Audit 354532

Assistance Living Number 93.224 Health Center Programs Grant Award Number H80CS00112 US Department of Health and Human Services Finding 2023-002 Compliance Requirement: Allowable Cost/Cost Principles Type of Finding: Material Weakness Criteria: Uniform Guidance Allowable Costs/Cost Principles addresses activities related to payroll and personnel which should be supported by a system of internal control that provides reasonable assurance that the charges are accurate, allowable, and properly allocated and are incorporated into the official records of the recipient organization. Condition: A walkthrough of fourteen individuals was performed to review personnel files and payroll related to salary for the Organization. Of the fourteen files reviewed, two had no approved current pay rate documented, and the salary or hourly rate paid was not the rate contained in the file. Also, there was no timesheet provided to support the time charged to the federal grant for eleven of the fourteen individuals tested. Cause: Management of the Organization’s human resources and payroll departments experienced substantial turnover during the year and personnel files were not prioritized to keep them in good order. Payroll documentation was not maintained properly. Also, new administrators were unaware that salaried employees who are paid with federal funds, must maintain documentation to support time allocated. Effect or Potential Effect: Without proper documentation, it is not possible to support the appropriate wage rate being paid to an individual. Also, it is not possible to prove an accurate allocation of time charged to a federal grant without time sheets, in accordance with the system that was in use. Questioned Costs: $142,546 Repeat Finding: The finding is a repeat finding (see prior year finding number 2022-005) Recommendation: Recommend that administrators become familiar with time and effort reporting requirements. Consider the use of a checklist within each file as an additional procedure to ensure that each file contains all necessary documents and that the file has been updated for current rates of pay. Views of Responsible Officials: Management agrees with the recommendation and will implement the use of a checklist to improve compliance.

Assistance Living Number 93.224 Health Center Programs Grant Award Number H80CS00112 US Department of Health and Human Services Finding 2023-002 Compliance Requirement: Allowable Cost/Cost Principles Type of Finding: Material Weakness Criteria: Uniform Guidance Allowable Costs/Cost Principles addresses activities related to payroll and personnel which should be supported by a system of internal control that provides reasonable assurance that the charges are accurate, allowable, and properly allocated and are incorporated into the official records of the recipient organization. Condition: A walkthrough of fourteen individuals was performed to review personnel files and payroll related to salary for the Organization. Of the fourteen files reviewed, two had no approved current pay rate documented, and the salary or hourly rate paid was not the rate contained in the file. Also, there was no timesheet provided to support the time charged to the federal grant for eleven of the fourteen individuals tested. Cause: Management of the Organization’s human resources and payroll departments experienced substantial turnover during the year and personnel files were not prioritized to keep them in good order. Payroll documentation was not maintained properly. Also, new administrators were unaware that salaried employees who are paid with federal funds, must maintain documentation to support time allocated. Effect or Potential Effect: Without proper documentation, it is not possible to support the appropriate wage rate being paid to an individual. Also, it is not possible to prove an accurate allocation of time charged to a federal grant without time sheets, in accordance with the system that was in use. Questioned Costs: $142,546 Repeat Finding: The finding is a repeat finding (see prior year finding number 2022-005) Recommendation: Recommend that administrators become familiar with time and effort reporting requirements. Consider the use of a checklist within each file as an additional procedure to ensure that each file contains all necessary documents and that the file has been updated for current rates of pay. Views of Responsible Officials: Management agrees with the recommendation and will implement the use of a checklist to improve compliance.

Assistance Living Number 93.224 Health Center Programs Grant Award Number H80CS00112 US Department of Health and Human Services Finding 2023-002 Compliance Requirement: Allowable Cost/Cost Principles Type of Finding: Material Weakness Criteria: Uniform Guidance Allowable Costs/Cost Principles addresses activities related to payroll and personnel which should be supported by a system of internal control that provides reasonable assurance that the charges are accurate, allowable, and properly allocated and are incorporated into the official records of the recipient organization. Condition: A walkthrough of fourteen individuals was performed to review personnel files and payroll related to salary for the Organization. Of the fourteen files reviewed, two had no approved current pay rate documented, and the salary or hourly rate paid was not the rate contained in the file. Also, there was no timesheet provided to support the time charged to the federal grant for eleven of the fourteen individuals tested. Cause: Management of the Organization’s human resources and payroll departments experienced substantial turnover during the year and personnel files were not prioritized to keep them in good order. Payroll documentation was not maintained properly. Also, new administrators were unaware that salaried employees who are paid with federal funds, must maintain documentation to support time allocated. Effect or Potential Effect: Without proper documentation, it is not possible to support the appropriate wage rate being paid to an individual. Also, it is not possible to prove an accurate allocation of time charged to a federal grant without time sheets, in accordance with the system that was in use. Questioned Costs: $142,546 Repeat Finding: The finding is a repeat finding (see prior year finding number 2022-005) Recommendation: Recommend that administrators become familiar with time and effort reporting requirements. Consider the use of a checklist within each file as an additional procedure to ensure that each file contains all necessary documents and that the file has been updated for current rates of pay. Views of Responsible Officials: Management agrees with the recommendation and will implement the use of a checklist to improve compliance.

Assistance Living Number 93.224 Health Center Programs Grant Award Number H80CS00112 US Department of Health and Human Services Finding 2023-002 Compliance Requirement: Allowable Cost/Cost Principles Type of Finding: Material Weakness Criteria: Uniform Guidance Allowable Costs/Cost Principles addresses activities related to payroll and personnel which should be supported by a system of internal control that provides reasonable assurance that the charges are accurate, allowable, and properly allocated and are incorporated into the official records of the recipient organization. Condition: A walkthrough of fourteen individuals was performed to review personnel files and payroll related to salary for the Organization. Of the fourteen files reviewed, two had no approved current pay rate documented, and the salary or hourly rate paid was not the rate contained in the file. Also, there was no timesheet provided to support the time charged to the federal grant for eleven of the fourteen individuals tested. Cause: Management of the Organization’s human resources and payroll departments experienced substantial turnover during the year and personnel files were not prioritized to keep them in good order. Payroll documentation was not maintained properly. Also, new administrators were unaware that salaried employees who are paid with federal funds, must maintain documentation to support time allocated. Effect or Potential Effect: Without proper documentation, it is not possible to support the appropriate wage rate being paid to an individual. Also, it is not possible to prove an accurate allocation of time charged to a federal grant without time sheets, in accordance with the system that was in use. Questioned Costs: $142,546 Repeat Finding: The finding is a repeat finding (see prior year finding number 2022-005) Recommendation: Recommend that administrators become familiar with time and effort reporting requirements. Consider the use of a checklist within each file as an additional procedure to ensure that each file contains all necessary documents and that the file has been updated for current rates of pay. Views of Responsible Officials: Management agrees with the recommendation and will implement the use of a checklist to improve compliance.

