Audit 347522

2022-005 Late reports, missing reports and variances from accounting records. 93.341 Analyses, Research and Studies to Address the Impact of CMS Programs on American Indian/Alaska Native (AI/AN) Beneficiaries and the Health Care System Serving these Beneficiaries 93.421 Strengthening Public Health Systems and Services Audit Results: Criteria:Per Uniform Guidance 2 CFR 200 Subpart D, Performance and Financial Monitoring and Reporting, reports should be submitted within the required timeframe per the grant agreement and should tie out to the financial records. Documentation should also be kept for all financial and programmatic reports submitted for all federal awards. Condition:Four of the financial reports were submitted late and four had a variance from the expenditures per the general ledger. In addition, programmatic reports were missing for both of the major programs tested. Questioned Costs:$12,060 Context:PIt is important that all reports are timely filed and there is documentation to support all programmatic and financial reports. This ensures that the Organization is in compliance with Uniform Guidance, as well as ensuring that they are properly expending the funds and completing the goals of the grants. Effect:As of the end of the grant period there was an overall variance of $12,060 between the amounts reported on the financial reporting and the general ledger. We were also unable to obtain programmatic reports to verify that these were filed. Cause:The late reports and variances are due to ineffective controls over reporting resulting from employee turnover, resulting in delays and missing reports to support the variances. Recommendation: Auditors recommend that grant personnel track all deadlines for submission of reports and that management be aware of these deadlines and track and review all submissions to ensure timely and accurate fillings. If there are delays, the Organization should request and document permission to submit late. The Organization should also maintain all federal award reporting documentation in a location where authorized personnel have access in order to ensure that it can always be located. It is critical to maintain complete and accurate documentation to ensure compliance with Uniform Guidance requirements. Views of Responsible Officials and Planned Corrective Actions: Management agrees with this Single Audit Finding and response is included in the Corrective Action Plan.

2022-006 Missing or unsigned salary documentation 93.341 Analyses, Research and Studies to Address the Impact of CMS Programs on American Indian/Alaska Native (AI/AN) Beneficiaries and the Health Care System Serving these Beneficiaries 93.421 Strengthening Public Health Systems and Services Audit Results: Criteria:Signed offer letters or salary change forms should be maintained for all active employes as evidence of approval of salary rates. Condition:During our testing of payroll, we noted that offer letters or salary change forms were not signed or could not be located for four of the employees tested. Effect:As a result, the Organization did not maintain the proper signed documentation for employee salaries. Cause:This is due to lack of controls over document retention resulting from employee turnover. Recommendation: Auditors recommend that offer letters and salary change forms are maintained for all active employees as documentary evidence that salary rates have been approved. It is critical that salary rates and changes be approved in order to be in compliance with Uniform Guidance requirements. Views of Responsible Officials and Planned Corrective Actions: Management agrees with this Single Audit Finding and response is included in the Corrective Action Plan.

2022-007 Improper monitoring of subrecipients 93.421 Strengthening Public Health Systems and Services Audit Results: Criteria:Organizations should check the status of subrecipients at least annually and maintain documentation as evidence. In addition, if their are findings on the audited financial statements of a subrecipient, there should be follow-up to determine the status of those findings in subsequent years. Condition:Auditors noted there was no documentary evidence of a check for suspension or debarment for any of the subrecipients and in addition there was no follow up on the audit findings for subrecipient. Effect:As a result, the Organization was missing documentation relating to subrecipient monitoring requirements for the year ended December 31, 2022. Cause:This is due to ineffective controls over subrecipient monitoring resulting in a lack of documentation, miscommunications during employee transitions and the need to train new employees on policies and procedures. Recommendation: Auditors recommend that there are checks at least annually for suspension or debarment and that documentation be maintained for all checks completed. In addition the Organization should follow up and obtain audited financial statements each year from subrecipients or other documentation showing the status of audit findings. It is critical that subrecipients are properly monitored to ensure that they are complying with Uniform Guidance requirements. Views of Responsible Officials and Planned Corrective Actions: Management agrees with this Single Audit Finding and response is included in the Corrective Action Plan.

2022-005 Late reports, missing reports and variances from accounting records. 93.341 Analyses, Research and Studies to Address the Impact of CMS Programs on American Indian/Alaska Native (AI/AN) Beneficiaries and the Health Care System Serving these Beneficiaries 93.421 Strengthening Public Health Systems and Services Audit Results: Criteria:Per Uniform Guidance 2 CFR 200 Subpart D, Performance and Financial Monitoring and Reporting, reports should be submitted within the required timeframe per the grant agreement and should tie out to the financial records. Documentation should also be kept for all financial and programmatic reports submitted for all federal awards. Condition:Four of the financial reports were submitted late and four had a variance from the expenditures per the general ledger. In addition, programmatic reports were missing for both of the major programs tested. Questioned Costs:$12,060 Context:PIt is important that all reports are timely filed and there is documentation to support all programmatic and financial reports. This ensures that the Organization is in compliance with Uniform Guidance, as well as ensuring that they are properly expending the funds and completing the goals of the grants. Effect:As of the end of the grant period there was an overall variance of $12,060 between the amounts reported on the financial reporting and the general ledger. We were also unable to obtain programmatic reports to verify that these were filed. Cause:The late reports and variances are due to ineffective controls over reporting resulting from employee turnover, resulting in delays and missing reports to support the variances. Recommendation: Auditors recommend that grant personnel track all deadlines for submission of reports and that management be aware of these deadlines and track and review all submissions to ensure timely and accurate fillings. If there are delays, the Organization should request and document permission to submit late. The Organization should also maintain all federal award reporting documentation in a location where authorized personnel have access in order to ensure that it can always be located. It is critical to maintain complete and accurate documentation to ensure compliance with Uniform Guidance requirements. Views of Responsible Officials and Planned Corrective Actions: Management agrees with this Single Audit Finding and response is included in the Corrective Action Plan.

2022-006 Missing or unsigned salary documentation 93.341 Analyses, Research and Studies to Address the Impact of CMS Programs on American Indian/Alaska Native (AI/AN) Beneficiaries and the Health Care System Serving these Beneficiaries 93.421 Strengthening Public Health Systems and Services Audit Results: Criteria:Signed offer letters or salary change forms should be maintained for all active employes as evidence of approval of salary rates. Condition:During our testing of payroll, we noted that offer letters or salary change forms were not signed or could not be located for four of the employees tested. Effect:As a result, the Organization did not maintain the proper signed documentation for employee salaries. Cause:This is due to lack of controls over document retention resulting from employee turnover. Recommendation: Auditors recommend that offer letters and salary change forms are maintained for all active employees as documentary evidence that salary rates have been approved. It is critical that salary rates and changes be approved in order to be in compliance with Uniform Guidance requirements. Views of Responsible Officials and Planned Corrective Actions: Management agrees with this Single Audit Finding and response is included in the Corrective Action Plan.

2022-007 Improper monitoring of subrecipients 93.421 Strengthening Public Health Systems and Services Audit Results: Criteria:Organizations should check the status of subrecipients at least annually and maintain documentation as evidence. In addition, if their are findings on the audited financial statements of a subrecipient, there should be follow-up to determine the status of those findings in subsequent years. Condition:Auditors noted there was no documentary evidence of a check for suspension or debarment for any of the subrecipients and in addition there was no follow up on the audit findings for subrecipient. Effect:As a result, the Organization was missing documentation relating to subrecipient monitoring requirements for the year ended December 31, 2022. Cause:This is due to ineffective controls over subrecipient monitoring resulting in a lack of documentation, miscommunications during employee transitions and the need to train new employees on policies and procedures. Recommendation: Auditors recommend that there are checks at least annually for suspension or debarment and that documentation be maintained for all checks completed. In addition the Organization should follow up and obtain audited financial statements each year from subrecipients or other documentation showing the status of audit findings. It is critical that subrecipients are properly monitored to ensure that they are complying with Uniform Guidance requirements. Views of Responsible Officials and Planned Corrective Actions: Management agrees with this Single Audit Finding and response is included in the Corrective Action Plan.

2022-005 Late reports, missing reports and variances from accounting records. 93.341 Analyses, Research and Studies to Address the Impact of CMS Programs on American Indian/Alaska Native (AI/AN) Beneficiaries and the Health Care System Serving these Beneficiaries 93.421 Strengthening Public Health Systems and Services Audit Results: Criteria:Per Uniform Guidance 2 CFR 200 Subpart D, Performance and Financial Monitoring and Reporting, reports should be submitted within the required timeframe per the grant agreement and should tie out to the financial records. Documentation should also be kept for all financial and programmatic reports submitted for all federal awards. Condition:Four of the financial reports were submitted late and four had a variance from the expenditures per the general ledger. In addition, programmatic reports were missing for both of the major programs tested. Questioned Costs:$12,060 Context:PIt is important that all reports are timely filed and there is documentation to support all programmatic and financial reports. This ensures that the Organization is in compliance with Uniform Guidance, as well as ensuring that they are properly expending the funds and completing the goals of the grants. Effect:As of the end of the grant period there was an overall variance of $12,060 between the amounts reported on the financial reporting and the general ledger. We were also unable to obtain programmatic reports to verify that these were filed. Cause:The late reports and variances are due to ineffective controls over reporting resulting from employee turnover, resulting in delays and missing reports to support the variances. Recommendation: Auditors recommend that grant personnel track all deadlines for submission of reports and that management be aware of these deadlines and track and review all submissions to ensure timely and accurate fillings. If there are delays, the Organization should request and document permission to submit late. The Organization should also maintain all federal award reporting documentation in a location where authorized personnel have access in order to ensure that it can always be located. It is critical to maintain complete and accurate documentation to ensure compliance with Uniform Guidance requirements. Views of Responsible Officials and Planned Corrective Actions: Management agrees with this Single Audit Finding and response is included in the Corrective Action Plan.

