Corrective Action Plans

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1. Immediate General Ledger Reconciliation: By April 30th, the outsourced accounting / bookkeeping vendor will review and reconcile all YTD general ledger accounts. 2. Conduct Thorough Review of Finance and Accounting Policies and Procedures: By May 31st, the Director of Administrative Operations wi...
1. Immediate General Ledger Reconciliation: By April 30th, the outsourced accounting / bookkeeping vendor will review and reconcile all YTD general ledger accounts. 2. Conduct Thorough Review of Finance and Accounting Policies and Procedures: By May 31st, the Director of Administrative Operations will have reviewed all internal policies and processes expected by the vendor to ensure all account balances and transactions are periodically reviewed for proper treatment in accordance with accounting principles generally accepted in the US. 3. Increase Vendor FTE Support: By June 1st, expand FTE allocation with the outsourced accounting and bookkeeping vendor to enhance financial reporting and audit readiness. 4. Bring in a Director of Finance: By July 15th, begin recruitment of a Director of Finance to oversee accounting, finance, and improving internal controls and reporting.
Finding 560845 (2024-001)
Significant Deficiency 2024
Finding 2024-001 Condition: The Town has not documented in writing its policies regarding federal awards. Corrective Action Planned: In conjunction with the Town Administrator and Accountant, the Select Board will establish a written policy based on Uniform Guidance regarding cash management,...
Finding 2024-001 Condition: The Town has not documented in writing its policies regarding federal awards. Corrective Action Planned: In conjunction with the Town Administrator and Accountant, the Select Board will establish a written policy based on Uniform Guidance regarding cash management, determination of allowable costs, employee travel, procurement and subrecipient monitoring pertaining to federal awards. Anticipated Completion Date: December 31, 2025 Contact: Holly Young, Interim Town Administrator
Finding #2: Untimely Return of Title IV Funds (R2T4) Criteria: Under 34 CFR 668.22(j), institutions must return unearned Title IV funds no later than 45 days from the date the institution determines that a student has withdrawn. Condition: Six R2T4s were submitted late. While four were linked to thi...
Finding #2: Untimely Return of Title IV Funds (R2T4) Criteria: Under 34 CFR 668.22(j), institutions must return unearned Title IV funds no later than 45 days from the date the institution determines that a student has withdrawn. Condition: Six R2T4s were submitted late. While four were linked to third-party service platform transitions, two delays were related to students experiencing hardship (homelessness and mental health emergencies) and internal documentation gaps. Effect: Noncompliance with R2T4 deadlines may result in program findings, increased liabilities, and recurring audit scrutiny if unresolved. Corrective Actions for R2T4: 6. R2T4 Tracker Implementation o Action: Launch a live R2T4 tracker in Campus Café, flagged by withdrawal status and showing days remaining until the 45-day deadline. o Due Date: May 15, 2025 o Lead: Registrar, Business Office, Financial Aid Lead 7. Case Ownership Assignment Protocol o Action: Assign R2T4 responsibility to ECM and Business Office, written timelines and escalation criteria. o Due Date: May 15, 2025 o Lead: Executive Director 8. R2T4 Checklist & Escalation Framework o Action: Finalize a standardized checklist for all R2T4 cases including withdrawal date, calculation verification, fund return confirmation, and dual review. o Due Date: May 15, 2025 o Lead: Operations Manager 9. Quarterly R2T4 Audit o Action: Conduct quarterly compliance audits on all R2T4 files and include findings in compliance reports. o Due Date: First audit by June 30, 2025 o Lead: Compliance Officer 10. Emergency Circumstance Protocol o Action: Document a formal protocol for handling R2T4 cases with student hardship that allows internal escalation, verification, and documentation of exception handling. o Due Date: July 1, 2025 o Lead: Executive Director Monitoring Plan: Compliance will provide a quarterly report on R2T4 timeliness to the Executive Director. Any case that nears 35 days will be auto escalated for executive intervention.
Finding #1: Delayed or Incomplete Enrollment Reporting Criteria: Per 34 CFR 685.309(b), institutions must report student enrollment status changes (withdrawals, graduations, leaves of absence) within 30 days of determination or every 60 days using a consistent reporting schedule. Condition: Enrollme...