Assistance Living Number 93.224 Health Center Programs Grant Award Number H80CS00112 US Department of Health and Human Services Finding 2023-002 Compliance Requirement: Allowable Cost/Cost Principles Type of Finding: Material Weakness Criteria: Uniform Guidance Allowable Costs/Cost Principles addresses activities related to payroll and personnel which should be supported by a system of internal control that provides reasonable assurance that the charges are accurate, allowable, and properly allocated and are incorporated into the official records of the recipient organization. Condition: A walkthrough of fourteen individuals was performed to review personnel files and payroll related to salary for the Organization. Of the fourteen files reviewed, two had no approved current pay rate documented, and the salary or hourly rate paid was not the rate contained in the file. Also, there was no timesheet provided to support the time charged to the federal grant for eleven of the fourteen individuals tested. Cause: Management of the Organization’s human resources and payroll departments experienced substantial turnover during the year and personnel files were not prioritized to keep them in good order. Payroll documentation was not maintained properly. Also, new administrators were unaware that salaried employees who are paid with federal funds, must maintain documentation to support time allocated. Effect or Potential Effect: Without proper documentation, it is not possible to support the appropriate wage rate being paid to an individual. Also, it is not possible to prove an accurate allocation of time charged to a federal grant without time sheets, in accordance with the system that was in use. Questioned Costs: $142,546 Repeat Finding: The finding is a repeat finding (see prior year finding number 2022-005) Recommendation: Recommend that administrators become familiar with time and effort reporting requirements. Consider the use of a checklist within each file as an additional procedure to ensure that each file contains all necessary documents and that the file has been updated for current rates of pay. Views of Responsible Officials: Management agrees with the recommendation and will implement the use of a checklist to improve compliance.

Assistance Listing Numbers 93.224 Consolidated Health Centers Grant Number H80CS00112 US Department of Health and Human Services Finding 2023-003 Compliance Requirement: Special Tests and Provisions-Sliding Fee Discounts Type of Finding: Material Weakness Criteria: Health centers are required to have a corresponding schedule of discounts applied and adjusted on the basis of the patient’s ability to pay and their eligibility. A patient’s eligibility to pay is determined on the basis of the official poverty guidelines. Condition and Context: Documents to verify income could not be located for six of the twenty-five patients selected for testing. Also, there was no documentation of family size for five of the patients in this sample. The result is that we were unable to determine eligibility for a total of seven of the fourteen tested. Cause: The condition can be attributed to turnover in patient management personnel and the fact that various files were moved off-site and stored without adequate communication to incoming personnel. Effect or Potential Effect: Sliding fee discounts given could potentially be incorrect, or the patient could be ineligible. Questioned Costs: None Repeat Finding: The finding is a repeat finding (see prior year finding number 2022-006) Recommendation: The Organization should be implementing and monitoring procedures to ensure that all supporting documents are kept for determining patient eligibility. Views of Responsible Officials: Management agrees with the finding.

Assistance Listing Numbers 93.224 Consolidated Health Centers Grant Number H80CS00112 US Department of Health and Human Services Finding 2023-003 Compliance Requirement: Special Tests and Provisions-Sliding Fee Discounts Type of Finding: Material Weakness Criteria: Health centers are required to have a corresponding schedule of discounts applied and adjusted on the basis of the patient’s ability to pay and their eligibility. A patient’s eligibility to pay is determined on the basis of the official poverty guidelines. Condition and Context: Documents to verify income could not be located for six of the twenty-five patients selected for testing. Also, there was no documentation of family size for five of the patients in this sample. The result is that we were unable to determine eligibility for a total of seven of the fourteen tested. Cause: The condition can be attributed to turnover in patient management personnel and the fact that various files were moved off-site and stored without adequate communication to incoming personnel. Effect or Potential Effect: Sliding fee discounts given could potentially be incorrect, or the patient could be ineligible. Questioned Costs: None Repeat Finding: The finding is a repeat finding (see prior year finding number 2022-006) Recommendation: The Organization should be implementing and monitoring procedures to ensure that all supporting documents are kept for determining patient eligibility. Views of Responsible Officials: Management agrees with the finding.

Assistance Listing Numbers 93.224 Consolidated Health Centers Grant Number H80CS00112 US Department of Health and Human Services Finding 2023-003 Compliance Requirement: Special Tests and Provisions-Sliding Fee Discounts Type of Finding: Material Weakness Criteria: Health centers are required to have a corresponding schedule of discounts applied and adjusted on the basis of the patient’s ability to pay and their eligibility. A patient’s eligibility to pay is determined on the basis of the official poverty guidelines. Condition and Context: Documents to verify income could not be located for six of the twenty-five patients selected for testing. Also, there was no documentation of family size for five of the patients in this sample. The result is that we were unable to determine eligibility for a total of seven of the fourteen tested. Cause: The condition can be attributed to turnover in patient management personnel and the fact that various files were moved off-site and stored without adequate communication to incoming personnel. Effect or Potential Effect: Sliding fee discounts given could potentially be incorrect, or the patient could be ineligible. Questioned Costs: None Repeat Finding: The finding is a repeat finding (see prior year finding number 2022-006) Recommendation: The Organization should be implementing and monitoring procedures to ensure that all supporting documents are kept for determining patient eligibility. Views of Responsible Officials: Management agrees with the finding.

