Criteria: The Code of Federal Regulations (CFR) Section 200.510(b) states in part, “The auditee must also prepare a schedule of federal expenditures for the period covered by the auditee’s consolidated financial statements which must include the total Federal awards expended as determined in accordance with 200.502.” Condition: During our review of the December 31, 2023 Schedule of Expenditures of Federal Awards (SEFA) prepared by management, we noted that controls over the preparation of the SEFA were not properly designed resulting in adjustments to the SEFA for amounts passed through to subrecipients that were identified during the audit. Questioned Costs: N/A Cause and Effect: Internal controls over preparation of the SEFA are not operating effectively to ensure accuracy of the final SEFA. As a result of the condition noted above, certain adjustments were required to be made to the final SEFA. Recommendation: We recommend management review current internal controls over preparation and tracking of federal expenditures to ensure that all federal awards are captured and reported in the correct period and that internal controls are properly designed to detect and correct errors to the SEFA. Views of Responsible Officials and Planned Corrective Actions: Management agrees with this Single Audit Finding and response is included in the Corrective Action Plan.
Criteria: The Code of Federal Regulations (CFR) Section 200.510(b) states in part, “The auditee must also prepare a schedule of federal expenditures for the period covered by the auditee’s consolidated financial statements which must include the total Federal awards expended as determined in accordance with 200.502.” Condition: During our review of the December 31, 2023 Schedule of Expenditures of Federal Awards (SEFA) prepared by management, we noted that controls over the preparation of the SEFA were not properly designed resulting in adjustments to the SEFA for amounts passed through to subrecipients that were identified during the audit. Questioned Costs: N/A Cause and Effect: Internal controls over preparation of the SEFA are not operating effectively to ensure accuracy of the final SEFA. As a result of the condition noted above, certain adjustments were required to be made to the final SEFA. Recommendation: We recommend management review current internal controls over preparation and tracking of federal expenditures to ensure that all federal awards are captured and reported in the correct period and that internal controls are properly designed to detect and correct errors to the SEFA. Views of Responsible Officials and Planned Corrective Actions: Management agrees with this Single Audit Finding and response is included in the Corrective Action Plan.
Schedule of Expenditures of Federal Awards (SEFA) Federal Agency: U.S. Department of Health and Human Services; U.S. Department of Agriculture (USDA) Program: National Bioterrorism Hospital Preparedness Program (ALN 93.889); Immunization Cooperative Agreements (ALN 93. 268); COVID-19 Epidemiology and Laboratory Capacity for Infectious Diseases (ELC)(ALN 93. 323); Child Support Services (ALN 93. 563); State Administrative Matching Grants for the Supplemental Nutrition Assistance Program (ALN 10.561) Pass-through Entity: Minnesota Department of Health; Minnesota Department of Human Services Federal Assistance Identification Number or Pass-Through Number: U90TP000529; 6NH23P0007370502; NH23P922628; NH23IP922628; NU50CK000508; 2001MNCEST; 2101MNCSES; 212MN127Q7503; 212MN101S2520; 212MN101S2514 Federal Award Year: Year ended December 31, 2023 Type of Finding: Significant Deficiency in Internal Control over Compliance; Other Matter Compliance Finding Criteria: 2 CFR 200.303(a) requires that each non-Federal entity must "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." 2 CFR 200.510(b) requires that “The auditee must prepare a schedule of expenditures of Federal awards awards (the “schedule”) for the period covered by the auditee’s financial statements which must include the total Federal awards expended as determined in accordance with ss 200.502... ...At minimum, the schedule must... ...(3) Provide total Federal awards expended for each individual Federal program and the Assistance Listings Number or other identifying number when the Assistance Listings information is not available…” Condition: While testing the SEFA, we noted that internal controls were not operating effectively over the preparation of the SEFA. In addition, we noted the following errors in the original SEFA we received for the audit: - $1,284,631 of expenditures were improperly included in ALN 93.889 when the amount should have been included in ALN 93.268. - $30,394 of expenditures was improperly included in ALN 93.889 when the amount should have been included in ALN 93.323. - $626,894 of expenditures related to ALN 93.563 was missing from the schedule. - $61,290 of expenditures related to ALN 10.561 was missing from the schedule. Cause: The errors of $1,284,631 and $30,394 related to ALN 93.889 were caused by the county hospital’s system of assigning identifying numbers within the chart of accounts not being applied to awards managed outside of the Hennepin Health Foundation. The errors of $626,894 related to ALN 93.563 and $61,290 related to ALN 10.561 related to the County’s reducing expenditures by a reversal of a prior year receivable transaction when determining the amount of expenditures. Effect: The errors in the preparation of the SEFA indicate noncompliance with the requirements for the Schedule, including ensuring that it is complete and accurate. Context: Approximately $2 million of errors were noted over the SEFA with total expenditures of approximately $360 million. Questioned Costs: None Repeat Finding?: No Recommendation: We recommend that the County strengthen its processes and controls over the preparation of the SEFA. Views of Responsible Officials: Hennepin County has reviewed and agrees with the finding and the recommendation.
Schedule of Expenditures of Federal Awards (SEFA) Federal Agency: U.S. Department of Health and Human Services; U.S. Department of Agriculture (USDA) Program: National Bioterrorism Hospital Preparedness Program (ALN 93.889); Immunization Cooperative Agreements (ALN 93. 268); COVID-19 Epidemiology and Laboratory Capacity for Infectious Diseases (ELC)(ALN 93. 323); Child Support Services (ALN 93. 563); State Administrative Matching Grants for the Supplemental Nutrition Assistance Program (ALN 10.561) Pass-through Entity: Minnesota Department of Health; Minnesota Department of Human Services Federal Assistance Identification Number or Pass-Through Number: U90TP000529; 6NH23P0007370502; NH23P922628; NH23IP922628; NU50CK000508; 2001MNCEST; 2101MNCSES; 212MN127Q7503; 212MN101S2520; 212MN101S2514 Federal Award Year: Year ended December 31, 2023 Type of Finding: Significant Deficiency in Internal Control over Compliance; Other Matter Compliance Finding Criteria: 2 CFR 200.303(a) requires that each non-Federal entity must "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." 2 CFR 200.510(b) requires that “The auditee must prepare a schedule of expenditures of Federal awards awards (the “schedule”) for the period covered by the auditee’s financial statements which must include the total Federal awards expended as determined in accordance with ss 200.502... ...At minimum, the schedule must... ...(3) Provide total Federal awards expended for each individual Federal program and the Assistance Listings Number or other identifying number when the Assistance Listings information is not available…” Condition: While testing the SEFA, we noted that internal controls were not operating effectively over the preparation of the SEFA. In addition, we noted the following errors in the original SEFA we received for the audit: - $1,284,631 of expenditures were improperly included in ALN 93.889 when the amount should have been included in ALN 93.268. - $30,394 of expenditures was improperly included in ALN 93.889 when the amount should have been included in ALN 93.323. - $626,894 of expenditures related to ALN 93.563 was missing from the schedule. - $61,290 of expenditures related to ALN 10.561 was missing from the schedule. Cause: The errors of $1,284,631 and $30,394 related to ALN 93.889 were caused by the county hospital’s system of assigning identifying numbers within the chart of accounts not being applied to awards managed outside of the Hennepin Health Foundation. The errors of $626,894 related to ALN 93.563 and $61,290 related to ALN 10.561 related to the County’s reducing expenditures by a reversal of a prior year receivable transaction when determining the amount of expenditures. Effect: The errors in the preparation of the SEFA indicate noncompliance with the requirements for the Schedule, including ensuring that it is complete and accurate. Context: Approximately $2 million of errors were noted over the SEFA with total expenditures of approximately $360 million. Questioned Costs: None Repeat Finding?: No Recommendation: We recommend that the County strengthen its processes and controls over the preparation of the SEFA. Views of Responsible Officials: Hennepin County has reviewed and agrees with the finding and the recommendation.
Schedule of Expenditures of Federal Awards (SEFA) Federal Agency: U.S. Department of Health and Human Services; U.S. Department of Agriculture (USDA) Program: National Bioterrorism Hospital Preparedness Program (ALN 93.889); Immunization Cooperative Agreements (ALN 93. 268); COVID-19 Epidemiology and Laboratory Capacity for Infectious Diseases (ELC)(ALN 93. 323); Child Support Services (ALN 93. 563); State Administrative Matching Grants for the Supplemental Nutrition Assistance Program (ALN 10.561) Pass-through Entity: Minnesota Department of Health; Minnesota Department of Human Services Federal Assistance Identification Number or Pass-Through Number: U90TP000529; 6NH23P0007370502; NH23P922628; NH23IP922628; NU50CK000508; 2001MNCEST; 2101MNCSES; 212MN127Q7503; 212MN101S2520; 212MN101S2514 Federal Award Year: Year ended December 31, 2023 Type of Finding: Significant Deficiency in Internal Control over Compliance; Other Matter Compliance Finding Criteria: 2 CFR 200.303(a) requires that each non-Federal entity must "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." 2 CFR 200.510(b) requires that “The auditee must prepare a schedule of expenditures of Federal awards awards (the “schedule”) for the period covered by the auditee’s financial statements which must include the total Federal awards expended as determined in accordance with ss 200.502... ...At minimum, the schedule must... ...(3) Provide total Federal awards expended for each individual Federal program and the Assistance Listings Number or other identifying number when the Assistance Listings information is not available…” Condition: While testing the SEFA, we noted that internal controls were not operating effectively over the preparation of the SEFA. In addition, we noted the following errors in the original SEFA we received for the audit: - $1,284,631 of expenditures were improperly included in ALN 93.889 when the amount should have been included in ALN 93.268. - $30,394 of expenditures was improperly included in ALN 93.889 when the amount should have been included in ALN 93.323. - $626,894 of expenditures related to ALN 93.563 was missing from the schedule. - $61,290 of expenditures related to ALN 10.561 was missing from the schedule. Cause: The errors of $1,284,631 and $30,394 related to ALN 93.889 were caused by the county hospital’s system of assigning identifying numbers within the chart of accounts not being applied to awards managed outside of the Hennepin Health Foundation. The errors of $626,894 related to ALN 93.563 and $61,290 related to ALN 10.561 related to the County’s reducing expenditures by a reversal of a prior year receivable transaction when determining the amount of expenditures. Effect: The errors in the preparation of the SEFA indicate noncompliance with the requirements for the Schedule, including ensuring that it is complete and accurate. Context: Approximately $2 million of errors were noted over the SEFA with total expenditures of approximately $360 million. Questioned Costs: None Repeat Finding?: No Recommendation: We recommend that the County strengthen its processes and controls over the preparation of the SEFA. Views of Responsible Officials: Hennepin County has reviewed and agrees with the finding and the recommendation.
Schedule of Expenditures of Federal Awards (SEFA) Federal Agency: U.S. Department of Health and Human Services; U.S. Department of Agriculture (USDA) Program: National Bioterrorism Hospital Preparedness Program (ALN 93.889); Immunization Cooperative Agreements (ALN 93. 268); COVID-19 Epidemiology and Laboratory Capacity for Infectious Diseases (ELC)(ALN 93. 323); Child Support Services (ALN 93. 563); State Administrative Matching Grants for the Supplemental Nutrition Assistance Program (ALN 10.561) Pass-through Entity: Minnesota Department of Health; Minnesota Department of Human Services Federal Assistance Identification Number or Pass-Through Number: U90TP000529; 6NH23P0007370502; NH23P922628; NH23IP922628; NU50CK000508; 2001MNCEST; 2101MNCSES; 212MN127Q7503; 212MN101S2520; 212MN101S2514 Federal Award Year: Year ended December 31, 2023 Type of Finding: Significant Deficiency in Internal Control over Compliance; Other Matter Compliance Finding Criteria: 2 CFR 200.303(a) requires that each non-Federal entity must "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." 2 CFR 200.510(b) requires that “The auditee must prepare a schedule of expenditures of Federal awards awards (the “schedule”) for the period covered by the auditee’s financial statements which must include the total Federal awards expended as determined in accordance with ss 200.502... ...At minimum, the schedule must... ...(3) Provide total Federal awards expended for each individual Federal program and the Assistance Listings Number or other identifying number when the Assistance Listings information is not available…” Condition: While testing the SEFA, we noted that internal controls were not operating effectively over the preparation of the SEFA. In addition, we noted the following errors in the original SEFA we received for the audit: - $1,284,631 of expenditures were improperly included in ALN 93.889 when the amount should have been included in ALN 93.268. - $30,394 of expenditures was improperly included in ALN 93.889 when the amount should have been included in ALN 93.323. - $626,894 of expenditures related to ALN 93.563 was missing from the schedule. - $61,290 of expenditures related to ALN 10.561 was missing from the schedule. Cause: The errors of $1,284,631 and $30,394 related to ALN 93.889 were caused by the county hospital’s system of assigning identifying numbers within the chart of accounts not being applied to awards managed outside of the Hennepin Health Foundation. The errors of $626,894 related to ALN 93.563 and $61,290 related to ALN 10.561 related to the County’s reducing expenditures by a reversal of a prior year receivable transaction when determining the amount of expenditures. Effect: The errors in the preparation of the SEFA indicate noncompliance with the requirements for the Schedule, including ensuring that it is complete and accurate. Context: Approximately $2 million of errors were noted over the SEFA with total expenditures of approximately $360 million. Questioned Costs: None Repeat Finding?: No Recommendation: We recommend that the County strengthen its processes and controls over the preparation of the SEFA. Views of Responsible Officials: Hennepin County has reviewed and agrees with the finding and the recommendation.
Schedule of Expenditures of Federal Awards (SEFA) Federal Agency: U.S. Department of Health and Human Services; U.S. Department of Agriculture (USDA) Program: National Bioterrorism Hospital Preparedness Program (ALN 93.889); Immunization Cooperative Agreements (ALN 93. 268); COVID-19 Epidemiology and Laboratory Capacity for Infectious Diseases (ELC)(ALN 93. 323); Child Support Services (ALN 93. 563); State Administrative Matching Grants for the Supplemental Nutrition Assistance Program (ALN 10.561) Pass-through Entity: Minnesota Department of Health; Minnesota Department of Human Services Federal Assistance Identification Number or Pass-Through Number: U90TP000529; 6NH23P0007370502; NH23P922628; NH23IP922628; NU50CK000508; 2001MNCEST; 2101MNCSES; 212MN127Q7503; 212MN101S2520; 212MN101S2514 Federal Award Year: Year ended December 31, 2023 Type of Finding: Significant Deficiency in Internal Control over Compliance; Other Matter Compliance Finding Criteria: 2 CFR 200.303(a) requires that each non-Federal entity must "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." 2 CFR 200.510(b) requires that “The auditee must prepare a schedule of expenditures of Federal awards awards (the “schedule”) for the period covered by the auditee’s financial statements which must include the total Federal awards expended as determined in accordance with ss 200.502... ...At minimum, the schedule must... ...(3) Provide total Federal awards expended for each individual Federal program and the Assistance Listings Number or other identifying number when the Assistance Listings information is not available…” Condition: While testing the SEFA, we noted that internal controls were not operating effectively over the preparation of the SEFA. In addition, we noted the following errors in the original SEFA we received for the audit: - $1,284,631 of expenditures were improperly included in ALN 93.889 when the amount should have been included in ALN 93.268. - $30,394 of expenditures was improperly included in ALN 93.889 when the amount should have been included in ALN 93.323. - $626,894 of expenditures related to ALN 93.563 was missing from the schedule. - $61,290 of expenditures related to ALN 10.561 was missing from the schedule. Cause: The errors of $1,284,631 and $30,394 related to ALN 93.889 were caused by the county hospital’s system of assigning identifying numbers within the chart of accounts not being applied to awards managed outside of the Hennepin Health Foundation. The errors of $626,894 related to ALN 93.563 and $61,290 related to ALN 10.561 related to the County’s reducing expenditures by a reversal of a prior year receivable transaction when determining the amount of expenditures. Effect: The errors in the preparation of the SEFA indicate noncompliance with the requirements for the Schedule, including ensuring that it is complete and accurate. Context: Approximately $2 million of errors were noted over the SEFA with total expenditures of approximately $360 million. Questioned Costs: None Repeat Finding?: No Recommendation: We recommend that the County strengthen its processes and controls over the preparation of the SEFA. Views of Responsible Officials: Hennepin County has reviewed and agrees with the finding and the recommendation.
2023-001 – Preparation of the Schedule of Expenditures of Federal Awards Identification of the Federal Program – 93.224/93.527 Health Center Program Cluster Criteria – CFR Section §200.510(b) states in part: “The auditee must also prepare a schedule of expenditures of Federal awards (Schedule) 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”. CFR Section §200.502(a) also states that, “The determination of when a Federal award is expended must be based on when the activity related to the Federal award occurs”. Condition – We noted that there were significant adjustments needed to present a complete and accurate Schedule. Cause – WWH’s internal controls over preparation and review of the Schedule were not properly implemented for the year ended December 31, 2023. Such internal controls were designed to require timely review of the accuracy of the Schedule by appropriate personnel. Effect – The Schedule for the year ended December 31, 2023 inappropriately included $250,500 of expenditures related to previous years. Questioned costs – none Context – Internal controls or processes in place were not implemented as intended to ensure an accurate Schedule was prepared. Repeat finding – No Recommendation – We recommend the Schedule to be reviewed timely and with sufficient precision by the appropriate level of personnel. View of Responsible Officials - Management agrees with the Federal Award Finding regarding the determination of when a Federal award is expended. As part of the Corrective Action Plan, Grants management staff from Finance and Program departments are meeting regularly to ensure that the expenditures are recorded in the appropriate year.
2023-001 – Preparation of the Schedule of Expenditures of Federal Awards Identification of the Federal Program – 93.224/93.527 Health Center Program Cluster Criteria – CFR Section §200.510(b) states in part: “The auditee must also prepare a schedule of expenditures of Federal awards (Schedule) 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”. CFR Section §200.502(a) also states that, “The determination of when a Federal award is expended must be based on when the activity related to the Federal award occurs”. Condition – We noted that there were significant adjustments needed to present a complete and accurate Schedule. Cause – WWH’s internal controls over preparation and review of the Schedule were not properly implemented for the year ended December 31, 2023. Such internal controls were designed to require timely review of the accuracy of the Schedule by appropriate personnel. Effect – The Schedule for the year ended December 31, 2023 inappropriately included $250,500 of expenditures related to previous years. Questioned costs – none Context – Internal controls or processes in place were not implemented as intended to ensure an accurate Schedule was prepared. Repeat finding – No Recommendation – We recommend the Schedule to be reviewed timely and with sufficient precision by the appropriate level of personnel. View of Responsible Officials - Management agrees with the Federal Award Finding regarding the determination of when a Federal award is expended. As part of the Corrective Action Plan, Grants management staff from Finance and Program departments are meeting regularly to ensure that the expenditures are recorded in the appropriate year.
Finding 2023-001 – Reporting Information of the federal program: Federal Grantor: Department of Defense (DOD) Assistance Listing No.: 12.420, Military Medical Research and Development Pass-Through Grantor: Johns Hopkins University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.172, Human Genome Research Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.226, Research on Healthcare Costs, Quality and Outcomes Pass-Through Grantor: The Regents of the University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.242, Mental Health Research Grants Pass-Through Grantor: Rutgers State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.307, Minority Health and Health Disparities Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.310, Trans-NIH Research Support Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.350, National Center for Advancing Translational Sciences Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.351, Research Infrastructure Program Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.361, Nursing Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.368, 21st Century Cures Act – Precision Medicine Initiative Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.394, Cancer Detection and Diagnosis Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.395, Cancer Treatment Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.396, Cancer Biology Research Pass-Through Grantor: Tulane University, Louisiana State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.397, Cancer Centers Support Grants Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.667, Social Services Block Grant Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.837, Cardiovascular Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.838, Lung Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.847, Diabetes, Digestive, and Kidney Diseases Extramural Research Pass-Through Grantors: Northwestern University, Duke University, University of Washington, The Regents of University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.853, Extramural Research Programs in the Neurosciences and Neurological Disorders Pass-Through Grantor: Rush University Medical Center Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.855, Allergy, Immunology and Transplantation Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.859, Biomedical Research and Research Training Pass-Through Grantor: University of Wisconsin – Madison Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.865, Child Health and Human Development Extramural Research Pass-Through Grantors: Northwestern University, University of Washington, The Regents of the University of California Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.866, Aging Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.946, Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.994, Maternal and Child Health Services Block Grant to the States Pass-Through Grantor: Northwestern Memorial Hospital 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).” 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 grants related to the Research and Development Cluster were misstated by $233,405 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. In addition, an award which was not a federal grant award with expenditures of $148,388 was included on the preliminary Schedule provided by management. 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: The table below reflects the preliminary and adjusted assistance listing balances on the Schedule (only assistance listing programs which changed are included below): Assistance Listing No. Name of Federal Program Preliminary Schedule Adjusted Schedule Change 12.420 Military Medical Research and Development $ 241,025 $ 224,418 $ 16,607 93.172 Human Genome Research 14,874 15,121 (247) 93.226 Research on Healthcare Costs, Quality and Outcomes 251,325 248,842 2,483 93.242 Mental Health Research Grants 1,616,503 1,617,376 (873) 93.307 Minority Health and Health Disparities Research 17,323 15,122 2,201 93.310 Trans-NIH Research Support 313,459 313,490 (31) 93.350 National Center for Advancing Translational Sciences 516,734 518,429 (1,695) 93.351 Research Infrastructure Program 242,436 232,058 10,378 93.361 Nursing Research 8,745 7,645 1,100 93.368 21st Century Cures Act – Precision Medicine Initiative 100,324 94,609 5,715 93.394 Cancer Detection and Diagnosis Research 847,959 816,528 31,431 93.395 Cancer Treatment Research 438,349 439,286 (937) 93.396 Cancer Biology Research 93,919 88,642 5,277 93.397 Cancer Centers Support Grants 15,552 14,078 1,474 93.667 Social Services Block Grant 19,619 27,170 (7,551) 93.837 Cardiovascular Diseases Research 193,160 188,850 4,310 93.838 Lung Diseases Research 482,934 471,427 11,507 93.847 Diabetes, Digestive, and Kidney Diseases Extramural Research 1,075,493 1,035,041 40,452 93.853 Extramural Research Programs in the Neurosciences and Neurological Disorders 1,645,025 1,596,611 48,414 93.855 Allergy, Immunology and Transplantation Research 73,869 72,630 1,239 93.859 Biomedical Research and Research Training 363,336 366,791 (3,455) 93.865 Child Health and Human Development Extramural Research 3,790,797 3,733,008 57,789 93.866 Aging Research 1,101,363 1,098,891 2,472 93.946 Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs 80,039 78,033 2,006 93.994 Maternal and Child Health Services Block Grant to the States 171,995 168,656 3,339 The Role of Oral Care in Nonventilator Hospital-Acquired Pneumonia (NVHAP) Prevention 148,388 – 148,388 Total $ 13,864,545 $ 13,482,752 $ 381,793 Identification as a repeat finding, if applicable: The finding is not a repeat finding from the prior year. 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: Award amounts were changed on the Schedule after management’s review was executed. Management acknowledges that implementing the new Enterprise Resource Planning (ERP) system, in 2023 presented changes to the SEFA reporting. Management has identified and addressed the reporting issues within the new system to ensure that the grant totals are appropriately captured in the SEFA. Endeavor will enhance grant management award processes by revising its procedures and adding additional controls to monitor for accuracy of the core data. Management will reinforce the importance of timeliness and accuracy of the Schedule reporting totals to facilitate accurate reporting.
