Audit 368577

FY End
2024-12-31
Total Expended
$16.62M
Findings
90
Programs
38
Year: 2024 Accepted: 2025-09-29

Organization Exclusion Status:

Checking exclusion status...

Findings

ID Ref Severity Repeat Requirement
1156219 2024-003 Material Weakness Yes C
1156220 2024-003 Material Weakness Yes C
1156221 2024-003 Material Weakness Yes C
1156222 2024-003 Material Weakness Yes C
1156223 2024-003 Material Weakness Yes C
1156224 2024-003 Material Weakness Yes C
1156225 2024-003 Material Weakness Yes C
1156226 2024-003 Material Weakness Yes C
1156227 2024-003 Material Weakness Yes C
1156228 2024-003 Material Weakness Yes C
1156229 2024-003 Material Weakness Yes C
1156230 2024-003 Material Weakness Yes C
1156231 2024-003 Material Weakness Yes C
1156232 2024-003 Material Weakness Yes C
1156233 2024-003 Material Weakness Yes C
1156234 2024-001 Material Weakness Yes L
1156235 2024-002 Material Weakness Yes M
1156236 2024-003 Material Weakness Yes C
1156237 2024-003 Material Weakness Yes C
1156238 2024-003 Material Weakness Yes C
1156239 2024-003 Material Weakness Yes C
1156240 2024-003 Material Weakness Yes C
1156241 2024-003 Material Weakness Yes C
1156242 2024-003 Material Weakness Yes C
1156243 2024-001 Material Weakness Yes L
1156244 2024-003 Material Weakness Yes C
1156245 2024-003 Material Weakness Yes C
1156246 2024-003 Material Weakness Yes C
1156247 2024-003 Material Weakness Yes C
1156248 2024-003 Material Weakness Yes C
1156249 2024-003 Material Weakness Yes C
1156250 2024-003 Material Weakness Yes C
1156251 2024-003 Material Weakness Yes C
1156252 2024-003 Material Weakness Yes C
1156253 2024-003 Material Weakness Yes C
1156254 2024-003 Material Weakness Yes C
1156255 2024-003 Material Weakness Yes C
1156256 2024-003 Material Weakness Yes C
1156257 2024-003 Material Weakness Yes C
1156258 2024-003 Material Weakness Yes C
1156259 2024-003 Material Weakness Yes C
1156260 2024-003 Material Weakness Yes C
1156261 2024-003 Material Weakness Yes C
1156262 2024-003 Material Weakness Yes C
1156263 2024-003 Material Weakness Yes C
1156264 2024-003 Material Weakness Yes C
1156265 2024-003 Material Weakness Yes C
1156266 2024-003 Material Weakness Yes C
1156267 2024-003 Material Weakness Yes C
1156268 2024-003 Material Weakness Yes C
1156269 2024-003 Material Weakness Yes C
1156270 2024-003 Material Weakness Yes C
1156271 2024-003 Material Weakness Yes C
1156272 2024-003 Material Weakness Yes C
1156273 2024-003 Material Weakness Yes C
1156274 2024-003 Material Weakness Yes C
1156275 2024-003 Material Weakness Yes C
1156276 2024-003 Material Weakness Yes C
1156277 2024-003 Material Weakness Yes C
1156278 2024-003 Material Weakness Yes C
1156279 2024-003 Material Weakness Yes C
1156280 2024-003 Material Weakness Yes C
1156281 2024-003 Material Weakness Yes C
1156282 2024-003 Material Weakness Yes C
1156283 2024-003 Material Weakness Yes C
1156284 2024-003 Material Weakness Yes C
1156285 2024-003 Material Weakness Yes C
1156286 2024-003 Material Weakness Yes C
1156287 2024-003 Material Weakness Yes C
1156288 2024-003 Material Weakness Yes C
1156289 2024-003 Material Weakness Yes C
1156290 2024-003 Material Weakness Yes C
1156291 2024-003 Material Weakness Yes C
1156292 2024-003 Material Weakness Yes C
1156293 2024-003 Material Weakness Yes C
1156294 2024-003 Material Weakness Yes C
1156295 2024-003 Material Weakness Yes C
1156296 2024-003 Material Weakness Yes C
1156297 2024-003 Material Weakness Yes C
1156298 2024-003 Material Weakness Yes C
1156299 2024-003 Material Weakness Yes C
1156300 2024-003 Material Weakness Yes C
1156301 2024-003 Material Weakness Yes C
1156302 2024-003 Material Weakness Yes C
1156303 2024-003 Material Weakness Yes C
1156304 2024-003 Material Weakness Yes C
1156305 2024-003 Material Weakness Yes C
1156306 2024-003 Material Weakness Yes C
1156307 2024-003 Material Weakness Yes C
1156308 2024-003 Material Weakness Yes C

