Corrective Action Plans

Finding 1236914 (2025-003)

Material Weakness 2025

WI

Reporting Internal Control / Segregation of Duties

Management acknowledges that the current process did not result in a documented review for the performance report selected for testing. To strengthen internal controls and ensure compliance with SAFER program requirements, the Village will implement a procedure requiring all grant‑related reports to...

Management acknowledges that the current process did not result in a documented review for the performance report selected for testing. To strengthen internal controls and ensure compliance with SAFER program requirements, the Village will implement a procedure requiring all grant‑related reports to undergo a documented review by someone other than the preparer prior to submission. This review will be recorded outside of FEMAGo and incorporated into our grant management workflow for future reporting periods.

View Audit 412355

Finding 1236912 (2025-001)

Material Weakness 2025

Whatley Health Services, Inc.

AL

Reporting § 200.512

The Corporation is increasing its efforts to ensure that its policies and procedures are in place to ensure timely submission of reports. Completion Date: Estimated September 2026 Contact Person: Rajuan Sherman Chief Financial Officer 2731 M.L. King, Jr. Blvd Tuscaloosa, AL 35403 (205) 614-6070 rshe...

The Corporation is increasing its efforts to ensure that its policies and procedures are in place to ensure timely submission of reports. Completion Date: Estimated September 2026 Contact Person: Rajuan Sherman Chief Financial Officer 2731 M.L. King, Jr. Blvd Tuscaloosa, AL 35403 (205) 614-6070 rsherman@whatleyhealth.org

View Audit 412347

Finding 1236911 (2025-002)

Material Weakness 2025

Chillicothe R-II School District

MO

Procurement, Suspension & Debarment

The District has implemented bidding procedures for the 2025-2026 school year

View Audit 412344

Finding 1236909 (2025-002)

Material Weakness 2025

Community Directions, Inc.

LA

HUD Housing Programs Cash Management

FINDING #2025-002 RESERVE FOR REPLACEMENT Condition: The Reserve for Replacement account balance for Cotton City Rental was underfunded by $2,400. Recommendation: The management agent should ensure that all required deposits are made to the Reserve for Replacement account and that the balance in tha...

FINDING #2025-002 RESERVE FOR REPLACEMENT Condition: The Reserve for Replacement account balance for Cotton City Rental was underfunded by $2,400. Recommendation: The management agent should ensure that all required deposits are made to the Reserve for Replacement account and that the balance in that account meets the minimum required balance in accordance with the regulatory agreement between the Entity and HUD. View of Responsible Officials and Planned Corrective Action: The management agent agrees with the finding and the auditor’s recommendations have been adopted.

View Audit 412343

Finding 1236906 (2025-001)

Material Weakness 2025

Community Directions, Inc.

LA

HUD Housing Programs Matching / Level of Effort / Earmarking Internal Control / Segregation of Duties

FINDING #2025-001 SURPLUS CASH Condition: At December 31, 2022 the Entity had surplus cash totaling $9,162, due to Home Funds. Park Ridge Apartments, Phase 3 had surplus cash in the amount of $4,000. Park Ridge Apartments, Phase 4 had surplus cash in the amount of $2,077. Park Ridge Apartments, Phas...

FINDING #2025-001 SURPLUS CASH Condition: At December 31, 2022 the Entity had surplus cash totaling $9,162, due to Home Funds. Park Ridge Apartments, Phase 3 had surplus cash in the amount of $4,000. Park Ridge Apartments, Phase 4 had surplus cash in the amount of $2,077. Park Ridge Apartments, Phase 5 had surplus cash in the amount of $1,379. Parsk Ridge Apartments, Phase 6 had surplus cash in the amount of $1,706. The Entity paid the surplus cash for Park Ridge Apartments, Phase 3 and Phase 6, leaving a balance of $3,456 at December 31, 2024. There were no payments to surplus cash during the current fiscal year. Recommendation: The management agent should compute an estimate of surplus cash for the fiscal year upon completion of that period. In the event that surplus cash exists at the completion of the fiscal period, the management agent should make an installment payment on the HOME note. Views of Responsible Officials and Planned Corrective Action: The management agent agrees with the finding and the auditor’s recommendations have been adopted. Surplus cash will be calculated upon the completion of an annual fiscal period. If it is concluded that surplus cash exists at the end of the annual fiscal period, an installment payment will be made on the loan.