Finding 2023-001 – Reporting Information of the federal program: Federal Grantor: Department of Defense (DOD) Assistance Listing No.: 12.420, Military Medical Research and Development Pass-Through Grantor: Johns Hopkins University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.172, Human Genome Research Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.226, Research on Healthcare Costs, Quality and Outcomes Pass-Through Grantor: The Regents of the University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.242, Mental Health Research Grants Pass-Through Grantor: Rutgers State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.307, Minority Health and Health Disparities Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.310, Trans-NIH Research Support Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.350, National Center for Advancing Translational Sciences Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.351, Research Infrastructure Program Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.361, Nursing Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.368, 21st Century Cures Act – Precision Medicine Initiative Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.394, Cancer Detection and Diagnosis Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.395, Cancer Treatment Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.396, Cancer Biology Research Pass-Through Grantor: Tulane University, Louisiana State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.397, Cancer Centers Support Grants Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.667, Social Services Block Grant Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.837, Cardiovascular Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.838, Lung Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.847, Diabetes, Digestive, and Kidney Diseases Extramural Research Pass-Through Grantors: Northwestern University, Duke University, University of Washington, The Regents of University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.853, Extramural Research Programs in the Neurosciences and Neurological Disorders Pass-Through Grantor: Rush University Medical Center Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.855, Allergy, Immunology and Transplantation Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.859, Biomedical Research and Research Training Pass-Through Grantor: University of Wisconsin – Madison Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.865, Child Health and Human Development Extramural Research Pass-Through Grantors: Northwestern University, University of Washington, The Regents of the University of California Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.866, Aging Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.946, Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.994, Maternal and Child Health Services Block Grant to the States Pass-Through Grantor: Northwestern Memorial Hospital 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).” 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 grants related to the Research and Development Cluster were misstated by $233,405 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. In addition, an award which was not a federal grant award with expenditures of $148,388 was included on the preliminary Schedule provided by management. 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: The table below reflects the preliminary and adjusted assistance listing balances on the Schedule (only assistance listing programs which changed are included below): Assistance Listing No. Name of Federal Program Preliminary Schedule Adjusted Schedule Change 12.420 Military Medical Research and Development $ 241,025 $ 224,418 $ 16,607 93.172 Human Genome Research 14,874 15,121 (247) 93.226 Research on Healthcare Costs, Quality and Outcomes 251,325 248,842 2,483 93.242 Mental Health Research Grants 1,616,503 1,617,376 (873) 93.307 Minority Health and Health Disparities Research 17,323 15,122 2,201 93.310 Trans-NIH Research Support 313,459 313,490 (31) 93.350 National Center for Advancing Translational Sciences 516,734 518,429 (1,695) 93.351 Research Infrastructure Program 242,436 232,058 10,378 93.361 Nursing Research 8,745 7,645 1,100 93.368 21st Century Cures Act – Precision Medicine Initiative 100,324 94,609 5,715 93.394 Cancer Detection and Diagnosis Research 847,959 816,528 31,431 93.395 Cancer Treatment Research 438,349 439,286 (937) 93.396 Cancer Biology Research 93,919 88,642 5,277 93.397 Cancer Centers Support Grants 15,552 14,078 1,474 93.667 Social Services Block Grant 19,619 27,170 (7,551) 93.837 Cardiovascular Diseases Research 193,160 188,850 4,310 93.838 Lung Diseases Research 482,934 471,427 11,507 93.847 Diabetes, Digestive, and Kidney Diseases Extramural Research 1,075,493 1,035,041 40,452 93.853 Extramural Research Programs in the Neurosciences and Neurological Disorders 1,645,025 1,596,611 48,414 93.855 Allergy, Immunology and Transplantation Research 73,869 72,630 1,239 93.859 Biomedical Research and Research Training 363,336 366,791 (3,455) 93.865 Child Health and Human Development Extramural Research 3,790,797 3,733,008 57,789 93.866 Aging Research 1,101,363 1,098,891 2,472 93.946 Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs 80,039 78,033 2,006 93.994 Maternal and Child Health Services Block Grant to the States 171,995 168,656 3,339 The Role of Oral Care in Nonventilator Hospital-Acquired Pneumonia (NVHAP) Prevention 148,388 – 148,388 Total $ 13,864,545 $ 13,482,752 $ 381,793 Identification as a repeat finding, if applicable: The finding is not a repeat finding from the prior year. 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: Award amounts were changed on the Schedule after management’s review was executed. Management acknowledges that implementing the new Enterprise Resource Planning (ERP) system, in 2023 presented changes to the SEFA reporting. Management has identified and addressed the reporting issues within the new system to ensure that the grant totals are appropriately captured in the SEFA. Endeavor will enhance grant management award processes by revising its procedures and adding additional controls to monitor for accuracy of the core data. Management will reinforce the importance of timeliness and accuracy of the Schedule reporting totals to facilitate accurate reporting.
Finding 2023-001 – Reporting Information of the federal program: Federal Grantor: Department of Defense (DOD) Assistance Listing No.: 12.420, Military Medical Research and Development Pass-Through Grantor: Johns Hopkins University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.172, Human Genome Research Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.226, Research on Healthcare Costs, Quality and Outcomes Pass-Through Grantor: The Regents of the University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.242, Mental Health Research Grants Pass-Through Grantor: Rutgers State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.307, Minority Health and Health Disparities Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.310, Trans-NIH Research Support Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.350, National Center for Advancing Translational Sciences Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.351, Research Infrastructure Program Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.361, Nursing Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.368, 21st Century Cures Act – Precision Medicine Initiative Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.394, Cancer Detection and Diagnosis Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.395, Cancer Treatment Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.396, Cancer Biology Research Pass-Through Grantor: Tulane University, Louisiana State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.397, Cancer Centers Support Grants Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.667, Social Services Block Grant Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.837, Cardiovascular Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.838, Lung Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.847, Diabetes, Digestive, and Kidney Diseases Extramural Research Pass-Through Grantors: Northwestern University, Duke University, University of Washington, The Regents of University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.853, Extramural Research Programs in the Neurosciences and Neurological Disorders Pass-Through Grantor: Rush University Medical Center Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.855, Allergy, Immunology and Transplantation Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.859, Biomedical Research and Research Training Pass-Through Grantor: University of Wisconsin – Madison Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.865, Child Health and Human Development Extramural Research Pass-Through Grantors: Northwestern University, University of Washington, The Regents of the University of California Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.866, Aging Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.946, Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.994, Maternal and Child Health Services Block Grant to the States Pass-Through Grantor: Northwestern Memorial Hospital 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).” 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 grants related to the Research and Development Cluster were misstated by $233,405 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. In addition, an award which was not a federal grant award with expenditures of $148,388 was included on the preliminary Schedule provided by management. 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: The table below reflects the preliminary and adjusted assistance listing balances on the Schedule (only assistance listing programs which changed are included below): Assistance Listing No. Name of Federal Program Preliminary Schedule Adjusted Schedule Change 12.420 Military Medical Research and Development $ 241,025 $ 224,418 $ 16,607 93.172 Human Genome Research 14,874 15,121 (247) 93.226 Research on Healthcare Costs, Quality and Outcomes 251,325 248,842 2,483 93.242 Mental Health Research Grants 1,616,503 1,617,376 (873) 93.307 Minority Health and Health Disparities Research 17,323 15,122 2,201 93.310 Trans-NIH Research Support 313,459 313,490 (31) 93.350 National Center for Advancing Translational Sciences 516,734 518,429 (1,695) 93.351 Research Infrastructure Program 242,436 232,058 10,378 93.361 Nursing Research 8,745 7,645 1,100 93.368 21st Century Cures Act – Precision Medicine Initiative 100,324 94,609 5,715 93.394 Cancer Detection and Diagnosis Research 847,959 816,528 31,431 93.395 Cancer Treatment Research 438,349 439,286 (937) 93.396 Cancer Biology Research 93,919 88,642 5,277 93.397 Cancer Centers Support Grants 15,552 14,078 1,474 93.667 Social Services Block Grant 19,619 27,170 (7,551) 93.837 Cardiovascular Diseases Research 193,160 188,850 4,310 93.838 Lung Diseases Research 482,934 471,427 11,507 93.847 Diabetes, Digestive, and Kidney Diseases Extramural Research 1,075,493 1,035,041 40,452 93.853 Extramural Research Programs in the Neurosciences and Neurological Disorders 1,645,025 1,596,611 48,414 93.855 Allergy, Immunology and Transplantation Research 73,869 72,630 1,239 93.859 Biomedical Research and Research Training 363,336 366,791 (3,455) 93.865 Child Health and Human Development Extramural Research 3,790,797 3,733,008 57,789 93.866 Aging Research 1,101,363 1,098,891 2,472 93.946 Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs 80,039 78,033 2,006 93.994 Maternal and Child Health Services Block Grant to the States 171,995 168,656 3,339 The Role of Oral Care in Nonventilator Hospital-Acquired Pneumonia (NVHAP) Prevention 148,388 – 148,388 Total $ 13,864,545 $ 13,482,752 $ 381,793 Identification as a repeat finding, if applicable: The finding is not a repeat finding from the prior year. 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: Award amounts were changed on the Schedule after management’s review was executed. Management acknowledges that implementing the new Enterprise Resource Planning (ERP) system, in 2023 presented changes to the SEFA reporting. Management has identified and addressed the reporting issues within the new system to ensure that the grant totals are appropriately captured in the SEFA. Endeavor will enhance grant management award processes by revising its procedures and adding additional controls to monitor for accuracy of the core data. Management will reinforce the importance of timeliness and accuracy of the Schedule reporting totals to facilitate accurate reporting.
Finding 2023-001 – Reporting Information of the federal program: Federal Grantor: Department of Defense (DOD) Assistance Listing No.: 12.420, Military Medical Research and Development Pass-Through Grantor: Johns Hopkins University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.172, Human Genome Research Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.226, Research on Healthcare Costs, Quality and Outcomes Pass-Through Grantor: The Regents of the University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.242, Mental Health Research Grants Pass-Through Grantor: Rutgers State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.307, Minority Health and Health Disparities Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.310, Trans-NIH Research Support Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.350, National Center for Advancing Translational Sciences Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.351, Research Infrastructure Program Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.361, Nursing Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.368, 21st Century Cures Act – Precision Medicine Initiative Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.394, Cancer Detection and Diagnosis Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.395, Cancer Treatment Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.396, Cancer Biology Research Pass-Through Grantor: Tulane University, Louisiana State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.397, Cancer Centers Support Grants Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.667, Social Services Block Grant Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.837, Cardiovascular Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.838, Lung Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.847, Diabetes, Digestive, and Kidney Diseases Extramural Research Pass-Through Grantors: Northwestern University, Duke University, University of Washington, The Regents of University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.853, Extramural Research Programs in the Neurosciences and Neurological Disorders Pass-Through Grantor: Rush University Medical Center Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.855, Allergy, Immunology and Transplantation Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.859, Biomedical Research and Research Training Pass-Through Grantor: University of Wisconsin – Madison Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.865, Child Health and Human Development Extramural Research Pass-Through Grantors: Northwestern University, University of Washington, The Regents of the University of California Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.866, Aging Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.946, Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.994, Maternal and Child Health Services Block Grant to the States Pass-Through Grantor: Northwestern Memorial Hospital 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).” 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 grants related to the Research and Development Cluster were misstated by $233,405 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. In addition, an award which was not a federal grant award with expenditures of $148,388 was included on the preliminary Schedule provided by management. 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: The table below reflects the preliminary and adjusted assistance listing balances on the Schedule (only assistance listing programs which changed are included below): Assistance Listing No. Name of Federal Program Preliminary Schedule Adjusted Schedule Change 12.420 Military Medical Research and Development $ 241,025 $ 224,418 $ 16,607 93.172 Human Genome Research 14,874 15,121 (247) 93.226 Research on Healthcare Costs, Quality and Outcomes 251,325 248,842 2,483 93.242 Mental Health Research Grants 1,616,503 1,617,376 (873) 93.307 Minority Health and Health Disparities Research 17,323 15,122 2,201 93.310 Trans-NIH Research Support 313,459 313,490 (31) 93.350 National Center for Advancing Translational Sciences 516,734 518,429 (1,695) 93.351 Research Infrastructure Program 242,436 232,058 10,378 93.361 Nursing Research 8,745 7,645 1,100 93.368 21st Century Cures Act – Precision Medicine Initiative 100,324 94,609 5,715 93.394 Cancer Detection and Diagnosis Research 847,959 816,528 31,431 93.395 Cancer Treatment Research 438,349 439,286 (937) 93.396 Cancer Biology Research 93,919 88,642 5,277 93.397 Cancer Centers Support Grants 15,552 14,078 1,474 93.667 Social Services Block Grant 19,619 27,170 (7,551) 93.837 Cardiovascular Diseases Research 193,160 188,850 4,310 93.838 Lung Diseases Research 482,934 471,427 11,507 93.847 Diabetes, Digestive, and Kidney Diseases Extramural Research 1,075,493 1,035,041 40,452 93.853 Extramural Research Programs in the Neurosciences and Neurological Disorders 1,645,025 1,596,611 48,414 93.855 Allergy, Immunology and Transplantation Research 73,869 72,630 1,239 93.859 Biomedical Research and Research Training 363,336 366,791 (3,455) 93.865 Child Health and Human Development Extramural Research 3,790,797 3,733,008 57,789 93.866 Aging Research 1,101,363 1,098,891 2,472 93.946 Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs 80,039 78,033 2,006 93.994 Maternal and Child Health Services Block Grant to the States 171,995 168,656 3,339 The Role of Oral Care in Nonventilator Hospital-Acquired Pneumonia (NVHAP) Prevention 148,388 – 148,388 Total $ 13,864,545 $ 13,482,752 $ 381,793 Identification as a repeat finding, if applicable: The finding is not a repeat finding from the prior year. 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: Award amounts were changed on the Schedule after management’s review was executed. Management acknowledges that implementing the new Enterprise Resource Planning (ERP) system, in 2023 presented changes to the SEFA reporting. Management has identified and addressed the reporting issues within the new system to ensure that the grant totals are appropriately captured in the SEFA. Endeavor will enhance grant management award processes by revising its procedures and adding additional controls to monitor for accuracy of the core data. Management will reinforce the importance of timeliness and accuracy of the Schedule reporting totals to facilitate accurate reporting.
Finding 2023-001 – Reporting Information of the federal program: Federal Grantor: Department of Defense (DOD) Assistance Listing No.: 12.420, Military Medical Research and Development Pass-Through Grantor: Johns Hopkins University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.172, Human Genome Research Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.226, Research on Healthcare Costs, Quality and Outcomes Pass-Through Grantor: The Regents of the University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.242, Mental Health Research Grants Pass-Through Grantor: Rutgers State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.307, Minority Health and Health Disparities Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.310, Trans-NIH Research Support Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.350, National Center for Advancing Translational Sciences Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.351, Research Infrastructure Program Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.361, Nursing Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.368, 21st Century Cures Act – Precision Medicine Initiative Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.394, Cancer Detection and Diagnosis Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.395, Cancer Treatment Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.396, Cancer Biology Research Pass-Through Grantor: Tulane University, Louisiana State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.397, Cancer Centers Support Grants Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.667, Social Services Block Grant Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.837, Cardiovascular Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.838, Lung Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.847, Diabetes, Digestive, and Kidney Diseases Extramural Research Pass-Through Grantors: Northwestern University, Duke University, University of Washington, The Regents of University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.853, Extramural Research Programs in the Neurosciences and Neurological Disorders Pass-Through Grantor: Rush University Medical Center Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.855, Allergy, Immunology and Transplantation Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.859, Biomedical Research and Research Training Pass-Through Grantor: University of Wisconsin – Madison Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.865, Child Health and Human Development Extramural Research Pass-Through Grantors: Northwestern University, University of Washington, The Regents of the University of California Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.866, Aging Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.946, Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.994, Maternal and Child Health Services Block Grant to the States Pass-Through Grantor: Northwestern Memorial Hospital 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).” 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 grants related to the Research and Development Cluster were misstated by $233,405 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. In addition, an award which was not a federal grant award with expenditures of $148,388 was included on the preliminary Schedule provided by management. 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: The table below reflects the preliminary and adjusted assistance listing balances on the Schedule (only assistance listing programs which changed are included below): Assistance Listing No. Name of Federal Program Preliminary Schedule Adjusted Schedule Change 12.420 Military Medical Research and Development $ 241,025 $ 224,418 $ 16,607 93.172 Human Genome Research 14,874 15,121 (247) 93.226 Research on Healthcare Costs, Quality and Outcomes 251,325 248,842 2,483 93.242 Mental Health Research Grants 1,616,503 1,617,376 (873) 93.307 Minority Health and Health Disparities Research 17,323 15,122 2,201 93.310 Trans-NIH Research Support 313,459 313,490 (31) 93.350 National Center for Advancing Translational Sciences 516,734 518,429 (1,695) 93.351 Research Infrastructure Program 242,436 232,058 10,378 93.361 Nursing Research 8,745 7,645 1,100 93.368 21st Century Cures Act – Precision Medicine Initiative 100,324 94,609 5,715 93.394 Cancer Detection and Diagnosis Research 847,959 816,528 31,431 93.395 Cancer Treatment Research 438,349 439,286 (937) 93.396 Cancer Biology Research 93,919 88,642 5,277 93.397 Cancer Centers Support Grants 15,552 14,078 1,474 93.667 Social Services Block Grant 19,619 27,170 (7,551) 93.837 Cardiovascular Diseases Research 193,160 188,850 4,310 93.838 Lung Diseases Research 482,934 471,427 11,507 93.847 Diabetes, Digestive, and Kidney Diseases Extramural Research 1,075,493 1,035,041 40,452 93.853 Extramural Research Programs in the Neurosciences and Neurological Disorders 1,645,025 1,596,611 48,414 93.855 Allergy, Immunology and Transplantation Research 73,869 72,630 1,239 93.859 Biomedical Research and Research Training 363,336 366,791 (3,455) 93.865 Child Health and Human Development Extramural Research 3,790,797 3,733,008 57,789 93.866 Aging Research 1,101,363 1,098,891 2,472 93.946 Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs 80,039 78,033 2,006 93.994 Maternal and Child Health Services Block Grant to the States 171,995 168,656 3,339 The Role of Oral Care in Nonventilator Hospital-Acquired Pneumonia (NVHAP) Prevention 148,388 – 148,388 Total $ 13,864,545 $ 13,482,752 $ 381,793 Identification as a repeat finding, if applicable: The finding is not a repeat finding from the prior year. 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: Award amounts were changed on the Schedule after management’s review was executed. Management acknowledges that implementing the new Enterprise Resource Planning (ERP) system, in 2023 presented changes to the SEFA reporting. Management has identified and addressed the reporting issues within the new system to ensure that the grant totals are appropriately captured in the SEFA. Endeavor will enhance grant management award processes by revising its procedures and adding additional controls to monitor for accuracy of the core data. Management will reinforce the importance of timeliness and accuracy of the Schedule reporting totals to facilitate accurate reporting.
Finding 2023-001 – Reporting Information of the federal program: Federal Grantor: Department of Defense (DOD) Assistance Listing No.: 12.420, Military Medical Research and Development Pass-Through Grantor: Johns Hopkins University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.172, Human Genome Research Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.226, Research on Healthcare Costs, Quality and Outcomes Pass-Through Grantor: The Regents of the University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.242, Mental Health Research Grants Pass-Through Grantor: Rutgers State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.307, Minority Health and Health Disparities Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.310, Trans-NIH Research Support Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.350, National Center for Advancing Translational Sciences Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.351, Research Infrastructure Program Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.361, Nursing Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.368, 21st Century Cures Act – Precision Medicine Initiative Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.394, Cancer Detection and Diagnosis Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.395, Cancer Treatment Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.396, Cancer Biology Research Pass-Through Grantor: Tulane University, Louisiana State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.397, Cancer Centers Support Grants Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.667, Social Services Block Grant Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.837, Cardiovascular Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.838, Lung Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.847, Diabetes, Digestive, and Kidney Diseases Extramural Research Pass-Through Grantors: Northwestern University, Duke University, University of Washington, The Regents of University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.853, Extramural Research Programs in the Neurosciences and Neurological Disorders Pass-Through Grantor: Rush University Medical Center Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.855, Allergy, Immunology and Transplantation Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.859, Biomedical Research and Research Training Pass-Through Grantor: University of Wisconsin – Madison Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.865, Child Health and Human Development Extramural Research Pass-Through Grantors: Northwestern University, University of Washington, The Regents of the University of California Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.866, Aging Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.946, Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.994, Maternal and Child Health Services Block Grant to the States Pass-Through Grantor: Northwestern Memorial Hospital 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).” 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 grants related to the Research and Development Cluster were misstated by $233,405 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. In addition, an award which was not a federal grant award with expenditures of $148,388 was included on the preliminary Schedule provided by management. 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: The table below reflects the preliminary and adjusted assistance listing balances on the Schedule (only assistance listing programs which changed are included below): Assistance Listing No. Name of Federal Program Preliminary Schedule Adjusted Schedule Change 12.420 Military Medical Research and Development $ 241,025 $ 224,418 $ 16,607 93.172 Human Genome Research 14,874 15,121 (247) 93.226 Research on Healthcare Costs, Quality and Outcomes 251,325 248,842 2,483 93.242 Mental Health Research Grants 1,616,503 1,617,376 (873) 93.307 Minority Health and Health Disparities Research 17,323 15,122 2,201 93.310 Trans-NIH Research Support 313,459 313,490 (31) 93.350 National Center for Advancing Translational Sciences 516,734 518,429 (1,695) 93.351 Research Infrastructure Program 242,436 232,058 10,378 93.361 Nursing Research 8,745 7,645 1,100 93.368 21st Century Cures Act – Precision Medicine Initiative 100,324 94,609 5,715 93.394 Cancer Detection and Diagnosis Research 847,959 816,528 31,431 93.395 Cancer Treatment Research 438,349 439,286 (937) 93.396 Cancer Biology Research 93,919 88,642 5,277 93.397 Cancer Centers Support Grants 15,552 14,078 1,474 93.667 Social Services Block Grant 19,619 27,170 (7,551) 93.837 Cardiovascular Diseases Research 193,160 188,850 4,310 93.838 Lung Diseases Research 482,934 471,427 11,507 93.847 Diabetes, Digestive, and Kidney Diseases Extramural Research 1,075,493 1,035,041 40,452 93.853 Extramural Research Programs in the Neurosciences and Neurological Disorders 1,645,025 1,596,611 48,414 93.855 Allergy, Immunology and Transplantation Research 73,869 72,630 1,239 93.859 Biomedical Research and Research Training 363,336 366,791 (3,455) 93.865 Child Health and Human Development Extramural Research 3,790,797 3,733,008 57,789 93.866 Aging Research 1,101,363 1,098,891 2,472 93.946 Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs 80,039 78,033 2,006 93.994 Maternal and Child Health Services Block Grant to the States 171,995 168,656 3,339 The Role of Oral Care in Nonventilator Hospital-Acquired Pneumonia (NVHAP) Prevention 148,388 – 148,388 Total $ 13,864,545 $ 13,482,752 $ 381,793 Identification as a repeat finding, if applicable: The finding is not a repeat finding from the prior year. 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: Award amounts were changed on the Schedule after management’s review was executed. Management acknowledges that implementing the new Enterprise Resource Planning (ERP) system, in 2023 presented changes to the SEFA reporting. Management has identified and addressed the reporting issues within the new system to ensure that the grant totals are appropriately captured in the SEFA. Endeavor will enhance grant management award processes by revising its procedures and adding additional controls to monitor for accuracy of the core data. Management will reinforce the importance of timeliness and accuracy of the Schedule reporting totals to facilitate accurate reporting.