Finding #1: Delayed or Incomplete Enrollment Reporting Criteria: Per 34 CFR 685.309(b), institutions must report student enrollment status changes (withdrawals, graduations, leaves of absence) within 30 days of determination or every 60 days using a consistent reporting schedule. Condition: Enrollment changes for several students were not reported to NSLDS within the required timelines. Delays resulted from third-party servicer (ECM) processing issues, gaps in cross-verification, and lack of internal triggers for mid-enrollment aid recipients. Effect: Untimely reporting may result in incorrect loan repayment statuses for borrowers and may trigger additional oversight by the Department of Education. Corrective Actions for Enrollment Reporting: 1. Shared Operational Calendar with Alerts o Action: Expand the institutional calendar to include enrollment reporting cycles with automated alerts 15 and 5 days before reporting deadlines. o Due Date: May 15, 2025 o Lead: Registrar 2. Internal Monthly Cross-Verification Audit o Action: Reconcile Campus Café enrollment records with ECM NSLDS batch confirmations monthly to catch and correct discrepancies. o Due Date: Begins May 2025, ongoing o Lead: Compliance Officer 3. Enhanced Title IV Status Tracking o Action: Update batch tracker template to log when students begin receiving Title IV aid after initial enrollment, with clear notation requirements. o Due Date: May 15, 2025, Ongoing o Lead: Registrar 4. Targeted Staff Training o Action: Deliver internal training on accurate Title IV status coding and enrollment reporting procedures to Registrar and Business Office teams. o Due Date: May 15, 2025 o Lead: Executive Director & Registrar 5. Bi-Monthly Enrollment Reporting Review o Action: Conduct a compliance review every 8 weeks to assess reporting timeliness and documentation quality. o Due Date: Begins May 2025 o Lead: Compliance Officer Monitoring Plan: Compliance team will issue bi-monthly reports to the Executive Director summarizing reporting performance and identifying risk patterns.
2024-002 Student Financial Aid Cluster – Assistance Listing 84.063 and 84.268 Recommendation: The College should evaluate their procedures and review policies surrounding reporting enrollment effective dates and program enrollment effective dates NSLDS. Explanation of disagreement with audit finding...
2024-002 Student Financial Aid Cluster – Assistance Listing 84.063 and 84.268 Recommendation: The College should evaluate their procedures and review policies surrounding reporting enrollment effective dates and program enrollment effective dates NSLDS. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: Through the review of program reporting and campus reporting, the college will identify the cause for the data error. The college will explore the impact of branch campuses and the potential to shift to a single college reporting model. The following specific steps will be completed. 1. Identify and Analyze the Issues 2. Root Cause Analysis 3. Corrective Measures 4. Automation: Implement automated checks and balances to ensure data integrity before files are processed and sent. Name(s) of the contact person(s) responsible for corrective action: Patricia Munsch, Ph.D. Vice President for Student Affairs Nancy Brewer, College Director for Financial Aid Cheryl Eldredge, College Associate Dean for Registrar and Master Schedule Planned completion date for corrective action plan: December 31, 2026
2024-001 Student Financial Aid Cluster – Assistance Listing 84.063 and 84.268 Recommendation: The College should review their reporting internal controls and procedures to ensure that they require students' statuses to be reported timely to NSLDS as required by federal regulations. The College shoul...
2024-001 Student Financial Aid Cluster – Assistance Listing 84.063 and 84.268 Recommendation: The College should review their reporting internal controls and procedures to ensure that they require students' statuses to be reported timely to NSLDS as required by federal regulations. The College should evaluate their procedures and review policies surrounding reporting status changes to NSLDS to ensure the enrollment effective date reported to NSLDS aligns with the College’s last date of attendance. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: Through the work of a college-wide task force the following actions will be taken in response to the finding. The task force will include representatives from Information Technology, Institutional Research, Financial Aid, Registrar, along with Ellucian consultants. To summarize the steps and details of implementation to the specific areas are as follows: 1. Review Reporting Controls and Procedures 2. Address Error Code 22 3. Review Procedures Surrounding Reporting Status Changes 4. Assure Accuracy in Reporting Enrollment Effective Date Name(s) of the contact person(s) responsible for corrective action: Patricia Munsch, Ph.D. Vice President for Student Affairs Nancy Brewer, College Director for Financial Aid Planned completion date for corrective action plan: December 31, 2026
2024-003 Student Financial Aid Cluster – Assistance Listing 84.063, 84.268, 84.007, and 84.033 Recommendation: We recommend reviewing and implementing GLBA guidelines in order to explain the College’s information-sharing practices to their customers and to safeguard sensitive data, including student...