View Audit 412343

Finding 1236900 (2025-001)

Material Weakness 2025

The New York and Presbyterian Hospital

NY

Allowable Costs / Cost Principles Matching / Level of Effort / Earmarking Internal Control / Segregation of Duties § 200.303 § 200.403

Finding COVID-19 – 2025-001 Allowable Costs/Cost Principles Information on the federal program: Federal agency: U.S. Department of Homeland Security Pass-through program from: State of New York Division of Homeland Security and Emergency Services Federal Assistance Listing Number: 97.036 COVID-19 Di...

Finding COVID-19 – 2025-001 Allowable Costs/Cost Principles Information on the federal program: Federal agency: U.S. Department of Homeland Security Pass-through program from: State of New York Division of Homeland Security and Emergency Services Federal Assistance Listing Number: 97.036 COVID-19 Disaster Grants – Public Assistance (Presidentially Declared Disasters) Contract/pass-through entity identifying number: 140215 Award period of performance: January 20, 2020 – July 1, 2022 Planned corrective action: COVID-19-eligible pharmacy costs consisted of a high volume of lower-cost items and were identified through a process distinct from other cost categories. Cost data were obtained from NYP’s materials management system, which records purchase orders placed with primary vendors for medications and supplies. NYP submitted for FEMA reimbursement only those medication costs identified as related to the treatment of patients during the COVID-19 pandemic. Pharmacy vendors may adjust purchase orders when medications or supplies are unavailable or available in quantities different from those requested. The internal control process for the pharmacy portion of NYP’s COVID-19 submissions did not verify that purchase orders were fulfilled as recorded, supported by vendor invoices and receipt documentation, and paid before the associated costs were included in reimbursement claims. Going forward, designated Finance and Pharmacy personnel will reconcile purchase orders to vendor invoices, receipt records, and proof of payment before submission; exceptions will be resolved and documented, and management will periodically review the control’s operation to confirm that only eligible, incurred, and paid costs are claimed. Name of responsible officials: Richard Einwechter Vice President, Financial Operations (212) 585-6589 rie9001@nyp.org Gary Sorkin Vice President Insurance and Risk Management (212) 297-5714 gas9063@nyp.org

View Audit 412335

Finding 1236899 (2025-004)

Material Weakness 2025

Housing Authority of the City of Columbia

MO

HUD Housing Programs

Management should continue providing training and guidance to staff on HUD regulations and Administrative Plan requirements, while reinforcing the circumstances under which reduced payment standards may be applied to participant households and ensuring appropriate supervisory review. Staff should co...

Management should continue providing training and guidance to staff on HUD regulations and Administrative Plan requirements, while reinforcing the circumstances under which reduced payment standards may be applied to participant households and ensuring appropriate supervisory review. Staff should consistently follow applicable HUD requirements, documented guidance, and the Administrative Plan when determining and applying payment standards.

View Audit 412334

Finding 1236896 (2025-003)

Material Weakness 2025

Housing Authority of the City of Columbia

MO

HUD Housing Programs Special Tests & Provisions

Section 8 Housing Choice Voucher Program staff will conduct a monthly review of failed HQS re-inspections and outstanding deficiencies as a standing agenda item during regular operational meetings to ensure units meeting HUD’s abatement requirements are identified and placed into abatement timely. A...

Section 8 Housing Choice Voucher Program staff will conduct a monthly review of failed HQS re-inspections and outstanding deficiencies as a standing agenda item during regular operational meetings to ensure units meeting HUD’s abatement requirements are identified and placed into abatement timely. Any required abatements identified through the review will be addressed promptly and documented by responsible program staff.

View Audit 412334

Finding 1236893 (2025-002)

Material Weakness 2025

Housing Authority of the City of Columbia

MO

HUD Housing Programs

Section 8 Housing Choice Voucher Program staff will conduct a monthly review of participant exits, portability actions, and unit transfers as a standing agenda item during regular operational meetings to ensure all required HUD-50058 submissions are completed within HUD’s required 60-day timeframe. ...