Finding 2023-001 – Reporting Information of the federal program: Federal Grantor: Department of Defense (DOD) Assistance Listing No.: 12.420, Military Medical Research and Development Pass-Through Grantor: Johns Hopkins University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.172, Human Genome Research Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.226, Research on Healthcare Costs, Quality and Outcomes Pass-Through Grantor: The Regents of the University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.242, Mental Health Research Grants Pass-Through Grantor: Rutgers State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.307, Minority Health and Health Disparities Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.310, Trans-NIH Research Support Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.350, National Center for Advancing Translational Sciences Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.351, Research Infrastructure Program Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.361, Nursing Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.368, 21st Century Cures Act – Precision Medicine Initiative Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.394, Cancer Detection and Diagnosis Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.395, Cancer Treatment Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.396, Cancer Biology Research Pass-Through Grantor: Tulane University, Louisiana State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.397, Cancer Centers Support Grants Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.667, Social Services Block Grant Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.837, Cardiovascular Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.838, Lung Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.847, Diabetes, Digestive, and Kidney Diseases Extramural Research Pass-Through Grantors: Northwestern University, Duke University, University of Washington, The Regents of University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.853, Extramural Research Programs in the Neurosciences and Neurological Disorders Pass-Through Grantor: Rush University Medical Center Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.855, Allergy, Immunology and Transplantation Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.859, Biomedical Research and Research Training Pass-Through Grantor: University of Wisconsin – Madison Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.865, Child Health and Human Development Extramural Research Pass-Through Grantors: Northwestern University, University of Washington, The Regents of the University of California Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.866, Aging Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.946, Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.994, Maternal and Child Health Services Block Grant to the States Pass-Through Grantor: Northwestern Memorial Hospital 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).” 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 grants related to the Research and Development Cluster were misstated by $233,405 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. In addition, an award which was not a federal grant award with expenditures of $148,388 was included on the preliminary Schedule provided by management. 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: The table below reflects the preliminary and adjusted assistance listing balances on the Schedule (only assistance listing programs which changed are included below): Assistance Listing No. Name of Federal Program Preliminary Schedule Adjusted Schedule Change 12.420 Military Medical Research and Development $ 241,025 $ 224,418 $ 16,607 93.172 Human Genome Research 14,874 15,121 (247) 93.226 Research on Healthcare Costs, Quality and Outcomes 251,325 248,842 2,483 93.242 Mental Health Research Grants 1,616,503 1,617,376 (873) 93.307 Minority Health and Health Disparities Research 17,323 15,122 2,201 93.310 Trans-NIH Research Support 313,459 313,490 (31) 93.350 National Center for Advancing Translational Sciences 516,734 518,429 (1,695) 93.351 Research Infrastructure Program 242,436 232,058 10,378 93.361 Nursing Research 8,745 7,645 1,100 93.368 21st Century Cures Act – Precision Medicine Initiative 100,324 94,609 5,715 93.394 Cancer Detection and Diagnosis Research 847,959 816,528 31,431 93.395 Cancer Treatment Research 438,349 439,286 (937) 93.396 Cancer Biology Research 93,919 88,642 5,277 93.397 Cancer Centers Support Grants 15,552 14,078 1,474 93.667 Social Services Block Grant 19,619 27,170 (7,551) 93.837 Cardiovascular Diseases Research 193,160 188,850 4,310 93.838 Lung Diseases Research 482,934 471,427 11,507 93.847 Diabetes, Digestive, and Kidney Diseases Extramural Research 1,075,493 1,035,041 40,452 93.853 Extramural Research Programs in the Neurosciences and Neurological Disorders 1,645,025 1,596,611 48,414 93.855 Allergy, Immunology and Transplantation Research 73,869 72,630 1,239 93.859 Biomedical Research and Research Training 363,336 366,791 (3,455) 93.865 Child Health and Human Development Extramural Research 3,790,797 3,733,008 57,789 93.866 Aging Research 1,101,363 1,098,891 2,472 93.946 Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs 80,039 78,033 2,006 93.994 Maternal and Child Health Services Block Grant to the States 171,995 168,656 3,339 The Role of Oral Care in Nonventilator Hospital-Acquired Pneumonia (NVHAP) Prevention 148,388 – 148,388 Total $ 13,864,545 $ 13,482,752 $ 381,793 Identification as a repeat finding, if applicable: The finding is not a repeat finding from the prior year. 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: Award amounts were changed on the Schedule after management’s review was executed. Management acknowledges that implementing the new Enterprise Resource Planning (ERP) system, in 2023 presented changes to the SEFA reporting. Management has identified and addressed the reporting issues within the new system to ensure that the grant totals are appropriately captured in the SEFA. Endeavor will enhance grant management award processes by revising its procedures and adding additional controls to monitor for accuracy of the core data. Management will reinforce the importance of timeliness and accuracy of the Schedule reporting totals to facilitate accurate reporting.
Finding 2023-001 – Reporting Information of the federal program: Federal Grantor: Department of Defense (DOD) Assistance Listing No.: 12.420, Military Medical Research and Development Pass-Through Grantor: Johns Hopkins University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.172, Human Genome Research Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.226, Research on Healthcare Costs, Quality and Outcomes Pass-Through Grantor: The Regents of the University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.242, Mental Health Research Grants Pass-Through Grantor: Rutgers State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.307, Minority Health and Health Disparities Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.310, Trans-NIH Research Support Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.350, National Center for Advancing Translational Sciences Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.351, Research Infrastructure Program Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.361, Nursing Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.368, 21st Century Cures Act – Precision Medicine Initiative Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.394, Cancer Detection and Diagnosis Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.395, Cancer Treatment Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.396, Cancer Biology Research Pass-Through Grantor: Tulane University, Louisiana State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.397, Cancer Centers Support Grants Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.667, Social Services Block Grant Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.837, Cardiovascular Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.838, Lung Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.847, Diabetes, Digestive, and Kidney Diseases Extramural Research Pass-Through Grantors: Northwestern University, Duke University, University of Washington, The Regents of University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.853, Extramural Research Programs in the Neurosciences and Neurological Disorders Pass-Through Grantor: Rush University Medical Center Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.855, Allergy, Immunology and Transplantation Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.859, Biomedical Research and Research Training Pass-Through Grantor: University of Wisconsin – Madison Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.865, Child Health and Human Development Extramural Research Pass-Through Grantors: Northwestern University, University of Washington, The Regents of the University of California Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.866, Aging Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.946, Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.994, Maternal and Child Health Services Block Grant to the States Pass-Through Grantor: Northwestern Memorial Hospital 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).” 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 grants related to the Research and Development Cluster were misstated by $233,405 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. In addition, an award which was not a federal grant award with expenditures of $148,388 was included on the preliminary Schedule provided by management. 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: The table below reflects the preliminary and adjusted assistance listing balances on the Schedule (only assistance listing programs which changed are included below): Assistance Listing No. Name of Federal Program Preliminary Schedule Adjusted Schedule Change 12.420 Military Medical Research and Development $ 241,025 $ 224,418 $ 16,607 93.172 Human Genome Research 14,874 15,121 (247) 93.226 Research on Healthcare Costs, Quality and Outcomes 251,325 248,842 2,483 93.242 Mental Health Research Grants 1,616,503 1,617,376 (873) 93.307 Minority Health and Health Disparities Research 17,323 15,122 2,201 93.310 Trans-NIH Research Support 313,459 313,490 (31) 93.350 National Center for Advancing Translational Sciences 516,734 518,429 (1,695) 93.351 Research Infrastructure Program 242,436 232,058 10,378 93.361 Nursing Research 8,745 7,645 1,100 93.368 21st Century Cures Act – Precision Medicine Initiative 100,324 94,609 5,715 93.394 Cancer Detection and Diagnosis Research 847,959 816,528 31,431 93.395 Cancer Treatment Research 438,349 439,286 (937) 93.396 Cancer Biology Research 93,919 88,642 5,277 93.397 Cancer Centers Support Grants 15,552 14,078 1,474 93.667 Social Services Block Grant 19,619 27,170 (7,551) 93.837 Cardiovascular Diseases Research 193,160 188,850 4,310 93.838 Lung Diseases Research 482,934 471,427 11,507 93.847 Diabetes, Digestive, and Kidney Diseases Extramural Research 1,075,493 1,035,041 40,452 93.853 Extramural Research Programs in the Neurosciences and Neurological Disorders 1,645,025 1,596,611 48,414 93.855 Allergy, Immunology and Transplantation Research 73,869 72,630 1,239 93.859 Biomedical Research and Research Training 363,336 366,791 (3,455) 93.865 Child Health and Human Development Extramural Research 3,790,797 3,733,008 57,789 93.866 Aging Research 1,101,363 1,098,891 2,472 93.946 Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs 80,039 78,033 2,006 93.994 Maternal and Child Health Services Block Grant to the States 171,995 168,656 3,339 The Role of Oral Care in Nonventilator Hospital-Acquired Pneumonia (NVHAP) Prevention 148,388 – 148,388 Total $ 13,864,545 $ 13,482,752 $ 381,793 Identification as a repeat finding, if applicable: The finding is not a repeat finding from the prior year. 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: Award amounts were changed on the Schedule after management’s review was executed. Management acknowledges that implementing the new Enterprise Resource Planning (ERP) system, in 2023 presented changes to the SEFA reporting. Management has identified and addressed the reporting issues within the new system to ensure that the grant totals are appropriately captured in the SEFA. Endeavor will enhance grant management award processes by revising its procedures and adding additional controls to monitor for accuracy of the core data. Management will reinforce the importance of timeliness and accuracy of the Schedule reporting totals to facilitate accurate reporting.
Finding 2023-001 – Reporting Information of the federal program: Federal Grantor: Department of Defense (DOD) Assistance Listing No.: 12.420, Military Medical Research and Development Pass-Through Grantor: Johns Hopkins University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.172, Human Genome Research Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.226, Research on Healthcare Costs, Quality and Outcomes Pass-Through Grantor: The Regents of the University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.242, Mental Health Research Grants Pass-Through Grantor: Rutgers State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.307, Minority Health and Health Disparities Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.310, Trans-NIH Research Support Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.350, National Center for Advancing Translational Sciences Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.351, Research Infrastructure Program Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.361, Nursing Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.368, 21st Century Cures Act – Precision Medicine Initiative Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.394, Cancer Detection and Diagnosis Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.395, Cancer Treatment Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.396, Cancer Biology Research Pass-Through Grantor: Tulane University, Louisiana State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.397, Cancer Centers Support Grants Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.667, Social Services Block Grant Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.837, Cardiovascular Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.838, Lung Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.847, Diabetes, Digestive, and Kidney Diseases Extramural Research Pass-Through Grantors: Northwestern University, Duke University, University of Washington, The Regents of University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.853, Extramural Research Programs in the Neurosciences and Neurological Disorders Pass-Through Grantor: Rush University Medical Center Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.855, Allergy, Immunology and Transplantation Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.859, Biomedical Research and Research Training Pass-Through Grantor: University of Wisconsin – Madison Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.865, Child Health and Human Development Extramural Research Pass-Through Grantors: Northwestern University, University of Washington, The Regents of the University of California Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.866, Aging Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.946, Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.994, Maternal and Child Health Services Block Grant to the States Pass-Through Grantor: Northwestern Memorial Hospital 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).” 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 grants related to the Research and Development Cluster were misstated by $233,405 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. In addition, an award which was not a federal grant award with expenditures of $148,388 was included on the preliminary Schedule provided by management. 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: The table below reflects the preliminary and adjusted assistance listing balances on the Schedule (only assistance listing programs which changed are included below): Assistance Listing No. Name of Federal Program Preliminary Schedule Adjusted Schedule Change 12.420 Military Medical Research and Development $ 241,025 $ 224,418 $ 16,607 93.172 Human Genome Research 14,874 15,121 (247) 93.226 Research on Healthcare Costs, Quality and Outcomes 251,325 248,842 2,483 93.242 Mental Health Research Grants 1,616,503 1,617,376 (873) 93.307 Minority Health and Health Disparities Research 17,323 15,122 2,201 93.310 Trans-NIH Research Support 313,459 313,490 (31) 93.350 National Center for Advancing Translational Sciences 516,734 518,429 (1,695) 93.351 Research Infrastructure Program 242,436 232,058 10,378 93.361 Nursing Research 8,745 7,645 1,100 93.368 21st Century Cures Act – Precision Medicine Initiative 100,324 94,609 5,715 93.394 Cancer Detection and Diagnosis Research 847,959 816,528 31,431 93.395 Cancer Treatment Research 438,349 439,286 (937) 93.396 Cancer Biology Research 93,919 88,642 5,277 93.397 Cancer Centers Support Grants 15,552 14,078 1,474 93.667 Social Services Block Grant 19,619 27,170 (7,551) 93.837 Cardiovascular Diseases Research 193,160 188,850 4,310 93.838 Lung Diseases Research 482,934 471,427 11,507 93.847 Diabetes, Digestive, and Kidney Diseases Extramural Research 1,075,493 1,035,041 40,452 93.853 Extramural Research Programs in the Neurosciences and Neurological Disorders 1,645,025 1,596,611 48,414 93.855 Allergy, Immunology and Transplantation Research 73,869 72,630 1,239 93.859 Biomedical Research and Research Training 363,336 366,791 (3,455) 93.865 Child Health and Human Development Extramural Research 3,790,797 3,733,008 57,789 93.866 Aging Research 1,101,363 1,098,891 2,472 93.946 Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs 80,039 78,033 2,006 93.994 Maternal and Child Health Services Block Grant to the States 171,995 168,656 3,339 The Role of Oral Care in Nonventilator Hospital-Acquired Pneumonia (NVHAP) Prevention 148,388 – 148,388 Total $ 13,864,545 $ 13,482,752 $ 381,793 Identification as a repeat finding, if applicable: The finding is not a repeat finding from the prior year. 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: Award amounts were changed on the Schedule after management’s review was executed. Management acknowledges that implementing the new Enterprise Resource Planning (ERP) system, in 2023 presented changes to the SEFA reporting. Management has identified and addressed the reporting issues within the new system to ensure that the grant totals are appropriately captured in the SEFA. Endeavor will enhance grant management award processes by revising its procedures and adding additional controls to monitor for accuracy of the core data. Management will reinforce the importance of timeliness and accuracy of the Schedule reporting totals to facilitate accurate reporting.
Finding 2023-001 – Reporting Information of the federal program: Federal Grantor: Department of Defense (DOD) Assistance Listing No.: 12.420, Military Medical Research and Development Pass-Through Grantor: Johns Hopkins University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.172, Human Genome Research Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.226, Research on Healthcare Costs, Quality and Outcomes Pass-Through Grantor: The Regents of the University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.242, Mental Health Research Grants Pass-Through Grantor: Rutgers State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.307, Minority Health and Health Disparities Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.310, Trans-NIH Research Support Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.350, National Center for Advancing Translational Sciences Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.351, Research Infrastructure Program Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.361, Nursing Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.368, 21st Century Cures Act – Precision Medicine Initiative Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.394, Cancer Detection and Diagnosis Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.395, Cancer Treatment Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.396, Cancer Biology Research Pass-Through Grantor: Tulane University, Louisiana State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.397, Cancer Centers Support Grants Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.667, Social Services Block Grant Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.837, Cardiovascular Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.838, Lung Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.847, Diabetes, Digestive, and Kidney Diseases Extramural Research Pass-Through Grantors: Northwestern University, Duke University, University of Washington, The Regents of University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.853, Extramural Research Programs in the Neurosciences and Neurological Disorders Pass-Through Grantor: Rush University Medical Center Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.855, Allergy, Immunology and Transplantation Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.859, Biomedical Research and Research Training Pass-Through Grantor: University of Wisconsin – Madison Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.865, Child Health and Human Development Extramural Research Pass-Through Grantors: Northwestern University, University of Washington, The Regents of the University of California Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.866, Aging Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.946, Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.994, Maternal and Child Health Services Block Grant to the States Pass-Through Grantor: Northwestern Memorial Hospital 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).” 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 grants related to the Research and Development Cluster were misstated by $233,405 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. In addition, an award which was not a federal grant award with expenditures of $148,388 was included on the preliminary Schedule provided by management. 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: The table below reflects the preliminary and adjusted assistance listing balances on the Schedule (only assistance listing programs which changed are included below): Assistance Listing No. Name of Federal Program Preliminary Schedule Adjusted Schedule Change 12.420 Military Medical Research and Development $ 241,025 $ 224,418 $ 16,607 93.172 Human Genome Research 14,874 15,121 (247) 93.226 Research on Healthcare Costs, Quality and Outcomes 251,325 248,842 2,483 93.242 Mental Health Research Grants 1,616,503 1,617,376 (873) 93.307 Minority Health and Health Disparities Research 17,323 15,122 2,201 93.310 Trans-NIH Research Support 313,459 313,490 (31) 93.350 National Center for Advancing Translational Sciences 516,734 518,429 (1,695) 93.351 Research Infrastructure Program 242,436 232,058 10,378 93.361 Nursing Research 8,745 7,645 1,100 93.368 21st Century Cures Act – Precision Medicine Initiative 100,324 94,609 5,715 93.394 Cancer Detection and Diagnosis Research 847,959 816,528 31,431 93.395 Cancer Treatment Research 438,349 439,286 (937) 93.396 Cancer Biology Research 93,919 88,642 5,277 93.397 Cancer Centers Support Grants 15,552 14,078 1,474 93.667 Social Services Block Grant 19,619 27,170 (7,551) 93.837 Cardiovascular Diseases Research 193,160 188,850 4,310 93.838 Lung Diseases Research 482,934 471,427 11,507 93.847 Diabetes, Digestive, and Kidney Diseases Extramural Research 1,075,493 1,035,041 40,452 93.853 Extramural Research Programs in the Neurosciences and Neurological Disorders 1,645,025 1,596,611 48,414 93.855 Allergy, Immunology and Transplantation Research 73,869 72,630 1,239 93.859 Biomedical Research and Research Training 363,336 366,791 (3,455) 93.865 Child Health and Human Development Extramural Research 3,790,797 3,733,008 57,789 93.866 Aging Research 1,101,363 1,098,891 2,472 93.946 Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs 80,039 78,033 2,006 93.994 Maternal and Child Health Services Block Grant to the States 171,995 168,656 3,339 The Role of Oral Care in Nonventilator Hospital-Acquired Pneumonia (NVHAP) Prevention 148,388 – 148,388 Total $ 13,864,545 $ 13,482,752 $ 381,793 Identification as a repeat finding, if applicable: The finding is not a repeat finding from the prior year. 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: Award amounts were changed on the Schedule after management’s review was executed. Management acknowledges that implementing the new Enterprise Resource Planning (ERP) system, in 2023 presented changes to the SEFA reporting. Management has identified and addressed the reporting issues within the new system to ensure that the grant totals are appropriately captured in the SEFA. Endeavor will enhance grant management award processes by revising its procedures and adding additional controls to monitor for accuracy of the core data. Management will reinforce the importance of timeliness and accuracy of the Schedule reporting totals to facilitate accurate reporting.
Finding 2023-001 – Reporting Information of the federal program: Federal Grantor: Department of Defense (DOD) Assistance Listing No.: 12.420, Military Medical Research and Development Pass-Through Grantor: Johns Hopkins University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.172, Human Genome Research Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.226, Research on Healthcare Costs, Quality and Outcomes Pass-Through Grantor: The Regents of the University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.242, Mental Health Research Grants Pass-Through Grantor: Rutgers State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.307, Minority Health and Health Disparities Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.310, Trans-NIH Research Support Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.350, National Center for Advancing Translational Sciences Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.351, Research Infrastructure Program Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.361, Nursing Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.368, 21st Century Cures Act – Precision Medicine Initiative Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.394, Cancer Detection and Diagnosis Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.395, Cancer Treatment Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.396, Cancer Biology Research Pass-Through Grantor: Tulane University, Louisiana State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.397, Cancer Centers Support Grants Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.667, Social Services Block Grant Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.837, Cardiovascular Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.838, Lung Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.847, Diabetes, Digestive, and Kidney Diseases Extramural Research Pass-Through Grantors: Northwestern University, Duke University, University of Washington, The Regents of University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.853, Extramural Research Programs in the Neurosciences and Neurological Disorders Pass-Through Grantor: Rush University Medical Center Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.855, Allergy, Immunology and Transplantation Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.859, Biomedical Research and Research Training Pass-Through Grantor: University of Wisconsin – Madison Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.865, Child Health and Human Development Extramural Research Pass-Through Grantors: Northwestern University, University of Washington, The Regents of the University of California Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.866, Aging Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.946, Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.994, Maternal and Child Health Services Block Grant to the States Pass-Through Grantor: Northwestern Memorial Hospital 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).” 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 grants related to the Research and Development Cluster were misstated by $233,405 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. In addition, an award which was not a federal grant award with expenditures of $148,388 was included on the preliminary Schedule provided by management. 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: The table below reflects the preliminary and adjusted assistance listing balances on the Schedule (only assistance listing programs which changed are included below): Assistance Listing No. Name of Federal Program Preliminary Schedule Adjusted Schedule Change 12.420 Military Medical Research and Development $ 241,025 $ 224,418 $ 16,607 93.172 Human Genome Research 14,874 15,121 (247) 93.226 Research on Healthcare Costs, Quality and Outcomes 251,325 248,842 2,483 93.242 Mental Health Research Grants 1,616,503 1,617,376 (873) 93.307 Minority Health and Health Disparities Research 17,323 15,122 2,201 93.310 Trans-NIH Research Support 313,459 313,490 (31) 93.350 National Center for Advancing Translational Sciences 516,734 518,429 (1,695) 93.351 Research Infrastructure Program 242,436 232,058 10,378 93.361 Nursing Research 8,745 7,645 1,100 93.368 21st Century Cures Act – Precision Medicine Initiative 100,324 94,609 5,715 93.394 Cancer Detection and Diagnosis Research 847,959 816,528 31,431 93.395 Cancer Treatment Research 438,349 439,286 (937) 93.396 Cancer Biology Research 93,919 88,642 5,277 93.397 Cancer Centers Support Grants 15,552 14,078 1,474 93.667 Social Services Block Grant 19,619 27,170 (7,551) 93.837 Cardiovascular Diseases Research 193,160 188,850 4,310 93.838 Lung Diseases Research 482,934 471,427 11,507 93.847 Diabetes, Digestive, and Kidney Diseases Extramural Research 1,075,493 1,035,041 40,452 93.853 Extramural Research Programs in the Neurosciences and Neurological Disorders 1,645,025 1,596,611 48,414 93.855 Allergy, Immunology and Transplantation Research 73,869 72,630 1,239 93.859 Biomedical Research and Research Training 363,336 366,791 (3,455) 93.865 Child Health and Human Development Extramural Research 3,790,797 3,733,008 57,789 93.866 Aging Research 1,101,363 1,098,891 2,472 93.946 Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs 80,039 78,033 2,006 93.994 Maternal and Child Health Services Block Grant to the States 171,995 168,656 3,339 The Role of Oral Care in Nonventilator Hospital-Acquired Pneumonia (NVHAP) Prevention 148,388 – 148,388 Total $ 13,864,545 $ 13,482,752 $ 381,793 Identification as a repeat finding, if applicable: The finding is not a repeat finding from the prior year. 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: Award amounts were changed on the Schedule after management’s review was executed. Management acknowledges that implementing the new Enterprise Resource Planning (ERP) system, in 2023 presented changes to the SEFA reporting. Management has identified and addressed the reporting issues within the new system to ensure that the grant totals are appropriately captured in the SEFA. Endeavor will enhance grant management award processes by revising its procedures and adding additional controls to monitor for accuracy of the core data. Management will reinforce the importance of timeliness and accuracy of the Schedule reporting totals to facilitate accurate reporting.