Programs

ALN Program Spent Major Findings
93.866 Aging Research $1.16M Yes 1
93.323 Covid-19 Epidemiology and Laboratory Capacity for Infectious Diseases (elc) $1.07M Yes 2
93.242 Mental Health Research Grants $775,500 Yes 1
21.027 Covid-19 Coronavirus State and Local Fiscal Recovery Funds $582,530 Yes 0
93.391 Covid-19 Activities to Support State, Tribal, Local and Territorial (stlt)health Department Response to Public Health Or Healthcare Crisis $525,406 Yes 1
93.350 National Center for Advancing Translational Sciences $448,957 Yes 1
93.368 21st Century Cures Act - Precision Medicine Initiative $303,736 Yes 1
93.172 Human Genome Research $286,291 Yes 1
93.838 Lung Diseases Research $198,571 Yes 1
16.560 National Institute of Justice Research, Evaluation, and Development Project Grants $180,535 Yes 0
93.351 Research Infrastrcuture Programs $157,600 Yes 1
93.837 Cardiovascular Disease Research $108,016 Yes 1
93.994 Maternal and Child Health Services Block Grant to the States $100,083 Yes 0
93.268 Immunization Research, Demonstration, Public Information and Education Training and Clinical Skills Improvement Projects $92,586 Yes 0
93.859 Biomedical Research and Research Training $89,868 Yes 1
93.946 Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs $66,500 Yes 0
93.671 Family Violence Prevention and Services/domestic Violence Shelter and Supportive Seevices $66,397 Yes 0
93.865 Child Health and Human Development Extramural Research $61,357 Yes 1
14.218 Community Development Block Grants/entitlement Grants $34,846 Yes 0
93.395 Cancer Treatment Research $31,725 Yes 1
93.399 Cancer Control $26,068 Yes 1
93.847 Diabetes, Digestive, and Kidney Diseases Extramural Research $24,024 Yes 1
93.226 Research on Healthcare Costs, Quality and Outcomes $22,635 Yes 1
93.855 Allergy, Immunology and Transplantation Research $19,234 Yes 1
12.420 Military Medical Research and Development $17,771 Yes 1
93.396 Cancer Biology Research $17,301 Yes 1
93.110 Maternal and Child Health Federal Consolidated Programs $16,507 Yes 1
93.353 Cancer Treatment Research $16,200 Yes 1
93.307 Minority Health and Health Disparities Research $12,526 Yes 1
93.397 Cancer Center Support Grants $10,797 Yes 1
93.889 National Bioterrorism Hospital Preparedness Program $10,000 Yes 0
93.839 Blood Diseases and Resources Research $7,626 Yes 1
93.853 Extramural Research Programs in the Neurosciences and Neurological Disorders $7,192 Yes 1
93.935 Project Grants for Renovation Or Construction at Tertiary Perinatal Facilities $5,000 Yes 1
93.361 Nursing Research $4,563 Yes 1
93.667 Social Services Block Grant $2,346 Yes 1
93.394 Cancer Detetction and Diagnosis Research $356 Yes 1
93.310 Trans-Nih Research Support $-10,837 Yes 1

Contacts

Name Title Type
MBKKNQM9QME3 Annaliza Villamin Auditee
8476184642 David Nathan Auditor
No contacts on file

Notes to SEFA

Endeavor Health (the Company) received federal funding through grants and contracts with certain federal agencies and subcontracts with various other agencies. All expenditures related to the federal awards are included in the Schedule of Expenditures of Federal Awards (SEFA).
The accompanying SEFA is presented on the accrual basis of accounting. The information in the SEFA is presented in accordance with the requirements of Title 2 U.S. Code of Federal Regulations Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (Uniform Guidance). Therefore, some amounts presented in the SEFA may differ from amounts presented in or used in the preparation of the financial statements.
The Company did not use the 10% de minimis indirect cost rate allowed by the Uniform Guidance.