Assistance Listing Numbers 93.224 Consolidated Health Centers Grant Number H80CS00112 US Department of Health and Human Services Finding 2023-003 Compliance Requirement: Special Tests and Provisions-Sliding Fee Discounts Type of Finding: Material Weakness Criteria: Health centers are required to have a corresponding schedule of discounts applied and adjusted on the basis of the patient’s ability to pay and their eligibility. A patient’s eligibility to pay is determined on the basis of the official poverty guidelines. Condition and Context: Documents to verify income could not be located for six of the twenty-five patients selected for testing. Also, there was no documentation of family size for five of the patients in this sample. The result is that we were unable to determine eligibility for a total of seven of the fourteen tested. Cause: The condition can be attributed to turnover in patient management personnel and the fact that various files were moved off-site and stored without adequate communication to incoming personnel. Effect or Potential Effect: Sliding fee discounts given could potentially be incorrect, or the patient could be ineligible. Questioned Costs: None Repeat Finding: The finding is a repeat finding (see prior year finding number 2022-006) Recommendation: The Organization should be implementing and monitoring procedures to ensure that all supporting documents are kept for determining patient eligibility. Views of Responsible Officials: Management agrees with the finding.

Assistance Listing Numbers 93.224 Consolidated Health Centers Grant Number H80CS00112 US Department of Health and Human Services Finding 2023-003 Compliance Requirement: Special Tests and Provisions-Sliding Fee Discounts Type of Finding: Material Weakness Criteria: Health centers are required to have a corresponding schedule of discounts applied and adjusted on the basis of the patient’s ability to pay and their eligibility. A patient’s eligibility to pay is determined on the basis of the official poverty guidelines. Condition and Context: Documents to verify income could not be located for six of the twenty-five patients selected for testing. Also, there was no documentation of family size for five of the patients in this sample. The result is that we were unable to determine eligibility for a total of seven of the fourteen tested. Cause: The condition can be attributed to turnover in patient management personnel and the fact that various files were moved off-site and stored without adequate communication to incoming personnel. Effect or Potential Effect: Sliding fee discounts given could potentially be incorrect, or the patient could be ineligible. Questioned Costs: None Repeat Finding: The finding is a repeat finding (see prior year finding number 2022-006) Recommendation: The Organization should be implementing and monitoring procedures to ensure that all supporting documents are kept for determining patient eligibility. Views of Responsible Officials: Management agrees with the finding.

Assistance Listing Numbers 93.224 Consolidated Health Centers Grant Number H80CS00112 US Department of Health and Human Services Finding 2023-004 Compliance Requirement: Reporting Type of Finding: Material Weakness Criteria: Per CFR Subpart F, the audit, data collection form, and the reporting package must be submitted within 30 calendar days after receipt of report, or nine months after the end of the audit period. Condition: The report for the year ended December 31, 2023, was not filed within the required report submission period. Cause: This condition can be attributed to the extensive turnover in the Clinic’s administrative positions which included the Chief Financial Officer. Financial statements did not receive sufficient attention to be completed and audited in a timely manner. Effect or Potential Effect: Tardiness in financial reporting prevents management from identifying and addressing errors and issues in a timely manner. Late submission of reports to the Clearinghouse prevents the organization from maintaining compliance with OMB guidelines. Questioned Costs: None Repeat Finding: The finding is a repeat finding (See prior year finding number 2022-007) Recommendation: The Organization must give a higher priority to its financial reporting cycle to avoid obvious challenges. Views of Responsible Officials: Management agrees with the finding. Finding 2022-007 Compliance Requirement: Reporting Type of Finding: Material Weakness Criteria: Per CFR Subpart F, the audit, data collection form, and the reporting package must be submitted within 30 calendar days after receipt of report, or nine months after the end of the audit period. Condition: The report for the year ended December 31, 2022 was not filed within the required report submission period. Cause: This condition can be attributed to the extensive turnover in the Clinic’s administrative positions which included the Chief Financial Officer. Financial statements did not receive sufficient attention to be completed and audited in a timely manner. Effect: Tardiness in financial reporting prevents management from identifying and addressing errors and issues in a timely manner. Late submission of reports to the Clearinghouse prevents the organization from maintaining compliance with OMB guidelines. Questioned Costs: None Repeat Finding: No Recommendation: The Organization must give a higher priority to its financial reporting cycle to avoid obvious challenges. Management’s Response: Management agrees with the finding.

Assistance Listing Numbers 93.224 Consolidated Health Centers Grant Number H80CS00112 US Department of Health and Human Services Finding 2023-004 Compliance Requirement: Reporting Type of Finding: Material Weakness Criteria: Per CFR Subpart F, the audit, data collection form, and the reporting package must be submitted within 30 calendar days after receipt of report, or nine months after the end of the audit period. Condition: The report for the year ended December 31, 2023, was not filed within the required report submission period. Cause: This condition can be attributed to the extensive turnover in the Clinic’s administrative positions which included the Chief Financial Officer. Financial statements did not receive sufficient attention to be completed and audited in a timely manner. Effect or Potential Effect: Tardiness in financial reporting prevents management from identifying and addressing errors and issues in a timely manner. Late submission of reports to the Clearinghouse prevents the organization from maintaining compliance with OMB guidelines. Questioned Costs: None Repeat Finding: The finding is a repeat finding (See prior year finding number 2022-007) Recommendation: The Organization must give a higher priority to its financial reporting cycle to avoid obvious challenges. Views of Responsible Officials: Management agrees with the finding. Finding 2022-007 Compliance Requirement: Reporting Type of Finding: Material Weakness Criteria: Per CFR Subpart F, the audit, data collection form, and the reporting package must be submitted within 30 calendar days after receipt of report, or nine months after the end of the audit period. Condition: The report for the year ended December 31, 2022 was not filed within the required report submission period. Cause: This condition can be attributed to the extensive turnover in the Clinic’s administrative positions which included the Chief Financial Officer. Financial statements did not receive sufficient attention to be completed and audited in a timely manner. Effect: Tardiness in financial reporting prevents management from identifying and addressing errors and issues in a timely manner. Late submission of reports to the Clearinghouse prevents the organization from maintaining compliance with OMB guidelines. Questioned Costs: None Repeat Finding: No Recommendation: The Organization must give a higher priority to its financial reporting cycle to avoid obvious challenges. Management’s Response: Management agrees with the finding.