2022-006 Missing or unsigned salary documentation 93.341 Analyses, Research and Studies to Address the Impact of CMS Programs on American Indian/Alaska Native (AI/AN) Beneficiaries and the Health Care System Serving these Beneficiaries 93.421 Strengthening Public Health Systems and Services Audit Results: Criteria:Signed offer letters or salary change forms should be maintained for all active employes as evidence of approval of salary rates. Condition:During our testing of payroll, we noted that offer letters or salary change forms were not signed or could not be located for four of the employees tested. Effect:As a result, the Organization did not maintain the proper signed documentation for employee salaries. Cause:This is due to lack of controls over document retention resulting from employee turnover. Recommendation: Auditors recommend that offer letters and salary change forms are maintained for all active employees as documentary evidence that salary rates have been approved. It is critical that salary rates and changes be approved in order to be in compliance with Uniform Guidance requirements. Views of Responsible Officials and Planned Corrective Actions: Management agrees with this Single Audit Finding and response is included in the Corrective Action Plan.

2022-007 Improper monitoring of subrecipients 93.421 Strengthening Public Health Systems and Services Audit Results: Criteria:Organizations should check the status of subrecipients at least annually and maintain documentation as evidence. In addition, if their are findings on the audited financial statements of a subrecipient, there should be follow-up to determine the status of those findings in subsequent years. Condition:Auditors noted there was no documentary evidence of a check for suspension or debarment for any of the subrecipients and in addition there was no follow up on the audit findings for subrecipient. Effect:As a result, the Organization was missing documentation relating to subrecipient monitoring requirements for the year ended December 31, 2022. Cause:This is due to ineffective controls over subrecipient monitoring resulting in a lack of documentation, miscommunications during employee transitions and the need to train new employees on policies and procedures. Recommendation: Auditors recommend that there are checks at least annually for suspension or debarment and that documentation be maintained for all checks completed. In addition the Organization should follow up and obtain audited financial statements each year from subrecipients or other documentation showing the status of audit findings. It is critical that subrecipients are properly monitored to ensure that they are complying with Uniform Guidance requirements. Views of Responsible Officials and Planned Corrective Actions: Management agrees with this Single Audit Finding and response is included in the Corrective Action Plan.

2022-005 Late reports, missing reports and variances from accounting records. 93.341 Analyses, Research and Studies to Address the Impact of CMS Programs on American Indian/Alaska Native (AI/AN) Beneficiaries and the Health Care System Serving these Beneficiaries 93.421 Strengthening Public Health Systems and Services Audit Results: Criteria:Per Uniform Guidance 2 CFR 200 Subpart D, Performance and Financial Monitoring and Reporting, reports should be submitted within the required timeframe per the grant agreement and should tie out to the financial records. Documentation should also be kept for all financial and programmatic reports submitted for all federal awards. Condition:Four of the financial reports were submitted late and four had a variance from the expenditures per the general ledger. In addition, programmatic reports were missing for both of the major programs tested. Questioned Costs:$12,060 Context:PIt is important that all reports are timely filed and there is documentation to support all programmatic and financial reports. This ensures that the Organization is in compliance with Uniform Guidance, as well as ensuring that they are properly expending the funds and completing the goals of the grants. Effect:As of the end of the grant period there was an overall variance of $12,060 between the amounts reported on the financial reporting and the general ledger. We were also unable to obtain programmatic reports to verify that these were filed. Cause:The late reports and variances are due to ineffective controls over reporting resulting from employee turnover, resulting in delays and missing reports to support the variances. Recommendation: Auditors recommend that grant personnel track all deadlines for submission of reports and that management be aware of these deadlines and track and review all submissions to ensure timely and accurate fillings. If there are delays, the Organization should request and document permission to submit late. The Organization should also maintain all federal award reporting documentation in a location where authorized personnel have access in order to ensure that it can always be located. It is critical to maintain complete and accurate documentation to ensure compliance with Uniform Guidance requirements. Views of Responsible Officials and Planned Corrective Actions: Management agrees with this Single Audit Finding and response is included in the Corrective Action Plan.

2022-006 Missing or unsigned salary documentation 93.341 Analyses, Research and Studies to Address the Impact of CMS Programs on American Indian/Alaska Native (AI/AN) Beneficiaries and the Health Care System Serving these Beneficiaries 93.421 Strengthening Public Health Systems and Services Audit Results: Criteria:Signed offer letters or salary change forms should be maintained for all active employes as evidence of approval of salary rates. Condition:During our testing of payroll, we noted that offer letters or salary change forms were not signed or could not be located for four of the employees tested. Effect:As a result, the Organization did not maintain the proper signed documentation for employee salaries. Cause:This is due to lack of controls over document retention resulting from employee turnover. Recommendation: Auditors recommend that offer letters and salary change forms are maintained for all active employees as documentary evidence that salary rates have been approved. It is critical that salary rates and changes be approved in order to be in compliance with Uniform Guidance requirements. Views of Responsible Officials and Planned Corrective Actions: Management agrees with this Single Audit Finding and response is included in the Corrective Action Plan.

2022-007 Improper monitoring of subrecipients 93.421 Strengthening Public Health Systems and Services Audit Results: Criteria:Organizations should check the status of subrecipients at least annually and maintain documentation as evidence. In addition, if their are findings on the audited financial statements of a subrecipient, there should be follow-up to determine the status of those findings in subsequent years. Condition:Auditors noted there was no documentary evidence of a check for suspension or debarment for any of the subrecipients and in addition there was no follow up on the audit findings for subrecipient. Effect:As a result, the Organization was missing documentation relating to subrecipient monitoring requirements for the year ended December 31, 2022. Cause:This is due to ineffective controls over subrecipient monitoring resulting in a lack of documentation, miscommunications during employee transitions and the need to train new employees on policies and procedures. Recommendation: Auditors recommend that there are checks at least annually for suspension or debarment and that documentation be maintained for all checks completed. In addition the Organization should follow up and obtain audited financial statements each year from subrecipients or other documentation showing the status of audit findings. It is critical that subrecipients are properly monitored to ensure that they are complying with Uniform Guidance requirements. Views of Responsible Officials and Planned Corrective Actions: Management agrees with this Single Audit Finding and response is included in the Corrective Action Plan.

2022-005 Late reports, missing reports and variances from accounting records. 93.341 Analyses, Research and Studies to Address the Impact of CMS Programs on American Indian/Alaska Native (AI/AN) Beneficiaries and the Health Care System Serving these Beneficiaries 93.421 Strengthening Public Health Systems and Services Audit Results: Criteria:Per Uniform Guidance 2 CFR 200 Subpart D, Performance and Financial Monitoring and Reporting, reports should be submitted within the required timeframe per the grant agreement and should tie out to the financial records. Documentation should also be kept for all financial and programmatic reports submitted for all federal awards. Condition:Four of the financial reports were submitted late and four had a variance from the expenditures per the general ledger. In addition, programmatic reports were missing for both of the major programs tested. Questioned Costs:$12,060 Context:PIt is important that all reports are timely filed and there is documentation to support all programmatic and financial reports. This ensures that the Organization is in compliance with Uniform Guidance, as well as ensuring that they are properly expending the funds and completing the goals of the grants. Effect:As of the end of the grant period there was an overall variance of $12,060 between the amounts reported on the financial reporting and the general ledger. We were also unable to obtain programmatic reports to verify that these were filed. Cause:The late reports and variances are due to ineffective controls over reporting resulting from employee turnover, resulting in delays and missing reports to support the variances. Recommendation: Auditors recommend that grant personnel track all deadlines for submission of reports and that management be aware of these deadlines and track and review all submissions to ensure timely and accurate fillings. If there are delays, the Organization should request and document permission to submit late. The Organization should also maintain all federal award reporting documentation in a location where authorized personnel have access in order to ensure that it can always be located. It is critical to maintain complete and accurate documentation to ensure compliance with Uniform Guidance requirements. Views of Responsible Officials and Planned Corrective Actions: Management agrees with this Single Audit Finding and response is included in the Corrective Action Plan.

2022-006 Missing or unsigned salary documentation 93.341 Analyses, Research and Studies to Address the Impact of CMS Programs on American Indian/Alaska Native (AI/AN) Beneficiaries and the Health Care System Serving these Beneficiaries 93.421 Strengthening Public Health Systems and Services Audit Results: Criteria:Signed offer letters or salary change forms should be maintained for all active employes as evidence of approval of salary rates. Condition:During our testing of payroll, we noted that offer letters or salary change forms were not signed or could not be located for four of the employees tested. Effect:As a result, the Organization did not maintain the proper signed documentation for employee salaries. Cause:This is due to lack of controls over document retention resulting from employee turnover. Recommendation: Auditors recommend that offer letters and salary change forms are maintained for all active employees as documentary evidence that salary rates have been approved. It is critical that salary rates and changes be approved in order to be in compliance with Uniform Guidance requirements. Views of Responsible Officials and Planned Corrective Actions: Management agrees with this Single Audit Finding and response is included in the Corrective Action Plan.

2022-007 Improper monitoring of subrecipients 93.421 Strengthening Public Health Systems and Services Audit Results: Criteria:Organizations should check the status of subrecipients at least annually and maintain documentation as evidence. In addition, if their are findings on the audited financial statements of a subrecipient, there should be follow-up to determine the status of those findings in subsequent years. Condition:Auditors noted there was no documentary evidence of a check for suspension or debarment for any of the subrecipients and in addition there was no follow up on the audit findings for subrecipient. Effect:As a result, the Organization was missing documentation relating to subrecipient monitoring requirements for the year ended December 31, 2022. Cause:This is due to ineffective controls over subrecipient monitoring resulting in a lack of documentation, miscommunications during employee transitions and the need to train new employees on policies and procedures. Recommendation: Auditors recommend that there are checks at least annually for suspension or debarment and that documentation be maintained for all checks completed. In addition the Organization should follow up and obtain audited financial statements each year from subrecipients or other documentation showing the status of audit findings. It is critical that subrecipients are properly monitored to ensure that they are complying with Uniform Guidance requirements. Views of Responsible Officials and Planned Corrective Actions: Management agrees with this Single Audit Finding and response is included in the Corrective Action Plan.