Section 8 Housing Choice Voucher Program staff will conduct a monthly review of participant exits, portability actions, and unit transfers as a standing agenda item during regular operational meetings to ensure all required HUD-50058 submissions are completed within HUD’s required 60-day timeframe. Any outstanding submissions identified through the review will be addressed promptly and documented by responsible program staff.

View Audit 412334

Finding 1236890 (2025-001)

Material Weakness 2025

Hawley-Winton Housing Development Fund Company, Inc.

NY

Subrecipient Monitoring Reporting § 200.512

Finding #2025-001 Current Year Reporting Package and Data Collection Not Filed Timely: Recommendation: We recommend that management implement procedures to ensure that reporting packages and data collection forms are filed timely in the future. Action taken: Hawley-Winton Apartments agrees with the ...

Finding #2025-001 Current Year Reporting Package and Data Collection Not Filed Timely: Recommendation: We recommend that management implement procedures to ensure that reporting packages and data collection forms are filed timely in the future. Action taken: Hawley-Winton Apartments agrees with the auditor’s recommendations and will implement procedures to ensure timely filing in the future. For questions regarding this corrective action plan, please contact John Lutz, Vice President of Financial Strategy, at (315) 424-1821.

View Audit 412328

Finding 1236887 (2025-002)

Material Weakness 2025

Tioga County Conservation District

PA

Procurement, Suspension & Debarment

Management is formalizing the use of existing written policies that are program specific to cover all district programs.

View Audit 412325

Finding 1236886 (2025-002)

Material Weakness 2025

Steger Housing Development Fund Company

NY

The Organization made any outstanding deposits to the replacement reserve during the year ended September 30, 2026.

View Audit 412324

Finding 1236885 (2025-001)

Material Weakness 2025

Steger Housing Development Fund Company

NY

Reporting

The Organization has put in place procedures for ensuring the annual reporting to the Federal Audit Clearinghouse is done in a timely manner.

View Audit 412324

Finding 1236884 (2025-003)

Material Weakness 2025

The Healing Place Inc. and Subsidiaries

KY

Special Tests & Provisions Subrecipient Monitoring

Management Response: Proper record keeping of training will be maintained.

View Audit 412323

Finding 1236883 (2025-001)

Material Weakness 2025

Franklin County Technical School District

MA

Allowable Costs / Cost Principles Subrecipient Monitoring Significant Deficiency

Audit Finding Reference: 2025-001 Description of Finding: The audit revealed that a time and effort record was incomplete, and documented hours worked were not approved by the Supervisor prior to payroll processing. Planned Corrective Action: The District will strengthen its current review procedure...

Audit Finding Reference: 2025-001 Description of Finding: The audit revealed that a time and effort record was incomplete, and documented hours worked were not approved by the Supervisor prior to payroll processing. Planned Corrective Action: The District will strengthen its current review procedures for all timesheets supporting payroll costs charged to federal grants. Until the new electronic timekeeping system is implemented, employees will be required to complete and sign their timesheets, and the timesheets will be reviewed and approved by the appropriate supervisor prior to submission for payroll processing. The Business Manager will also review timesheets as part of the payroll warrant review and approval process to verify that required employee and supervisory approvals are documented. These requirements have been reviewed and reinforced with the employee responsible for payroll processing, as well as with supervisors responsible for reviewing and approving timesheets. Periodic monitoring will be performed by the Business Manager to ensure that established timesheet procedures are being consistently followed and that payroll costs charged to federal awards are supported by appropriate documentation. The District has also purchased absence and time management software and will implement the timekeeping component by January 2027. The new electronic system will eliminate paper timesheets and provide a consistent process for recording, reviewing, and approving employee time. All electronic timesheets will be reviewed and approved by the appropriate supervisor prior to submission for payroll processing. Name of Contact Person and Completion Date: Liz Bouchard, Business Manager Franklin County Technical School Completion Date: January 2027

View Audit 412321

Finding 1236882 (2025-009)

Material Weakness 2025

City of Roanoke, Virginia

VA

HUD Housing Programs Material Weakness Reporting

Management concurs with recommendation. Staffing issues contributed to this condition. Management has developed more breadth of staff to prepare and review reports. This includes the program manager of Lead Safe Roanoke, the Housing Programs and Policy Officer and the Project Grants Manager. Going f...