Assistance Listing Numbers 93.224 Consolidated Health Centers Grant Number H80CS00112 US Department of Health and Human Services Finding 2023-004 Compliance Requirement: Reporting Type of Finding: Material Weakness Criteria: Per CFR Subpart F, the audit, data collection form, and the reporting package must be submitted within 30 calendar days after receipt of report, or nine months after the end of the audit period. Condition: The report for the year ended December 31, 2023, was not filed within the required report submission period. Cause: This condition can be attributed to the extensive turnover in the Clinic’s administrative positions which included the Chief Financial Officer. Financial statements did not receive sufficient attention to be completed and audited in a timely manner. Effect or Potential Effect: Tardiness in financial reporting prevents management from identifying and addressing errors and issues in a timely manner. Late submission of reports to the Clearinghouse prevents the organization from maintaining compliance with OMB guidelines. Questioned Costs: None Repeat Finding: The finding is a repeat finding (See prior year finding number 2022-007) Recommendation: The Organization must give a higher priority to its financial reporting cycle to avoid obvious challenges. Views of Responsible Officials: Management agrees with the finding. Finding 2022-007 Compliance Requirement: Reporting Type of Finding: Material Weakness Criteria: Per CFR Subpart F, the audit, data collection form, and the reporting package must be submitted within 30 calendar days after receipt of report, or nine months after the end of the audit period. Condition: The report for the year ended December 31, 2022 was not filed within the required report submission period. Cause: This condition can be attributed to the extensive turnover in the Clinic’s administrative positions which included the Chief Financial Officer. Financial statements did not receive sufficient attention to be completed and audited in a timely manner. Effect: Tardiness in financial reporting prevents management from identifying and addressing errors and issues in a timely manner. Late submission of reports to the Clearinghouse prevents the organization from maintaining compliance with OMB guidelines. Questioned Costs: None Repeat Finding: No Recommendation: The Organization must give a higher priority to its financial reporting cycle to avoid obvious challenges. Management’s Response: Management agrees with the finding.

Assistance Listing Numbers 93.224 Consolidated Health Centers Grant Number H80CS00112 US Department of Health and Human Services Finding 2023-004 Compliance Requirement: Reporting Type of Finding: Material Weakness Criteria: Per CFR Subpart F, the audit, data collection form, and the reporting package must be submitted within 30 calendar days after receipt of report, or nine months after the end of the audit period. Condition: The report for the year ended December 31, 2023, was not filed within the required report submission period. Cause: This condition can be attributed to the extensive turnover in the Clinic’s administrative positions which included the Chief Financial Officer. Financial statements did not receive sufficient attention to be completed and audited in a timely manner. Effect or Potential Effect: Tardiness in financial reporting prevents management from identifying and addressing errors and issues in a timely manner. Late submission of reports to the Clearinghouse prevents the organization from maintaining compliance with OMB guidelines. Questioned Costs: None Repeat Finding: The finding is a repeat finding (See prior year finding number 2022-007) Recommendation: The Organization must give a higher priority to its financial reporting cycle to avoid obvious challenges. Views of Responsible Officials: Management agrees with the finding. Finding 2022-007 Compliance Requirement: Reporting Type of Finding: Material Weakness Criteria: Per CFR Subpart F, the audit, data collection form, and the reporting package must be submitted within 30 calendar days after receipt of report, or nine months after the end of the audit period. Condition: The report for the year ended December 31, 2022 was not filed within the required report submission period. Cause: This condition can be attributed to the extensive turnover in the Clinic’s administrative positions which included the Chief Financial Officer. Financial statements did not receive sufficient attention to be completed and audited in a timely manner. Effect: Tardiness in financial reporting prevents management from identifying and addressing errors and issues in a timely manner. Late submission of reports to the Clearinghouse prevents the organization from maintaining compliance with OMB guidelines. Questioned Costs: None Repeat Finding: No Recommendation: The Organization must give a higher priority to its financial reporting cycle to avoid obvious challenges. Management’s Response: Management agrees with the finding.

Assistance Listing Numbers 93.224 Consolidated Health Centers Grant Number H80CS00112 US Department of Health and Human Services Finding 2023-004 Compliance Requirement: Reporting Type of Finding: Material Weakness Criteria: Per CFR Subpart F, the audit, data collection form, and the reporting package must be submitted within 30 calendar days after receipt of report, or nine months after the end of the audit period. Condition: The report for the year ended December 31, 2023, was not filed within the required report submission period. Cause: This condition can be attributed to the extensive turnover in the Clinic’s administrative positions which included the Chief Financial Officer. Financial statements did not receive sufficient attention to be completed and audited in a timely manner. Effect or Potential Effect: Tardiness in financial reporting prevents management from identifying and addressing errors and issues in a timely manner. Late submission of reports to the Clearinghouse prevents the organization from maintaining compliance with OMB guidelines. Questioned Costs: None Repeat Finding: The finding is a repeat finding (See prior year finding number 2022-007) Recommendation: The Organization must give a higher priority to its financial reporting cycle to avoid obvious challenges. Views of Responsible Officials: Management agrees with the finding. Finding 2022-007 Compliance Requirement: Reporting Type of Finding: Material Weakness Criteria: Per CFR Subpart F, the audit, data collection form, and the reporting package must be submitted within 30 calendar days after receipt of report, or nine months after the end of the audit period. Condition: The report for the year ended December 31, 2022 was not filed within the required report submission period. Cause: This condition can be attributed to the extensive turnover in the Clinic’s administrative positions which included the Chief Financial Officer. Financial statements did not receive sufficient attention to be completed and audited in a timely manner. Effect: Tardiness in financial reporting prevents management from identifying and addressing errors and issues in a timely manner. Late submission of reports to the Clearinghouse prevents the organization from maintaining compliance with OMB guidelines. Questioned Costs: None Repeat Finding: No Recommendation: The Organization must give a higher priority to its financial reporting cycle to avoid obvious challenges. Management’s Response: Management agrees with the finding.