2024-003 Student Financial Aid Cluster – Assistance Listing 84.063, 84.268, 84.007, and 84.033 Recommendation: We recommend reviewing and implementing GLBA guidelines in order to explain the College’s information-sharing practices to their customers and to safeguard sensitive data, including student financial information. We also recommend designating a qualified individual responsible for implementing and monitoring the institution’s information security program. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: The College is working toward documenting its policy and procedures with the proper oversight and its continual monitoring of all GLBA guidelines and the sensitive student data therein. While the College has been in the practice of safeguarding all its sensitive student data and adhering to all the GLBA guidelines. It has not been properly documented. The qualified designated individual responsible for the implementation and continued monitoring is Jason Fried, College Director of Service Delivery and IT Compliance. Name(s) of the contact person(s) responsible for corrective action: Sara E. Gorton, CPA, Vice President for Business and Financial Affairs Holmer A. Avellan, CPA, CFE, Controller Jaime Hahn, Senior Auditor Stephen Clark, College Administrative Director of Infrastructure Services Jason Fried, College Director of Service Delivery and IT Compliance Planned completion date for corrective action plan: August 31, 2025 If the Department of Education has questions regarding this plan, please call: Sara Gorton, CPA, VP of Finance and Business Affairs 631-451-4223
Views of responsible officials and planned corrective actions: Management agrees that the reports had inaccuracies. The staff will report consistently in the future.
Views of responsible officials and planned corrective actions: Management agrees that the reports had inaccuracies. The staff will report consistently in the future.
Views of responsible officials and planned corrective actions: Management agrees with the finding consider their procurement policy to align with the requirements of 2 CFR 200.318 and are expecting to be a low-risk auditee during the 2025 fiscal year.
Views of responsible officials and planned corrective actions: Management agrees with the finding consider their procurement policy to align with the requirements of 2 CFR 200.318 and are expecting to be a low-risk auditee during the 2025 fiscal year.
Rural Development Multi-Family Housing Revitalization Demonstration Program – Assistance Listing No. 10.447 Recommendation: We recommend that Authority approve a federal procurement policy and implement controls to ensure it is being followed. Explanation of disagreement with audit finding: There is...
Rural Development Multi-Family Housing Revitalization Demonstration Program – Assistance Listing No. 10.447 Recommendation: We recommend that Authority approve a federal procurement policy and implement controls to ensure it is being followed. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: The board will develop and approve written procurement policies in accordance with federal requirements. Name(s) of the contact person(s) responsible for corrective action: Sue Broihahn Planned completion date for corrective action plan: The plan will be implemented during the year ending December 31, 2025.
Management will review its process for requesting reimbursements and reconciling same to the ledger.
Management will review its process for requesting reimbursements and reconciling same to the ledger.
Views of Responsible Officials: Federal grant requests and reporting is the function of three teams: Programs, Development and Finance. Prior to the hiring of the VP-Finance, the Associate Director, Grants Management and Compliance met with the Associate Director, Partnerships on a quarterly basis t...
Views of Responsible Officials: Federal grant requests and reporting is the function of three teams: Programs, Development and Finance. Prior to the hiring of the VP-Finance, the Associate Director, Grants Management and Compliance met with the Associate Director, Partnerships on a quarterly basis to discuss required program spend reimbursements and projected program cash needs prior to submitting the formal requests. With the onboarding of the new VP-Finance, internal review processes were changed to incorporate more robust segregation of duties, alignment with the internal cash management policies and procedures and formal review of drawdown requests prior to submission. The VP-Finance became a permanent employee in October 2024 and since then all submissions have obtained the appropriate approval prior to submission.
Views of Responsible Officials: Over the past three (3) years, the organization has increased the skill set and capacity among teams for risk assessment and awards management. Subaward policies have been reviewed and all subaward recipients are required to complete pre-award surveys (which include t...
Views of Responsible Officials: Over the past three (3) years, the organization has increased the skill set and capacity among teams for risk assessment and awards management. Subaward policies have been reviewed and all subaward recipients are required to complete pre-award surveys (which include the risk assessment unless the subrecipients are pre-approved by USAID and exempted from such policies). The Associate Director of Grants and Compliance continues to work with members of the Program team to monitor all subrecipient awards for full compliance with 2 CFR 200.516(a). After the FY2022 findings, Astraea sought documentation from federal agencies where risk assessment exemptions applied. The inception of some of these subawards predated FY2022. While we had intended to perform new retroactive risk assessments, the suspension of the federal awards as of January 24, 11:59PM and subsequent termination of the awards had clear instructions to stop work, and therefore made such requests impossible.