Finding 2023-001 – Reporting Information of the federal program: Federal Grantor: Department of Defense (DOD) Assistance Listing No.: 12.420, Military Medical Research and Development Pass-Through Grantor: Johns Hopkins University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.172, Human Genome Research Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.226, Research on Healthcare Costs, Quality and Outcomes Pass-Through Grantor: The Regents of the University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.242, Mental Health Research Grants Pass-Through Grantor: Rutgers State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.307, Minority Health and Health Disparities Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.310, Trans-NIH Research Support Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.350, National Center for Advancing Translational Sciences Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.351, Research Infrastructure Program Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.361, Nursing Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.368, 21st Century Cures Act – Precision Medicine Initiative Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.394, Cancer Detection and Diagnosis Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.395, Cancer Treatment Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.396, Cancer Biology Research Pass-Through Grantor: Tulane University, Louisiana State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.397, Cancer Centers Support Grants Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.667, Social Services Block Grant Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.837, Cardiovascular Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.838, Lung Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.847, Diabetes, Digestive, and Kidney Diseases Extramural Research Pass-Through Grantors: Northwestern University, Duke University, University of Washington, The Regents of University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.853, Extramural Research Programs in the Neurosciences and Neurological Disorders Pass-Through Grantor: Rush University Medical Center Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.855, Allergy, Immunology and Transplantation Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.859, Biomedical Research and Research Training Pass-Through Grantor: University of Wisconsin – Madison Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.865, Child Health and Human Development Extramural Research Pass-Through Grantors: Northwestern University, University of Washington, The Regents of the University of California Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.866, Aging Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.946, Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.994, Maternal and Child Health Services Block Grant to the States Pass-Through Grantor: Northwestern Memorial Hospital 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).” 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 grants related to the Research and Development Cluster were misstated by $233,405 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. In addition, an award which was not a federal grant award with expenditures of $148,388 was included on the preliminary Schedule provided by management. 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: The table below reflects the preliminary and adjusted assistance listing balances on the Schedule (only assistance listing programs which changed are included below): Assistance Listing No. Name of Federal Program Preliminary Schedule Adjusted Schedule Change 12.420 Military Medical Research and Development $ 241,025 $ 224,418 $ 16,607 93.172 Human Genome Research 14,874 15,121 (247) 93.226 Research on Healthcare Costs, Quality and Outcomes 251,325 248,842 2,483 93.242 Mental Health Research Grants 1,616,503 1,617,376 (873) 93.307 Minority Health and Health Disparities Research 17,323 15,122 2,201 93.310 Trans-NIH Research Support 313,459 313,490 (31) 93.350 National Center for Advancing Translational Sciences 516,734 518,429 (1,695) 93.351 Research Infrastructure Program 242,436 232,058 10,378 93.361 Nursing Research 8,745 7,645 1,100 93.368 21st Century Cures Act – Precision Medicine Initiative 100,324 94,609 5,715 93.394 Cancer Detection and Diagnosis Research 847,959 816,528 31,431 93.395 Cancer Treatment Research 438,349 439,286 (937) 93.396 Cancer Biology Research 93,919 88,642 5,277 93.397 Cancer Centers Support Grants 15,552 14,078 1,474 93.667 Social Services Block Grant 19,619 27,170 (7,551) 93.837 Cardiovascular Diseases Research 193,160 188,850 4,310 93.838 Lung Diseases Research 482,934 471,427 11,507 93.847 Diabetes, Digestive, and Kidney Diseases Extramural Research 1,075,493 1,035,041 40,452 93.853 Extramural Research Programs in the Neurosciences and Neurological Disorders 1,645,025 1,596,611 48,414 93.855 Allergy, Immunology and Transplantation Research 73,869 72,630 1,239 93.859 Biomedical Research and Research Training 363,336 366,791 (3,455) 93.865 Child Health and Human Development Extramural Research 3,790,797 3,733,008 57,789 93.866 Aging Research 1,101,363 1,098,891 2,472 93.946 Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs 80,039 78,033 2,006 93.994 Maternal and Child Health Services Block Grant to the States 171,995 168,656 3,339 The Role of Oral Care in Nonventilator Hospital-Acquired Pneumonia (NVHAP) Prevention 148,388 – 148,388 Total $ 13,864,545 $ 13,482,752 $ 381,793 Identification as a repeat finding, if applicable: The finding is not a repeat finding from the prior year. 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: Award amounts were changed on the Schedule after management’s review was executed. Management acknowledges that implementing the new Enterprise Resource Planning (ERP) system, in 2023 presented changes to the SEFA reporting. Management has identified and addressed the reporting issues within the new system to ensure that the grant totals are appropriately captured in the SEFA. Endeavor will enhance grant management award processes by revising its procedures and adding additional controls to monitor for accuracy of the core data. Management will reinforce the importance of timeliness and accuracy of the Schedule reporting totals to facilitate accurate reporting.
Finding 2023-001 – Reporting Information of the federal program: Federal Grantor: Department of Defense (DOD) Assistance Listing No.: 12.420, Military Medical Research and Development Pass-Through Grantor: Johns Hopkins University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.172, Human Genome Research Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.226, Research on Healthcare Costs, Quality and Outcomes Pass-Through Grantor: The Regents of the University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.242, Mental Health Research Grants Pass-Through Grantor: Rutgers State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.307, Minority Health and Health Disparities Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.310, Trans-NIH Research Support Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.350, National Center for Advancing Translational Sciences Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.351, Research Infrastructure Program Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.361, Nursing Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.368, 21st Century Cures Act – Precision Medicine Initiative Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.394, Cancer Detection and Diagnosis Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.395, Cancer Treatment Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.396, Cancer Biology Research Pass-Through Grantor: Tulane University, Louisiana State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.397, Cancer Centers Support Grants Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.667, Social Services Block Grant Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.837, Cardiovascular Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.838, Lung Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.847, Diabetes, Digestive, and Kidney Diseases Extramural Research Pass-Through Grantors: Northwestern University, Duke University, University of Washington, The Regents of University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.853, Extramural Research Programs in the Neurosciences and Neurological Disorders Pass-Through Grantor: Rush University Medical Center Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.855, Allergy, Immunology and Transplantation Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.859, Biomedical Research and Research Training Pass-Through Grantor: University of Wisconsin – Madison Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.865, Child Health and Human Development Extramural Research Pass-Through Grantors: Northwestern University, University of Washington, The Regents of the University of California Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.866, Aging Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.946, Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.994, Maternal and Child Health Services Block Grant to the States Pass-Through Grantor: Northwestern Memorial Hospital 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).” 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 grants related to the Research and Development Cluster were misstated by $233,405 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. In addition, an award which was not a federal grant award with expenditures of $148,388 was included on the preliminary Schedule provided by management. 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: The table below reflects the preliminary and adjusted assistance listing balances on the Schedule (only assistance listing programs which changed are included below): Assistance Listing No. Name of Federal Program Preliminary Schedule Adjusted Schedule Change 12.420 Military Medical Research and Development $ 241,025 $ 224,418 $ 16,607 93.172 Human Genome Research 14,874 15,121 (247) 93.226 Research on Healthcare Costs, Quality and Outcomes 251,325 248,842 2,483 93.242 Mental Health Research Grants 1,616,503 1,617,376 (873) 93.307 Minority Health and Health Disparities Research 17,323 15,122 2,201 93.310 Trans-NIH Research Support 313,459 313,490 (31) 93.350 National Center for Advancing Translational Sciences 516,734 518,429 (1,695) 93.351 Research Infrastructure Program 242,436 232,058 10,378 93.361 Nursing Research 8,745 7,645 1,100 93.368 21st Century Cures Act – Precision Medicine Initiative 100,324 94,609 5,715 93.394 Cancer Detection and Diagnosis Research 847,959 816,528 31,431 93.395 Cancer Treatment Research 438,349 439,286 (937) 93.396 Cancer Biology Research 93,919 88,642 5,277 93.397 Cancer Centers Support Grants 15,552 14,078 1,474 93.667 Social Services Block Grant 19,619 27,170 (7,551) 93.837 Cardiovascular Diseases Research 193,160 188,850 4,310 93.838 Lung Diseases Research 482,934 471,427 11,507 93.847 Diabetes, Digestive, and Kidney Diseases Extramural Research 1,075,493 1,035,041 40,452 93.853 Extramural Research Programs in the Neurosciences and Neurological Disorders 1,645,025 1,596,611 48,414 93.855 Allergy, Immunology and Transplantation Research 73,869 72,630 1,239 93.859 Biomedical Research and Research Training 363,336 366,791 (3,455) 93.865 Child Health and Human Development Extramural Research 3,790,797 3,733,008 57,789 93.866 Aging Research 1,101,363 1,098,891 2,472 93.946 Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs 80,039 78,033 2,006 93.994 Maternal and Child Health Services Block Grant to the States 171,995 168,656 3,339 The Role of Oral Care in Nonventilator Hospital-Acquired Pneumonia (NVHAP) Prevention 148,388 – 148,388 Total $ 13,864,545 $ 13,482,752 $ 381,793 Identification as a repeat finding, if applicable: The finding is not a repeat finding from the prior year. 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: Award amounts were changed on the Schedule after management’s review was executed. Management acknowledges that implementing the new Enterprise Resource Planning (ERP) system, in 2023 presented changes to the SEFA reporting. Management has identified and addressed the reporting issues within the new system to ensure that the grant totals are appropriately captured in the SEFA. Endeavor will enhance grant management award processes by revising its procedures and adding additional controls to monitor for accuracy of the core data. Management will reinforce the importance of timeliness and accuracy of the Schedule reporting totals to facilitate accurate reporting.
Finding 2023-001 – Reporting Information of the federal program: Federal Grantor: Department of Defense (DOD) Assistance Listing No.: 12.420, Military Medical Research and Development Pass-Through Grantor: Johns Hopkins University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.172, Human Genome Research Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.226, Research on Healthcare Costs, Quality and Outcomes Pass-Through Grantor: The Regents of the University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.242, Mental Health Research Grants Pass-Through Grantor: Rutgers State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.307, Minority Health and Health Disparities Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.310, Trans-NIH Research Support Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.350, National Center for Advancing Translational Sciences Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.351, Research Infrastructure Program Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.361, Nursing Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.368, 21st Century Cures Act – Precision Medicine Initiative Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.394, Cancer Detection and Diagnosis Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.395, Cancer Treatment Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.396, Cancer Biology Research Pass-Through Grantor: Tulane University, Louisiana State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.397, Cancer Centers Support Grants Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.667, Social Services Block Grant Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.837, Cardiovascular Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.838, Lung Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.847, Diabetes, Digestive, and Kidney Diseases Extramural Research Pass-Through Grantors: Northwestern University, Duke University, University of Washington, The Regents of University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.853, Extramural Research Programs in the Neurosciences and Neurological Disorders Pass-Through Grantor: Rush University Medical Center Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.855, Allergy, Immunology and Transplantation Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.859, Biomedical Research and Research Training Pass-Through Grantor: University of Wisconsin – Madison Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.865, Child Health and Human Development Extramural Research Pass-Through Grantors: Northwestern University, University of Washington, The Regents of the University of California Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.866, Aging Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.946, Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.994, Maternal and Child Health Services Block Grant to the States Pass-Through Grantor: Northwestern Memorial Hospital 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).” 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 grants related to the Research and Development Cluster were misstated by $233,405 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. In addition, an award which was not a federal grant award with expenditures of $148,388 was included on the preliminary Schedule provided by management. 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: The table below reflects the preliminary and adjusted assistance listing balances on the Schedule (only assistance listing programs which changed are included below): Assistance Listing No. Name of Federal Program Preliminary Schedule Adjusted Schedule Change 12.420 Military Medical Research and Development $ 241,025 $ 224,418 $ 16,607 93.172 Human Genome Research 14,874 15,121 (247) 93.226 Research on Healthcare Costs, Quality and Outcomes 251,325 248,842 2,483 93.242 Mental Health Research Grants 1,616,503 1,617,376 (873) 93.307 Minority Health and Health Disparities Research 17,323 15,122 2,201 93.310 Trans-NIH Research Support 313,459 313,490 (31) 93.350 National Center for Advancing Translational Sciences 516,734 518,429 (1,695) 93.351 Research Infrastructure Program 242,436 232,058 10,378 93.361 Nursing Research 8,745 7,645 1,100 93.368 21st Century Cures Act – Precision Medicine Initiative 100,324 94,609 5,715 93.394 Cancer Detection and Diagnosis Research 847,959 816,528 31,431 93.395 Cancer Treatment Research 438,349 439,286 (937) 93.396 Cancer Biology Research 93,919 88,642 5,277 93.397 Cancer Centers Support Grants 15,552 14,078 1,474 93.667 Social Services Block Grant 19,619 27,170 (7,551) 93.837 Cardiovascular Diseases Research 193,160 188,850 4,310 93.838 Lung Diseases Research 482,934 471,427 11,507 93.847 Diabetes, Digestive, and Kidney Diseases Extramural Research 1,075,493 1,035,041 40,452 93.853 Extramural Research Programs in the Neurosciences and Neurological Disorders 1,645,025 1,596,611 48,414 93.855 Allergy, Immunology and Transplantation Research 73,869 72,630 1,239 93.859 Biomedical Research and Research Training 363,336 366,791 (3,455) 93.865 Child Health and Human Development Extramural Research 3,790,797 3,733,008 57,789 93.866 Aging Research 1,101,363 1,098,891 2,472 93.946 Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs 80,039 78,033 2,006 93.994 Maternal and Child Health Services Block Grant to the States 171,995 168,656 3,339 The Role of Oral Care in Nonventilator Hospital-Acquired Pneumonia (NVHAP) Prevention 148,388 – 148,388 Total $ 13,864,545 $ 13,482,752 $ 381,793 Identification as a repeat finding, if applicable: The finding is not a repeat finding from the prior year. 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: Award amounts were changed on the Schedule after management’s review was executed. Management acknowledges that implementing the new Enterprise Resource Planning (ERP) system, in 2023 presented changes to the SEFA reporting. Management has identified and addressed the reporting issues within the new system to ensure that the grant totals are appropriately captured in the SEFA. Endeavor will enhance grant management award processes by revising its procedures and adding additional controls to monitor for accuracy of the core data. Management will reinforce the importance of timeliness and accuracy of the Schedule reporting totals to facilitate accurate reporting.
Finding 2023-001 – Reporting Information of the federal program: Federal Grantor: Department of Defense (DOD) Assistance Listing No.: 12.420, Military Medical Research and Development Pass-Through Grantor: Johns Hopkins University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.172, Human Genome Research Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.226, Research on Healthcare Costs, Quality and Outcomes Pass-Through Grantor: The Regents of the University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.242, Mental Health Research Grants Pass-Through Grantor: Rutgers State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.307, Minority Health and Health Disparities Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.310, Trans-NIH Research Support Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.350, National Center for Advancing Translational Sciences Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.351, Research Infrastructure Program Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.361, Nursing Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.368, 21st Century Cures Act – Precision Medicine Initiative Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.394, Cancer Detection and Diagnosis Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.395, Cancer Treatment Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.396, Cancer Biology Research Pass-Through Grantor: Tulane University, Louisiana State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.397, Cancer Centers Support Grants Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.667, Social Services Block Grant Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.837, Cardiovascular Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.838, Lung Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.847, Diabetes, Digestive, and Kidney Diseases Extramural Research Pass-Through Grantors: Northwestern University, Duke University, University of Washington, The Regents of University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.853, Extramural Research Programs in the Neurosciences and Neurological Disorders Pass-Through Grantor: Rush University Medical Center Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.855, Allergy, Immunology and Transplantation Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.859, Biomedical Research and Research Training Pass-Through Grantor: University of Wisconsin – Madison Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.865, Child Health and Human Development Extramural Research Pass-Through Grantors: Northwestern University, University of Washington, The Regents of the University of California Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.866, Aging Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.946, Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.994, Maternal and Child Health Services Block Grant to the States Pass-Through Grantor: Northwestern Memorial Hospital 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).” 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 grants related to the Research and Development Cluster were misstated by $233,405 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. In addition, an award which was not a federal grant award with expenditures of $148,388 was included on the preliminary Schedule provided by management. 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: The table below reflects the preliminary and adjusted assistance listing balances on the Schedule (only assistance listing programs which changed are included below): Assistance Listing No. Name of Federal Program Preliminary Schedule Adjusted Schedule Change 12.420 Military Medical Research and Development $ 241,025 $ 224,418 $ 16,607 93.172 Human Genome Research 14,874 15,121 (247) 93.226 Research on Healthcare Costs, Quality and Outcomes 251,325 248,842 2,483 93.242 Mental Health Research Grants 1,616,503 1,617,376 (873) 93.307 Minority Health and Health Disparities Research 17,323 15,122 2,201 93.310 Trans-NIH Research Support 313,459 313,490 (31) 93.350 National Center for Advancing Translational Sciences 516,734 518,429 (1,695) 93.351 Research Infrastructure Program 242,436 232,058 10,378 93.361 Nursing Research 8,745 7,645 1,100 93.368 21st Century Cures Act – Precision Medicine Initiative 100,324 94,609 5,715 93.394 Cancer Detection and Diagnosis Research 847,959 816,528 31,431 93.395 Cancer Treatment Research 438,349 439,286 (937) 93.396 Cancer Biology Research 93,919 88,642 5,277 93.397 Cancer Centers Support Grants 15,552 14,078 1,474 93.667 Social Services Block Grant 19,619 27,170 (7,551) 93.837 Cardiovascular Diseases Research 193,160 188,850 4,310 93.838 Lung Diseases Research 482,934 471,427 11,507 93.847 Diabetes, Digestive, and Kidney Diseases Extramural Research 1,075,493 1,035,041 40,452 93.853 Extramural Research Programs in the Neurosciences and Neurological Disorders 1,645,025 1,596,611 48,414 93.855 Allergy, Immunology and Transplantation Research 73,869 72,630 1,239 93.859 Biomedical Research and Research Training 363,336 366,791 (3,455) 93.865 Child Health and Human Development Extramural Research 3,790,797 3,733,008 57,789 93.866 Aging Research 1,101,363 1,098,891 2,472 93.946 Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs 80,039 78,033 2,006 93.994 Maternal and Child Health Services Block Grant to the States 171,995 168,656 3,339 The Role of Oral Care in Nonventilator Hospital-Acquired Pneumonia (NVHAP) Prevention 148,388 – 148,388 Total $ 13,864,545 $ 13,482,752 $ 381,793 Identification as a repeat finding, if applicable: The finding is not a repeat finding from the prior year. 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: Award amounts were changed on the Schedule after management’s review was executed. Management acknowledges that implementing the new Enterprise Resource Planning (ERP) system, in 2023 presented changes to the SEFA reporting. Management has identified and addressed the reporting issues within the new system to ensure that the grant totals are appropriately captured in the SEFA. Endeavor will enhance grant management award processes by revising its procedures and adding additional controls to monitor for accuracy of the core data. Management will reinforce the importance of timeliness and accuracy of the Schedule reporting totals to facilitate accurate reporting.
Finding 2023-001 – Reporting Information of the federal program: Federal Grantor: Department of Defense (DOD) Assistance Listing No.: 12.420, Military Medical Research and Development Pass-Through Grantor: Johns Hopkins University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.172, Human Genome Research Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.226, Research on Healthcare Costs, Quality and Outcomes Pass-Through Grantor: The Regents of the University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.242, Mental Health Research Grants Pass-Through Grantor: Rutgers State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.307, Minority Health and Health Disparities Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.310, Trans-NIH Research Support Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.350, National Center for Advancing Translational Sciences Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.351, Research Infrastructure Program Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.361, Nursing Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.368, 21st Century Cures Act – Precision Medicine Initiative Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.394, Cancer Detection and Diagnosis Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.395, Cancer Treatment Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.396, Cancer Biology Research Pass-Through Grantor: Tulane University, Louisiana State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.397, Cancer Centers Support Grants Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.667, Social Services Block Grant Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.837, Cardiovascular Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.838, Lung Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.847, Diabetes, Digestive, and Kidney Diseases Extramural Research Pass-Through Grantors: Northwestern University, Duke University, University of Washington, The Regents of University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.853, Extramural Research Programs in the Neurosciences and Neurological Disorders Pass-Through Grantor: Rush University Medical Center Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.855, Allergy, Immunology and Transplantation Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.859, Biomedical Research and Research Training Pass-Through Grantor: University of Wisconsin – Madison Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.865, Child Health and Human Development Extramural Research Pass-Through Grantors: Northwestern University, University of Washington, The Regents of the University of California Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.866, Aging Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.946, Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.994, Maternal and Child Health Services Block Grant to the States Pass-Through Grantor: Northwestern Memorial Hospital 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).” 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 grants related to the Research and Development Cluster were misstated by $233,405 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. In addition, an award which was not a federal grant award with expenditures of $148,388 was included on the preliminary Schedule provided by management. 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: The table below reflects the preliminary and adjusted assistance listing balances on the Schedule (only assistance listing programs which changed are included below): Assistance Listing No. Name of Federal Program Preliminary Schedule Adjusted Schedule Change 12.420 Military Medical Research and Development $ 241,025 $ 224,418 $ 16,607 93.172 Human Genome Research 14,874 15,121 (247) 93.226 Research on Healthcare Costs, Quality and Outcomes 251,325 248,842 2,483 93.242 Mental Health Research Grants 1,616,503 1,617,376 (873) 93.307 Minority Health and Health Disparities Research 17,323 15,122 2,201 93.310 Trans-NIH Research Support 313,459 313,490 (31) 93.350 National Center for Advancing Translational Sciences 516,734 518,429 (1,695) 93.351 Research Infrastructure Program 242,436 232,058 10,378 93.361 Nursing Research 8,745 7,645 1,100 93.368 21st Century Cures Act – Precision Medicine Initiative 100,324 94,609 5,715 93.394 Cancer Detection and Diagnosis Research 847,959 816,528 31,431 93.395 Cancer Treatment Research 438,349 439,286 (937) 93.396 Cancer Biology Research 93,919 88,642 5,277 93.397 Cancer Centers Support Grants 15,552 14,078 1,474 93.667 Social Services Block Grant 19,619 27,170 (7,551) 93.837 Cardiovascular Diseases Research 193,160 188,850 4,310 93.838 Lung Diseases Research 482,934 471,427 11,507 93.847 Diabetes, Digestive, and Kidney Diseases Extramural Research 1,075,493 1,035,041 40,452 93.853 Extramural Research Programs in the Neurosciences and Neurological Disorders 1,645,025 1,596,611 48,414 93.855 Allergy, Immunology and Transplantation Research 73,869 72,630 1,239 93.859 Biomedical Research and Research Training 363,336 366,791 (3,455) 93.865 Child Health and Human Development Extramural Research 3,790,797 3,733,008 57,789 93.866 Aging Research 1,101,363 1,098,891 2,472 93.946 Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs 80,039 78,033 2,006 93.994 Maternal and Child Health Services Block Grant to the States 171,995 168,656 3,339 The Role of Oral Care in Nonventilator Hospital-Acquired Pneumonia (NVHAP) Prevention 148,388 – 148,388 Total $ 13,864,545 $ 13,482,752 $ 381,793 Identification as a repeat finding, if applicable: The finding is not a repeat finding from the prior year. 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: Award amounts were changed on the Schedule after management’s review was executed. Management acknowledges that implementing the new Enterprise Resource Planning (ERP) system, in 2023 presented changes to the SEFA reporting. Management has identified and addressed the reporting issues within the new system to ensure that the grant totals are appropriately captured in the SEFA. Endeavor will enhance grant management award processes by revising its procedures and adding additional controls to monitor for accuracy of the core data. Management will reinforce the importance of timeliness and accuracy of the Schedule reporting totals to facilitate accurate reporting.