Assistance Living Number 93.224 Health Center Programs Grant Award Number H80CS00112 US Department of Health and Human Services Finding 2023-002 Compliance Requirement: Allowable Cost/Cost Principles Type of Finding: Material Weakness Criteria: Uniform Guidance Allowable Costs/Cost Principles addresses activities related to payroll and personnel which should be supported by a system of internal control that provides reasonable assurance that the charges are accurate, allowable, and properly allocated and are incorporated into the official records of the recipient organization. Condition: A walkthrough of fourteen individuals was performed to review personnel files and payroll related to salary for the Organization. Of the fourteen files reviewed, two had no approved current pay rate documented, and the salary or hourly rate paid was not the rate contained in the file. Also, there was no timesheet provided to support the time charged to the federal grant for eleven of the fourteen individuals tested. Cause: Management of the Organization’s human resources and payroll departments experienced substantial turnover during the year and personnel files were not prioritized to keep them in good order. Payroll documentation was not maintained properly. Also, new administrators were unaware that salaried employees who are paid with federal funds, must maintain documentation to support time allocated. Effect or Potential Effect: Without proper documentation, it is not possible to support the appropriate wage rate being paid to an individual. Also, it is not possible to prove an accurate allocation of time charged to a federal grant without time sheets, in accordance with the system that was in use. Questioned Costs: $142,546 Repeat Finding: The finding is a repeat finding (see prior year finding number 2022-005) Recommendation: Recommend that administrators become familiar with time and effort reporting requirements. Consider the use of a checklist within each file as an additional procedure to ensure that each file contains all necessary documents and that the file has been updated for current rates of pay. Views of Responsible Officials: Management agrees with the recommendation and will implement the use of a checklist to improve compliance.

Assistance Living Number 93.224 Health Center Programs Grant Award Number H80CS00112 US Department of Health and Human Services Finding 2023-002 Compliance Requirement: Allowable Cost/Cost Principles Type of Finding: Material Weakness Criteria: Uniform Guidance Allowable Costs/Cost Principles addresses activities related to payroll and personnel which should be supported by a system of internal control that provides reasonable assurance that the charges are accurate, allowable, and properly allocated and are incorporated into the official records of the recipient organization. Condition: A walkthrough of fourteen individuals was performed to review personnel files and payroll related to salary for the Organization. Of the fourteen files reviewed, two had no approved current pay rate documented, and the salary or hourly rate paid was not the rate contained in the file. Also, there was no timesheet provided to support the time charged to the federal grant for eleven of the fourteen individuals tested. Cause: Management of the Organization’s human resources and payroll departments experienced substantial turnover during the year and personnel files were not prioritized to keep them in good order. Payroll documentation was not maintained properly. Also, new administrators were unaware that salaried employees who are paid with federal funds, must maintain documentation to support time allocated. Effect or Potential Effect: Without proper documentation, it is not possible to support the appropriate wage rate being paid to an individual. Also, it is not possible to prove an accurate allocation of time charged to a federal grant without time sheets, in accordance with the system that was in use. Questioned Costs: $142,546 Repeat Finding: The finding is a repeat finding (see prior year finding number 2022-005) Recommendation: Recommend that administrators become familiar with time and effort reporting requirements. Consider the use of a checklist within each file as an additional procedure to ensure that each file contains all necessary documents and that the file has been updated for current rates of pay. Views of Responsible Officials: Management agrees with the recommendation and will implement the use of a checklist to improve compliance.

Assistance Living Number 93.224 Health Center Programs Grant Award Number H80CS00112 US Department of Health and Human Services Finding 2023-002 Compliance Requirement: Allowable Cost/Cost Principles Type of Finding: Material Weakness Criteria: Uniform Guidance Allowable Costs/Cost Principles addresses activities related to payroll and personnel which should be supported by a system of internal control that provides reasonable assurance that the charges are accurate, allowable, and properly allocated and are incorporated into the official records of the recipient organization. Condition: A walkthrough of fourteen individuals was performed to review personnel files and payroll related to salary for the Organization. Of the fourteen files reviewed, two had no approved current pay rate documented, and the salary or hourly rate paid was not the rate contained in the file. Also, there was no timesheet provided to support the time charged to the federal grant for eleven of the fourteen individuals tested. Cause: Management of the Organization’s human resources and payroll departments experienced substantial turnover during the year and personnel files were not prioritized to keep them in good order. Payroll documentation was not maintained properly. Also, new administrators were unaware that salaried employees who are paid with federal funds, must maintain documentation to support time allocated. Effect or Potential Effect: Without proper documentation, it is not possible to support the appropriate wage rate being paid to an individual. Also, it is not possible to prove an accurate allocation of time charged to a federal grant without time sheets, in accordance with the system that was in use. Questioned Costs: $142,546 Repeat Finding: The finding is a repeat finding (see prior year finding number 2022-005) Recommendation: Recommend that administrators become familiar with time and effort reporting requirements. Consider the use of a checklist within each file as an additional procedure to ensure that each file contains all necessary documents and that the file has been updated for current rates of pay. Views of Responsible Officials: Management agrees with the recommendation and will implement the use of a checklist to improve compliance.

Assistance Living Number 93.224 Health Center Programs Grant Award Number H80CS00112 US Department of Health and Human Services Finding 2023-002 Compliance Requirement: Allowable Cost/Cost Principles Type of Finding: Material Weakness Criteria: Uniform Guidance Allowable Costs/Cost Principles addresses activities related to payroll and personnel which should be supported by a system of internal control that provides reasonable assurance that the charges are accurate, allowable, and properly allocated and are incorporated into the official records of the recipient organization. Condition: A walkthrough of fourteen individuals was performed to review personnel files and payroll related to salary for the Organization. Of the fourteen files reviewed, two had no approved current pay rate documented, and the salary or hourly rate paid was not the rate contained in the file. Also, there was no timesheet provided to support the time charged to the federal grant for eleven of the fourteen individuals tested. Cause: Management of the Organization’s human resources and payroll departments experienced substantial turnover during the year and personnel files were not prioritized to keep them in good order. Payroll documentation was not maintained properly. Also, new administrators were unaware that salaried employees who are paid with federal funds, must maintain documentation to support time allocated. Effect or Potential Effect: Without proper documentation, it is not possible to support the appropriate wage rate being paid to an individual. Also, it is not possible to prove an accurate allocation of time charged to a federal grant without time sheets, in accordance with the system that was in use. Questioned Costs: $142,546 Repeat Finding: The finding is a repeat finding (see prior year finding number 2022-005) Recommendation: Recommend that administrators become familiar with time and effort reporting requirements. Consider the use of a checklist within each file as an additional procedure to ensure that each file contains all necessary documents and that the file has been updated for current rates of pay. Views of Responsible Officials: Management agrees with the recommendation and will implement the use of a checklist to improve compliance.

