather than a combination of paper delivery and/or email. By only email delivery, a trail can be followed to ensure both offices have received notification that the withdrawal process and its completion. As an additional safeguard, a regular review between all offices that manage student withdrawals will be conducted to ensure student cases have been completed timely. The email communication plan was put into place on February 13th, the monthly review will begin with the Month of March 2025.
Finding ref number: 2024-001 Finding caption: The District did not have adequate internal controls and did not comply with federal suspension and debarment requirements. Name, address, and telephone of District contact person: Brandon Rose PO Box 98 Pateros, WA 98846 (509) 923-2751 Corrective ...
Finding ref number: 2024-001 Finding caption: The District did not have adequate internal controls and did not comply with federal suspension and debarment requirements. Name, address, and telephone of District contact person: Brandon Rose PO Box 98 Pateros, WA 98846 (509) 923-2751 Corrective action the auditee plans to take in response to the finding: The District has ensured the current staff are aware of the issue regarding the Interlocal Agreement to purchase food commodities and the need to verify those documents annually regardless of ongoing business with the entity. The District will annually check the leading entity in August to ensure the suspension and debarment was completed. If the District office does not locate the information on the leading entity, the District will go out to SAM.gov to check the suspension and debarment and save proof that it was completed. Anticipated date to complete the corrective action: 4/8/2025
Auditors Finding: We noted MLSA under reported subgrant revenues and expenses due a reconciling difference. Managements Response: Contact: Alison Paul, Executive Director MLSA concurs with this finding. Managements Corrective Action Plan: Management will hold an accounting team training to explain t...
Auditors Finding: We noted MLSA under reported subgrant revenues and expenses due a reconciling difference. Managements Response: Contact: Alison Paul, Executive Director MLSA concurs with this finding. Managements Corrective Action Plan: Management will hold an accounting team training to explain the accounting error and how to prevent this in the future. Management will continue quarterly reconciliations and review of expenses including refreshing the reconciliation if late journal entries are recorded. Management will continue to require the review and posting of journal entries under the current criteria. Periodic review and monitoring of revenue and expense accounts will be implemented to include, but not be limited to, reviewing abnormal entries in revenue and expense accounts.
The District will implement a process to track the submission time for the data collection form and single audit package.
The District will implement a process to track the submission time for the data collection form and single audit package.
MAYFIELD MEMORIAL APARTMENTS, INC. Charlotte, North Carolina CORRECTIVE ACTION PLAN April 14, 2025 U.S. Department of Housing and Urban Development Five Points Plaza Building 40 Marietta Street Atlanta, Georgia 30303 Mayfield Memorial Apartments, I...
MAYFIELD MEMORIAL APARTMENTS, INC. Charlotte, North Carolina CORRECTIVE ACTION PLAN April 14, 2025 U.S. Department of Housing and Urban Development Five Points Plaza Building 40 Marietta Street Atlanta, Georgia 30303 Mayfield Memorial Apartments, Inc. respectfully submits the following Corrective Action Plan for the year ended December 31, 2024. Bernard Robinson & Company, L.L.P. 1501 Highwoods Blvd., Suite 300 Greensboro, North Carolina 27410 The finding from the December 31, 2024 Schedule of Findings and Questioned Costs is discussed below. The finding is numbered consistently with the number assigned in the schedule. Finding - Federal Award Program Audit Finding 2024-001: U.S. Department of Housing and Urban Development, Mortgage Insurance for the Purchase or Refinancing of Existing Multifamily Projects (Section 223(f)/207). Recommendation: We recommend that management fund the delinquent residual receipts deposits as soon as the Project has sufficient operating cash flow. Action Taken: Management agrees with the finding and will fund the delinquent residual receipts deposits as operating cash flow allows. If HUD has questions regarding this action plan, please call Claudia Keene at (704)771-1696. Sincerely yours, Claudia Keene Controller Multifamily Select, Inc. Managing Agent
Finding 561177 (2024-003)
Significant Deficiency 2024
Finding no.: 2024-003 Contact person(s) responsible: Kymberly Horner, Executive Director for PCRI and Radha Mehrotra, Controller 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 peri...
Finding no.: 2024-003 Contact person(s) responsible: Kymberly Horner, Executive Director for PCRI and Radha Mehrotra, Controller 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 2025
Finding 561176 (2024-002)
Significant Deficiency 2024
Finding no.: 2024-002 Contact person(s) responsible: Kymberly Horner, Executive Director for PCRI and Radha Mehrotra, Controller for Cascade Management Corrective action planned: The improvements in processes mentioned in the plan to address Fining no. 2024-001 will serve to accelerate closing ...
Finding no.: 2024-002 Contact person(s) responsible: Kymberly Horner, Executive Director for PCRI and Radha Mehrotra, Controller for Cascade Management Corrective action planned: The improvements in processes mentioned in the plan to address Fining no. 2024-001 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 2025
Finding 561175 (2024-001)
Significant Deficiency 2024
Finding no.: 2024-001 Contact person(s) responsible: Kymberly Horner, Executive Director for PCRI and Radha Mehrotra, Controller for Cascade Management Corrective action planned: The closing of books and preparation for audit procedures is being addressed via improvements in internal controls r...
Finding no.: 2024-001 Contact person(s) responsible: Kymberly Horner, Executive Director for PCRI and Radha Mehrotra, Controller 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 2025
The Agency has attempted to segregate accounting duties by having a person who does not initiate, prepare or post disbursements review the bank statements and co-sign all checks. The Agency will continue to monitor its policies and procedures in an effort to improve control efficiencies, however, a...
The Agency has attempted to segregate accounting duties by having a person who does not initiate, prepare or post disbursements review the bank statements and co-sign all checks. The Agency will continue to monitor its policies and procedures in an effort to improve control efficiencies, however, at this time, the Agency has determined that the cost of eliminating this material weakness in internal control would exceed its benefit.
The Authority has attempted to segregate accounting duties by having a person who does not initiate, prepare or post disbursements review the bank statements and co-sign all checks. The Authority will continue to monitor its policies and procedures in an effort to improve control efficiencies, howe...
The Authority has attempted to segregate accounting duties by having a person who does not initiate, prepare or post disbursements review the bank statements and co-sign all checks. The Authority will continue to monitor its policies and procedures in an effort to improve control efficiencies, however, at this time, the Authority has determined that the cost of eliminating the deficiency would exceed its benefit.
Finding Reference Number: 2024-003 View of Responsible Official and Planned Corrective Action Date: Corrective Action: The Finance Director and the Treasurer will review internal controls to ensure the proper segregation of duties. The Finance Director and the Executive Director will review job...
Finding Reference Number: 2024-003 View of Responsible Official and Planned Corrective Action Date: Corrective Action: The Finance Director and the Treasurer will review internal controls to ensure the proper segregation of duties. The Finance Director and the Executive Director will review job duties of the Finance Director and appropriate staff will be trained as back-up. We have a third party outside accountant that prepares quarterly and annual reporting. All reports are reviewed by the Executive Director, the Finance Director and the third-party accountant to ensure that the reports are accurate. After the initial review, the third-party accountant is present at the finance committee when the reports are presented. Name of Contact Person: Susan Dana, Finance Director Projected Completion Date: June 30, 2025
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