Finding 2023-001 – Reporting Information of the federal program: Federal Grantor: Department of Defense (DOD) Assistance Listing No.: 12.420, Military Medical Research and Development Pass-Through Grantor: Johns Hopkins University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.172, Human Genome Research Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.226, Research on Healthcare Costs, Quality and Outcomes Pass-Through Grantor: The Regents of the University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.242, Mental Health Research Grants Pass-Through Grantor: Rutgers State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.307, Minority Health and Health Disparities Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.310, Trans-NIH Research Support Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.350, National Center for Advancing Translational Sciences Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.351, Research Infrastructure Program Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.361, Nursing Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.368, 21st Century Cures Act – Precision Medicine Initiative Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.394, Cancer Detection and Diagnosis Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.395, Cancer Treatment Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.396, Cancer Biology Research Pass-Through Grantor: Tulane University, Louisiana State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.397, Cancer Centers Support Grants Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.667, Social Services Block Grant Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.837, Cardiovascular Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.838, Lung Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.847, Diabetes, Digestive, and Kidney Diseases Extramural Research Pass-Through Grantors: Northwestern University, Duke University, University of Washington, The Regents of University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.853, Extramural Research Programs in the Neurosciences and Neurological Disorders Pass-Through Grantor: Rush University Medical Center Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.855, Allergy, Immunology and Transplantation Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.859, Biomedical Research and Research Training Pass-Through Grantor: University of Wisconsin – Madison Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.865, Child Health and Human Development Extramural Research Pass-Through Grantors: Northwestern University, University of Washington, The Regents of the University of California Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.866, Aging Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.946, Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.994, Maternal and Child Health Services Block Grant to the States Pass-Through Grantor: Northwestern Memorial Hospital 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).” 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 grants related to the Research and Development Cluster were misstated by $233,405 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. In addition, an award which was not a federal grant award with expenditures of $148,388 was included on the preliminary Schedule provided by management. 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: The table below reflects the preliminary and adjusted assistance listing balances on the Schedule (only assistance listing programs which changed are included below): Assistance Listing No. Name of Federal Program Preliminary Schedule Adjusted Schedule Change 12.420 Military Medical Research and Development $ 241,025 $ 224,418 $ 16,607 93.172 Human Genome Research 14,874 15,121 (247) 93.226 Research on Healthcare Costs, Quality and Outcomes 251,325 248,842 2,483 93.242 Mental Health Research Grants 1,616,503 1,617,376 (873) 93.307 Minority Health and Health Disparities Research 17,323 15,122 2,201 93.310 Trans-NIH Research Support 313,459 313,490 (31) 93.350 National Center for Advancing Translational Sciences 516,734 518,429 (1,695) 93.351 Research Infrastructure Program 242,436 232,058 10,378 93.361 Nursing Research 8,745 7,645 1,100 93.368 21st Century Cures Act – Precision Medicine Initiative 100,324 94,609 5,715 93.394 Cancer Detection and Diagnosis Research 847,959 816,528 31,431 93.395 Cancer Treatment Research 438,349 439,286 (937) 93.396 Cancer Biology Research 93,919 88,642 5,277 93.397 Cancer Centers Support Grants 15,552 14,078 1,474 93.667 Social Services Block Grant 19,619 27,170 (7,551) 93.837 Cardiovascular Diseases Research 193,160 188,850 4,310 93.838 Lung Diseases Research 482,934 471,427 11,507 93.847 Diabetes, Digestive, and Kidney Diseases Extramural Research 1,075,493 1,035,041 40,452 93.853 Extramural Research Programs in the Neurosciences and Neurological Disorders 1,645,025 1,596,611 48,414 93.855 Allergy, Immunology and Transplantation Research 73,869 72,630 1,239 93.859 Biomedical Research and Research Training 363,336 366,791 (3,455) 93.865 Child Health and Human Development Extramural Research 3,790,797 3,733,008 57,789 93.866 Aging Research 1,101,363 1,098,891 2,472 93.946 Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs 80,039 78,033 2,006 93.994 Maternal and Child Health Services Block Grant to the States 171,995 168,656 3,339 The Role of Oral Care in Nonventilator Hospital-Acquired Pneumonia (NVHAP) Prevention 148,388 – 148,388 Total $ 13,864,545 $ 13,482,752 $ 381,793 Identification as a repeat finding, if applicable: The finding is not a repeat finding from the prior year. 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: Award amounts were changed on the Schedule after management’s review was executed. Management acknowledges that implementing the new Enterprise Resource Planning (ERP) system, in 2023 presented changes to the SEFA reporting. Management has identified and addressed the reporting issues within the new system to ensure that the grant totals are appropriately captured in the SEFA. Endeavor will enhance grant management award processes by revising its procedures and adding additional controls to monitor for accuracy of the core data. Management will reinforce the importance of timeliness and accuracy of the Schedule reporting totals to facilitate accurate reporting.
Finding 2023-001 – Reporting Information of the federal program: Federal Grantor: Department of Defense (DOD) Assistance Listing No.: 12.420, Military Medical Research and Development Pass-Through Grantor: Johns Hopkins University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.172, Human Genome Research Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.226, Research on Healthcare Costs, Quality and Outcomes Pass-Through Grantor: The Regents of the University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.242, Mental Health Research Grants Pass-Through Grantor: Rutgers State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.307, Minority Health and Health Disparities Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.310, Trans-NIH Research Support Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.350, National Center for Advancing Translational Sciences Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.351, Research Infrastructure Program Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.361, Nursing Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.368, 21st Century Cures Act – Precision Medicine Initiative Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.394, Cancer Detection and Diagnosis Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.395, Cancer Treatment Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.396, Cancer Biology Research Pass-Through Grantor: Tulane University, Louisiana State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.397, Cancer Centers Support Grants Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.667, Social Services Block Grant Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.837, Cardiovascular Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.838, Lung Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.847, Diabetes, Digestive, and Kidney Diseases Extramural Research Pass-Through Grantors: Northwestern University, Duke University, University of Washington, The Regents of University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.853, Extramural Research Programs in the Neurosciences and Neurological Disorders Pass-Through Grantor: Rush University Medical Center Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.855, Allergy, Immunology and Transplantation Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.859, Biomedical Research and Research Training Pass-Through Grantor: University of Wisconsin – Madison Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.865, Child Health and Human Development Extramural Research Pass-Through Grantors: Northwestern University, University of Washington, The Regents of the University of California Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.866, Aging Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.946, Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.994, Maternal and Child Health Services Block Grant to the States Pass-Through Grantor: Northwestern Memorial Hospital 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).” 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 grants related to the Research and Development Cluster were misstated by $233,405 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. In addition, an award which was not a federal grant award with expenditures of $148,388 was included on the preliminary Schedule provided by management. 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: The table below reflects the preliminary and adjusted assistance listing balances on the Schedule (only assistance listing programs which changed are included below): Assistance Listing No. Name of Federal Program Preliminary Schedule Adjusted Schedule Change 12.420 Military Medical Research and Development $ 241,025 $ 224,418 $ 16,607 93.172 Human Genome Research 14,874 15,121 (247) 93.226 Research on Healthcare Costs, Quality and Outcomes 251,325 248,842 2,483 93.242 Mental Health Research Grants 1,616,503 1,617,376 (873) 93.307 Minority Health and Health Disparities Research 17,323 15,122 2,201 93.310 Trans-NIH Research Support 313,459 313,490 (31) 93.350 National Center for Advancing Translational Sciences 516,734 518,429 (1,695) 93.351 Research Infrastructure Program 242,436 232,058 10,378 93.361 Nursing Research 8,745 7,645 1,100 93.368 21st Century Cures Act – Precision Medicine Initiative 100,324 94,609 5,715 93.394 Cancer Detection and Diagnosis Research 847,959 816,528 31,431 93.395 Cancer Treatment Research 438,349 439,286 (937) 93.396 Cancer Biology Research 93,919 88,642 5,277 93.397 Cancer Centers Support Grants 15,552 14,078 1,474 93.667 Social Services Block Grant 19,619 27,170 (7,551) 93.837 Cardiovascular Diseases Research 193,160 188,850 4,310 93.838 Lung Diseases Research 482,934 471,427 11,507 93.847 Diabetes, Digestive, and Kidney Diseases Extramural Research 1,075,493 1,035,041 40,452 93.853 Extramural Research Programs in the Neurosciences and Neurological Disorders 1,645,025 1,596,611 48,414 93.855 Allergy, Immunology and Transplantation Research 73,869 72,630 1,239 93.859 Biomedical Research and Research Training 363,336 366,791 (3,455) 93.865 Child Health and Human Development Extramural Research 3,790,797 3,733,008 57,789 93.866 Aging Research 1,101,363 1,098,891 2,472 93.946 Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs 80,039 78,033 2,006 93.994 Maternal and Child Health Services Block Grant to the States 171,995 168,656 3,339 The Role of Oral Care in Nonventilator Hospital-Acquired Pneumonia (NVHAP) Prevention 148,388 – 148,388 Total $ 13,864,545 $ 13,482,752 $ 381,793 Identification as a repeat finding, if applicable: The finding is not a repeat finding from the prior year. 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: Award amounts were changed on the Schedule after management’s review was executed. Management acknowledges that implementing the new Enterprise Resource Planning (ERP) system, in 2023 presented changes to the SEFA reporting. Management has identified and addressed the reporting issues within the new system to ensure that the grant totals are appropriately captured in the SEFA. Endeavor will enhance grant management award processes by revising its procedures and adding additional controls to monitor for accuracy of the core data. Management will reinforce the importance of timeliness and accuracy of the Schedule reporting totals to facilitate accurate reporting.
Finding 2023-001 – Reporting Information of the federal program: Federal Grantor: Department of Defense (DOD) Assistance Listing No.: 12.420, Military Medical Research and Development Pass-Through Grantor: Johns Hopkins University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.172, Human Genome Research Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.226, Research on Healthcare Costs, Quality and Outcomes Pass-Through Grantor: The Regents of the University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.242, Mental Health Research Grants Pass-Through Grantor: Rutgers State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.307, Minority Health and Health Disparities Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.310, Trans-NIH Research Support Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.350, National Center for Advancing Translational Sciences Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.351, Research Infrastructure Program Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.361, Nursing Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.368, 21st Century Cures Act – Precision Medicine Initiative Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.394, Cancer Detection and Diagnosis Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.395, Cancer Treatment Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.396, Cancer Biology Research Pass-Through Grantor: Tulane University, Louisiana State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.397, Cancer Centers Support Grants Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.667, Social Services Block Grant Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.837, Cardiovascular Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.838, Lung Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.847, Diabetes, Digestive, and Kidney Diseases Extramural Research Pass-Through Grantors: Northwestern University, Duke University, University of Washington, The Regents of University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.853, Extramural Research Programs in the Neurosciences and Neurological Disorders Pass-Through Grantor: Rush University Medical Center Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.855, Allergy, Immunology and Transplantation Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.859, Biomedical Research and Research Training Pass-Through Grantor: University of Wisconsin – Madison Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.865, Child Health and Human Development Extramural Research Pass-Through Grantors: Northwestern University, University of Washington, The Regents of the University of California Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.866, Aging Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.946, Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.994, Maternal and Child Health Services Block Grant to the States Pass-Through Grantor: Northwestern Memorial Hospital 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).” 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 grants related to the Research and Development Cluster were misstated by $233,405 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. In addition, an award which was not a federal grant award with expenditures of $148,388 was included on the preliminary Schedule provided by management. 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: The table below reflects the preliminary and adjusted assistance listing balances on the Schedule (only assistance listing programs which changed are included below): Assistance Listing No. Name of Federal Program Preliminary Schedule Adjusted Schedule Change 12.420 Military Medical Research and Development $ 241,025 $ 224,418 $ 16,607 93.172 Human Genome Research 14,874 15,121 (247) 93.226 Research on Healthcare Costs, Quality and Outcomes 251,325 248,842 2,483 93.242 Mental Health Research Grants 1,616,503 1,617,376 (873) 93.307 Minority Health and Health Disparities Research 17,323 15,122 2,201 93.310 Trans-NIH Research Support 313,459 313,490 (31) 93.350 National Center for Advancing Translational Sciences 516,734 518,429 (1,695) 93.351 Research Infrastructure Program 242,436 232,058 10,378 93.361 Nursing Research 8,745 7,645 1,100 93.368 21st Century Cures Act – Precision Medicine Initiative 100,324 94,609 5,715 93.394 Cancer Detection and Diagnosis Research 847,959 816,528 31,431 93.395 Cancer Treatment Research 438,349 439,286 (937) 93.396 Cancer Biology Research 93,919 88,642 5,277 93.397 Cancer Centers Support Grants 15,552 14,078 1,474 93.667 Social Services Block Grant 19,619 27,170 (7,551) 93.837 Cardiovascular Diseases Research 193,160 188,850 4,310 93.838 Lung Diseases Research 482,934 471,427 11,507 93.847 Diabetes, Digestive, and Kidney Diseases Extramural Research 1,075,493 1,035,041 40,452 93.853 Extramural Research Programs in the Neurosciences and Neurological Disorders 1,645,025 1,596,611 48,414 93.855 Allergy, Immunology and Transplantation Research 73,869 72,630 1,239 93.859 Biomedical Research and Research Training 363,336 366,791 (3,455) 93.865 Child Health and Human Development Extramural Research 3,790,797 3,733,008 57,789 93.866 Aging Research 1,101,363 1,098,891 2,472 93.946 Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs 80,039 78,033 2,006 93.994 Maternal and Child Health Services Block Grant to the States 171,995 168,656 3,339 The Role of Oral Care in Nonventilator Hospital-Acquired Pneumonia (NVHAP) Prevention 148,388 – 148,388 Total $ 13,864,545 $ 13,482,752 $ 381,793 Identification as a repeat finding, if applicable: The finding is not a repeat finding from the prior year. 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: Award amounts were changed on the Schedule after management’s review was executed. Management acknowledges that implementing the new Enterprise Resource Planning (ERP) system, in 2023 presented changes to the SEFA reporting. Management has identified and addressed the reporting issues within the new system to ensure that the grant totals are appropriately captured in the SEFA. Endeavor will enhance grant management award processes by revising its procedures and adding additional controls to monitor for accuracy of the core data. Management will reinforce the importance of timeliness and accuracy of the Schedule reporting totals to facilitate accurate reporting.
Finding 2023-001 – Reporting Information of the federal program: Federal Grantor: Department of Defense (DOD) Assistance Listing No.: 12.420, Military Medical Research and Development Pass-Through Grantor: Johns Hopkins University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.172, Human Genome Research Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.226, Research on Healthcare Costs, Quality and Outcomes Pass-Through Grantor: The Regents of the University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.242, Mental Health Research Grants Pass-Through Grantor: Rutgers State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.307, Minority Health and Health Disparities Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.310, Trans-NIH Research Support Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.350, National Center for Advancing Translational Sciences Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.351, Research Infrastructure Program Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.361, Nursing Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.368, 21st Century Cures Act – Precision Medicine Initiative Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.394, Cancer Detection and Diagnosis Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.395, Cancer Treatment Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.396, Cancer Biology Research Pass-Through Grantor: Tulane University, Louisiana State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.397, Cancer Centers Support Grants Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.667, Social Services Block Grant Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.837, Cardiovascular Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.838, Lung Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.847, Diabetes, Digestive, and Kidney Diseases Extramural Research Pass-Through Grantors: Northwestern University, Duke University, University of Washington, The Regents of University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.853, Extramural Research Programs in the Neurosciences and Neurological Disorders Pass-Through Grantor: Rush University Medical Center Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.855, Allergy, Immunology and Transplantation Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.859, Biomedical Research and Research Training Pass-Through Grantor: University of Wisconsin – Madison Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.865, Child Health and Human Development Extramural Research Pass-Through Grantors: Northwestern University, University of Washington, The Regents of the University of California Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.866, Aging Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.946, Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.994, Maternal and Child Health Services Block Grant to the States Pass-Through Grantor: Northwestern Memorial Hospital 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).” 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 grants related to the Research and Development Cluster were misstated by $233,405 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. In addition, an award which was not a federal grant award with expenditures of $148,388 was included on the preliminary Schedule provided by management. 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: The table below reflects the preliminary and adjusted assistance listing balances on the Schedule (only assistance listing programs which changed are included below): Assistance Listing No. Name of Federal Program Preliminary Schedule Adjusted Schedule Change 12.420 Military Medical Research and Development $ 241,025 $ 224,418 $ 16,607 93.172 Human Genome Research 14,874 15,121 (247) 93.226 Research on Healthcare Costs, Quality and Outcomes 251,325 248,842 2,483 93.242 Mental Health Research Grants 1,616,503 1,617,376 (873) 93.307 Minority Health and Health Disparities Research 17,323 15,122 2,201 93.310 Trans-NIH Research Support 313,459 313,490 (31) 93.350 National Center for Advancing Translational Sciences 516,734 518,429 (1,695) 93.351 Research Infrastructure Program 242,436 232,058 10,378 93.361 Nursing Research 8,745 7,645 1,100 93.368 21st Century Cures Act – Precision Medicine Initiative 100,324 94,609 5,715 93.394 Cancer Detection and Diagnosis Research 847,959 816,528 31,431 93.395 Cancer Treatment Research 438,349 439,286 (937) 93.396 Cancer Biology Research 93,919 88,642 5,277 93.397 Cancer Centers Support Grants 15,552 14,078 1,474 93.667 Social Services Block Grant 19,619 27,170 (7,551) 93.837 Cardiovascular Diseases Research 193,160 188,850 4,310 93.838 Lung Diseases Research 482,934 471,427 11,507 93.847 Diabetes, Digestive, and Kidney Diseases Extramural Research 1,075,493 1,035,041 40,452 93.853 Extramural Research Programs in the Neurosciences and Neurological Disorders 1,645,025 1,596,611 48,414 93.855 Allergy, Immunology and Transplantation Research 73,869 72,630 1,239 93.859 Biomedical Research and Research Training 363,336 366,791 (3,455) 93.865 Child Health and Human Development Extramural Research 3,790,797 3,733,008 57,789 93.866 Aging Research 1,101,363 1,098,891 2,472 93.946 Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs 80,039 78,033 2,006 93.994 Maternal and Child Health Services Block Grant to the States 171,995 168,656 3,339 The Role of Oral Care in Nonventilator Hospital-Acquired Pneumonia (NVHAP) Prevention 148,388 – 148,388 Total $ 13,864,545 $ 13,482,752 $ 381,793 Identification as a repeat finding, if applicable: The finding is not a repeat finding from the prior year. 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: Award amounts were changed on the Schedule after management’s review was executed. Management acknowledges that implementing the new Enterprise Resource Planning (ERP) system, in 2023 presented changes to the SEFA reporting. Management has identified and addressed the reporting issues within the new system to ensure that the grant totals are appropriately captured in the SEFA. Endeavor will enhance grant management award processes by revising its procedures and adding additional controls to monitor for accuracy of the core data. Management will reinforce the importance of timeliness and accuracy of the Schedule reporting totals to facilitate accurate reporting.
Finding 2023-001 – Reporting Information of the federal program: Federal Grantor: Department of Defense (DOD) Assistance Listing No.: 12.420, Military Medical Research and Development Pass-Through Grantor: Johns Hopkins University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.172, Human Genome Research Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.226, Research on Healthcare Costs, Quality and Outcomes Pass-Through Grantor: The Regents of the University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.242, Mental Health Research Grants Pass-Through Grantor: Rutgers State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.307, Minority Health and Health Disparities Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.310, Trans-NIH Research Support Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.350, National Center for Advancing Translational Sciences Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.351, Research Infrastructure Program Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.361, Nursing Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.368, 21st Century Cures Act – Precision Medicine Initiative Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.394, Cancer Detection and Diagnosis Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.395, Cancer Treatment Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.396, Cancer Biology Research Pass-Through Grantor: Tulane University, Louisiana State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.397, Cancer Centers Support Grants Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.667, Social Services Block Grant Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.837, Cardiovascular Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.838, Lung Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.847, Diabetes, Digestive, and Kidney Diseases Extramural Research Pass-Through Grantors: Northwestern University, Duke University, University of Washington, The Regents of University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.853, Extramural Research Programs in the Neurosciences and Neurological Disorders Pass-Through Grantor: Rush University Medical Center Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.855, Allergy, Immunology and Transplantation Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.859, Biomedical Research and Research Training Pass-Through Grantor: University of Wisconsin – Madison Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.865, Child Health and Human Development Extramural Research Pass-Through Grantors: Northwestern University, University of Washington, The Regents of the University of California Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.866, Aging Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.946, Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.994, Maternal and Child Health Services Block Grant to the States Pass-Through Grantor: Northwestern Memorial Hospital 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).” 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 grants related to the Research and Development Cluster were misstated by $233,405 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. In addition, an award which was not a federal grant award with expenditures of $148,388 was included on the preliminary Schedule provided by management. 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: The table below reflects the preliminary and adjusted assistance listing balances on the Schedule (only assistance listing programs which changed are included below): Assistance Listing No. Name of Federal Program Preliminary Schedule Adjusted Schedule Change 12.420 Military Medical Research and Development $ 241,025 $ 224,418 $ 16,607 93.172 Human Genome Research 14,874 15,121 (247) 93.226 Research on Healthcare Costs, Quality and Outcomes 251,325 248,842 2,483 93.242 Mental Health Research Grants 1,616,503 1,617,376 (873) 93.307 Minority Health and Health Disparities Research 17,323 15,122 2,201 93.310 Trans-NIH Research Support 313,459 313,490 (31) 93.350 National Center for Advancing Translational Sciences 516,734 518,429 (1,695) 93.351 Research Infrastructure Program 242,436 232,058 10,378 93.361 Nursing Research 8,745 7,645 1,100 93.368 21st Century Cures Act – Precision Medicine Initiative 100,324 94,609 5,715 93.394 Cancer Detection and Diagnosis Research 847,959 816,528 31,431 93.395 Cancer Treatment Research 438,349 439,286 (937) 93.396 Cancer Biology Research 93,919 88,642 5,277 93.397 Cancer Centers Support Grants 15,552 14,078 1,474 93.667 Social Services Block Grant 19,619 27,170 (7,551) 93.837 Cardiovascular Diseases Research 193,160 188,850 4,310 93.838 Lung Diseases Research 482,934 471,427 11,507 93.847 Diabetes, Digestive, and Kidney Diseases Extramural Research 1,075,493 1,035,041 40,452 93.853 Extramural Research Programs in the Neurosciences and Neurological Disorders 1,645,025 1,596,611 48,414 93.855 Allergy, Immunology and Transplantation Research 73,869 72,630 1,239 93.859 Biomedical Research and Research Training 363,336 366,791 (3,455) 93.865 Child Health and Human Development Extramural Research 3,790,797 3,733,008 57,789 93.866 Aging Research 1,101,363 1,098,891 2,472 93.946 Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs 80,039 78,033 2,006 93.994 Maternal and Child Health Services Block Grant to the States 171,995 168,656 3,339 The Role of Oral Care in Nonventilator Hospital-Acquired Pneumonia (NVHAP) Prevention 148,388 – 148,388 Total $ 13,864,545 $ 13,482,752 $ 381,793 Identification as a repeat finding, if applicable: The finding is not a repeat finding from the prior year. 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: Award amounts were changed on the Schedule after management’s review was executed. Management acknowledges that implementing the new Enterprise Resource Planning (ERP) system, in 2023 presented changes to the SEFA reporting. Management has identified and addressed the reporting issues within the new system to ensure that the grant totals are appropriately captured in the SEFA. Endeavor will enhance grant management award processes by revising its procedures and adding additional controls to monitor for accuracy of the core data. Management will reinforce the importance of timeliness and accuracy of the Schedule reporting totals to facilitate accurate reporting.