Finding Details

Finding 2024-002 – Subrecipient MonitoringInformation of the federal program:Federal Grantor: United States Department of Health and Human ServicesPass-Through Grantor: Chicago Department of Public HealthAssistance Listing No.: 93.323, COVID-19 Epidemiology and Laboratory Capacity for Infectious Diseases (ELC)Criteria or Specific Requirement (Including Statutory, Regulatory, or Other Citation):Section 200.303 of the Uniform Guidance states the following regarding internal control: “The non-Federal entity must: (a) Establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non-Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. These internal controls should be in compliance with guidance in “Standards for Internal Control in the Federal Government” issued by the Comptroller General of the United States or the “Internal Control Integrated Framework,” issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO).”Section 200.332 of the Uniform Guidance states that all pass-through entities must:“(b) Evaluate each subrecipient’s risk of noncompliance with Federal statutes, regulations, and the terms and conditions of the subaward for purposes of determining the appropriate subrecipient monitoring described in paragraphs (d) and (e) of this section, which may include consideration of such factors as:(1) The subrecipient’s prior experience with the same or similar subawards,(2) The results of previous audits including whether or not the subrecipient receives a Single Audit in accordance with Subpart F Audit Requirements of this part, and the extent to which the same or similar subaward has been audited as a major program,(3) Whether the subrecipient has new personnel or new or substantially changed systems, and(4) The extent and results of Federal awarding agency monitoring (e.g., if the subrecipient also receives Federal awards directly from a Federal awarding agency).”Section 200.332 of the Uniform Guidance further states that all pass-through entities must:“(g) Consider whether the results of the subrecipient’s audits, on-site reviews, or other monitoring indicate conditions that necessitate adjustments to the pass-through entity’s own records.”Condition:Although subrecipient monitoring procedures were performed during the fiscal year, management did not perform and document a risk assessment upon entering into subaward agreements with its subrecipients in order to determine the extent of monitoring procedures that should be performed to be responsive to the assessed risk. In addition, management did not obtain the Uniform Guidance audit report from its subrecipients.Cause:Management did not have internal controls in place that required completion of the documentation evidencing review of the risk assessment of the subrecipients at the beginning of the award and monitoring of the Uniform Guidance audit reports of the subrecipients. The documentation was not completed as management considered the subrecipients to be vendors.Questioned costs:None.Context:Total federal expenditures passed through to subrecipients that required a risk assessment of and review of the Uniform Guidance audit report reported in the Schedule were $646,101, representing 60% of total ELC expenditures of $1,069,344 for the year ended December 31, 2024.Effect or potential effect:Monitoring performed over a subrecipient may not be responsive to the risk for that subrecipient. A subrecipient’s Uniform Guidance audit report could contain findings that are not properly reviewed and evaluated.Identification as a repeat finding, if applicable:The finding is not a repeat finding.Recommendation:Management should establish written internal controls and procedures related to subrecipient risk assessments in accordance with Uniform Guidance Section 200.33 2(b). In addition, Endeavor should modify the subrecipient Uniform Guidance audit report review process to include a section for Endeavor to document its review of and conclusions reached over the subrecipient’s Uniform Guidance audit report.Views of Responsible Officials:Management acknowledges the findings regarding subrecipient monitoring. The oversight occurred because a risk assessment was not conducted prior to entering into subaward agreements during the reporting period. We recognize the importance of ensuring that subrecipients comply with federal requirements, and we understand that effective monitoring is a key responsibility of the pass-through entity. Going forward, subrecipient monitoring will be integrated into all new subaward agreements to ensure adherence to federal requirements.
Finding 2024-001 – ReportingInformation of the federal program:Federal Grantor: Department of Health and Human Services (HHS)Assistance Listing No.: 93.391, COVID-19 Activities to Support State, Tribal, Local and Territorial (STLT) Health Department Response to Public Health or Healthcare CrisisPass-Through Grantor: Chicago Department of Public HealthFederal Grantor: Department of Health and Human Services (HHS)Assistance Listing No.: 93.323, COVID-19 Epidemiology and Laboratory Capacity for Infectious DiseasesPass-Through Grantor: Chicago Department of Public HealthCriteria or specific requirement (including statutory, regulatory, or other citation):Section 200.303 of the Uniform Guidance states the following regarding internal control: “The non-Federal entity must: (a) Establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non-Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. These internal controls should be in compliance with guidance in “Standards for Internal Control in the Federal Government” issued by the Comptroller General of the United States or the “Internal