Assistance Living Number 93.224 Health Center Programs Grant Award Number H80CS00112 US Department of Health and Human Services Finding 2023-002 Compliance Requirement: Allowable Cost/Cost Principles Type of Finding: Material Weakness Criteria: Uniform Guidance Allowable Costs/Cost Principles addresses activities related to payroll and personnel which should be supported by a system of internal control that provides reasonable assurance that the charges are accurate, allowable, and properly allocated and are incorporated into the official records of the recipient organization. Condition: A walkthrough of fourteen individuals was performed to review personnel files and payroll related to salary for the Organization. Of the fourteen files reviewed, two had no approved current pay rate documented, and the salary or hourly rate paid was not the rate contained in the file. Also, there was no timesheet provided to support the time charged to the federal grant for eleven of the fourteen individuals tested. Cause: Management of the Organization’s human resources and payroll departments experienced substantial turnover during the year and personnel files were not prioritized to keep them in good order. Payroll documentation was not maintained properly. Also, new administrators were unaware that salaried employees who are paid with federal funds, must maintain documentation to support time allocated. Effect or Potential Effect: Without proper documentation, it is not possible to support the appropriate wage rate being paid to an individual. Also, it is not possible to prove an accurate allocation of time charged to a federal grant without time sheets, in accordance with the system that was in use. Questioned Costs: $142,546 Repeat Finding: The finding is a repeat finding (see prior year finding number 2022-005) Recommendation: Recommend that administrators become familiar with time and effort reporting requirements. Consider the use of a checklist within each file as an additional procedure to ensure that each file contains all necessary documents and that the file has been updated for current rates of pay. Views of Responsible Officials: Management agrees with the recommendation and will implement the use of a checklist to improve compliance.

Assistance Listing Numbers 93.224 Consolidated Health Centers Grant Number H80CS00112 US Department of Health and Human Services Finding 2023-003 Compliance Requirement: Special Tests and Provisions-Sliding Fee Discounts Type of Finding: Material Weakness Criteria: Health centers are required to have a corresponding schedule of discounts applied and adjusted on the basis of the patient’s ability to pay and their eligibility. A patient’s eligibility to pay is determined on the basis of the official poverty guidelines. Condition and Context: Documents to verify income could not be located for six of the twenty-five patients selected for testing. Also, there was no documentation of family size for five of the patients in this sample. The result is that we were unable to determine eligibility for a total of seven of the fourteen tested. Cause: The condition can be attributed to turnover in patient management personnel and the fact that various files were moved off-site and stored without adequate communication to incoming personnel. Effect or Potential Effect: Sliding fee discounts given could potentially be incorrect, or the patient could be ineligible. Questioned Costs: None Repeat Finding: The finding is a repeat finding (see prior year finding number 2022-006) Recommendation: The Organization should be implementing and monitoring procedures to ensure that all supporting documents are kept for determining patient eligibility. Views of Responsible Officials: Management agrees with the finding.

Assistance Listing Numbers 93.224 Consolidated Health Centers Grant Number H80CS00112 US Department of Health and Human Services Finding 2023-003 Compliance Requirement: Special Tests and Provisions-Sliding Fee Discounts Type of Finding: Material Weakness Criteria: Health centers are required to have a corresponding schedule of discounts applied and adjusted on the basis of the patient’s ability to pay and their eligibility. A patient’s eligibility to pay is determined on the basis of the official poverty guidelines. Condition and Context: Documents to verify income could not be located for six of the twenty-five patients selected for testing. Also, there was no documentation of family size for five of the patients in this sample. The result is that we were unable to determine eligibility for a total of seven of the fourteen tested. Cause: The condition can be attributed to turnover in patient management personnel and the fact that various files were moved off-site and stored without adequate communication to incoming personnel. Effect or Potential Effect: Sliding fee discounts given could potentially be incorrect, or the patient could be ineligible. Questioned Costs: None Repeat Finding: The finding is a repeat finding (see prior year finding number 2022-006) Recommendation: The Organization should be implementing and monitoring procedures to ensure that all supporting documents are kept for determining patient eligibility. Views of Responsible Officials: Management agrees with the finding.

Assistance Listing Numbers 93.224 Consolidated Health Centers Grant Number H80CS00112 US Department of Health and Human Services Finding 2023-003 Compliance Requirement: Special Tests and Provisions-Sliding Fee Discounts Type of Finding: Material Weakness Criteria: Health centers are required to have a corresponding schedule of discounts applied and adjusted on the basis of the patient’s ability to pay and their eligibility. A patient’s eligibility to pay is determined on the basis of the official poverty guidelines. Condition and Context: Documents to verify income could not be located for six of the twenty-five patients selected for testing. Also, there was no documentation of family size for five of the patients in this sample. The result is that we were unable to determine eligibility for a total of seven of the fourteen tested. Cause: The condition can be attributed to turnover in patient management personnel and the fact that various files were moved off-site and stored without adequate communication to incoming personnel. Effect or Potential Effect: Sliding fee discounts given could potentially be incorrect, or the patient could be ineligible. Questioned Costs: None Repeat Finding: The finding is a repeat finding (see prior year finding number 2022-006) Recommendation: The Organization should be implementing and monitoring procedures to ensure that all supporting documents are kept for determining patient eligibility. Views of Responsible Officials: Management agrees with the finding.