2022-005 Late reports, missing reports and variances from accounting records. 93.341 Analyses, Research and Studies to Address the Impact of CMS Programs on American Indian/Alaska Native (AI/AN) Beneficiaries and the Health Care System Serving these Beneficiaries 93.421 Strengthening Public Health Systems and Services Audit Results: Criteria:Per Uniform Guidance 2 CFR 200 Subpart D, Performance and Financial Monitoring and Reporting, reports should be submitted within the required timeframe per the grant agreement and should tie out to the financial records. Documentation should also be kept for all financial and programmatic reports submitted for all federal awards. Condition:Four of the financial reports were submitted late and four had a variance from the expenditures per the general ledger. In addition, programmatic reports were missing for both of the major programs tested. Questioned Costs:$12,060 Context:PIt is important that all reports are timely filed and there is documentation to support all programmatic and financial reports. This ensures that the Organization is in compliance with Uniform Guidance, as well as ensuring that they are properly expending the funds and completing the goals of the grants. Effect:As of the end of the grant period there was an overall variance of $12,060 between the amounts reported on the financial reporting and the general ledger. We were also unable to obtain programmatic reports to verify that these were filed. Cause:The late reports and variances are due to ineffective controls over reporting resulting from employee turnover, resulting in delays and missing reports to support the variances. Recommendation: Auditors recommend that grant personnel track all deadlines for submission of reports and that management be aware of these deadlines and track and review all submissions to ensure timely and accurate fillings. If there are delays, the Organization should request and document permission to submit late. The Organization should also maintain all federal award reporting documentation in a location where authorized personnel have access in order to ensure that it can always be located. It is critical to maintain complete and accurate documentation to ensure compliance with Uniform Guidance requirements. Views of Responsible Officials and Planned Corrective Actions: Management agrees with this Single Audit Finding and response is included in the Corrective Action Plan.

2022-006 Missing or unsigned salary documentation 93.341 Analyses, Research and Studies to Address the Impact of CMS Programs on American Indian/Alaska Native (AI/AN) Beneficiaries and the Health Care System Serving these Beneficiaries 93.421 Strengthening Public Health Systems and Services Audit Results: Criteria:Signed offer letters or salary change forms should be maintained for all active employes as evidence of approval of salary rates. Condition:During our testing of payroll, we noted that offer letters or salary change forms were not signed or could not be located for four of the employees tested. Effect:As a result, the Organization did not maintain the proper signed documentation for employee salaries. Cause:This is due to lack of controls over document retention resulting from employee turnover. Recommendation: Auditors recommend that offer letters and salary change forms are maintained for all active employees as documentary evidence that salary rates have been approved. It is critical that salary rates and changes be approved in order to be in compliance with Uniform Guidance requirements. Views of Responsible Officials and Planned Corrective Actions: Management agrees with this Single Audit Finding and response is included in the Corrective Action Plan.

2022-007 Improper monitoring of subrecipients 93.421 Strengthening Public Health Systems and Services Audit Results: Criteria:Organizations should check the status of subrecipients at least annually and maintain documentation as evidence. In addition, if their are findings on the audited financial statements of a subrecipient, there should be follow-up to determine the status of those findings in subsequent years. Condition:Auditors noted there was no documentary evidence of a check for suspension or debarment for any of the subrecipients and in addition there was no follow up on the audit findings for subrecipient. Effect:As a result, the Organization was missing documentation relating to subrecipient monitoring requirements for the year ended December 31, 2022. Cause:This is due to ineffective controls over subrecipient monitoring resulting in a lack of documentation, miscommunications during employee transitions and the need to train new employees on policies and procedures. Recommendation: Auditors recommend that there are checks at least annually for suspension or debarment and that documentation be maintained for all checks completed. In addition the Organization should follow up and obtain audited financial statements each year from subrecipients or other documentation showing the status of audit findings. It is critical that subrecipients are properly monitored to ensure that they are complying with Uniform Guidance requirements. Views of Responsible Officials and Planned Corrective Actions: Management agrees with this Single Audit Finding and response is included in the Corrective Action Plan.

2022-005 Late reports, missing reports and variances from accounting records. 93.341 Analyses, Research and Studies to Address the Impact of CMS Programs on American Indian/Alaska Native (AI/AN) Beneficiaries and the Health Care System Serving these Beneficiaries 93.421 Strengthening Public Health Systems and Services Audit Results: Criteria:Per Uniform Guidance 2 CFR 200 Subpart D, Performance and Financial Monitoring and Reporting, reports should be submitted within the required timeframe per the grant agreement and should tie out to the financial records. Documentation should also be kept for all financial and programmatic reports submitted for all federal awards. Condition:Four of the financial reports were submitted late and four had a variance from the expenditures per the general ledger. In addition, programmatic reports were missing for both of the major programs tested. Questioned Costs:$12,060 Context:PIt is important that all reports are timely filed and there is documentation to support all programmatic and financial reports. This ensures that the Organization is in compliance with Uniform Guidance, as well as ensuring that they are properly expending the funds and completing the goals of the grants. Effect:As of the end of the grant period there was an overall variance of $12,060 between the amounts reported on the financial reporting and the general ledger. We were also unable to obtain programmatic reports to verify that these were filed. Cause:The late reports and variances are due to ineffective controls over reporting resulting from employee turnover, resulting in delays and missing reports to support the variances. Recommendation: Auditors recommend that grant personnel track all deadlines for submission of reports and that management be aware of these deadlines and track and review all submissions to ensure timely and accurate fillings. If there are delays, the Organization should request and document permission to submit late. The Organization should also maintain all federal award reporting documentation in a location where authorized personnel have access in order to ensure that it can always be located. It is critical to maintain complete and accurate documentation to ensure compliance with Uniform Guidance requirements. Views of Responsible Officials and Planned Corrective Actions: Management agrees with this Single Audit Finding and response is included in the Corrective Action Plan.

2022-006 Missing or unsigned salary documentation 93.341 Analyses, Research and Studies to Address the Impact of CMS Programs on American Indian/Alaska Native (AI/AN) Beneficiaries and the Health Care System Serving these Beneficiaries 93.421 Strengthening Public Health Systems and Services Audit Results: Criteria:Signed offer letters or salary change forms should be maintained for all active employes as evidence of approval of salary rates. Condition:During our testing of payroll, we noted that offer letters or salary change forms were not signed or could not be located for four of the employees tested. Effect:As a result, the Organization did not maintain the proper signed documentation for employee salaries. Cause:This is due to lack of controls over document retention resulting from employee turnover. Recommendation: Auditors recommend that offer letters and salary change forms are maintained for all active employees as documentary evidence that salary rates have been approved. It is critical that salary rates and changes be approved in order to be in compliance with Uniform Guidance requirements. Views of Responsible Officials and Planned Corrective Actions: Management agrees with this Single Audit Finding and response is included in the Corrective Action Plan.

2022-007 Improper monitoring of subrecipients 93.421 Strengthening Public Health Systems and Services Audit Results: Criteria:Organizations should check the status of subrecipients at least annually and maintain documentation as evidence. In addition, if their are findings on the audited financial statements of a subrecipient, there should be follow-up to determine the status of those findings in subsequent years. Condition:Auditors noted there was no documentary evidence of a check for suspension or debarment for any of the subrecipients and in addition there was no follow up on the audit findings for subrecipient. Effect:As a result, the Organization was missing documentation relating to subrecipient monitoring requirements for the year ended December 31, 2022. Cause:This is due to ineffective controls over subrecipient monitoring resulting in a lack of documentation, miscommunications during employee transitions and the need to train new employees on policies and procedures. Recommendation: Auditors recommend that there are checks at least annually for suspension or debarment and that documentation be maintained for all checks completed. In addition the Organization should follow up and obtain audited financial statements each year from subrecipients or other documentation showing the status of audit findings. It is critical that subrecipients are properly monitored to ensure that they are complying with Uniform Guidance requirements. Views of Responsible Officials and Planned Corrective Actions: Management agrees with this Single Audit Finding and response is included in the Corrective Action Plan.

2022-005 Late reports, missing reports and variances from accounting records. 93.341 Analyses, Research and Studies to Address the Impact of CMS Programs on American Indian/Alaska Native (AI/AN) Beneficiaries and the Health Care System Serving these Beneficiaries 93.421 Strengthening Public Health Systems and Services Audit Results: Criteria:Per Uniform Guidance 2 CFR 200 Subpart D, Performance and Financial Monitoring and Reporting, reports should be submitted within the required timeframe per the grant agreement and should tie out to the financial records. Documentation should also be kept for all financial and programmatic reports submitted for all federal awards. Condition:Four of the financial reports were submitted late and four had a variance from the expenditures per the general ledger. In addition, programmatic reports were missing for both of the major programs tested. Questioned Costs:$12,060 Context:PIt is important that all reports are timely filed and there is documentation to support all programmatic and financial reports. This ensures that the Organization is in compliance with Uniform Guidance, as well as ensuring that they are properly expending the funds and completing the goals of the grants. Effect:As of the end of the grant period there was an overall variance of $12,060 between the amounts reported on the financial reporting and the general ledger. We were also unable to obtain programmatic reports to verify that these were filed. Cause:The late reports and variances are due to ineffective controls over reporting resulting from employee turnover, resulting in delays and missing reports to support the variances. Recommendation: Auditors recommend that grant personnel track all deadlines for submission of reports and that management be aware of these deadlines and track and review all submissions to ensure timely and accurate fillings. If there are delays, the Organization should request and document permission to submit late. The Organization should also maintain all federal award reporting documentation in a location where authorized personnel have access in order to ensure that it can always be located. It is critical to maintain complete and accurate documentation to ensure compliance with Uniform Guidance requirements. Views of Responsible Officials and Planned Corrective Actions: Management agrees with this Single Audit Finding and response is included in the Corrective Action Plan.