Management concurs with recommendation. Staffing issues contributed to this condition. Management has developed more breadth of staff to prepare and review reports. This includes the program manager of Lead Safe Roanoke, the Housing Programs and Policy Officer and the Project Grants Manager. Going forward, the City will ensure that reports are prepared, reviewed and approved by someone other than the preparer and submitted in a timely manner.

View Audit 412315

Finding 1236877 (2025-008)

Material Weakness 2025

City of Roanoke, Virginia

VA

Reporting

Management concurs with recommendation. Staffing issues contributed to this condition. Management has developed more breadth of staff to prepare and review reports. This includes the program manager of Lead Safe Roanoke, the Housing Programs and Policy Officer and the Project Grants Manager. Central...

Management concurs with recommendation. Staffing issues contributed to this condition. Management has developed more breadth of staff to prepare and review reports. This includes the program manager of Lead Safe Roanoke, the Housing Programs and Policy Officer and the Project Grants Manager. Centralization of financial management tasks within the Housing office is also planned. Going forward, the City will ensure that reports are prepared, reviewed and submitted in a timely manner.

View Audit 412315

Finding 1236872 (2025-007)

Material Weakness 2025

City of Roanoke, Virginia

VA

Reporting

Management concurs recommendation. The City acknowledges that supporting documentation was not readily available for review for the Project and Expenditures quarterly reports and that the Quarter 3 cumulative expenditures did not agree with the amounts reported on the Schedule of Expenditures of fed...

Management concurs recommendation. The City acknowledges that supporting documentation was not readily available for review for the Project and Expenditures quarterly reports and that the Quarter 3 cumulative expenditures did not agree with the amounts reported on the Schedule of Expenditures of federal Awards (SEFA) and the reconciled remaining balance of funds recorded as unearned revenue. Staff turnover, financial system challenges, and the lack of a dedicated grant accountant contributed to these deficiencies. Corrective action has already begun for preparing, reviewing, and maintaining Federal award rep01ting documentation. Supporting documentation for quarterly Project and Expenditures reports will be maintained in a designated shared electronic drive and organized by reporting period and Federal award to ensure documentation is readily accessible for review. A reconciliation was completed for the quarter ending June 30, 2026, and the quarterly report agrees to the general ledger.

View Audit 412315

Finding 1236849 (2025-006)

Material Weakness 2025

City of Roanoke, Virginia

VA

Subrecipient Monitoring

Management agrees with the finding. Staff turnover and the lack of a dedicated grant accountant contributed to the deficiencies in the monitoring process. The City is currently correcting this responsibility for subrecipient monitoring. The designated staff has begun desk monitoring of all subrecipi...

Management agrees with the finding. Staff turnover and the lack of a dedicated grant accountant contributed to the deficiencies in the monitoring process. The City is currently correcting this responsibility for subrecipient monitoring. The designated staff has begun desk monitoring of all subrecipients to ensure required monitoring activities are completed and properly documented. These corrective actions will be implemented as part of the City's ongoing grant management processes and will apply to current and future Federal awards subject to subrecipient monitoring requirements.

View Audit 412315

Finding 1236826 (2025-005)

Material Weakness 2025

City of Roanoke, Virginia

VA

Reporting

Management concurs with recommendation. Staffing issues contributed to this condition. Management has developed more breadth of staff to prepare and review repo11s. This includes the program manager of Lead Safe Roanoke, the Housing Programs and Policy Officer and the Project Grants Manager. Going f...

Management concurs with recommendation. Staffing issues contributed to this condition. Management has developed more breadth of staff to prepare and review repo11s. This includes the program manager of Lead Safe Roanoke, the Housing Programs and Policy Officer and the Project Grants Manager. Going forward, the City will ensure that reports are prepared, reviewed and submitted in a timely manner.