Control Integrated Framework,” issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO).”The Uniform Guidance 2 CFR section 200.510 states, “(b) Schedule of expenditures of Federal awards. The auditee must also prepare a schedule of expenditures of federal awards (SEFA) for the period covered by the auditee’s financial statements which must include the total Federal awards expended as determined in accordance with §200.502 Basis for determining Federal awards expended.”Condition:Certain expenditures related to the COVID-19 Activities to Support State, Tribal, Local and Territorial (STLT) Health Department Response to Public Health or Healthcare Crisis and the COVID-19 Epidemiology and Laboratory Capacity for Infectious Diseases were overstated by $347,352 and $164,120, respectively, on the preliminary schedule of expenditures of federal awards (the Schedule) provided by management due to the inappropriate classification of costs within the general ledger; the final Schedule was corrected.Cause:Endeavor’s internal controls over the preparation of the Schedule were not sufficient to properly accumulate and accurately report all expenditures of federal awards.Effect or Potential Effect:Inaccurate or improper reporting of expenditures results in a misstated Schedule and can also potentially result in insufficient testing of the major programs or improper identification of major programs for audit purposes.Questioned costs:None.Context:Endeavor reported expenditures of $872,758 on the preliminary SEFA, but on the final SEFA reported $525,406 related to the COVID-19 Activities to Support State, Tribal, Local and Territorial (STLT) Health Department Response to Public Health or Healthcare Crisis. Endeavor reported expenditures of $1,233,464 on the preliminary SEFA, but on the final SEFA reported $1,069,344 related to the COVID-19 Epidemiology and Laboratory Capacity for Infectious Diseases.Identification as a repeat finding, if applicable:This is a repeat finding of 2023-001.Recommendation:Management should implement internal controls to ensure amounts are appropriately accumulated and reported on the Schedule and all federal expenditures are appropriately identified and reported on the Schedule.Views of responsible officials:Management acknowledges the findings related to SEFA reporting. The issue arose from miscommunication in determining which expenditures should be reported for the programs in question. We recognize the importance of accurate and complete reporting. We will enhance our review and communication processes to ensure clarity between program managers and the finance team when identifying reportable expenditures. We have already taken steps to address this issue by:• Creating a new policy and procedure for SEFA reporting and establishing clear guidance and documentation for expenses that should be included in the SEFA.• Implementing an expanded review process to ensure accuracy prior to submission.
Finding 2024-003 – Subrecipient Cash ManagementIdentification of the federal program:Federal Grantor: Department of Health and Human Services (HHS)Assistance Listing No.: 12.420, Military Medical Research and DevelopmentGrant Award: W81XWH2010210Federal Grantor: Department of Health and Human Services (HHS)Assistance Listing No.: 93.395, Cancer Treatment ResearchGrant Award: R01CA248574Federal Grantor: Department of Health and Human Services (HHS)Assistance Listing No.: 93.847, Diabetes, Digestive, and Kidney Diseases Extramural ResearchGrant Award: R01DK133328Criteria or specific requirement (including statutory, regulatory or other citation):Section 200.303 of the Uniform Guidance states the following regarding internal control: “The non-Federal entity must: (a) Establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non-Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. These internal controls should be in compliance with guidance in “Standards for Internal Control in the Federal Government” issued by the Comptroller General of the United States or the “Internal Control Integrated Framework,” issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO).”2 CFR 200.305 (c) states, “…the Federal agency or pass-through entity must make payment within 30 calendar days after receipt of the payment request unless the Federal agency or pass-through entity reasonably believes the request to be improper.”Condition:Management did not have sufficiently designed internal controls to ensure all payments made to subrecipients were made within the required time frames.Cause:Management did not ensure that all subrecipient cash payments were made within the required time frame.Effect or potential effect:Subrecipients are not paid within the time frame established in the Uniform Guidance.Questioned costs:None.Context:We tested a sample of 10 subrecipient payments, and identified 4 payments that were not paid within 30 days of receipt. Total expenditures for the Research and Development Cluster were $13,427,764 at December 31, 2024. Total subrecipient expenditures for the year ended December 31, 2024, were $2,133,172.Identification as a repeat finding, if applicable:This finding is not a repeat finding from the prior year.Recommendation:Management should ensure subrecipient payments are made within the required time frames included in the Uniform Guidance.Views of responsible officials:Management concurs with the finding and will increase the priority around the 30-day processing deadline mandated by the Uniform Guidance 2 FR 200.305 (b)(3), including review of current processes, policies, and procedures to minimize the time between invoice receipt and the transfer of federal funds to the subrecipient.