2022-006 Missing or unsigned salary documentation 93.341 Analyses, Research and Studies to Address the Impact of CMS Programs on American Indian/Alaska Native (AI/AN) Beneficiaries and the Health Care System Serving these Beneficiaries 93.421 Strengthening Public Health Systems and Services Audit Results: Criteria:Signed offer letters or salary change forms should be maintained for all active employes as evidence of approval of salary rates. Condition:During our testing of payroll, we noted that offer letters or salary change forms were not signed or could not be located for four of the employees tested. Effect:As a result, the Organization did not maintain the proper signed documentation for employee salaries. Cause:This is due to lack of controls over document retention resulting from employee turnover. Recommendation: Auditors recommend that offer letters and salary change forms are maintained for all active employees as documentary evidence that salary rates have been approved. It is critical that salary rates and changes be approved in order to be in compliance with Uniform Guidance requirements. Views of Responsible Officials and Planned Corrective Actions: Management agrees with this Single Audit Finding and response is included in the Corrective Action Plan.

2022-007 Improper monitoring of subrecipients 93.421 Strengthening Public Health Systems and Services Audit Results: Criteria:Organizations should check the status of subrecipients at least annually and maintain documentation as evidence. In addition, if their are findings on the audited financial statements of a subrecipient, there should be follow-up to determine the status of those findings in subsequent years. Condition:Auditors noted there was no documentary evidence of a check for suspension or debarment for any of the subrecipients and in addition there was no follow up on the audit findings for subrecipient. Effect:As a result, the Organization was missing documentation relating to subrecipient monitoring requirements for the year ended December 31, 2022. Cause:This is due to ineffective controls over subrecipient monitoring resulting in a lack of documentation, miscommunications during employee transitions and the need to train new employees on policies and procedures. Recommendation: Auditors recommend that there are checks at least annually for suspension or debarment and that documentation be maintained for all checks completed. In addition the Organization should follow up and obtain audited financial statements each year from subrecipients or other documentation showing the status of audit findings. It is critical that subrecipients are properly monitored to ensure that they are complying with Uniform Guidance requirements. Views of Responsible Officials and Planned Corrective Actions: Management agrees with this Single Audit Finding and response is included in the Corrective Action Plan.

2022-005 Late reports, missing reports and variances from accounting records. 93.341 Analyses, Research and Studies to Address the Impact of CMS Programs on American Indian/Alaska Native (AI/AN) Beneficiaries and the Health Care System Serving these Beneficiaries 93.421 Strengthening Public Health Systems and Services Audit Results: Criteria:Per Uniform Guidance 2 CFR 200 Subpart D, Performance and Financial Monitoring and Reporting, reports should be submitted within the required timeframe per the grant agreement and should tie out to the financial records. Documentation should also be kept for all financial and programmatic reports submitted for all federal awards. Condition:Four of the financial reports were submitted late and four had a variance from the expenditures per the general ledger. In addition, programmatic reports were missing for both of the major programs tested. Questioned Costs:$12,060 Context:PIt is important that all reports are timely filed and there is documentation to support all programmatic and financial reports. This ensures that the Organization is in compliance with Uniform Guidance, as well as ensuring that they are properly expending the funds and completing the goals of the grants. Effect:As of the end of the grant period there was an overall variance of $12,060 between the amounts reported on the financial reporting and the general ledger. We were also unable to obtain programmatic reports to verify that these were filed. Cause:The late reports and variances are due to ineffective controls over reporting resulting from employee turnover, resulting in delays and missing reports to support the variances. Recommendation: Auditors recommend that grant personnel track all deadlines for submission of reports and that management be aware of these deadlines and track and review all submissions to ensure timely and accurate fillings. If there are delays, the Organization should request and document permission to submit late. The Organization should also maintain all federal award reporting documentation in a location where authorized personnel have access in order to ensure that it can always be located. It is critical to maintain complete and accurate documentation to ensure compliance with Uniform Guidance requirements. Views of Responsible Officials and Planned Corrective Actions: Management agrees with this Single Audit Finding and response is included in the Corrective Action Plan.

2022-006 Missing or unsigned salary documentation 93.341 Analyses, Research and Studies to Address the Impact of CMS Programs on American Indian/Alaska Native (AI/AN) Beneficiaries and the Health Care System Serving these Beneficiaries 93.421 Strengthening Public Health Systems and Services Audit Results: Criteria:Signed offer letters or salary change forms should be maintained for all active employes as evidence of approval of salary rates. Condition:During our testing of payroll, we noted that offer letters or salary change forms were not signed or could not be located for four of the employees tested. Effect:As a result, the Organization did not maintain the proper signed documentation for employee salaries. Cause:This is due to lack of controls over document retention resulting from employee turnover. Recommendation: Auditors recommend that offer letters and salary change forms are maintained for all active employees as documentary evidence that salary rates have been approved. It is critical that salary rates and changes be approved in order to be in compliance with Uniform Guidance requirements. Views of Responsible Officials and Planned Corrective Actions: Management agrees with this Single Audit Finding and response is included in the Corrective Action Plan.

2022-007 Improper monitoring of subrecipients 93.421 Strengthening Public Health Systems and Services Audit Results: Criteria:Organizations should check the status of subrecipients at least annually and maintain documentation as evidence. In addition, if their are findings on the audited financial statements of a subrecipient, there should be follow-up to determine the status of those findings in subsequent years. Condition:Auditors noted there was no documentary evidence of a check for suspension or debarment for any of the subrecipients and in addition there was no follow up on the audit findings for subrecipient. Effect:As a result, the Organization was missing documentation relating to subrecipient monitoring requirements for the year ended December 31, 2022. Cause:This is due to ineffective controls over subrecipient monitoring resulting in a lack of documentation, miscommunications during employee transitions and the need to train new employees on policies and procedures. Recommendation: Auditors recommend that there are checks at least annually for suspension or debarment and that documentation be maintained for all checks completed. In addition the Organization should follow up and obtain audited financial statements each year from subrecipients or other documentation showing the status of audit findings. It is critical that subrecipients are properly monitored to ensure that they are complying with Uniform Guidance requirements. Views of Responsible Officials and Planned Corrective Actions: Management agrees with this Single Audit Finding and response is included in the Corrective Action Plan.

2022-004 Missing documentation for procurement, suspension and debarment 93.341 Analyses, Research and Studies to Address the Impact of CMS Programs on American Indian/Alaska Native (AI/AN) Beneficiaries and the Health Care System Serving these Beneficiaries Audit Results: Criteria: Per Uniform Guidance 2 CFR 200.318, any contracts procured with federal funds for over $10,000 should be obtained via a bidding process or documentation is required to show that the contractor is the sole source for the services. In addition, the Organization should keep documentation to show that they have verified that contractors are not suspended or debarred. Condition: Bid or sole source documentation was missing for all five contracts that we selected for testing and there was no documentation of the verification that the contractor was not suspended or debarred. Questioned Costs: None Context: It is important to determine that contractors used are eligible for work and that they have not been suspended or debarred from performing work on projects supported by federal funds It is also important to have full and open competition on contract work that is federally funded. Effect:As a result, the Organization was missing documentation relating to the requirements for procurement, suspension and debarment. Cause:This is due to ineffective controls over the procurement process resulting from staff turnover. Recommendation: Auditors recommend that the Organization maintain all federal award documentation in a location where all authorized personnel have access in order to ensure that it can always be located. We also recommend that management create a process for procurement, including how bids are obtained and maintained for proof of compliance with Uniform Guidance. Management should also establish procedures for verifying that contractors are not suspended or debarred and a system for maintaining this verification should be established. It is critical to maintain detailed documentation to ensure compliance with Uniform Guidance requirements. Views of Responsible Officials and Planned Corrective Actions: Management agrees with this Single Audit Finding and response is included in the Corrective Action Plan

2022-005 Late reports, missing reports and variances from accounting records. 93.341 Analyses, Research and Studies to Address the Impact of CMS Programs on American Indian/Alaska Native (AI/AN) Beneficiaries and the Health Care System Serving these Beneficiaries 93.421 Strengthening Public Health Systems and Services Audit Results: Criteria:Per Uniform Guidance 2 CFR 200 Subpart D, Performance and Financial Monitoring and Reporting, reports should be submitted within the required timeframe per the grant agreement and should tie out to the financial records. Documentation should also be kept for all financial and programmatic reports submitted for all federal awards. Condition:Four of the financial reports were submitted late and four had a variance from the expenditures per the general ledger. In addition, programmatic reports were missing for both of the major programs tested. Questioned Costs:$12,060 Context:PIt is important that all reports are timely filed and there is documentation to support all programmatic and financial reports. This ensures that the Organization is in compliance with Uniform Guidance, as well as ensuring that they are properly expending the funds and completing the goals of the grants. Effect:As of the end of the grant period there was an overall variance of $12,060 between the amounts reported on the financial reporting and the general ledger. We were also unable to obtain programmatic reports to verify that these were filed. Cause:The late reports and variances are due to ineffective controls over reporting resulting from employee turnover, resulting in delays and missing reports to support the variances. Recommendation: Auditors recommend that grant personnel track all deadlines for submission of reports and that management be aware of these deadlines and track and review all submissions to ensure timely and accurate fillings. If there are delays, the Organization should request and document permission to submit late. The Organization should also maintain all federal award reporting documentation in a location where authorized personnel have access in order to ensure that it can always be located. It is critical to maintain complete and accurate documentation to ensure compliance with Uniform Guidance requirements. Views of Responsible Officials and Planned Corrective Actions: Management agrees with this Single Audit Finding and response is included in the Corrective Action Plan.

2022-006 Missing or unsigned salary documentation 93.341 Analyses, Research and Studies to Address the Impact of CMS Programs on American Indian/Alaska Native (AI/AN) Beneficiaries and the Health Care System Serving these Beneficiaries 93.421 Strengthening Public Health Systems and Services Audit Results: Criteria:Signed offer letters or salary change forms should be maintained for all active employes as evidence of approval of salary rates. Condition:During our testing of payroll, we noted that offer letters or salary change forms were not signed or could not be located for four of the employees tested. Effect:As a result, the Organization did not maintain the proper signed documentation for employee salaries. Cause:This is due to lack of controls over document retention resulting from employee turnover. Recommendation: Auditors recommend that offer letters and salary change forms are maintained for all active employees as documentary evidence that salary rates have been approved. It is critical that salary rates and changes be approved in order to be in compliance with Uniform Guidance requirements. Views of Responsible Officials and Planned Corrective Actions: Management agrees with this Single Audit Finding and response is included in the Corrective Action Plan.