Views of Responsible Officials: All Astraea staff members are required to complete timesheets. Astraea’s internal processes were reviewed and overhauled in December 2021 (midway through FY2022) with department heads determining how their direct reports would spend time on various Astraea work stream...
Views of Responsible Officials: All Astraea staff members are required to complete timesheets. Astraea’s internal processes were reviewed and overhauled in December 2021 (midway through FY2022) with department heads determining how their direct reports would spend time on various Astraea work streams and projects. This information is detailed in a level of effort (LOE) spreadsheet tracked against timesheets and budgets regularly. However, the processes for instituting regular updates to the LOE spreadsheet and timesheet allocations remained time-consuming and highly manual in FY2023 – which we believe resulted in misallocations. Astraea is currently reviewing internal processes to ensure, 1) that review and revision of the LOE spreadsheet and timesheet allocations can happen in a timely manner with less administrative burden, and 2) allowance of a more detailed review of the payroll allocation approval and entry process. As of January 1, 2025, a new finance system was implemented allowing for greater sophistication, consistency and automation of these processes. We do not expect to see this finding upon completion of our FY25 audit.
Finding 560666 (2024-004)
Significant Deficiency 2024
2024-004 Coronavirus Relief Funds – Assistance Listing No. 21.027 Recommendation: CLA recommends the City review procurement policies for the entire City to ensure it meets the minimum requirements of 2 CFR 200 for all federal grants. Explanation of disagreement with audit finding: There is no disa...
2024-004 Coronavirus Relief Funds – Assistance Listing No. 21.027 Recommendation: CLA recommends the City review procurement policies for the entire City to ensure it meets the minimum requirements of 2 CFR 200 for all federal grants. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: The City will review procurement policies for the entire City to ensure it meets the minimum requirements of 2 CFR 200 for all federal grants. Name of the contact person responsible for corrective action: Tammy Kasal, City Clerk/Treasurer Planned completion date for corrective action plan: December 31, 2024
Those charged with governance agreed with the finding and will work to maintain tenant files in accordance with legislation, regulations, and the terms and conditions of the major federal award program.
Those charged with governance agreed with the finding and will work to maintain tenant files in accordance with legislation, regulations, and the terms and conditions of the major federal award program.
The District will establish and maintain internal controls that will safeguard District assets to the best of their abilities.
The District will establish and maintain internal controls that will safeguard District assets to the best of their abilities.
The working plan is for one person to deposit money, one person to enter receipts into Software, and one person to reconcile the bank statements. Accounts Payable - we have a chain of approval for requisitions - building Principal, Superintendent, Director of Finance, and Accounts Payable Clerk.
The working plan is for one person to deposit money, one person to enter receipts into Software, and one person to reconcile the bank statements. Accounts Payable - we have a chain of approval for requisitions - building Principal, Superintendent, Director of Finance, and Accounts Payable Clerk.
The Utility will adopt a policy to ensure that all vendors and contracts paid with federal awards, are not suspended or disbarred by verifying it on the SAM website.
The Utility will adopt a policy to ensure that all vendors and contracts paid with federal awards, are not suspended or disbarred by verifying it on the SAM website.
DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT Continuum of Care – Assistance Listing No. 14.267 Recommendation: We recommend that management review the procurement, suspension and debarment requirements for federal programs as well as the organization's policies related to these requirements. Manage...
DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT Continuum of Care – Assistance Listing No. 14.267 Recommendation: We recommend that management review the procurement, suspension and debarment requirements for federal programs as well as the organization's policies related to these requirements. Management should ensure that such practices are being followed to comply with federal requirements. We also recommend that all current vendors in use are assessed and considered for compliance with procurement, suspension and debarment practices. Explanation of disagreement with audit finding: There is no disagreement with the audit finding. Action taken in response to finding: Policy review & update: Completed a comprehensive review of federal procurement, suspension and debarment requirements and revised the organization’s policies to align with those standards. Vendor assessment: Screened all active vendors against the SAM .gov exclusion list; documented results and removed or remediated any non-compliant relationships. Training & communication: Held mandatory training for procurement, finance and compliance teams on the updated policies and federal requirements. Ongoing monitoring: Established process to communicate exclusions to senior management to ensure continuous adherence. Name of the contact person responsible for corrective action: Christine Simiriglia, President & CEO Planned completion date for corrective action plan: June 30, 2025
View Audit 356518 Questioned Costs: $1
We acknowledge that system configuration errors in the Student Financial Aid Department resulted in the disbursement of federal direct student loans exceeding aggregate loan limits for three students. The University reimbursed the over-awarded funds to the Department of Education in February 2025 an...