View Audit 412315

Finding 1236825 (2025-004)

Material Weakness 2025

City of Roanoke, Virginia

VA

HUD Housing Programs Material Weakness Reporting

Management concurs with recommendation. Staffing issues contributed to this condition. Management has developed more breadth of staff to prepare and review reports. This includes the program manager of Lead Safe Roanoke, the Hous ing Programs and Policy Officer and the Project Grants Manager. Going ...

Management concurs with recommendation. Staffing issues contributed to this condition. Management has developed more breadth of staff to prepare and review reports. This includes the program manager of Lead Safe Roanoke, the Hous ing Programs and Policy Officer and the Project Grants Manager. Going forward, the City will ensure that reports are prepared and reviewed by separate qualified individuals and that such review is documented.

View Audit 412315

Finding 1236824 (2025-003)

Material Weakness 2025

City of Roanoke, Virginia

VA

Subrecipient Monitoring § 200.331

Management concurs with the finding. The City has reinforced its subrecipient monitoring procedures and will ensure monitoring is performed and documented in accordance with its Program Participant Monitoring Plan. Responsibilities have been clarified, a monitoring schedule and checklist have been i...

Management concurs with the finding. The City has reinforced its subrecipient monitoring procedures and will ensure monitoring is performed and documented in accordance with its Program Participant Monitoring Plan. Responsibilities have been clarified, a monitoring schedule and checklist have been implemented, and supervisory review will be incorporated to help ensure required monitoring activities are completed, documented, and retained in the grant files.

View Audit 412315

Finding 1236821 (2025-001)

Material Weakness 2025

Community Health Foundation of Puerto Rico, Inc.

PR

Reporting § 200.328

See Corrective Action Plan table/chart.

View Audit 412314

Finding 1236820 (2025-002)

Material Weakness 2025

Northshore Health Centers, INC

IN

Special Tests & Provisions

2025-002 Findings Reported by Uniform Guidance – The following steps have been taken or will be taken to address Finding 2025-002: • NorthShore Health Centers, Inc. acknowledged the sliding fee adjustment errors resulted from incorrect calculation of sliding fee discount. Management will add an addi...

2025-002 Findings Reported by Uniform Guidance – The following steps have been taken or will be taken to address Finding 2025-002: • NorthShore Health Centers, Inc. acknowledged the sliding fee adjustment errors resulted from incorrect calculation of sliding fee discount. Management will add an additional layer of review over the application of the sliding fee scale. Further, the Center will implement a process to periodically review sliding fee adjustments throughout the year for accuracy. • Management expects full implementation as of December 31, 2026

View Audit 412311

Finding 1236819 (2025-003)

Material Weakness 2025

Chemung County Treasurer

NY

Reporting Cash Management § 200.303

Views of Responsible Officials and Planned Corrective Actions: To address financial management and compliance deficiencies within the Federal Transit Cluster, the County will implement a robust monitoring and reconciliation process by taking the following measures: Dedicated Grant Tracking and Calen...

Views of Responsible Officials and Planned Corrective Actions: To address financial management and compliance deficiencies within the Federal Transit Cluster, the County will implement a robust monitoring and reconciliation process by taking the following measures: Dedicated Grant Tracking and Calendaring: A specialized grant calendar and tracking log will be established by the Transit Manager, specifically for Federal Transit programs. This log will track the live status of all open grants, reimbursement claims and drawdowns (submitted, pending, approved, and paid) alongside required programmatic documentation. Routine Reconciliations: The Transit Manager will perform monthly reconciliations matching grant drawdowns and reimbursement claims directly against underlying eligible expenditure details, the general ledger, and the Schedule of Expenditures of Federal Awards (SEFA). Oversight and Cutoff Reviews: Documented Budget Office review will be mandated for all quarterly transit grant reconciliations and period-end cutoff evaluations to confirm that federal grant receivables and deferred revenue/inflows are accurately recorded. Specialized Training: The County will provide targeted training to both Transit Department personnel, Budget Office, and Treasurer’s Office staff to ensure full compliance with Uniform Guidance financial management standards, reconciliation rules, and federal award reporting criteria.

View Audit 412304

Corrective Action Plans

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