Finding 2023-001 – Reporting Information of the federal program: Federal Grantor: Department of Defense (DOD) Assistance Listing No.: 12.420, Military Medical Research and Development Pass-Through Grantor: Johns Hopkins University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.172, Human Genome Research Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.226, Research on Healthcare Costs, Quality and Outcomes Pass-Through Grantor: The Regents of the University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.242, Mental Health Research Grants Pass-Through Grantor: Rutgers State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.307, Minority Health and Health Disparities Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.310, Trans-NIH Research Support Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.350, National Center for Advancing Translational Sciences Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.351, Research Infrastructure Program Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.361, Nursing Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.368, 21st Century Cures Act – Precision Medicine Initiative Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.394, Cancer Detection and Diagnosis Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.395, Cancer Treatment Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.396, Cancer Biology Research Pass-Through Grantor: Tulane University, Louisiana State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.397, Cancer Centers Support Grants Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.667, Social Services Block Grant Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.837, Cardiovascular Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.838, Lung Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.847, Diabetes, Digestive, and Kidney Diseases Extramural Research Pass-Through Grantors: Northwestern University, Duke University, University of Washington, The Regents of University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.853, Extramural Research Programs in the Neurosciences and Neurological Disorders Pass-Through Grantor: Rush University Medical Center Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.855, Allergy, Immunology and Transplantation Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.859, Biomedical Research and Research Training Pass-Through Grantor: University of Wisconsin – Madison Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.865, Child Health and Human Development Extramural Research Pass-Through Grantors: Northwestern University, University of Washington, The Regents of the University of California Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.866, Aging Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.946, Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.994, Maternal and Child Health Services Block Grant to the States Pass-Through Grantor: Northwestern Memorial Hospital 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).” 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 grants related to the Research and Development Cluster were misstated by $233,405 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. In addition, an award which was not a federal grant award with expenditures of $148,388 was included on the preliminary Schedule provided by management. 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: The table below reflects the preliminary and adjusted assistance listing balances on the Schedule (only assistance listing programs which changed are included below): Assistance Listing No. Name of Federal Program Preliminary Schedule Adjusted Schedule Change 12.420 Military Medical Research and Development $ 241,025 $ 224,418 $ 16,607 93.172 Human Genome Research 14,874 15,121 (247) 93.226 Research on Healthcare Costs, Quality and Outcomes 251,325 248,842 2,483 93.242 Mental Health Research Grants 1,616,503 1,617,376 (873) 93.307 Minority Health and Health Disparities Research 17,323 15,122 2,201 93.310 Trans-NIH Research Support 313,459 313,490 (31) 93.350 National Center for Advancing Translational Sciences 516,734 518,429 (1,695) 93.351 Research Infrastructure Program 242,436 232,058 10,378 93.361 Nursing Research 8,745 7,645 1,100 93.368 21st Century Cures Act – Precision Medicine Initiative 100,324 94,609 5,715 93.394 Cancer Detection and Diagnosis Research 847,959 816,528 31,431 93.395 Cancer Treatment Research 438,349 439,286 (937) 93.396 Cancer Biology Research 93,919 88,642 5,277 93.397 Cancer Centers Support Grants 15,552 14,078 1,474 93.667 Social Services Block Grant 19,619 27,170 (7,551) 93.837 Cardiovascular Diseases Research 193,160 188,850 4,310 93.838 Lung Diseases Research 482,934 471,427 11,507 93.847 Diabetes, Digestive, and Kidney Diseases Extramural Research 1,075,493 1,035,041 40,452 93.853 Extramural Research Programs in the Neurosciences and Neurological Disorders 1,645,025 1,596,611 48,414 93.855 Allergy, Immunology and Transplantation Research 73,869 72,630 1,239 93.859 Biomedical Research and Research Training 363,336 366,791 (3,455) 93.865 Child Health and Human Development Extramural Research 3,790,797 3,733,008 57,789 93.866 Aging Research 1,101,363 1,098,891 2,472 93.946 Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs 80,039 78,033 2,006 93.994 Maternal and Child Health Services Block Grant to the States 171,995 168,656 3,339 The Role of Oral Care in Nonventilator Hospital-Acquired Pneumonia (NVHAP) Prevention 148,388 – 148,388 Total $ 13,864,545 $ 13,482,752 $ 381,793 Identification as a repeat finding, if applicable: The finding is not a repeat finding from the prior year. 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: Award amounts were changed on the Schedule after management’s review was executed. Management acknowledges that implementing the new Enterprise Resource Planning (ERP) system, in 2023 presented changes to the SEFA reporting. Management has identified and addressed the reporting issues within the new system to ensure that the grant totals are appropriately captured in the SEFA. Endeavor will enhance grant management award processes by revising its procedures and adding additional controls to monitor for accuracy of the core data. Management will reinforce the importance of timeliness and accuracy of the Schedule reporting totals to facilitate accurate reporting.
Finding 2023-001 – Reporting Information of the federal program: Federal Grantor: Department of Defense (DOD) Assistance Listing No.: 12.420, Military Medical Research and Development Pass-Through Grantor: Johns Hopkins University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.172, Human Genome Research Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.226, Research on Healthcare Costs, Quality and Outcomes Pass-Through Grantor: The Regents of the University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.242, Mental Health Research Grants Pass-Through Grantor: Rutgers State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.307, Minority Health and Health Disparities Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.310, Trans-NIH Research Support Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.350, National Center for Advancing Translational Sciences Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.351, Research Infrastructure Program Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.361, Nursing Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.368, 21st Century Cures Act – Precision Medicine Initiative Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.394, Cancer Detection and Diagnosis Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.395, Cancer Treatment Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.396, Cancer Biology Research Pass-Through Grantor: Tulane University, Louisiana State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.397, Cancer Centers Support Grants Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.667, Social Services Block Grant Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.837, Cardiovascular Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.838, Lung Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.847, Diabetes, Digestive, and Kidney Diseases Extramural Research Pass-Through Grantors: Northwestern University, Duke University, University of Washington, The Regents of University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.853, Extramural Research Programs in the Neurosciences and Neurological Disorders Pass-Through Grantor: Rush University Medical Center Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.855, Allergy, Immunology and Transplantation Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.859, Biomedical Research and Research Training Pass-Through Grantor: University of Wisconsin – Madison Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.865, Child Health and Human Development Extramural Research Pass-Through Grantors: Northwestern University, University of Washington, The Regents of the University of California Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.866, Aging Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.946, Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.994, Maternal and Child Health Services Block Grant to the States Pass-Through Grantor: Northwestern Memorial Hospital 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).” 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 grants related to the Research and Development Cluster were misstated by $233,405 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. In addition, an award which was not a federal grant award with expenditures of $148,388 was included on the preliminary Schedule provided by management. 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: The table below reflects the preliminary and adjusted assistance listing balances on the Schedule (only assistance listing programs which changed are included below): Assistance Listing No. Name of Federal Program Preliminary Schedule Adjusted Schedule Change 12.420 Military Medical Research and Development $ 241,025 $ 224,418 $ 16,607 93.172 Human Genome Research 14,874 15,121 (247) 93.226 Research on Healthcare Costs, Quality and Outcomes 251,325 248,842 2,483 93.242 Mental Health Research Grants 1,616,503 1,617,376 (873) 93.307 Minority Health and Health Disparities Research 17,323 15,122 2,201 93.310 Trans-NIH Research Support 313,459 313,490 (31) 93.350 National Center for Advancing Translational Sciences 516,734 518,429 (1,695) 93.351 Research Infrastructure Program 242,436 232,058 10,378 93.361 Nursing Research 8,745 7,645 1,100 93.368 21st Century Cures Act – Precision Medicine Initiative 100,324 94,609 5,715 93.394 Cancer Detection and Diagnosis Research 847,959 816,528 31,431 93.395 Cancer Treatment Research 438,349 439,286 (937) 93.396 Cancer Biology Research 93,919 88,642 5,277 93.397 Cancer Centers Support Grants 15,552 14,078 1,474 93.667 Social Services Block Grant 19,619 27,170 (7,551) 93.837 Cardiovascular Diseases Research 193,160 188,850 4,310 93.838 Lung Diseases Research 482,934 471,427 11,507 93.847 Diabetes, Digestive, and Kidney Diseases Extramural Research 1,075,493 1,035,041 40,452 93.853 Extramural Research Programs in the Neurosciences and Neurological Disorders 1,645,025 1,596,611 48,414 93.855 Allergy, Immunology and Transplantation Research 73,869 72,630 1,239 93.859 Biomedical Research and Research Training 363,336 366,791 (3,455) 93.865 Child Health and Human Development Extramural Research 3,790,797 3,733,008 57,789 93.866 Aging Research 1,101,363 1,098,891 2,472 93.946 Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs 80,039 78,033 2,006 93.994 Maternal and Child Health Services Block Grant to the States 171,995 168,656 3,339 The Role of Oral Care in Nonventilator Hospital-Acquired Pneumonia (NVHAP) Prevention 148,388 – 148,388 Total $ 13,864,545 $ 13,482,752 $ 381,793 Identification as a repeat finding, if applicable: The finding is not a repeat finding from the prior year. 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: Award amounts were changed on the Schedule after management’s review was executed. Management acknowledges that implementing the new Enterprise Resource Planning (ERP) system, in 2023 presented changes to the SEFA reporting. Management has identified and addressed the reporting issues within the new system to ensure that the grant totals are appropriately captured in the SEFA. Endeavor will enhance grant management award processes by revising its procedures and adding additional controls to monitor for accuracy of the core data. Management will reinforce the importance of timeliness and accuracy of the Schedule reporting totals to facilitate accurate reporting.
Finding 2023-001 – Reporting Information of the federal program: Federal Grantor: Department of Defense (DOD) Assistance Listing No.: 12.420, Military Medical Research and Development Pass-Through Grantor: Johns Hopkins University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.172, Human Genome Research Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.226, Research on Healthcare Costs, Quality and Outcomes Pass-Through Grantor: The Regents of the University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.242, Mental Health Research Grants Pass-Through Grantor: Rutgers State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.307, Minority Health and Health Disparities Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.310, Trans-NIH Research Support Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.350, National Center for Advancing Translational Sciences Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.351, Research Infrastructure Program Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.361, Nursing Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.368, 21st Century Cures Act – Precision Medicine Initiative Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.394, Cancer Detection and Diagnosis Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.395, Cancer Treatment Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.396, Cancer Biology Research Pass-Through Grantor: Tulane University, Louisiana State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.397, Cancer Centers Support Grants Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.667, Social Services Block Grant Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.837, Cardiovascular Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.838, Lung Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.847, Diabetes, Digestive, and Kidney Diseases Extramural Research Pass-Through Grantors: Northwestern University, Duke University, University of Washington, The Regents of University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.853, Extramural Research Programs in the Neurosciences and Neurological Disorders Pass-Through Grantor: Rush University Medical Center Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.855, Allergy, Immunology and Transplantation Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.859, Biomedical Research and Research Training Pass-Through Grantor: University of Wisconsin – Madison Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.865, Child Health and Human Development Extramural Research Pass-Through Grantors: Northwestern University, University of Washington, The Regents of the University of California Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.866, Aging Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.946, Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.994, Maternal and Child Health Services Block Grant to the States Pass-Through Grantor: Northwestern Memorial Hospital 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).” 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 grants related to the Research and Development Cluster were misstated by $233,405 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. In addition, an award which was not a federal grant award with expenditures of $148,388 was included on the preliminary Schedule provided by management. 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: The table below reflects the preliminary and adjusted assistance listing balances on the Schedule (only assistance listing programs which changed are included below): Assistance Listing No. Name of Federal Program Preliminary Schedule Adjusted Schedule Change 12.420 Military Medical Research and Development $ 241,025 $ 224,418 $ 16,607 93.172 Human Genome Research 14,874 15,121 (247) 93.226 Research on Healthcare Costs, Quality and Outcomes 251,325 248,842 2,483 93.242 Mental Health Research Grants 1,616,503 1,617,376 (873) 93.307 Minority Health and Health Disparities Research 17,323 15,122 2,201 93.310 Trans-NIH Research Support 313,459 313,490 (31) 93.350 National Center for Advancing Translational Sciences 516,734 518,429 (1,695) 93.351 Research Infrastructure Program 242,436 232,058 10,378 93.361 Nursing Research 8,745 7,645 1,100 93.368 21st Century Cures Act – Precision Medicine Initiative 100,324 94,609 5,715 93.394 Cancer Detection and Diagnosis Research 847,959 816,528 31,431 93.395 Cancer Treatment Research 438,349 439,286 (937) 93.396 Cancer Biology Research 93,919 88,642 5,277 93.397 Cancer Centers Support Grants 15,552 14,078 1,474 93.667 Social Services Block Grant 19,619 27,170 (7,551) 93.837 Cardiovascular Diseases Research 193,160 188,850 4,310 93.838 Lung Diseases Research 482,934 471,427 11,507 93.847 Diabetes, Digestive, and Kidney Diseases Extramural Research 1,075,493 1,035,041 40,452 93.853 Extramural Research Programs in the Neurosciences and Neurological Disorders 1,645,025 1,596,611 48,414 93.855 Allergy, Immunology and Transplantation Research 73,869 72,630 1,239 93.859 Biomedical Research and Research Training 363,336 366,791 (3,455) 93.865 Child Health and Human Development Extramural Research 3,790,797 3,733,008 57,789 93.866 Aging Research 1,101,363 1,098,891 2,472 93.946 Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs 80,039 78,033 2,006 93.994 Maternal and Child Health Services Block Grant to the States 171,995 168,656 3,339 The Role of Oral Care in Nonventilator Hospital-Acquired Pneumonia (NVHAP) Prevention 148,388 – 148,388 Total $ 13,864,545 $ 13,482,752 $ 381,793 Identification as a repeat finding, if applicable: The finding is not a repeat finding from the prior year. 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: Award amounts were changed on the Schedule after management’s review was executed. Management acknowledges that implementing the new Enterprise Resource Planning (ERP) system, in 2023 presented changes to the SEFA reporting. Management has identified and addressed the reporting issues within the new system to ensure that the grant totals are appropriately captured in the SEFA. Endeavor will enhance grant management award processes by revising its procedures and adding additional controls to monitor for accuracy of the core data. Management will reinforce the importance of timeliness and accuracy of the Schedule reporting totals to facilitate accurate reporting.
Finding 2023-001 – Reporting Information of the federal program: Federal Grantor: Department of Defense (DOD) Assistance Listing No.: 12.420, Military Medical Research and Development Pass-Through Grantor: Johns Hopkins University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.172, Human Genome Research Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.226, Research on Healthcare Costs, Quality and Outcomes Pass-Through Grantor: The Regents of the University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.242, Mental Health Research Grants Pass-Through Grantor: Rutgers State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.307, Minority Health and Health Disparities Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.310, Trans-NIH Research Support Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.350, National Center for Advancing Translational Sciences Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.351, Research Infrastructure Program Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.361, Nursing Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.368, 21st Century Cures Act – Precision Medicine Initiative Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.394, Cancer Detection and Diagnosis Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.395, Cancer Treatment Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.396, Cancer Biology Research Pass-Through Grantor: Tulane University, Louisiana State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.397, Cancer Centers Support Grants Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.667, Social Services Block Grant Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.837, Cardiovascular Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.838, Lung Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.847, Diabetes, Digestive, and Kidney Diseases Extramural Research Pass-Through Grantors: Northwestern University, Duke University, University of Washington, The Regents of University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.853, Extramural Research Programs in the Neurosciences and Neurological Disorders Pass-Through Grantor: Rush University Medical Center Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.855, Allergy, Immunology and Transplantation Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.859, Biomedical Research and Research Training Pass-Through Grantor: University of Wisconsin – Madison Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.865, Child Health and Human Development Extramural Research Pass-Through Grantors: Northwestern University, University of Washington, The Regents of the University of California Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.866, Aging Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.946, Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.994, Maternal and Child Health Services Block Grant to the States Pass-Through Grantor: Northwestern Memorial Hospital 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).” 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 grants related to the Research and Development Cluster were misstated by $233,405 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. In addition, an award which was not a federal grant award with expenditures of $148,388 was included on the preliminary Schedule provided by management. 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: The table below reflects the preliminary and adjusted assistance listing balances on the Schedule (only assistance listing programs which changed are included below): Assistance Listing No. Name of Federal Program Preliminary Schedule Adjusted Schedule Change 12.420 Military Medical Research and Development $ 241,025 $ 224,418 $ 16,607 93.172 Human Genome Research 14,874 15,121 (247) 93.226 Research on Healthcare Costs, Quality and Outcomes 251,325 248,842 2,483 93.242 Mental Health Research Grants 1,616,503 1,617,376 (873) 93.307 Minority Health and Health Disparities Research 17,323 15,122 2,201 93.310 Trans-NIH Research Support 313,459 313,490 (31) 93.350 National Center for Advancing Translational Sciences 516,734 518,429 (1,695) 93.351 Research Infrastructure Program 242,436 232,058 10,378 93.361 Nursing Research 8,745 7,645 1,100 93.368 21st Century Cures Act – Precision Medicine Initiative 100,324 94,609 5,715 93.394 Cancer Detection and Diagnosis Research 847,959 816,528 31,431 93.395 Cancer Treatment Research 438,349 439,286 (937) 93.396 Cancer Biology Research 93,919 88,642 5,277 93.397 Cancer Centers Support Grants 15,552 14,078 1,474 93.667 Social Services Block Grant 19,619 27,170 (7,551) 93.837 Cardiovascular Diseases Research 193,160 188,850 4,310 93.838 Lung Diseases Research 482,934 471,427 11,507 93.847 Diabetes, Digestive, and Kidney Diseases Extramural Research 1,075,493 1,035,041 40,452 93.853 Extramural Research Programs in the Neurosciences and Neurological Disorders 1,645,025 1,596,611 48,414 93.855 Allergy, Immunology and Transplantation Research 73,869 72,630 1,239 93.859 Biomedical Research and Research Training 363,336 366,791 (3,455) 93.865 Child Health and Human Development Extramural Research 3,790,797 3,733,008 57,789 93.866 Aging Research 1,101,363 1,098,891 2,472 93.946 Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs 80,039 78,033 2,006 93.994 Maternal and Child Health Services Block Grant to the States 171,995 168,656 3,339 The Role of Oral Care in Nonventilator Hospital-Acquired Pneumonia (NVHAP) Prevention 148,388 – 148,388 Total $ 13,864,545 $ 13,482,752 $ 381,793 Identification as a repeat finding, if applicable: The finding is not a repeat finding from the prior year. 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: Award amounts were changed on the Schedule after management’s review was executed. Management acknowledges that implementing the new Enterprise Resource Planning (ERP) system, in 2023 presented changes to the SEFA reporting. Management has identified and addressed the reporting issues within the new system to ensure that the grant totals are appropriately captured in the SEFA. Endeavor will enhance grant management award processes by revising its procedures and adding additional controls to monitor for accuracy of the core data. Management will reinforce the importance of timeliness and accuracy of the Schedule reporting totals to facilitate accurate reporting.
Finding 2023-001 – Reporting Information of the federal program: Federal Grantor: Department of Defense (DOD) Assistance Listing No.: 12.420, Military Medical Research and Development Pass-Through Grantor: Johns Hopkins University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.172, Human Genome Research Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.226, Research on Healthcare Costs, Quality and Outcomes Pass-Through Grantor: The Regents of the University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.242, Mental Health Research Grants Pass-Through Grantor: Rutgers State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.307, Minority Health and Health Disparities Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.310, Trans-NIH Research Support Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.350, National Center for Advancing Translational Sciences Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.351, Research Infrastructure Program Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.361, Nursing Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.368, 21st Century Cures Act – Precision Medicine Initiative Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.394, Cancer Detection and Diagnosis Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.395, Cancer Treatment Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.396, Cancer Biology Research Pass-Through Grantor: Tulane University, Louisiana State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.397, Cancer Centers Support Grants Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.667, Social Services Block Grant Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.837, Cardiovascular Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.838, Lung Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.847, Diabetes, Digestive, and Kidney Diseases Extramural Research Pass-Through Grantors: Northwestern University, Duke University, University of Washington, The Regents of University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.853, Extramural Research Programs in the Neurosciences and Neurological Disorders Pass-Through Grantor: Rush University Medical Center Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.855, Allergy, Immunology and Transplantation Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.859, Biomedical Research and Research Training Pass-Through Grantor: University of Wisconsin – Madison Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.865, Child Health and Human Development Extramural Research Pass-Through Grantors: Northwestern University, University of Washington, The Regents of the University of California Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.866, Aging Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.946, Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.994, Maternal and Child Health Services Block Grant to the States Pass-Through Grantor: Northwestern Memorial Hospital 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).” 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 grants related to the Research and Development Cluster were misstated by $233,405 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. In addition, an award which was not a federal grant award with expenditures of $148,388 was included on the preliminary Schedule provided by management. 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: The table below reflects the preliminary and adjusted assistance listing balances on the Schedule (only assistance listing programs which changed are included below): Assistance Listing No. Name of Federal Program Preliminary Schedule Adjusted Schedule Change 12.420 Military Medical Research and Development $ 241,025 $ 224,418 $ 16,607 93.172 Human Genome Research 14,874 15,121 (247) 93.226 Research on Healthcare Costs, Quality and Outcomes 251,325 248,842 2,483 93.242 Mental Health Research Grants 1,616,503 1,617,376 (873) 93.307 Minority Health and Health Disparities Research 17,323 15,122 2,201 93.310 Trans-NIH Research Support 313,459 313,490 (31) 93.350 National Center for Advancing Translational Sciences 516,734 518,429 (1,695) 93.351 Research Infrastructure Program 242,436 232,058 10,378 93.361 Nursing Research 8,745 7,645 1,100 93.368 21st Century Cures Act – Precision Medicine Initiative 100,324 94,609 5,715 93.394 Cancer Detection and Diagnosis Research 847,959 816,528 31,431 93.395 Cancer Treatment Research 438,349 439,286 (937) 93.396 Cancer Biology Research 93,919 88,642 5,277 93.397 Cancer Centers Support Grants 15,552 14,078 1,474 93.667 Social Services Block Grant 19,619 27,170 (7,551) 93.837 Cardiovascular Diseases Research 193,160 188,850 4,310 93.838 Lung Diseases Research 482,934 471,427 11,507 93.847 Diabetes, Digestive, and Kidney Diseases Extramural Research 1,075,493 1,035,041 40,452 93.853 Extramural Research Programs in the Neurosciences and Neurological Disorders 1,645,025 1,596,611 48,414 93.855 Allergy, Immunology and Transplantation Research 73,869 72,630 1,239 93.859 Biomedical Research and Research Training 363,336 366,791 (3,455) 93.865 Child Health and Human Development Extramural Research 3,790,797 3,733,008 57,789 93.866 Aging Research 1,101,363 1,098,891 2,472 93.946 Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs 80,039 78,033 2,006 93.994 Maternal and Child Health Services Block Grant to the States 171,995 168,656 3,339 The Role of Oral Care in Nonventilator Hospital-Acquired Pneumonia (NVHAP) Prevention 148,388 – 148,388 Total $ 13,864,545 $ 13,482,752 $ 381,793 Identification as a repeat finding, if applicable: The finding is not a repeat finding from the prior year. 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: Award amounts were changed on the Schedule after management’s review was executed. Management acknowledges that implementing the new Enterprise Resource Planning (ERP) system, in 2023 presented changes to the SEFA reporting. Management has identified and addressed the reporting issues within the new system to ensure that the grant totals are appropriately captured in the SEFA. Endeavor will enhance grant management award processes by revising its procedures and adding additional controls to monitor for accuracy of the core data. Management will reinforce the importance of timeliness and accuracy of the Schedule reporting totals to facilitate accurate reporting.