2022-005 Late reports, missing reports and variances from accounting records. 93.341 Analyses, Research and Studies to Address the Impact of CMS Programs on American Indian/Alaska Native (AI/AN) Beneficiaries and the Health Care System Serving these Beneficiaries 93.421 Strengthening Public Health Systems and Services Audit Results: Criteria:Per Uniform Guidance 2 CFR 200 Subpart D, Performance and Financial Monitoring and Reporting, reports should be submitted within the required timeframe per the grant agreement and should tie out to the financial records. Documentation should also be kept for all financial and programmatic reports submitted for all federal awards. Condition:Four of the financial reports were submitted late and four had a variance from the expenditures per the general ledger. In addition, programmatic reports were missing for both of the major programs tested. Questioned Costs:$12,060 Context:PIt is important that all reports are timely filed and there is documentation to support all programmatic and financial reports. This ensures that the Organization is in compliance with Uniform Guidance, as well as ensuring that they are properly expending the funds and completing the goals of the grants. Effect:As of the end of the grant period there was an overall variance of $12,060 between the amounts reported on the financial reporting and the general ledger. We were also unable to obtain programmatic reports to verify that these were filed. Cause:The late reports and variances are due to ineffective controls over reporting resulting from employee turnover, resulting in delays and missing reports to support the variances. Recommendation: Auditors recommend that grant personnel track all deadlines for submission of reports and that management be aware of these deadlines and track and review all submissions to ensure timely and accurate fillings. If there are delays, the Organization should request and document permission to submit late. The Organization should also maintain all federal award reporting documentation in a location where authorized personnel have access in order to ensure that it can always be located. It is critical to maintain complete and accurate documentation to ensure compliance with Uniform Guidance requirements. Views of Responsible Officials and Planned Corrective Actions: Management agrees with this Single Audit Finding and response is included in the Corrective Action Plan.

2022-006 Missing or unsigned salary documentation 93.341 Analyses, Research and Studies to Address the Impact of CMS Programs on American Indian/Alaska Native (AI/AN) Beneficiaries and the Health Care System Serving these Beneficiaries 93.421 Strengthening Public Health Systems and Services Audit Results: Criteria:Signed offer letters or salary change forms should be maintained for all active employes as evidence of approval of salary rates. Condition:During our testing of payroll, we noted that offer letters or salary change forms were not signed or could not be located for four of the employees tested. Effect:As a result, the Organization did not maintain the proper signed documentation for employee salaries. Cause:This is due to lack of controls over document retention resulting from employee turnover. Recommendation: Auditors recommend that offer letters and salary change forms are maintained for all active employees as documentary evidence that salary rates have been approved. It is critical that salary rates and changes be approved in order to be in compliance with Uniform Guidance requirements. Views of Responsible Officials and Planned Corrective Actions: Management agrees with this Single Audit Finding and response is included in the Corrective Action Plan.

2022-007 Improper monitoring of subrecipients 93.421 Strengthening Public Health Systems and Services Audit Results: Criteria:Organizations should check the status of subrecipients at least annually and maintain documentation as evidence. In addition, if their are findings on the audited financial statements of a subrecipient, there should be follow-up to determine the status of those findings in subsequent years. Condition:Auditors noted there was no documentary evidence of a check for suspension or debarment for any of the subrecipients and in addition there was no follow up on the audit findings for subrecipient. Effect:As a result, the Organization was missing documentation relating to subrecipient monitoring requirements for the year ended December 31, 2022. Cause:This is due to ineffective controls over subrecipient monitoring resulting in a lack of documentation, miscommunications during employee transitions and the need to train new employees on policies and procedures. Recommendation: Auditors recommend that there are checks at least annually for suspension or debarment and that documentation be maintained for all checks completed. In addition the Organization should follow up and obtain audited financial statements each year from subrecipients or other documentation showing the status of audit findings. It is critical that subrecipients are properly monitored to ensure that they are complying with Uniform Guidance requirements. Views of Responsible Officials and Planned Corrective Actions: Management agrees with this Single Audit Finding and response is included in the Corrective Action Plan.

2022-005 Late reports, missing reports and variances from accounting records. 93.341 Analyses, Research and Studies to Address the Impact of CMS Programs on American Indian/Alaska Native (AI/AN) Beneficiaries and the Health Care System Serving these Beneficiaries 93.421 Strengthening Public Health Systems and Services Audit Results: Criteria:Per Uniform Guidance 2 CFR 200 Subpart D, Performance and Financial Monitoring and Reporting, reports should be submitted within the required timeframe per the grant agreement and should tie out to the financial records. Documentation should also be kept for all financial and programmatic reports submitted for all federal awards. Condition:Four of the financial reports were submitted late and four had a variance from the expenditures per the general ledger. In addition, programmatic reports were missing for both of the major programs tested. Questioned Costs:$12,060 Context:PIt is important that all reports are timely filed and there is documentation to support all programmatic and financial reports. This ensures that the Organization is in compliance with Uniform Guidance, as well as ensuring that they are properly expending the funds and completing the goals of the grants. Effect:As of the end of the grant period there was an overall variance of $12,060 between the amounts reported on the financial reporting and the general ledger. We were also unable to obtain programmatic reports to verify that these were filed. Cause:The late reports and variances are due to ineffective controls over reporting resulting from employee turnover, resulting in delays and missing reports to support the variances. Recommendation: Auditors recommend that grant personnel track all deadlines for submission of reports and that management be aware of these deadlines and track and review all submissions to ensure timely and accurate fillings. If there are delays, the Organization should request and document permission to submit late. The Organization should also maintain all federal award reporting documentation in a location where authorized personnel have access in order to ensure that it can always be located. It is critical to maintain complete and accurate documentation to ensure compliance with Uniform Guidance requirements. Views of Responsible Officials and Planned Corrective Actions: Management agrees with this Single Audit Finding and response is included in the Corrective Action Plan.

2022-006 Missing or unsigned salary documentation 93.341 Analyses, Research and Studies to Address the Impact of CMS Programs on American Indian/Alaska Native (AI/AN) Beneficiaries and the Health Care System Serving these Beneficiaries 93.421 Strengthening Public Health Systems and Services Audit Results: Criteria:Signed offer letters or salary change forms should be maintained for all active employes as evidence of approval of salary rates. Condition:During our testing of payroll, we noted that offer letters or salary change forms were not signed or could not be located for four of the employees tested. Effect:As a result, the Organization did not maintain the proper signed documentation for employee salaries. Cause:This is due to lack of controls over document retention resulting from employee turnover. Recommendation: Auditors recommend that offer letters and salary change forms are maintained for all active employees as documentary evidence that salary rates have been approved. It is critical that salary rates and changes be approved in order to be in compliance with Uniform Guidance requirements. Views of Responsible Officials and Planned Corrective Actions: Management agrees with this Single Audit Finding and response is included in the Corrective Action Plan.

2022-007 Improper monitoring of subrecipients 93.421 Strengthening Public Health Systems and Services Audit Results: Criteria:Organizations should check the status of subrecipients at least annually and maintain documentation as evidence. In addition, if their are findings on the audited financial statements of a subrecipient, there should be follow-up to determine the status of those findings in subsequent years. Condition:Auditors noted there was no documentary evidence of a check for suspension or debarment for any of the subrecipients and in addition there was no follow up on the audit findings for subrecipient. Effect:As a result, the Organization was missing documentation relating to subrecipient monitoring requirements for the year ended December 31, 2022. Cause:This is due to ineffective controls over subrecipient monitoring resulting in a lack of documentation, miscommunications during employee transitions and the need to train new employees on policies and procedures. Recommendation: Auditors recommend that there are checks at least annually for suspension or debarment and that documentation be maintained for all checks completed. In addition the Organization should follow up and obtain audited financial statements each year from subrecipients or other documentation showing the status of audit findings. It is critical that subrecipients are properly monitored to ensure that they are complying with Uniform Guidance requirements. Views of Responsible Officials and Planned Corrective Actions: Management agrees with this Single Audit Finding and response is included in the Corrective Action Plan.

2022-005 Late reports, missing reports and variances from accounting records. 93.341 Analyses, Research and Studies to Address the Impact of CMS Programs on American Indian/Alaska Native (AI/AN) Beneficiaries and the Health Care System Serving these Beneficiaries 93.421 Strengthening Public Health Systems and Services Audit Results: Criteria:Per Uniform Guidance 2 CFR 200 Subpart D, Performance and Financial Monitoring and Reporting, reports should be submitted within the required timeframe per the grant agreement and should tie out to the financial records. Documentation should also be kept for all financial and programmatic reports submitted for all federal awards. Condition:Four of the financial reports were submitted late and four had a variance from the expenditures per the general ledger. In addition, programmatic reports were missing for both of the major programs tested. Questioned Costs:$12,060 Context:PIt is important that all reports are timely filed and there is documentation to support all programmatic and financial reports. This ensures that the Organization is in compliance with Uniform Guidance, as well as ensuring that they are properly expending the funds and completing the goals of the grants. Effect:As of the end of the grant period there was an overall variance of $12,060 between the amounts reported on the financial reporting and the general ledger. We were also unable to obtain programmatic reports to verify that these were filed. Cause:The late reports and variances are due to ineffective controls over reporting resulting from employee turnover, resulting in delays and missing reports to support the variances. Recommendation: Auditors recommend that grant personnel track all deadlines for submission of reports and that management be aware of these deadlines and track and review all submissions to ensure timely and accurate fillings. If there are delays, the Organization should request and document permission to submit late. The Organization should also maintain all federal award reporting documentation in a location where authorized personnel have access in order to ensure that it can always be located. It is critical to maintain complete and accurate documentation to ensure compliance with Uniform Guidance requirements. Views of Responsible Officials and Planned Corrective Actions: Management agrees with this Single Audit Finding and response is included in the Corrective Action Plan.

