Audit 405779

Health Center Program Cluster ALN Nos. 93.224 and 93.527 U.S. Department of Health and Human Services Award No. 2 H80CS00800, June 1, 2023 - May 31, 2024 Award No. 5 H80CS00800, June 1, 2022 - May 31, 2023 Award No. 2 H8FCS41036, April 1, 2023 - March 31, 2023 Criteria or Specific Requirement – Procurement, Suspension & Debarment – 2 CFR 200.320 Condition – The Organization did not comply with their policy governing procurement requirements for the purchase of goods and services charged to federal awards. Cause – Support was not maintained for the procurement policy being followed including bids that were required to be obtained. Effect or potential effect – A competitive bidding process may not have been followed within the guidelines or the procurement policy. Questioned cost – Unknown Context – A sample of two procurements were tested out of the total population of 17 procurements. The sampling methodology used is not and is not intended to be statistically valid. One procurement tested did not maintain proper support that the procurement process was followed. Identification as a repeat finding, if applicable – Repeat finding, see 2022-005 Recommendation – We recommend management maintains support for all bids obtained and the conclusions reached as part of the procurement process. Views of responsible officials and planned corrective actions - Management agrees with the recommendation to maintain support for all bids obtained and the conclusions reached as part of the procurement process. The procurement audit sample contained expenses incurred by a Provider Staffing Agency. We were unable to provide support that we obtained multiple bids from staffing agencies. Going forward we will confirm rates via email and maintain the documentation supporting the fact that we are obtaining quotations from an adequate number of qualified sources. In addition, the following actions are being taken: • The Procurement Policy is being sent out to all relevant personnel to remind them of the procedures that must be followed before making purchases greater than $25,000. • Personnel will be required to send in the quotes from the qualified sources at the time the purchase order is submitted. Anticipated date of completion: December 31, 2026

Health Center Program Cluster ALN Nos. 93.224 and 93.527 U.S. Department of Health and Human Services Award No.2 H80CS00800, June 1, 2023 - May 31, 2024 Award No.5 H80CS00800, June 1, 2022 - May 31, 2023 Award No.3 H8FCS41036, April 1, 2021 - March 31, 2023 Criteria or Specific Requirement – Reporting – 2 CFR 200.328 and 2 CFR 200.329 Condition – The Organization is required to prepare and submit an annual Uniform Data System (UDS) report for each calendar year and an annual Federal Financial Report (FFR) for each grant year for the Health Center Cluster. These reports are to be prepared using accurate financial information. Cause – The Organization was unable to provide supporting documentation that agreed to the line items tested in the reports. The Organization’s practice management system was incorrectly set up to classify certain adjustments as sliding fee discounts and a manual correction was not made during the preparation of the UDS report. Effect or Potential Effect – Potential errors were made on the annual UDS and FFR reports. Questioned Cost – None Context – The annual UDS report and annual FFR were selected for testing out of total population of three reports. The sampling methodology used is not and is not intended to be statistically valid. Of the ten inputs tested, five exceptions were noted related to the annual UDS report. The FFR report tested was not accurately reported or could not be properly supported. Identification as a repeat finding, if applicable – Not a repeat finding. Recommendation – Management should follow established policies and procedures to ensure the required reports are prepared using accurate information and supporting documentation for federal grant reports are maintained. Views of responsible officials and planned corrective actions - Management agrees with the recommendation to ensure the required reports are prepared using accurate information and supporting documentation for federal grant reports are maintained. • All system generated reports will be maintained in the preparation of the UDS and FFR reports. • A report will be run out of the practice management system identifying qualified sliding fee discounts to be included in the UDS report. Anticipated date of completion: December 31, 2026 Contact person responsible – Margaret Boemmel, CFO