Audit 413186

Assistance Living Number 93.224 Community Health Centers Grant Award Number H80CS00112 US Department of Health and Human Services Finding 2025-002 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, one did not contain a signed I-9 Form and one was missing an application/resume. Also, there was no time sheet provided to support the time charged to the federal grant for two of the fourteen individuals tested. Cause: Management of the Organization’s human resources area turned over several times during the past few years and personnel files were not prioritized during those years. The current human resources manager was tasked with restructuring and automating personnel files to keep them in good order and in accordance with the Organization’s policy. During this process it appears that a few documents may have escaped attention. Previously, new administrators were unaware that salaried employees who are paid with federal funds must maintain documentation to support time allocated to the federal grant. Although this requirement was adopted in 2025, enforcement was not sufficient to prevent some unsupported payments of salary. 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: $177,488 Repeat Finding: The finding is a repeat finding (see prior year finding number 2024-003). Recommendation: We recommend that management enhance enforcement of its policy that all salaried staff prepare time sheets to meet the time and effort reporting requirement. Also, consideration should be given to having a second review of the checklist in place to ensure that all necessary documents have been included in each file. 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 Community Health Centers Grant Number H80CS00112 US Department of Health and Human Services Finding 2025-003 Compliance Requirement: Special Tests and Provisions-Sliding Fee Discounts Type of Finding: Material Weakness Criteria: Health centers are required to adjust the amounts owed for health center services based 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: Of the twenty-five patients selected for testing the Federal Poverty Guideline (FPG), thirteen files did not contain verification that the patient had no income. Also, 5 files did not contain evidence of review by the Health Center’s staff. Cause: The condition can be attributed to a control step that was eliminated when the system for documenting these files was automated. Effect or Potential Effect: Patients may have received discounts greater than the amount they were eligible to receive. Questioned Costs: None Repeat Finding: The is not a repeat finding. Recommendation: The Organization should be revisit the control steps used to determine sliding fee and consider adding a process to make sure that patient’s representation of no income is independently verified and that staff always sign off that the process of verification is complete. Views of Responsible Officials: Management agrees with the finding.

Assistance Listing Numbers 93.224 Community Health Centers Grant Number H80CS00112 US Department of Health and Human Services Finding 2025-004 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, 2024, 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 Senior Accountant. Financial statements did not receive sufficient attention to be completed and submitted to the independent auditor in time to meet the reporting deadline. 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 2024-004). Recommendation: The Organization must give higher priority to its financial reporting cycle to avoid late submission of required reports. Views of Responsible Officials: Management agrees with the finding.