2022-006 Missing or unsigned salary documentation 93.341 Analyses, Research and Studies to Address the Impact of CMS Programs on American Indian/Alaska Native (AI/AN) Beneficiaries and the Health Care System Serving these Beneficiaries 93.421 Strengthening Public Health Systems and Services Audit Results: Criteria:Signed offer letters or salary change forms should be maintained for all active employes as evidence of approval of salary rates. Condition:During our testing of payroll, we noted that offer letters or salary change forms were not signed or could not be located for four of the employees tested. Effect:As a result, the Organization did not maintain the proper signed documentation for employee salaries. Cause:This is due to lack of controls over document retention resulting from employee turnover. Recommendation: Auditors recommend that offer letters and salary change forms are maintained for all active employees as documentary evidence that salary rates have been approved. It is critical that salary rates and changes be approved in order to be in compliance with Uniform Guidance requirements. Views of Responsible Officials and Planned Corrective Actions: Management agrees with this Single Audit Finding and response is included in the Corrective Action Plan.

2022-007 Improper monitoring of subrecipients 93.421 Strengthening Public Health Systems and Services Audit Results: Criteria:Organizations should check the status of subrecipients at least annually and maintain documentation as evidence. In addition, if their are findings on the audited financial statements of a subrecipient, there should be follow-up to determine the status of those findings in subsequent years. Condition:Auditors noted there was no documentary evidence of a check for suspension or debarment for any of the subrecipients and in addition there was no follow up on the audit findings for subrecipient. Effect:As a result, the Organization was missing documentation relating to subrecipient monitoring requirements for the year ended December 31, 2022. Cause:This is due to ineffective controls over subrecipient monitoring resulting in a lack of documentation, miscommunications during employee transitions and the need to train new employees on policies and procedures. Recommendation: Auditors recommend that there are checks at least annually for suspension or debarment and that documentation be maintained for all checks completed. In addition the Organization should follow up and obtain audited financial statements each year from subrecipients or other documentation showing the status of audit findings. It is critical that subrecipients are properly monitored to ensure that they are complying with Uniform Guidance requirements. Views of Responsible Officials and Planned Corrective Actions: Management agrees with this Single Audit Finding and response is included in the Corrective Action Plan.

2022-005 Late reports, missing reports and variances from accounting records. 93.341 Analyses, Research and Studies to Address the Impact of CMS Programs on American Indian/Alaska Native (AI/AN) Beneficiaries and the Health Care System Serving these Beneficiaries 93.421 Strengthening Public Health Systems and Services Audit Results: Criteria:Per Uniform Guidance 2 CFR 200 Subpart D, Performance and Financial Monitoring and Reporting, reports should be submitted within the required timeframe per the grant agreement and should tie out to the financial records. Documentation should also be kept for all financial and programmatic reports submitted for all federal awards. Condition:Four of the financial reports were submitted late and four had a variance from the expenditures per the general ledger. In addition, programmatic reports were missing for both of the major programs tested. Questioned Costs:$12,060 Context:PIt is important that all reports are timely filed and there is documentation to support all programmatic and financial reports. This ensures that the Organization is in compliance with Uniform Guidance, as well as ensuring that they are properly expending the funds and completing the goals of the grants. Effect:As of the end of the grant period there was an overall variance of $12,060 between the amounts reported on the financial reporting and the general ledger. We were also unable to obtain programmatic reports to verify that these were filed. Cause:The late reports and variances are due to ineffective controls over reporting resulting from employee turnover, resulting in delays and missing reports to support the variances. Recommendation: Auditors recommend that grant personnel track all deadlines for submission of reports and that management be aware of these deadlines and track and review all submissions to ensure timely and accurate fillings. If there are delays, the Organization should request and document permission to submit late. The Organization should also maintain all federal award reporting documentation in a location where authorized personnel have access in order to ensure that it can always be located. It is critical to maintain complete and accurate documentation to ensure compliance with Uniform Guidance requirements. Views of Responsible Officials and Planned Corrective Actions: Management agrees with this Single Audit Finding and response is included in the Corrective Action Plan.

2022-006 Missing or unsigned salary documentation 93.341 Analyses, Research and Studies to Address the Impact of CMS Programs on American Indian/Alaska Native (AI/AN) Beneficiaries and the Health Care System Serving these Beneficiaries 93.421 Strengthening Public Health Systems and Services Audit Results: Criteria:Signed offer letters or salary change forms should be maintained for all active employes as evidence of approval of salary rates. Condition:During our testing of payroll, we noted that offer letters or salary change forms were not signed or could not be located for four of the employees tested. Effect:As a result, the Organization did not maintain the proper signed documentation for employee salaries. Cause:This is due to lack of controls over document retention resulting from employee turnover. Recommendation: Auditors recommend that offer letters and salary change forms are maintained for all active employees as documentary evidence that salary rates have been approved. It is critical that salary rates and changes be approved in order to be in compliance with Uniform Guidance requirements. Views of Responsible Officials and Planned Corrective Actions: Management agrees with this Single Audit Finding and response is included in the Corrective Action Plan.

2022-007 Improper monitoring of subrecipients 93.421 Strengthening Public Health Systems and Services Audit Results: Criteria:Organizations should check the status of subrecipients at least annually and maintain documentation as evidence. In addition, if their are findings on the audited financial statements of a subrecipient, there should be follow-up to determine the status of those findings in subsequent years. Condition:Auditors noted there was no documentary evidence of a check for suspension or debarment for any of the subrecipients and in addition there was no follow up on the audit findings for subrecipient. Effect:As a result, the Organization was missing documentation relating to subrecipient monitoring requirements for the year ended December 31, 2022. Cause:This is due to ineffective controls over subrecipient monitoring resulting in a lack of documentation, miscommunications during employee transitions and the need to train new employees on policies and procedures. Recommendation: Auditors recommend that there are checks at least annually for suspension or debarment and that documentation be maintained for all checks completed. In addition the Organization should follow up and obtain audited financial statements each year from subrecipients or other documentation showing the status of audit findings. It is critical that subrecipients are properly monitored to ensure that they are complying with Uniform Guidance requirements. Views of Responsible Officials and Planned Corrective Actions: Management agrees with this Single Audit Finding and response is included in the Corrective Action Plan.

2022-005 Late reports, missing reports and variances from accounting records. 93.341 Analyses, Research and Studies to Address the Impact of CMS Programs on American Indian/Alaska Native (AI/AN) Beneficiaries and the Health Care System Serving these Beneficiaries 93.421 Strengthening Public Health Systems and Services Audit Results: Criteria:Per Uniform Guidance 2 CFR 200 Subpart D, Performance and Financial Monitoring and Reporting, reports should be submitted within the required timeframe per the grant agreement and should tie out to the financial records. Documentation should also be kept for all financial and programmatic reports submitted for all federal awards. Condition:Four of the financial reports were submitted late and four had a variance from the expenditures per the general ledger. In addition, programmatic reports were missing for both of the major programs tested. Questioned Costs:$12,060 Context:PIt is important that all reports are timely filed and there is documentation to support all programmatic and financial reports. This ensures that the Organization is in compliance with Uniform Guidance, as well as ensuring that they are properly expending the funds and completing the goals of the grants. Effect:As of the end of the grant period there was an overall variance of $12,060 between the amounts reported on the financial reporting and the general ledger. We were also unable to obtain programmatic reports to verify that these were filed. Cause:The late reports and variances are due to ineffective controls over reporting resulting from employee turnover, resulting in delays and missing reports to support the variances. Recommendation: Auditors recommend that grant personnel track all deadlines for submission of reports and that management be aware of these deadlines and track and review all submissions to ensure timely and accurate fillings. If there are delays, the Organization should request and document permission to submit late. The Organization should also maintain all federal award reporting documentation in a location where authorized personnel have access in order to ensure that it can always be located. It is critical to maintain complete and accurate documentation to ensure compliance with Uniform Guidance requirements. Views of Responsible Officials and Planned Corrective Actions: Management agrees with this Single Audit Finding and response is included in the Corrective Action Plan.

2022-006 Missing or unsigned salary documentation 93.341 Analyses, Research and Studies to Address the Impact of CMS Programs on American Indian/Alaska Native (AI/AN) Beneficiaries and the Health Care System Serving these Beneficiaries 93.421 Strengthening Public Health Systems and Services Audit Results: Criteria:Signed offer letters or salary change forms should be maintained for all active employes as evidence of approval of salary rates. Condition:During our testing of payroll, we noted that offer letters or salary change forms were not signed or could not be located for four of the employees tested. Effect:As a result, the Organization did not maintain the proper signed documentation for employee salaries. Cause:This is due to lack of controls over document retention resulting from employee turnover. Recommendation: Auditors recommend that offer letters and salary change forms are maintained for all active employees as documentary evidence that salary rates have been approved. It is critical that salary rates and changes be approved in order to be in compliance with Uniform Guidance requirements. Views of Responsible Officials and Planned Corrective Actions: Management agrees with this Single Audit Finding and response is included in the Corrective Action Plan.

2022-007 Improper monitoring of subrecipients 93.421 Strengthening Public Health Systems and Services Audit Results: Criteria:Organizations should check the status of subrecipients at least annually and maintain documentation as evidence. In addition, if their are findings on the audited financial statements of a subrecipient, there should be follow-up to determine the status of those findings in subsequent years. Condition:Auditors noted there was no documentary evidence of a check for suspension or debarment for any of the subrecipients and in addition there was no follow up on the audit findings for subrecipient. Effect:As a result, the Organization was missing documentation relating to subrecipient monitoring requirements for the year ended December 31, 2022. Cause:This is due to ineffective controls over subrecipient monitoring resulting in a lack of documentation, miscommunications during employee transitions and the need to train new employees on policies and procedures. Recommendation: Auditors recommend that there are checks at least annually for suspension or debarment and that documentation be maintained for all checks completed. In addition the Organization should follow up and obtain audited financial statements each year from subrecipients or other documentation showing the status of audit findings. It is critical that subrecipients are properly monitored to ensure that they are complying with Uniform Guidance requirements. Views of Responsible Officials and Planned Corrective Actions: Management agrees with this Single Audit Finding and response is included in the Corrective Action Plan.