We acknowledge that system configuration errors in the Student Financial Aid Department resulted in the disbursement of federal direct student loans exceeding aggregate loan limits for three students. The University reimbursed the over-awarded funds to the Department of Education in February 2025 and adjusted the affected students' accounts accordingly. To address these deficiencies and ensure compliance with aggregate loan limits, the University has reviewed the financial aid management system to identify and correct configuration errors. Furthermore, the University will assign an independent reviewer to monitor loan disbursements monthly, ensuring they remain within aggregate loan limits and promptly addressing any discrepancies.
View Audit 356516 Questioned Costs: $1
The error identified stemmed from a lack of independent review caused by staffing turnover and unfilled positions within the Student Financial Aid Department during the year ended June 30, 2024. While the refund for one student was returned, we acknowledge that it was not processed within the requir...
The error identified stemmed from a lack of independent review caused by staffing turnover and unfilled positions within the Student Financial Aid Department during the year ended June 30, 2024. While the refund for one student was returned, we acknowledge that it was not processed within the required timeframe. To address this issue and ensure compliance moving forward, the University has prioritized filling vacant positions within the Student Financial Aid Department. Additionally, the University has implemented a procedure requiring an independent review of all R2T4 calculations. A designated reviewer will 400 Magnolia Street – Orangeburg, SC 29115 A University of the United Methodist Church verify computations and ensure compliance with federal requirements prior to the return or disbursement of funds.
The University will form a task force comprising representatives from IT, compliance, and legal departments to review the seven required elements of the Gramm-Leach-Bliley Act (GLBA) by May 31, 2025. The task force will draft a comprehensive written information security program that includes the des...
The University will form a task force comprising representatives from IT, compliance, and legal departments to review the seven required elements of the Gramm-Leach-Bliley Act (GLBA) by May 31, 2025. The task force will draft a comprehensive written information security program that includes the designation of a program coordinator, identification of 400 Magnolia Street – Orangeburg, SC 29115 A University of the United Methodist Church internal and external risks to sensitive information, implementation of safeguards to control these risks, regular testing and monitoring of safeguards, oversight of service providers, evaluation and adjustment of safeguards in response to changes, and continuous employee training on handling sensitive information. The draft program will be submitted for review and approval by senior leadership by June 30, 2025.
Views of Responsible Officials: The Grants manager and Grants Compliance manager positions had turnover in 2024. The search for their replacements continues. With various temporary staff filling the roles in 2024, delays occurred in meeting reporting deadlines. Management has reviewed all agreements...
Views of Responsible Officials: The Grants manager and Grants Compliance manager positions had turnover in 2024. The search for their replacements continues. With various temporary staff filling the roles in 2024, delays occurred in meeting reporting deadlines. Management has reviewed all agreements to ensure its tracking tools reflect all relevant due dates for financial and narrative reports, as required by the agreements. These tracking tools will be monitored monthly to ensure timely submissions of reports by the established due dates.
Finding 560587 (2024-001)
Significant Deficiency 2024
Reference Number: 2024-001 Name of Contact Person: Claudia Martinez, Finance Director Corrective Action: The City agrees with the finding. The City acknowledges the importance of timely submission of the Single Audit report in accordance with Uniform Guidance 2 CFR 200.512(a) and will take correct...
Reference Number: 2024-001 Name of Contact Person: Claudia Martinez, Finance Director Corrective Action: The City agrees with the finding. The City acknowledges the importance of timely submission of the Single Audit report in accordance with Uniform Guidance 2 CFR 200.512(a) and will take corrective action to remediate this issue. The City is committed to restoring compliance with federal reporting deadlines and will continue to evaluate and implement process improvements to ensure timely completion and submission of future Single Audit reports. Proposed Completion Date: The corrective actions outlined above will be fully implemented by June 30, 2025.
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