Assistance Listing Numbers 93.224 Consolidated Health Centers Grant Number H80CS00112 US Department of Health and Human Services Finding 2023-003 Compliance Requirement: Special Tests and Provisions-Sliding Fee Discounts Type of Finding: Material Weakness Criteria: Health centers are required to have a corresponding schedule of discounts applied and adjusted on the basis of the patient’s ability to pay and their eligibility. A patient’s eligibility to pay is determined on the basis of the official poverty guidelines. Condition and Context: Documents to verify income could not be located for six of the twenty-five patients selected for testing. Also, there was no documentation of family size for five of the patients in this sample. The result is that we were unable to determine eligibility for a total of seven of the fourteen tested. Cause: The condition can be attributed to turnover in patient management personnel and the fact that various files were moved off-site and stored without adequate communication to incoming personnel. Effect or Potential Effect: Sliding fee discounts given could potentially be incorrect, or the patient could be ineligible. Questioned Costs: None Repeat Finding: The finding is a repeat finding (see prior year finding number 2022-006) Recommendation: The Organization should be implementing and monitoring procedures to ensure that all supporting documents are kept for determining patient eligibility. Views of Responsible Officials: Management agrees with the finding.

Assistance Listing Numbers 93.224 Consolidated Health Centers Grant Number H80CS00112 US Department of Health and Human Services Finding 2023-003 Compliance Requirement: Special Tests and Provisions-Sliding Fee Discounts Type of Finding: Material Weakness Criteria: Health centers are required to have a corresponding schedule of discounts applied and adjusted on the basis of the patient’s ability to pay and their eligibility. A patient’s eligibility to pay is determined on the basis of the official poverty guidelines. Condition and Context: Documents to verify income could not be located for six of the twenty-five patients selected for testing. Also, there was no documentation of family size for five of the patients in this sample. The result is that we were unable to determine eligibility for a total of seven of the fourteen tested. Cause: The condition can be attributed to turnover in patient management personnel and the fact that various files were moved off-site and stored without adequate communication to incoming personnel. Effect or Potential Effect: Sliding fee discounts given could potentially be incorrect, or the patient could be ineligible. Questioned Costs: None Repeat Finding: The finding is a repeat finding (see prior year finding number 2022-006) Recommendation: The Organization should be implementing and monitoring procedures to ensure that all supporting documents are kept for determining patient eligibility. Views of Responsible Officials: Management agrees with the finding.

Assistance Listing Numbers 93.224 Consolidated Health Centers Grant Number H80CS00112 US Department of Health and Human Services Finding 2023-004 Compliance Requirement: Reporting Type of Finding: Material Weakness Criteria: Per CFR Subpart F, the audit, data collection form, and the reporting package must be submitted within 30 calendar days after receipt of report, or nine months after the end of the audit period. Condition: The report for the year ended December 31, 2023, was not filed within the required report submission period. Cause: This condition can be attributed to the extensive turnover in the Clinic’s administrative positions which included the Chief Financial Officer. Financial statements did not receive sufficient attention to be completed and audited in a timely manner. Effect or Potential Effect: Tardiness in financial reporting prevents management from identifying and addressing errors and issues in a timely manner. Late submission of reports to the Clearinghouse prevents the organization from maintaining compliance with OMB guidelines. Questioned Costs: None Repeat Finding: The finding is a repeat finding (See prior year finding number 2022-007) Recommendation: The Organization must give a higher priority to its financial reporting cycle to avoid obvious challenges. Views of Responsible Officials: Management agrees with the finding. Finding 2022-007 Compliance Requirement: Reporting Type of Finding: Material Weakness Criteria: Per CFR Subpart F, the audit, data collection form, and the reporting package must be submitted within 30 calendar days after receipt of report, or nine months after the end of the audit period. Condition: The report for the year ended December 31, 2022 was not filed within the required report submission period. Cause: This condition can be attributed to the extensive turnover in the Clinic’s administrative positions which included the Chief Financial Officer. Financial statements did not receive sufficient attention to be completed and audited in a timely manner. Effect: Tardiness in financial reporting prevents management from identifying and addressing errors and issues in a timely manner. Late submission of reports to the Clearinghouse prevents the organization from maintaining compliance with OMB guidelines. Questioned Costs: None Repeat Finding: No Recommendation: The Organization must give a higher priority to its financial reporting cycle to avoid obvious challenges. Management’s Response: Management agrees with the finding.

Assistance Listing Numbers 93.224 Consolidated Health Centers Grant Number H80CS00112 US Department of Health and Human Services Finding 2023-004 Compliance Requirement: Reporting Type of Finding: Material Weakness Criteria: Per CFR Subpart F, the audit, data collection form, and the reporting package must be submitted within 30 calendar days after receipt of report, or nine months after the end of the audit period. Condition: The report for the year ended December 31, 2023, was not filed within the required report submission period. Cause: This condition can be attributed to the extensive turnover in the Clinic’s administrative positions which included the Chief Financial Officer. Financial statements did not receive sufficient attention to be completed and audited in a timely manner. Effect or Potential Effect: Tardiness in financial reporting prevents management from identifying and addressing errors and issues in a timely manner. Late submission of reports to the Clearinghouse prevents the organization from maintaining compliance with OMB guidelines. Questioned Costs: None Repeat Finding: The finding is a repeat finding (See prior year finding number 2022-007) Recommendation: The Organization must give a higher priority to its financial reporting cycle to avoid obvious challenges. Views of Responsible Officials: Management agrees with the finding. Finding 2022-007 Compliance Requirement: Reporting Type of Finding: Material Weakness Criteria: Per CFR Subpart F, the audit, data collection form, and the reporting package must be submitted within 30 calendar days after receipt of report, or nine months after the end of the audit period. Condition: The report for the year ended December 31, 2022 was not filed within the required report submission period. Cause: This condition can be attributed to the extensive turnover in the Clinic’s administrative positions which included the Chief Financial Officer. Financial statements did not receive sufficient attention to be completed and audited in a timely manner. Effect: Tardiness in financial reporting prevents management from identifying and addressing errors and issues in a timely manner. Late submission of reports to the Clearinghouse prevents the organization from maintaining compliance with OMB guidelines. Questioned Costs: None Repeat Finding: No Recommendation: The Organization must give a higher priority to its financial reporting cycle to avoid obvious challenges. Management’s Response: Management agrees with the finding.