2022-005 Late reports, missing reports and variances from accounting records. 93.341 Analyses, Research and Studies to Address the Impact of CMS Programs on American Indian/Alaska Native (AI/AN) Beneficiaries and the Health Care System Serving these Beneficiaries 93.421 Strengthening Public Health Systems and Services Audit Results: Criteria:Per Uniform Guidance 2 CFR 200 Subpart D, Performance and Financial Monitoring and Reporting, reports should be submitted within the required timeframe per the grant agreement and should tie out to the financial records. Documentation should also be kept for all financial and programmatic reports submitted for all federal awards. Condition:Four of the financial reports were submitted late and four had a variance from the expenditures per the general ledger. In addition, programmatic reports were missing for both of the major programs tested. Questioned Costs:$12,060 Context:PIt is important that all reports are timely filed and there is documentation to support all programmatic and financial reports. This ensures that the Organization is in compliance with Uniform Guidance, as well as ensuring that they are properly expending the funds and completing the goals of the grants. Effect:As of the end of the grant period there was an overall variance of $12,060 between the amounts reported on the financial reporting and the general ledger. We were also unable to obtain programmatic reports to verify that these were filed. Cause:The late reports and variances are due to ineffective controls over reporting resulting from employee turnover, resulting in delays and missing reports to support the variances. Recommendation: Auditors recommend that grant personnel track all deadlines for submission of reports and that management be aware of these deadlines and track and review all submissions to ensure timely and accurate fillings. If there are delays, the Organization should request and document permission to submit late. The Organization should also maintain all federal award reporting documentation in a location where authorized personnel have access in order to ensure that it can always be located. It is critical to maintain complete and accurate documentation to ensure compliance with Uniform Guidance requirements. Views of Responsible Officials and Planned Corrective Actions: Management agrees with this Single Audit Finding and response is included in the Corrective Action Plan.

2022-006 Missing or unsigned salary documentation 93.341 Analyses, Research and Studies to Address the Impact of CMS Programs on American Indian/Alaska Native (AI/AN) Beneficiaries and the Health Care System Serving these Beneficiaries 93.421 Strengthening Public Health Systems and Services Audit Results: Criteria:Signed offer letters or salary change forms should be maintained for all active employes as evidence of approval of salary rates. Condition:During our testing of payroll, we noted that offer letters or salary change forms were not signed or could not be located for four of the employees tested. Effect:As a result, the Organization did not maintain the proper signed documentation for employee salaries. Cause:This is due to lack of controls over document retention resulting from employee turnover. Recommendation: Auditors recommend that offer letters and salary change forms are maintained for all active employees as documentary evidence that salary rates have been approved. It is critical that salary rates and changes be approved in order to be in compliance with Uniform Guidance requirements. Views of Responsible Officials and Planned Corrective Actions: Management agrees with this Single Audit Finding and response is included in the Corrective Action Plan.

2022-007 Improper monitoring of subrecipients 93.421 Strengthening Public Health Systems and Services Audit Results: Criteria:Organizations should check the status of subrecipients at least annually and maintain documentation as evidence. In addition, if their are findings on the audited financial statements of a subrecipient, there should be follow-up to determine the status of those findings in subsequent years. Condition:Auditors noted there was no documentary evidence of a check for suspension or debarment for any of the subrecipients and in addition there was no follow up on the audit findings for subrecipient. Effect:As a result, the Organization was missing documentation relating to subrecipient monitoring requirements for the year ended December 31, 2022. Cause:This is due to ineffective controls over subrecipient monitoring resulting in a lack of documentation, miscommunications during employee transitions and the need to train new employees on policies and procedures. Recommendation: Auditors recommend that there are checks at least annually for suspension or debarment and that documentation be maintained for all checks completed. In addition the Organization should follow up and obtain audited financial statements each year from subrecipients or other documentation showing the status of audit findings. It is critical that subrecipients are properly monitored to ensure that they are complying with Uniform Guidance requirements. Views of Responsible Officials and Planned Corrective Actions: Management agrees with this Single Audit Finding and response is included in the Corrective Action Plan.

2022-005 Late reports, missing reports and variances from accounting records. 93.341 Analyses, Research and Studies to Address the Impact of CMS Programs on American Indian/Alaska Native (AI/AN) Beneficiaries and the Health Care System Serving these Beneficiaries 93.421 Strengthening Public Health Systems and Services Audit Results: Criteria:Per Uniform Guidance 2 CFR 200 Subpart D, Performance and Financial Monitoring and Reporting, reports should be submitted within the required timeframe per the grant agreement and should tie out to the financial records. Documentation should also be kept for all financial and programmatic reports submitted for all federal awards. Condition:Four of the financial reports were submitted late and four had a variance from the expenditures per the general ledger. In addition, programmatic reports were missing for both of the major programs tested. Questioned Costs:$12,060 Context:PIt is important that all reports are timely filed and there is documentation to support all programmatic and financial reports. This ensures that the Organization is in compliance with Uniform Guidance, as well as ensuring that they are properly expending the funds and completing the goals of the grants. Effect:As of the end of the grant period there was an overall variance of $12,060 between the amounts reported on the financial reporting and the general ledger. We were also unable to obtain programmatic reports to verify that these were filed. Cause:The late reports and variances are due to ineffective controls over reporting resulting from employee turnover, resulting in delays and missing reports to support the variances. Recommendation: Auditors recommend that grant personnel track all deadlines for submission of reports and that management be aware of these deadlines and track and review all submissions to ensure timely and accurate fillings. If there are delays, the Organization should request and document permission to submit late. The Organization should also maintain all federal award reporting documentation in a location where authorized personnel have access in order to ensure that it can always be located. It is critical to maintain complete and accurate documentation to ensure compliance with Uniform Guidance requirements. Views of Responsible Officials and Planned Corrective Actions: Management agrees with this Single Audit Finding and response is included in the Corrective Action Plan.

2022-006 Missing or unsigned salary documentation 93.341 Analyses, Research and Studies to Address the Impact of CMS Programs on American Indian/Alaska Native (AI/AN) Beneficiaries and the Health Care System Serving these Beneficiaries 93.421 Strengthening Public Health Systems and Services Audit Results: Criteria:Signed offer letters or salary change forms should be maintained for all active employes as evidence of approval of salary rates. Condition:During our testing of payroll, we noted that offer letters or salary change forms were not signed or could not be located for four of the employees tested. Effect:As a result, the Organization did not maintain the proper signed documentation for employee salaries. Cause:This is due to lack of controls over document retention resulting from employee turnover. Recommendation: Auditors recommend that offer letters and salary change forms are maintained for all active employees as documentary evidence that salary rates have been approved. It is critical that salary rates and changes be approved in order to be in compliance with Uniform Guidance requirements. Views of Responsible Officials and Planned Corrective Actions: Management agrees with this Single Audit Finding and response is included in the Corrective Action Plan.

2022-007 Improper monitoring of subrecipients 93.421 Strengthening Public Health Systems and Services Audit Results: Criteria:Organizations should check the status of subrecipients at least annually and maintain documentation as evidence. In addition, if their are findings on the audited financial statements of a subrecipient, there should be follow-up to determine the status of those findings in subsequent years. Condition:Auditors noted there was no documentary evidence of a check for suspension or debarment for any of the subrecipients and in addition there was no follow up on the audit findings for subrecipient. Effect:As a result, the Organization was missing documentation relating to subrecipient monitoring requirements for the year ended December 31, 2022. Cause:This is due to ineffective controls over subrecipient monitoring resulting in a lack of documentation, miscommunications during employee transitions and the need to train new employees on policies and procedures. Recommendation: Auditors recommend that there are checks at least annually for suspension or debarment and that documentation be maintained for all checks completed. In addition the Organization should follow up and obtain audited financial statements each year from subrecipients or other documentation showing the status of audit findings. It is critical that subrecipients are properly monitored to ensure that they are complying with Uniform Guidance requirements. Views of Responsible Officials and Planned Corrective Actions: Management agrees with this Single Audit Finding and response is included in the Corrective Action Plan.

2022-005 Late reports, missing reports and variances from accounting records. 93.341 Analyses, Research and Studies to Address the Impact of CMS Programs on American Indian/Alaska Native (AI/AN) Beneficiaries and the Health Care System Serving these Beneficiaries 93.421 Strengthening Public Health Systems and Services Audit Results: Criteria:Per Uniform Guidance 2 CFR 200 Subpart D, Performance and Financial Monitoring and Reporting, reports should be submitted within the required timeframe per the grant agreement and should tie out to the financial records. Documentation should also be kept for all financial and programmatic reports submitted for all federal awards. Condition:Four of the financial reports were submitted late and four had a variance from the expenditures per the general ledger. In addition, programmatic reports were missing for both of the major programs tested. Questioned Costs:$12,060 Context:PIt is important that all reports are timely filed and there is documentation to support all programmatic and financial reports. This ensures that the Organization is in compliance with Uniform Guidance, as well as ensuring that they are properly expending the funds and completing the goals of the grants. Effect:As of the end of the grant period there was an overall variance of $12,060 between the amounts reported on the financial reporting and the general ledger. We were also unable to obtain programmatic reports to verify that these were filed. Cause:The late reports and variances are due to ineffective controls over reporting resulting from employee turnover, resulting in delays and missing reports to support the variances. Recommendation: Auditors recommend that grant personnel track all deadlines for submission of reports and that management be aware of these deadlines and track and review all submissions to ensure timely and accurate fillings. If there are delays, the Organization should request and document permission to submit late. The Organization should also maintain all federal award reporting documentation in a location where authorized personnel have access in order to ensure that it can always be located. It is critical to maintain complete and accurate documentation to ensure compliance with Uniform Guidance requirements. Views of Responsible Officials and Planned Corrective Actions: Management agrees with this Single Audit Finding and response is included in the Corrective Action Plan.