Finding 2023-001 – Reporting Information of the federal program: Federal Grantor: Department of Defense (DOD) Assistance Listing No.: 12.420, Military Medical Research and Development Pass-Through Grantor: Johns Hopkins University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.172, Human Genome Research Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.226, Research on Healthcare Costs, Quality and Outcomes Pass-Through Grantor: The Regents of the University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.242, Mental Health Research Grants Pass-Through Grantor: Rutgers State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.307, Minority Health and Health Disparities Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.310, Trans-NIH Research Support Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.350, National Center for Advancing Translational Sciences Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.351, Research Infrastructure Program Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.361, Nursing Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.368, 21st Century Cures Act – Precision Medicine Initiative Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.394, Cancer Detection and Diagnosis Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.395, Cancer Treatment Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.396, Cancer Biology Research Pass-Through Grantor: Tulane University, Louisiana State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.397, Cancer Centers Support Grants Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.667, Social Services Block Grant Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.837, Cardiovascular Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.838, Lung Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.847, Diabetes, Digestive, and Kidney Diseases Extramural Research Pass-Through Grantors: Northwestern University, Duke University, University of Washington, The Regents of University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.853, Extramural Research Programs in the Neurosciences and Neurological Disorders Pass-Through Grantor: Rush University Medical Center Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.855, Allergy, Immunology and Transplantation Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.859, Biomedical Research and Research Training Pass-Through Grantor: University of Wisconsin – Madison Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.865, Child Health and Human Development Extramural Research Pass-Through Grantors: Northwestern University, University of Washington, The Regents of the University of California Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.866, Aging Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.946, Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.994, Maternal and Child Health Services Block Grant to the States Pass-Through Grantor: Northwestern Memorial Hospital 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).” 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 grants related to the Research and Development Cluster were misstated by $233,405 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. In addition, an award which was not a federal grant award with expenditures of $148,388 was included on the preliminary Schedule provided by management. 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: The table below reflects the preliminary and adjusted assistance listing balances on the Schedule (only assistance listing programs which changed are included below): Assistance Listing No. Name of Federal Program Preliminary Schedule Adjusted Schedule Change 12.420 Military Medical Research and Development $ 241,025 $ 224,418 $ 16,607 93.172 Human Genome Research 14,874 15,121 (247) 93.226 Research on Healthcare Costs, Quality and Outcomes 251,325 248,842 2,483 93.242 Mental Health Research Grants 1,616,503 1,617,376 (873) 93.307 Minority Health and Health Disparities Research 17,323 15,122 2,201 93.310 Trans-NIH Research Support 313,459 313,490 (31) 93.350 National Center for Advancing Translational Sciences 516,734 518,429 (1,695) 93.351 Research Infrastructure Program 242,436 232,058 10,378 93.361 Nursing Research 8,745 7,645 1,100 93.368 21st Century Cures Act – Precision Medicine Initiative 100,324 94,609 5,715 93.394 Cancer Detection and Diagnosis Research 847,959 816,528 31,431 93.395 Cancer Treatment Research 438,349 439,286 (937) 93.396 Cancer Biology Research 93,919 88,642 5,277 93.397 Cancer Centers Support Grants 15,552 14,078 1,474 93.667 Social Services Block Grant 19,619 27,170 (7,551) 93.837 Cardiovascular Diseases Research 193,160 188,850 4,310 93.838 Lung Diseases Research 482,934 471,427 11,507 93.847 Diabetes, Digestive, and Kidney Diseases Extramural Research 1,075,493 1,035,041 40,452 93.853 Extramural Research Programs in the Neurosciences and Neurological Disorders 1,645,025 1,596,611 48,414 93.855 Allergy, Immunology and Transplantation Research 73,869 72,630 1,239 93.859 Biomedical Research and Research Training 363,336 366,791 (3,455) 93.865 Child Health and Human Development Extramural Research 3,790,797 3,733,008 57,789 93.866 Aging Research 1,101,363 1,098,891 2,472 93.946 Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs 80,039 78,033 2,006 93.994 Maternal and Child Health Services Block Grant to the States 171,995 168,656 3,339 The Role of Oral Care in Nonventilator Hospital-Acquired Pneumonia (NVHAP) Prevention 148,388 – 148,388 Total $ 13,864,545 $ 13,482,752 $ 381,793 Identification as a repeat finding, if applicable: The finding is not a repeat finding from the prior year. 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: Award amounts were changed on the Schedule after management’s review was executed. Management acknowledges that implementing the new Enterprise Resource Planning (ERP) system, in 2023 presented changes to the SEFA reporting. Management has identified and addressed the reporting issues within the new system to ensure that the grant totals are appropriately captured in the SEFA. Endeavor will enhance grant management award processes by revising its procedures and adding additional controls to monitor for accuracy of the core data. Management will reinforce the importance of timeliness and accuracy of the Schedule reporting totals to facilitate accurate reporting.
Finding 2023-001 – Reporting Information of the federal program: Federal Grantor: Department of Defense (DOD) Assistance Listing No.: 12.420, Military Medical Research and Development Pass-Through Grantor: Johns Hopkins University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.172, Human Genome Research Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.226, Research on Healthcare Costs, Quality and Outcomes Pass-Through Grantor: The Regents of the University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.242, Mental Health Research Grants Pass-Through Grantor: Rutgers State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.307, Minority Health and Health Disparities Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.310, Trans-NIH Research Support Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.350, National Center for Advancing Translational Sciences Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.351, Research Infrastructure Program Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.361, Nursing Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.368, 21st Century Cures Act – Precision Medicine Initiative Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.394, Cancer Detection and Diagnosis Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.395, Cancer Treatment Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.396, Cancer Biology Research Pass-Through Grantor: Tulane University, Louisiana State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.397, Cancer Centers Support Grants Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.667, Social Services Block Grant Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.837, Cardiovascular Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.838, Lung Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.847, Diabetes, Digestive, and Kidney Diseases Extramural Research Pass-Through Grantors: Northwestern University, Duke University, University of Washington, The Regents of University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.853, Extramural Research Programs in the Neurosciences and Neurological Disorders Pass-Through Grantor: Rush University Medical Center Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.855, Allergy, Immunology and Transplantation Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.859, Biomedical Research and Research Training Pass-Through Grantor: University of Wisconsin – Madison Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.865, Child Health and Human Development Extramural Research Pass-Through Grantors: Northwestern University, University of Washington, The Regents of the University of California Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.866, Aging Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.946, Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.994, Maternal and Child Health Services Block Grant to the States Pass-Through Grantor: Northwestern Memorial Hospital 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).” 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 grants related to the Research and Development Cluster were misstated by $233,405 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. In addition, an award which was not a federal grant award with expenditures of $148,388 was included on the preliminary Schedule provided by management. 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: The table below reflects the preliminary and adjusted assistance listing balances on the Schedule (only assistance listing programs which changed are included below): Assistance Listing No. Name of Federal Program Preliminary Schedule Adjusted Schedule Change 12.420 Military Medical Research and Development $ 241,025 $ 224,418 $ 16,607 93.172 Human Genome Research 14,874 15,121 (247) 93.226 Research on Healthcare Costs, Quality and Outcomes 251,325 248,842 2,483 93.242 Mental Health Research Grants 1,616,503 1,617,376 (873) 93.307 Minority Health and Health Disparities Research 17,323 15,122 2,201 93.310 Trans-NIH Research Support 313,459 313,490 (31) 93.350 National Center for Advancing Translational Sciences 516,734 518,429 (1,695) 93.351 Research Infrastructure Program 242,436 232,058 10,378 93.361 Nursing Research 8,745 7,645 1,100 93.368 21st Century Cures Act – Precision Medicine Initiative 100,324 94,609 5,715 93.394 Cancer Detection and Diagnosis Research 847,959 816,528 31,431 93.395 Cancer Treatment Research 438,349 439,286 (937) 93.396 Cancer Biology Research 93,919 88,642 5,277 93.397 Cancer Centers Support Grants 15,552 14,078 1,474 93.667 Social Services Block Grant 19,619 27,170 (7,551) 93.837 Cardiovascular Diseases Research 193,160 188,850 4,310 93.838 Lung Diseases Research 482,934 471,427 11,507 93.847 Diabetes, Digestive, and Kidney Diseases Extramural Research 1,075,493 1,035,041 40,452 93.853 Extramural Research Programs in the Neurosciences and Neurological Disorders 1,645,025 1,596,611 48,414 93.855 Allergy, Immunology and Transplantation Research 73,869 72,630 1,239 93.859 Biomedical Research and Research Training 363,336 366,791 (3,455) 93.865 Child Health and Human Development Extramural Research 3,790,797 3,733,008 57,789 93.866 Aging Research 1,101,363 1,098,891 2,472 93.946 Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs 80,039 78,033 2,006 93.994 Maternal and Child Health Services Block Grant to the States 171,995 168,656 3,339 The Role of Oral Care in Nonventilator Hospital-Acquired Pneumonia (NVHAP) Prevention 148,388 – 148,388 Total $ 13,864,545 $ 13,482,752 $ 381,793 Identification as a repeat finding, if applicable: The finding is not a repeat finding from the prior year. 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: Award amounts were changed on the Schedule after management’s review was executed. Management acknowledges that implementing the new Enterprise Resource Planning (ERP) system, in 2023 presented changes to the SEFA reporting. Management has identified and addressed the reporting issues within the new system to ensure that the grant totals are appropriately captured in the SEFA. Endeavor will enhance grant management award processes by revising its procedures and adding additional controls to monitor for accuracy of the core data. Management will reinforce the importance of timeliness and accuracy of the Schedule reporting totals to facilitate accurate reporting.
Finding 2023-001 – Reporting Information of the federal program: Federal Grantor: Department of Defense (DOD) Assistance Listing No.: 12.420, Military Medical Research and Development Pass-Through Grantor: Johns Hopkins University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.172, Human Genome Research Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.226, Research on Healthcare Costs, Quality and Outcomes Pass-Through Grantor: The Regents of the University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.242, Mental Health Research Grants Pass-Through Grantor: Rutgers State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.307, Minority Health and Health Disparities Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.310, Trans-NIH Research Support Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.350, National Center for Advancing Translational Sciences Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.351, Research Infrastructure Program Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.361, Nursing Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.368, 21st Century Cures Act – Precision Medicine Initiative Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.394, Cancer Detection and Diagnosis Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.395, Cancer Treatment Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.396, Cancer Biology Research Pass-Through Grantor: Tulane University, Louisiana State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.397, Cancer Centers Support Grants Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.667, Social Services Block Grant Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.837, Cardiovascular Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.838, Lung Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.847, Diabetes, Digestive, and Kidney Diseases Extramural Research Pass-Through Grantors: Northwestern University, Duke University, University of Washington, The Regents of University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.853, Extramural Research Programs in the Neurosciences and Neurological Disorders Pass-Through Grantor: Rush University Medical Center Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.855, Allergy, Immunology and Transplantation Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.859, Biomedical Research and Research Training Pass-Through Grantor: University of Wisconsin – Madison Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.865, Child Health and Human Development Extramural Research Pass-Through Grantors: Northwestern University, University of Washington, The Regents of the University of California Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.866, Aging Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.946, Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.994, Maternal and Child Health Services Block Grant to the States Pass-Through Grantor: Northwestern Memorial Hospital 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).” 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 grants related to the Research and Development Cluster were misstated by $233,405 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. In addition, an award which was not a federal grant award with expenditures of $148,388 was included on the preliminary Schedule provided by management. 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: The table below reflects the preliminary and adjusted assistance listing balances on the Schedule (only assistance listing programs which changed are included below): Assistance Listing No. Name of Federal Program Preliminary Schedule Adjusted Schedule Change 12.420 Military Medical Research and Development $ 241,025 $ 224,418 $ 16,607 93.172 Human Genome Research 14,874 15,121 (247) 93.226 Research on Healthcare Costs, Quality and Outcomes 251,325 248,842 2,483 93.242 Mental Health Research Grants 1,616,503 1,617,376 (873) 93.307 Minority Health and Health Disparities Research 17,323 15,122 2,201 93.310 Trans-NIH Research Support 313,459 313,490 (31) 93.350 National Center for Advancing Translational Sciences 516,734 518,429 (1,695) 93.351 Research Infrastructure Program 242,436 232,058 10,378 93.361 Nursing Research 8,745 7,645 1,100 93.368 21st Century Cures Act – Precision Medicine Initiative 100,324 94,609 5,715 93.394 Cancer Detection and Diagnosis Research 847,959 816,528 31,431 93.395 Cancer Treatment Research 438,349 439,286 (937) 93.396 Cancer Biology Research 93,919 88,642 5,277 93.397 Cancer Centers Support Grants 15,552 14,078 1,474 93.667 Social Services Block Grant 19,619 27,170 (7,551) 93.837 Cardiovascular Diseases Research 193,160 188,850 4,310 93.838 Lung Diseases Research 482,934 471,427 11,507 93.847 Diabetes, Digestive, and Kidney Diseases Extramural Research 1,075,493 1,035,041 40,452 93.853 Extramural Research Programs in the Neurosciences and Neurological Disorders 1,645,025 1,596,611 48,414 93.855 Allergy, Immunology and Transplantation Research 73,869 72,630 1,239 93.859 Biomedical Research and Research Training 363,336 366,791 (3,455) 93.865 Child Health and Human Development Extramural Research 3,790,797 3,733,008 57,789 93.866 Aging Research 1,101,363 1,098,891 2,472 93.946 Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs 80,039 78,033 2,006 93.994 Maternal and Child Health Services Block Grant to the States 171,995 168,656 3,339 The Role of Oral Care in Nonventilator Hospital-Acquired Pneumonia (NVHAP) Prevention 148,388 – 148,388 Total $ 13,864,545 $ 13,482,752 $ 381,793 Identification as a repeat finding, if applicable: The finding is not a repeat finding from the prior year. 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: Award amounts were changed on the Schedule after management’s review was executed. Management acknowledges that implementing the new Enterprise Resource Planning (ERP) system, in 2023 presented changes to the SEFA reporting. Management has identified and addressed the reporting issues within the new system to ensure that the grant totals are appropriately captured in the SEFA. Endeavor will enhance grant management award processes by revising its procedures and adding additional controls to monitor for accuracy of the core data. Management will reinforce the importance of timeliness and accuracy of the Schedule reporting totals to facilitate accurate reporting.
Finding 2023-001 – Reporting Information of the federal program: Federal Grantor: Department of Defense (DOD) Assistance Listing No.: 12.420, Military Medical Research and Development Pass-Through Grantor: Johns Hopkins University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.172, Human Genome Research Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.226, Research on Healthcare Costs, Quality and Outcomes Pass-Through Grantor: The Regents of the University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.242, Mental Health Research Grants Pass-Through Grantor: Rutgers State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.307, Minority Health and Health Disparities Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.310, Trans-NIH Research Support Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.350, National Center for Advancing Translational Sciences Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.351, Research Infrastructure Program Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.361, Nursing Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.368, 21st Century Cures Act – Precision Medicine Initiative Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.394, Cancer Detection and Diagnosis Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.395, Cancer Treatment Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.396, Cancer Biology Research Pass-Through Grantor: Tulane University, Louisiana State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.397, Cancer Centers Support Grants Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.667, Social Services Block Grant Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.837, Cardiovascular Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.838, Lung Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.847, Diabetes, Digestive, and Kidney Diseases Extramural Research Pass-Through Grantors: Northwestern University, Duke University, University of Washington, The Regents of University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.853, Extramural Research Programs in the Neurosciences and Neurological Disorders Pass-Through Grantor: Rush University Medical Center Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.855, Allergy, Immunology and Transplantation Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.859, Biomedical Research and Research Training Pass-Through Grantor: University of Wisconsin – Madison Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.865, Child Health and Human Development Extramural Research Pass-Through Grantors: Northwestern University, University of Washington, The Regents of the University of California Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.866, Aging Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.946, Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.994, Maternal and Child Health Services Block Grant to the States Pass-Through Grantor: Northwestern Memorial Hospital 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).” 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 grants related to the Research and Development Cluster were misstated by $233,405 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. In addition, an award which was not a federal grant award with expenditures of $148,388 was included on the preliminary Schedule provided by management. 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: The table below reflects the preliminary and adjusted assistance listing balances on the Schedule (only assistance listing programs which changed are included below): Assistance Listing No. Name of Federal Program Preliminary Schedule Adjusted Schedule Change 12.420 Military Medical Research and Development $ 241,025 $ 224,418 $ 16,607 93.172 Human Genome Research 14,874 15,121 (247) 93.226 Research on Healthcare Costs, Quality and Outcomes 251,325 248,842 2,483 93.242 Mental Health Research Grants 1,616,503 1,617,376 (873) 93.307 Minority Health and Health Disparities Research 17,323 15,122 2,201 93.310 Trans-NIH Research Support 313,459 313,490 (31) 93.350 National Center for Advancing Translational Sciences 516,734 518,429 (1,695) 93.351 Research Infrastructure Program 242,436 232,058 10,378 93.361 Nursing Research 8,745 7,645 1,100 93.368 21st Century Cures Act – Precision Medicine Initiative 100,324 94,609 5,715 93.394 Cancer Detection and Diagnosis Research 847,959 816,528 31,431 93.395 Cancer Treatment Research 438,349 439,286 (937) 93.396 Cancer Biology Research 93,919 88,642 5,277 93.397 Cancer Centers Support Grants 15,552 14,078 1,474 93.667 Social Services Block Grant 19,619 27,170 (7,551) 93.837 Cardiovascular Diseases Research 193,160 188,850 4,310 93.838 Lung Diseases Research 482,934 471,427 11,507 93.847 Diabetes, Digestive, and Kidney Diseases Extramural Research 1,075,493 1,035,041 40,452 93.853 Extramural Research Programs in the Neurosciences and Neurological Disorders 1,645,025 1,596,611 48,414 93.855 Allergy, Immunology and Transplantation Research 73,869 72,630 1,239 93.859 Biomedical Research and Research Training 363,336 366,791 (3,455) 93.865 Child Health and Human Development Extramural Research 3,790,797 3,733,008 57,789 93.866 Aging Research 1,101,363 1,098,891 2,472 93.946 Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs 80,039 78,033 2,006 93.994 Maternal and Child Health Services Block Grant to the States 171,995 168,656 3,339 The Role of Oral Care in Nonventilator Hospital-Acquired Pneumonia (NVHAP) Prevention 148,388 – 148,388 Total $ 13,864,545 $ 13,482,752 $ 381,793 Identification as a repeat finding, if applicable: The finding is not a repeat finding from the prior year. 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: Award amounts were changed on the Schedule after management’s review was executed. Management acknowledges that implementing the new Enterprise Resource Planning (ERP) system, in 2023 presented changes to the SEFA reporting. Management has identified and addressed the reporting issues within the new system to ensure that the grant totals are appropriately captured in the SEFA. Endeavor will enhance grant management award processes by revising its procedures and adding additional controls to monitor for accuracy of the core data. Management will reinforce the importance of timeliness and accuracy of the Schedule reporting totals to facilitate accurate reporting.
Finding 2023-001 – Reporting Information of the federal program: Federal Grantor: Department of Defense (DOD) Assistance Listing No.: 12.420, Military Medical Research and Development Pass-Through Grantor: Johns Hopkins University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.172, Human Genome Research Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.226, Research on Healthcare Costs, Quality and Outcomes Pass-Through Grantor: The Regents of the University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.242, Mental Health Research Grants Pass-Through Grantor: Rutgers State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.307, Minority Health and Health Disparities Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.310, Trans-NIH Research Support Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.350, National Center for Advancing Translational Sciences Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.351, Research Infrastructure Program Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.361, Nursing Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.368, 21st Century Cures Act – Precision Medicine Initiative Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.394, Cancer Detection and Diagnosis Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.395, Cancer Treatment Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.396, Cancer Biology Research Pass-Through Grantor: Tulane University, Louisiana State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.397, Cancer Centers Support Grants Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.667, Social Services Block Grant Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.837, Cardiovascular Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.838, Lung Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.847, Diabetes, Digestive, and Kidney Diseases Extramural Research Pass-Through Grantors: Northwestern University, Duke University, University of Washington, The Regents of University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.853, Extramural Research Programs in the Neurosciences and Neurological Disorders Pass-Through Grantor: Rush University Medical Center Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.855, Allergy, Immunology and Transplantation Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.859, Biomedical Research and Research Training Pass-Through Grantor: University of Wisconsin – Madison Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.865, Child Health and Human Development Extramural Research Pass-Through Grantors: Northwestern University, University of Washington, The Regents of the University of California Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.866, Aging Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.946, Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.994, Maternal and Child Health Services Block Grant to the States Pass-Through Grantor: Northwestern Memorial Hospital 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).” 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 grants related to the Research and Development Cluster were misstated by $233,405 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. In addition, an award which was not a federal grant award with expenditures of $148,388 was included on the preliminary Schedule provided by management. 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: The table below reflects the preliminary and adjusted assistance listing balances on the Schedule (only assistance listing programs which changed are included below): Assistance Listing No. Name of Federal Program Preliminary Schedule Adjusted Schedule Change 12.420 Military Medical Research and Development $ 241,025 $ 224,418 $ 16,607 93.172 Human Genome Research 14,874 15,121 (247) 93.226 Research on Healthcare Costs, Quality and Outcomes 251,325 248,842 2,483 93.242 Mental Health Research Grants 1,616,503 1,617,376 (873) 93.307 Minority Health and Health Disparities Research 17,323 15,122 2,201 93.310 Trans-NIH Research Support 313,459 313,490 (31) 93.350 National Center for Advancing Translational Sciences 516,734 518,429 (1,695) 93.351 Research Infrastructure Program 242,436 232,058 10,378 93.361 Nursing Research 8,745 7,645 1,100 93.368 21st Century Cures Act – Precision Medicine Initiative 100,324 94,609 5,715 93.394 Cancer Detection and Diagnosis Research 847,959 816,528 31,431 93.395 Cancer Treatment Research 438,349 439,286 (937) 93.396 Cancer Biology Research 93,919 88,642 5,277 93.397 Cancer Centers Support Grants 15,552 14,078 1,474 93.667 Social Services Block Grant 19,619 27,170 (7,551) 93.837 Cardiovascular Diseases Research 193,160 188,850 4,310 93.838 Lung Diseases Research 482,934 471,427 11,507 93.847 Diabetes, Digestive, and Kidney Diseases Extramural Research 1,075,493 1,035,041 40,452 93.853 Extramural Research Programs in the Neurosciences and Neurological Disorders 1,645,025 1,596,611 48,414 93.855 Allergy, Immunology and Transplantation Research 73,869 72,630 1,239 93.859 Biomedical Research and Research Training 363,336 366,791 (3,455) 93.865 Child Health and Human Development Extramural Research 3,790,797 3,733,008 57,789 93.866 Aging Research 1,101,363 1,098,891 2,472 93.946 Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs 80,039 78,033 2,006 93.994 Maternal and Child Health Services Block Grant to the States 171,995 168,656 3,339 The Role of Oral Care in Nonventilator Hospital-Acquired Pneumonia (NVHAP) Prevention 148,388 – 148,388 Total $ 13,864,545 $ 13,482,752 $ 381,793 Identification as a repeat finding, if applicable: The finding is not a repeat finding from the prior year. 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: Award amounts were changed on the Schedule after management’s review was executed. Management acknowledges that implementing the new Enterprise Resource Planning (ERP) system, in 2023 presented changes to the SEFA reporting. Management has identified and addressed the reporting issues within the new system to ensure that the grant totals are appropriately captured in the SEFA. Endeavor will enhance grant management award processes by revising its procedures and adding additional controls to monitor for accuracy of the core data. Management will reinforce the importance of timeliness and accuracy of the Schedule reporting totals to facilitate accurate reporting.