Assistance Listing Numbers 93.224 Consolidated Health Centers Grant Number H80CS00112 US Department of Health and Human Services Finding 2023-004 Compliance Requirement: Reporting Type of Finding: Material Weakness Criteria: Per CFR Subpart F, the audit, data collection form, and the reporting package must be submitted within 30 calendar days after receipt of report, or nine months after the end of the audit period. Condition: The report for the year ended December 31, 2023, was not filed within the required report submission period. Cause: This condition can be attributed to the extensive turnover in the Clinic’s administrative positions which included the Chief Financial Officer. Financial statements did not receive sufficient attention to be completed and audited in a timely manner. Effect or Potential Effect: Tardiness in financial reporting prevents management from identifying and addressing errors and issues in a timely manner. Late submission of reports to the Clearinghouse prevents the organization from maintaining compliance with OMB guidelines. Questioned Costs: None Repeat Finding: The finding is a repeat finding (See prior year finding number 2022-007) Recommendation: The Organization must give a higher priority to its financial reporting cycle to avoid obvious challenges. Views of Responsible Officials: Management agrees with the finding. Finding 2022-007 Compliance Requirement: Reporting Type of Finding: Material Weakness Criteria: Per CFR Subpart F, the audit, data collection form, and the reporting package must be submitted within 30 calendar days after receipt of report, or nine months after the end of the audit period. Condition: The report for the year ended December 31, 2022 was not filed within the required report submission period. Cause: This condition can be attributed to the extensive turnover in the Clinic’s administrative positions which included the Chief Financial Officer. Financial statements did not receive sufficient attention to be completed and audited in a timely manner. Effect: Tardiness in financial reporting prevents management from identifying and addressing errors and issues in a timely manner. Late submission of reports to the Clearinghouse prevents the organization from maintaining compliance with OMB guidelines. Questioned Costs: None Repeat Finding: No Recommendation: The Organization must give a higher priority to its financial reporting cycle to avoid obvious challenges. Management’s Response: Management agrees with the finding.

Assistance Listing Numbers 93.224 Consolidated Health Centers Grant Number H80CS00112 US Department of Health and Human Services Finding 2023-004 Compliance Requirement: Reporting Type of Finding: Material Weakness Criteria: Per CFR Subpart F, the audit, data collection form, and the reporting package must be submitted within 30 calendar days after receipt of report, or nine months after the end of the audit period. Condition: The report for the year ended December 31, 2023, was not filed within the required report submission period. Cause: This condition can be attributed to the extensive turnover in the Clinic’s administrative positions which included the Chief Financial Officer. Financial statements did not receive sufficient attention to be completed and audited in a timely manner. Effect or Potential Effect: Tardiness in financial reporting prevents management from identifying and addressing errors and issues in a timely manner. Late submission of reports to the Clearinghouse prevents the organization from maintaining compliance with OMB guidelines. Questioned Costs: None Repeat Finding: The finding is a repeat finding (See prior year finding number 2022-007) Recommendation: The Organization must give a higher priority to its financial reporting cycle to avoid obvious challenges. Views of Responsible Officials: Management agrees with the finding. Finding 2022-007 Compliance Requirement: Reporting Type of Finding: Material Weakness Criteria: Per CFR Subpart F, the audit, data collection form, and the reporting package must be submitted within 30 calendar days after receipt of report, or nine months after the end of the audit period. Condition: The report for the year ended December 31, 2022 was not filed within the required report submission period. Cause: This condition can be attributed to the extensive turnover in the Clinic’s administrative positions which included the Chief Financial Officer. Financial statements did not receive sufficient attention to be completed and audited in a timely manner. Effect: Tardiness in financial reporting prevents management from identifying and addressing errors and issues in a timely manner. Late submission of reports to the Clearinghouse prevents the organization from maintaining compliance with OMB guidelines. Questioned Costs: None Repeat Finding: No Recommendation: The Organization must give a higher priority to its financial reporting cycle to avoid obvious challenges. Management’s Response: Management agrees with the finding.

Assistance Listing Numbers 93.224 Consolidated Health Centers Grant Number H80CS00112 US Department of Health and Human Services Finding 2023-004 Compliance Requirement: Reporting Type of Finding: Material Weakness Criteria: Per CFR Subpart F, the audit, data collection form, and the reporting package must be submitted within 30 calendar days after receipt of report, or nine months after the end of the audit period. Condition: The report for the year ended December 31, 2023, was not filed within the required report submission period. Cause: This condition can be attributed to the extensive turnover in the Clinic’s administrative positions which included the Chief Financial Officer. Financial statements did not receive sufficient attention to be completed and audited in a timely manner. Effect or Potential Effect: Tardiness in financial reporting prevents management from identifying and addressing errors and issues in a timely manner. Late submission of reports to the Clearinghouse prevents the organization from maintaining compliance with OMB guidelines. Questioned Costs: None Repeat Finding: The finding is a repeat finding (See prior year finding number 2022-007) Recommendation: The Organization must give a higher priority to its financial reporting cycle to avoid obvious challenges. Views of Responsible Officials: Management agrees with the finding. Finding 2022-007 Compliance Requirement: Reporting Type of Finding: Material Weakness Criteria: Per CFR Subpart F, the audit, data collection form, and the reporting package must be submitted within 30 calendar days after receipt of report, or nine months after the end of the audit period. Condition: The report for the year ended December 31, 2022 was not filed within the required report submission period. Cause: This condition can be attributed to the extensive turnover in the Clinic’s administrative positions which included the Chief Financial Officer. Financial statements did not receive sufficient attention to be completed and audited in a timely manner. Effect: Tardiness in financial reporting prevents management from identifying and addressing errors and issues in a timely manner. Late submission of reports to the Clearinghouse prevents the organization from maintaining compliance with OMB guidelines. Questioned Costs: None Repeat Finding: No Recommendation: The Organization must give a higher priority to its financial reporting cycle to avoid obvious challenges. Management’s Response: Management agrees with the finding.