2022-006 Missing or unsigned salary documentation 93.341 Analyses, Research and Studies to Address the Impact of CMS Programs on American Indian/Alaska Native (AI/AN) Beneficiaries and the Health Care System Serving these Beneficiaries 93.421 Strengthening Public Health Systems and Services Audit Results: Criteria:Signed offer letters or salary change forms should be maintained for all active employes as evidence of approval of salary rates. Condition:During our testing of payroll, we noted that offer letters or salary change forms were not signed or could not be located for four of the employees tested. Effect:As a result, the Organization did not maintain the proper signed documentation for employee salaries. Cause:This is due to lack of controls over document retention resulting from employee turnover. Recommendation: Auditors recommend that offer letters and salary change forms are maintained for all active employees as documentary evidence that salary rates have been approved. It is critical that salary rates and changes be approved in order to be in compliance with Uniform Guidance requirements. Views of Responsible Officials and Planned Corrective Actions: Management agrees with this Single Audit Finding and response is included in the Corrective Action Plan.

2022-007 Improper monitoring of subrecipients 93.421 Strengthening Public Health Systems and Services Audit Results: Criteria:Organizations should check the status of subrecipients at least annually and maintain documentation as evidence. In addition, if their are findings on the audited financial statements of a subrecipient, there should be follow-up to determine the status of those findings in subsequent years. Condition:Auditors noted there was no documentary evidence of a check for suspension or debarment for any of the subrecipients and in addition there was no follow up on the audit findings for subrecipient. Effect:As a result, the Organization was missing documentation relating to subrecipient monitoring requirements for the year ended December 31, 2022. Cause:This is due to ineffective controls over subrecipient monitoring resulting in a lack of documentation, miscommunications during employee transitions and the need to train new employees on policies and procedures. Recommendation: Auditors recommend that there are checks at least annually for suspension or debarment and that documentation be maintained for all checks completed. In addition the Organization should follow up and obtain audited financial statements each year from subrecipients or other documentation showing the status of audit findings. It is critical that subrecipients are properly monitored to ensure that they are complying with Uniform Guidance requirements. Views of Responsible Officials and Planned Corrective Actions: Management agrees with this Single Audit Finding and response is included in the Corrective Action Plan.

2022-005 Late reports, missing reports and variances from accounting records. 93.341 Analyses, Research and Studies to Address the Impact of CMS Programs on American Indian/Alaska Native (AI/AN) Beneficiaries and the Health Care System Serving these Beneficiaries 93.421 Strengthening Public Health Systems and Services Audit Results: Criteria:Per Uniform Guidance 2 CFR 200 Subpart D, Performance and Financial Monitoring and Reporting, reports should be submitted within the required timeframe per the grant agreement and should tie out to the financial records. Documentation should also be kept for all financial and programmatic reports submitted for all federal awards. Condition:Four of the financial reports were submitted late and four had a variance from the expenditures per the general ledger. In addition, programmatic reports were missing for both of the major programs tested. Questioned Costs:$12,060 Context:PIt is important that all reports are timely filed and there is documentation to support all programmatic and financial reports. This ensures that the Organization is in compliance with Uniform Guidance, as well as ensuring that they are properly expending the funds and completing the goals of the grants. Effect:As of the end of the grant period there was an overall variance of $12,060 between the amounts reported on the financial reporting and the general ledger. We were also unable to obtain programmatic reports to verify that these were filed. Cause:The late reports and variances are due to ineffective controls over reporting resulting from employee turnover, resulting in delays and missing reports to support the variances. Recommendation: Auditors recommend that grant personnel track all deadlines for submission of reports and that management be aware of these deadlines and track and review all submissions to ensure timely and accurate fillings. If there are delays, the Organization should request and document permission to submit late. The Organization should also maintain all federal award reporting documentation in a location where authorized personnel have access in order to ensure that it can always be located. It is critical to maintain complete and accurate documentation to ensure compliance with Uniform Guidance requirements. Views of Responsible Officials and Planned Corrective Actions: Management agrees with this Single Audit Finding and response is included in the Corrective Action Plan.

2022-006 Missing or unsigned salary documentation 93.341 Analyses, Research and Studies to Address the Impact of CMS Programs on American Indian/Alaska Native (AI/AN) Beneficiaries and the Health Care System Serving these Beneficiaries 93.421 Strengthening Public Health Systems and Services Audit Results: Criteria:Signed offer letters or salary change forms should be maintained for all active employes as evidence of approval of salary rates. Condition:During our testing of payroll, we noted that offer letters or salary change forms were not signed or could not be located for four of the employees tested. Effect:As a result, the Organization did not maintain the proper signed documentation for employee salaries. Cause:This is due to lack of controls over document retention resulting from employee turnover. Recommendation: Auditors recommend that offer letters and salary change forms are maintained for all active employees as documentary evidence that salary rates have been approved. It is critical that salary rates and changes be approved in order to be in compliance with Uniform Guidance requirements. Views of Responsible Officials and Planned Corrective Actions: Management agrees with this Single Audit Finding and response is included in the Corrective Action Plan.

2022-007 Improper monitoring of subrecipients 93.421 Strengthening Public Health Systems and Services Audit Results: Criteria:Organizations should check the status of subrecipients at least annually and maintain documentation as evidence. In addition, if their are findings on the audited financial statements of a subrecipient, there should be follow-up to determine the status of those findings in subsequent years. Condition:Auditors noted there was no documentary evidence of a check for suspension or debarment for any of the subrecipients and in addition there was no follow up on the audit findings for subrecipient. Effect:As a result, the Organization was missing documentation relating to subrecipient monitoring requirements for the year ended December 31, 2022. Cause:This is due to ineffective controls over subrecipient monitoring resulting in a lack of documentation, miscommunications during employee transitions and the need to train new employees on policies and procedures. Recommendation: Auditors recommend that there are checks at least annually for suspension or debarment and that documentation be maintained for all checks completed. In addition the Organization should follow up and obtain audited financial statements each year from subrecipients or other documentation showing the status of audit findings. It is critical that subrecipients are properly monitored to ensure that they are complying with Uniform Guidance requirements. Views of Responsible Officials and Planned Corrective Actions: Management agrees with this Single Audit Finding and response is included in the Corrective Action Plan.

2022-004 Missing documentation for procurement, suspension and debarment 93.341 Analyses, Research and Studies to Address the Impact of CMS Programs on American Indian/Alaska Native (AI/AN) Beneficiaries and the Health Care System Serving these Beneficiaries Audit Results: Criteria: Per Uniform Guidance 2 CFR 200.318, any contracts procured with federal funds for over $10,000 should be obtained via a bidding process or documentation is required to show that the contractor is the sole source for the services. In addition, the Organization should keep documentation to show that they have verified that contractors are not suspended or debarred. Condition: Bid or sole source documentation was missing for all five contracts that we selected for testing and there was no documentation of the verification that the contractor was not suspended or debarred. Questioned Costs: None Context: It is important to determine that contractors used are eligible for work and that they have not been suspended or debarred from performing work on projects supported by federal funds It is also important to have full and open competition on contract work that is federally funded. Effect:As a result, the Organization was missing documentation relating to the requirements for procurement, suspension and debarment. Cause:This is due to ineffective controls over the procurement process resulting from staff turnover. Recommendation: Auditors recommend that the Organization maintain all federal award documentation in a location where all authorized personnel have access in order to ensure that it can always be located. We also recommend that management create a process for procurement, including how bids are obtained and maintained for proof of compliance with Uniform Guidance. Management should also establish procedures for verifying that contractors are not suspended or debarred and a system for maintaining this verification should be established. It is critical to maintain detailed documentation to ensure compliance with Uniform Guidance requirements. Views of Responsible Officials and Planned Corrective Actions: Management agrees with this Single Audit Finding and response is included in the Corrective Action Plan

2022-005 Late reports, missing reports and variances from accounting records. 93.341 Analyses, Research and Studies to Address the Impact of CMS Programs on American Indian/Alaska Native (AI/AN) Beneficiaries and the Health Care System Serving these Beneficiaries 93.421 Strengthening Public Health Systems and Services Audit Results: Criteria:Per Uniform Guidance 2 CFR 200 Subpart D, Performance and Financial Monitoring and Reporting, reports should be submitted within the required timeframe per the grant agreement and should tie out to the financial records. Documentation should also be kept for all financial and programmatic reports submitted for all federal awards. Condition:Four of the financial reports were submitted late and four had a variance from the expenditures per the general ledger. In addition, programmatic reports were missing for both of the major programs tested. Questioned Costs:$12,060 Context:PIt is important that all reports are timely filed and there is documentation to support all programmatic and financial reports. This ensures that the Organization is in compliance with Uniform Guidance, as well as ensuring that they are properly expending the funds and completing the goals of the grants. Effect:As of the end of the grant period there was an overall variance of $12,060 between the amounts reported on the financial reporting and the general ledger. We were also unable to obtain programmatic reports to verify that these were filed. Cause:The late reports and variances are due to ineffective controls over reporting resulting from employee turnover, resulting in delays and missing reports to support the variances. Recommendation: Auditors recommend that grant personnel track all deadlines for submission of reports and that management be aware of these deadlines and track and review all submissions to ensure timely and accurate fillings. If there are delays, the Organization should request and document permission to submit late. The Organization should also maintain all federal award reporting documentation in a location where authorized personnel have access in order to ensure that it can always be located. It is critical to maintain complete and accurate documentation to ensure compliance with Uniform Guidance requirements. Views of Responsible Officials and Planned Corrective Actions: Management agrees with this Single Audit Finding and response is included in the Corrective Action Plan.

2022-006 Missing or unsigned salary documentation 93.341 Analyses, Research and Studies to Address the Impact of CMS Programs on American Indian/Alaska Native (AI/AN) Beneficiaries and the Health Care System Serving these Beneficiaries 93.421 Strengthening Public Health Systems and Services Audit Results: Criteria:Signed offer letters or salary change forms should be maintained for all active employes as evidence of approval of salary rates. Condition:During our testing of payroll, we noted that offer letters or salary change forms were not signed or could not be located for four of the employees tested. Effect:As a result, the Organization did not maintain the proper signed documentation for employee salaries. Cause:This is due to lack of controls over document retention resulting from employee turnover. Recommendation: Auditors recommend that offer letters and salary change forms are maintained for all active employees as documentary evidence that salary rates have been approved. It is critical that salary rates and changes be approved in order to be in compliance with Uniform Guidance requirements. Views of Responsible Officials and Planned Corrective Actions: Management agrees with this Single Audit Finding and response is included in the Corrective Action Plan.