Finding 2023-001 – Reporting Information of the federal program: Federal Grantor: Department of Defense (DOD) Assistance Listing No.: 12.420, Military Medical Research and Development Pass-Through Grantor: Johns Hopkins University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.172, Human Genome Research Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.226, Research on Healthcare Costs, Quality and Outcomes Pass-Through Grantor: The Regents of the University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.242, Mental Health Research Grants Pass-Through Grantor: Rutgers State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.307, Minority Health and Health Disparities Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.310, Trans-NIH Research Support Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.350, National Center for Advancing Translational Sciences Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.351, Research Infrastructure Program Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.361, Nursing Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.368, 21st Century Cures Act – Precision Medicine Initiative Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.394, Cancer Detection and Diagnosis Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.395, Cancer Treatment Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.396, Cancer Biology Research Pass-Through Grantor: Tulane University, Louisiana State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.397, Cancer Centers Support Grants Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.667, Social Services Block Grant Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.837, Cardiovascular Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.838, Lung Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.847, Diabetes, Digestive, and Kidney Diseases Extramural Research Pass-Through Grantors: Northwestern University, Duke University, University of Washington, The Regents of University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.853, Extramural Research Programs in the Neurosciences and Neurological Disorders Pass-Through Grantor: Rush University Medical Center Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.855, Allergy, Immunology and Transplantation Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.859, Biomedical Research and Research Training Pass-Through Grantor: University of Wisconsin – Madison Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.865, Child Health and Human Development Extramural Research Pass-Through Grantors: Northwestern University, University of Washington, The Regents of the University of California Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.866, Aging Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.946, Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.994, Maternal and Child Health Services Block Grant to the States Pass-Through Grantor: Northwestern Memorial Hospital 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).” 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 grants related to the Research and Development Cluster were misstated by $233,405 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. In addition, an award which was not a federal grant award with expenditures of $148,388 was included on the preliminary Schedule provided by management. 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: The table below reflects the preliminary and adjusted assistance listing balances on the Schedule (only assistance listing programs which changed are included below): Assistance Listing No. Name of Federal Program Preliminary Schedule Adjusted Schedule Change 12.420 Military Medical Research and Development $ 241,025 $ 224,418 $ 16,607 93.172 Human Genome Research 14,874 15,121 (247) 93.226 Research on Healthcare Costs, Quality and Outcomes 251,325 248,842 2,483 93.242 Mental Health Research Grants 1,616,503 1,617,376 (873) 93.307 Minority Health and Health Disparities Research 17,323 15,122 2,201 93.310 Trans-NIH Research Support 313,459 313,490 (31) 93.350 National Center for Advancing Translational Sciences 516,734 518,429 (1,695) 93.351 Research Infrastructure Program 242,436 232,058 10,378 93.361 Nursing Research 8,745 7,645 1,100 93.368 21st Century Cures Act – Precision Medicine Initiative 100,324 94,609 5,715 93.394 Cancer Detection and Diagnosis Research 847,959 816,528 31,431 93.395 Cancer Treatment Research 438,349 439,286 (937) 93.396 Cancer Biology Research 93,919 88,642 5,277 93.397 Cancer Centers Support Grants 15,552 14,078 1,474 93.667 Social Services Block Grant 19,619 27,170 (7,551) 93.837 Cardiovascular Diseases Research 193,160 188,850 4,310 93.838 Lung Diseases Research 482,934 471,427 11,507 93.847 Diabetes, Digestive, and Kidney Diseases Extramural Research 1,075,493 1,035,041 40,452 93.853 Extramural Research Programs in the Neurosciences and Neurological Disorders 1,645,025 1,596,611 48,414 93.855 Allergy, Immunology and Transplantation Research 73,869 72,630 1,239 93.859 Biomedical Research and Research Training 363,336 366,791 (3,455) 93.865 Child Health and Human Development Extramural Research 3,790,797 3,733,008 57,789 93.866 Aging Research 1,101,363 1,098,891 2,472 93.946 Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs 80,039 78,033 2,006 93.994 Maternal and Child Health Services Block Grant to the States 171,995 168,656 3,339 The Role of Oral Care in Nonventilator Hospital-Acquired Pneumonia (NVHAP) Prevention 148,388 – 148,388 Total $ 13,864,545 $ 13,482,752 $ 381,793 Identification as a repeat finding, if applicable: The finding is not a repeat finding from the prior year. 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: Award amounts were changed on the Schedule after management’s review was executed. Management acknowledges that implementing the new Enterprise Resource Planning (ERP) system, in 2023 presented changes to the SEFA reporting. Management has identified and addressed the reporting issues within the new system to ensure that the grant totals are appropriately captured in the SEFA. Endeavor will enhance grant management award processes by revising its procedures and adding additional controls to monitor for accuracy of the core data. Management will reinforce the importance of timeliness and accuracy of the Schedule reporting totals to facilitate accurate reporting.
Finding 2023-001 – Reporting Information of the federal program: Federal Grantor: Department of Defense (DOD) Assistance Listing No.: 12.420, Military Medical Research and Development Pass-Through Grantor: Johns Hopkins University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.172, Human Genome Research Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.226, Research on Healthcare Costs, Quality and Outcomes Pass-Through Grantor: The Regents of the University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.242, Mental Health Research Grants Pass-Through Grantor: Rutgers State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.307, Minority Health and Health Disparities Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.310, Trans-NIH Research Support Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.350, National Center for Advancing Translational Sciences Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.351, Research Infrastructure Program Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.361, Nursing Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.368, 21st Century Cures Act – Precision Medicine Initiative Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.394, Cancer Detection and Diagnosis Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.395, Cancer Treatment Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.396, Cancer Biology Research Pass-Through Grantor: Tulane University, Louisiana State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.397, Cancer Centers Support Grants Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.667, Social Services Block Grant Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.837, Cardiovascular Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.838, Lung Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.847, Diabetes, Digestive, and Kidney Diseases Extramural Research Pass-Through Grantors: Northwestern University, Duke University, University of Washington, The Regents of University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.853, Extramural Research Programs in the Neurosciences and Neurological Disorders Pass-Through Grantor: Rush University Medical Center Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.855, Allergy, Immunology and Transplantation Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.859, Biomedical Research and Research Training Pass-Through Grantor: University of Wisconsin – Madison Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.865, Child Health and Human Development Extramural Research Pass-Through Grantors: Northwestern University, University of Washington, The Regents of the University of California Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.866, Aging Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.946, Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.994, Maternal and Child Health Services Block Grant to the States Pass-Through Grantor: Northwestern Memorial Hospital 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).” 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 grants related to the Research and Development Cluster were misstated by $233,405 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. In addition, an award which was not a federal grant award with expenditures of $148,388 was included on the preliminary Schedule provided by management. 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: The table below reflects the preliminary and adjusted assistance listing balances on the Schedule (only assistance listing programs which changed are included below): Assistance Listing No. Name of Federal Program Preliminary Schedule Adjusted Schedule Change 12.420 Military Medical Research and Development $ 241,025 $ 224,418 $ 16,607 93.172 Human Genome Research 14,874 15,121 (247) 93.226 Research on Healthcare Costs, Quality and Outcomes 251,325 248,842 2,483 93.242 Mental Health Research Grants 1,616,503 1,617,376 (873) 93.307 Minority Health and Health Disparities Research 17,323 15,122 2,201 93.310 Trans-NIH Research Support 313,459 313,490 (31) 93.350 National Center for Advancing Translational Sciences 516,734 518,429 (1,695) 93.351 Research Infrastructure Program 242,436 232,058 10,378 93.361 Nursing Research 8,745 7,645 1,100 93.368 21st Century Cures Act – Precision Medicine Initiative 100,324 94,609 5,715 93.394 Cancer Detection and Diagnosis Research 847,959 816,528 31,431 93.395 Cancer Treatment Research 438,349 439,286 (937) 93.396 Cancer Biology Research 93,919 88,642 5,277 93.397 Cancer Centers Support Grants 15,552 14,078 1,474 93.667 Social Services Block Grant 19,619 27,170 (7,551) 93.837 Cardiovascular Diseases Research 193,160 188,850 4,310 93.838 Lung Diseases Research 482,934 471,427 11,507 93.847 Diabetes, Digestive, and Kidney Diseases Extramural Research 1,075,493 1,035,041 40,452 93.853 Extramural Research Programs in the Neurosciences and Neurological Disorders 1,645,025 1,596,611 48,414 93.855 Allergy, Immunology and Transplantation Research 73,869 72,630 1,239 93.859 Biomedical Research and Research Training 363,336 366,791 (3,455) 93.865 Child Health and Human Development Extramural Research 3,790,797 3,733,008 57,789 93.866 Aging Research 1,101,363 1,098,891 2,472 93.946 Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs 80,039 78,033 2,006 93.994 Maternal and Child Health Services Block Grant to the States 171,995 168,656 3,339 The Role of Oral Care in Nonventilator Hospital-Acquired Pneumonia (NVHAP) Prevention 148,388 – 148,388 Total $ 13,864,545 $ 13,482,752 $ 381,793 Identification as a repeat finding, if applicable: The finding is not a repeat finding from the prior year. 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: Award amounts were changed on the Schedule after management’s review was executed. Management acknowledges that implementing the new Enterprise Resource Planning (ERP) system, in 2023 presented changes to the SEFA reporting. Management has identified and addressed the reporting issues within the new system to ensure that the grant totals are appropriately captured in the SEFA. Endeavor will enhance grant management award processes by revising its procedures and adding additional controls to monitor for accuracy of the core data. Management will reinforce the importance of timeliness and accuracy of the Schedule reporting totals to facilitate accurate reporting.
Finding 2023-001 – Reporting Information of the federal program: Federal Grantor: Department of Defense (DOD) Assistance Listing No.: 12.420, Military Medical Research and Development Pass-Through Grantor: Johns Hopkins University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.172, Human Genome Research Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.226, Research on Healthcare Costs, Quality and Outcomes Pass-Through Grantor: The Regents of the University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.242, Mental Health Research Grants Pass-Through Grantor: Rutgers State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.307, Minority Health and Health Disparities Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.310, Trans-NIH Research Support Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.350, National Center for Advancing Translational Sciences Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.351, Research Infrastructure Program Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.361, Nursing Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.368, 21st Century Cures Act – Precision Medicine Initiative Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.394, Cancer Detection and Diagnosis Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.395, Cancer Treatment Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.396, Cancer Biology Research Pass-Through Grantor: Tulane University, Louisiana State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.397, Cancer Centers Support Grants Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.667, Social Services Block Grant Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.837, Cardiovascular Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.838, Lung Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.847, Diabetes, Digestive, and Kidney Diseases Extramural Research Pass-Through Grantors: Northwestern University, Duke University, University of Washington, The Regents of University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.853, Extramural Research Programs in the Neurosciences and Neurological Disorders Pass-Through Grantor: Rush University Medical Center Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.855, Allergy, Immunology and Transplantation Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.859, Biomedical Research and Research Training Pass-Through Grantor: University of Wisconsin – Madison Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.865, Child Health and Human Development Extramural Research Pass-Through Grantors: Northwestern University, University of Washington, The Regents of the University of California Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.866, Aging Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.946, Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.994, Maternal and Child Health Services Block Grant to the States Pass-Through Grantor: Northwestern Memorial Hospital 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).” 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 grants related to the Research and Development Cluster were misstated by $233,405 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. In addition, an award which was not a federal grant award with expenditures of $148,388 was included on the preliminary Schedule provided by management. 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: The table below reflects the preliminary and adjusted assistance listing balances on the Schedule (only assistance listing programs which changed are included below): Assistance Listing No. Name of Federal Program Preliminary Schedule Adjusted Schedule Change 12.420 Military Medical Research and Development $ 241,025 $ 224,418 $ 16,607 93.172 Human Genome Research 14,874 15,121 (247) 93.226 Research on Healthcare Costs, Quality and Outcomes 251,325 248,842 2,483 93.242 Mental Health Research Grants 1,616,503 1,617,376 (873) 93.307 Minority Health and Health Disparities Research 17,323 15,122 2,201 93.310 Trans-NIH Research Support 313,459 313,490 (31) 93.350 National Center for Advancing Translational Sciences 516,734 518,429 (1,695) 93.351 Research Infrastructure Program 242,436 232,058 10,378 93.361 Nursing Research 8,745 7,645 1,100 93.368 21st Century Cures Act – Precision Medicine Initiative 100,324 94,609 5,715 93.394 Cancer Detection and Diagnosis Research 847,959 816,528 31,431 93.395 Cancer Treatment Research 438,349 439,286 (937) 93.396 Cancer Biology Research 93,919 88,642 5,277 93.397 Cancer Centers Support Grants 15,552 14,078 1,474 93.667 Social Services Block Grant 19,619 27,170 (7,551) 93.837 Cardiovascular Diseases Research 193,160 188,850 4,310 93.838 Lung Diseases Research 482,934 471,427 11,507 93.847 Diabetes, Digestive, and Kidney Diseases Extramural Research 1,075,493 1,035,041 40,452 93.853 Extramural Research Programs in the Neurosciences and Neurological Disorders 1,645,025 1,596,611 48,414 93.855 Allergy, Immunology and Transplantation Research 73,869 72,630 1,239 93.859 Biomedical Research and Research Training 363,336 366,791 (3,455) 93.865 Child Health and Human Development Extramural Research 3,790,797 3,733,008 57,789 93.866 Aging Research 1,101,363 1,098,891 2,472 93.946 Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs 80,039 78,033 2,006 93.994 Maternal and Child Health Services Block Grant to the States 171,995 168,656 3,339 The Role of Oral Care in Nonventilator Hospital-Acquired Pneumonia (NVHAP) Prevention 148,388 – 148,388 Total $ 13,864,545 $ 13,482,752 $ 381,793 Identification as a repeat finding, if applicable: The finding is not a repeat finding from the prior year. 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: Award amounts were changed on the Schedule after management’s review was executed. Management acknowledges that implementing the new Enterprise Resource Planning (ERP) system, in 2023 presented changes to the SEFA reporting. Management has identified and addressed the reporting issues within the new system to ensure that the grant totals are appropriately captured in the SEFA. Endeavor will enhance grant management award processes by revising its procedures and adding additional controls to monitor for accuracy of the core data. Management will reinforce the importance of timeliness and accuracy of the Schedule reporting totals to facilitate accurate reporting.
Finding 2023-001 – Reporting Information of the federal program: Federal Grantor: Department of Defense (DOD) Assistance Listing No.: 12.420, Military Medical Research and Development Pass-Through Grantor: Johns Hopkins University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.172, Human Genome Research Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.226, Research on Healthcare Costs, Quality and Outcomes Pass-Through Grantor: The Regents of the University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.242, Mental Health Research Grants Pass-Through Grantor: Rutgers State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.307, Minority Health and Health Disparities Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.310, Trans-NIH Research Support Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.350, National Center for Advancing Translational Sciences Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.351, Research Infrastructure Program Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.361, Nursing Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.368, 21st Century Cures Act – Precision Medicine Initiative Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.394, Cancer Detection and Diagnosis Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.395, Cancer Treatment Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.396, Cancer Biology Research Pass-Through Grantor: Tulane University, Louisiana State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.397, Cancer Centers Support Grants Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.667, Social Services Block Grant Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.837, Cardiovascular Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.838, Lung Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.847, Diabetes, Digestive, and Kidney Diseases Extramural Research Pass-Through Grantors: Northwestern University, Duke University, University of Washington, The Regents of University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.853, Extramural Research Programs in the Neurosciences and Neurological Disorders Pass-Through Grantor: Rush University Medical Center Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.855, Allergy, Immunology and Transplantation Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.859, Biomedical Research and Research Training Pass-Through Grantor: University of Wisconsin – Madison Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.865, Child Health and Human Development Extramural Research Pass-Through Grantors: Northwestern University, University of Washington, The Regents of the University of California Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.866, Aging Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.946, Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.994, Maternal and Child Health Services Block Grant to the States Pass-Through Grantor: Northwestern Memorial Hospital 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).” 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 grants related to the Research and Development Cluster were misstated by $233,405 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. In addition, an award which was not a federal grant award with expenditures of $148,388 was included on the preliminary Schedule provided by management. 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: The table below reflects the preliminary and adjusted assistance listing balances on the Schedule (only assistance listing programs which changed are included below): Assistance Listing No. Name of Federal Program Preliminary Schedule Adjusted Schedule Change 12.420 Military Medical Research and Development $ 241,025 $ 224,418 $ 16,607 93.172 Human Genome Research 14,874 15,121 (247) 93.226 Research on Healthcare Costs, Quality and Outcomes 251,325 248,842 2,483 93.242 Mental Health Research Grants 1,616,503 1,617,376 (873) 93.307 Minority Health and Health Disparities Research 17,323 15,122 2,201 93.310 Trans-NIH Research Support 313,459 313,490 (31) 93.350 National Center for Advancing Translational Sciences 516,734 518,429 (1,695) 93.351 Research Infrastructure Program 242,436 232,058 10,378 93.361 Nursing Research 8,745 7,645 1,100 93.368 21st Century Cures Act – Precision Medicine Initiative 100,324 94,609 5,715 93.394 Cancer Detection and Diagnosis Research 847,959 816,528 31,431 93.395 Cancer Treatment Research 438,349 439,286 (937) 93.396 Cancer Biology Research 93,919 88,642 5,277 93.397 Cancer Centers Support Grants 15,552 14,078 1,474 93.667 Social Services Block Grant 19,619 27,170 (7,551) 93.837 Cardiovascular Diseases Research 193,160 188,850 4,310 93.838 Lung Diseases Research 482,934 471,427 11,507 93.847 Diabetes, Digestive, and Kidney Diseases Extramural Research 1,075,493 1,035,041 40,452 93.853 Extramural Research Programs in the Neurosciences and Neurological Disorders 1,645,025 1,596,611 48,414 93.855 Allergy, Immunology and Transplantation Research 73,869 72,630 1,239 93.859 Biomedical Research and Research Training 363,336 366,791 (3,455) 93.865 Child Health and Human Development Extramural Research 3,790,797 3,733,008 57,789 93.866 Aging Research 1,101,363 1,098,891 2,472 93.946 Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs 80,039 78,033 2,006 93.994 Maternal and Child Health Services Block Grant to the States 171,995 168,656 3,339 The Role of Oral Care in Nonventilator Hospital-Acquired Pneumonia (NVHAP) Prevention 148,388 – 148,388 Total $ 13,864,545 $ 13,482,752 $ 381,793 Identification as a repeat finding, if applicable: The finding is not a repeat finding from the prior year. 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: Award amounts were changed on the Schedule after management’s review was executed. Management acknowledges that implementing the new Enterprise Resource Planning (ERP) system, in 2023 presented changes to the SEFA reporting. Management has identified and addressed the reporting issues within the new system to ensure that the grant totals are appropriately captured in the SEFA. Endeavor will enhance grant management award processes by revising its procedures and adding additional controls to monitor for accuracy of the core data. Management will reinforce the importance of timeliness and accuracy of the Schedule reporting totals to facilitate accurate reporting.
Finding 2023-001 – Reporting Information of the federal program: Federal Grantor: Department of Defense (DOD) Assistance Listing No.: 12.420, Military Medical Research and Development Pass-Through Grantor: Johns Hopkins University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.172, Human Genome Research Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.226, Research on Healthcare Costs, Quality and Outcomes Pass-Through Grantor: The Regents of the University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.242, Mental Health Research Grants Pass-Through Grantor: Rutgers State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.307, Minority Health and Health Disparities Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.310, Trans-NIH Research Support Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.350, National Center for Advancing Translational Sciences Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.351, Research Infrastructure Program Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.361, Nursing Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.368, 21st Century Cures Act – Precision Medicine Initiative Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.394, Cancer Detection and Diagnosis Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.395, Cancer Treatment Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.396, Cancer Biology Research Pass-Through Grantor: Tulane University, Louisiana State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.397, Cancer Centers Support Grants Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.667, Social Services Block Grant Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.837, Cardiovascular Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.838, Lung Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.847, Diabetes, Digestive, and Kidney Diseases Extramural Research Pass-Through Grantors: Northwestern University, Duke University, University of Washington, The Regents of University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.853, Extramural Research Programs in the Neurosciences and Neurological Disorders Pass-Through Grantor: Rush University Medical Center Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.855, Allergy, Immunology and Transplantation Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.859, Biomedical Research and Research Training Pass-Through Grantor: University of Wisconsin – Madison Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.865, Child Health and Human Development Extramural Research Pass-Through Grantors: Northwestern University, University of Washington, The Regents of the University of California Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.866, Aging Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.946, Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.994, Maternal and Child Health Services Block Grant to the States Pass-Through Grantor: Northwestern Memorial Hospital 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).” 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 grants related to the Research and Development Cluster were misstated by $233,405 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. In addition, an award which was not a federal grant award with expenditures of $148,388 was included on the preliminary Schedule provided by management. 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: The table below reflects the preliminary and adjusted assistance listing balances on the Schedule (only assistance listing programs which changed are included below): Assistance Listing No. Name of Federal Program Preliminary Schedule Adjusted Schedule Change 12.420 Military Medical Research and Development $ 241,025 $ 224,418 $ 16,607 93.172 Human Genome Research 14,874 15,121 (247) 93.226 Research on Healthcare Costs, Quality and Outcomes 251,325 248,842 2,483 93.242 Mental Health Research Grants 1,616,503 1,617,376 (873) 93.307 Minority Health and Health Disparities Research 17,323 15,122 2,201 93.310 Trans-NIH Research Support 313,459 313,490 (31) 93.350 National Center for Advancing Translational Sciences 516,734 518,429 (1,695) 93.351 Research Infrastructure Program 242,436 232,058 10,378 93.361 Nursing Research 8,745 7,645 1,100 93.368 21st Century Cures Act – Precision Medicine Initiative 100,324 94,609 5,715 93.394 Cancer Detection and Diagnosis Research 847,959 816,528 31,431 93.395 Cancer Treatment Research 438,349 439,286 (937) 93.396 Cancer Biology Research 93,919 88,642 5,277 93.397 Cancer Centers Support Grants 15,552 14,078 1,474 93.667 Social Services Block Grant 19,619 27,170 (7,551) 93.837 Cardiovascular Diseases Research 193,160 188,850 4,310 93.838 Lung Diseases Research 482,934 471,427 11,507 93.847 Diabetes, Digestive, and Kidney Diseases Extramural Research 1,075,493 1,035,041 40,452 93.853 Extramural Research Programs in the Neurosciences and Neurological Disorders 1,645,025 1,596,611 48,414 93.855 Allergy, Immunology and Transplantation Research 73,869 72,630 1,239 93.859 Biomedical Research and Research Training 363,336 366,791 (3,455) 93.865 Child Health and Human Development Extramural Research 3,790,797 3,733,008 57,789 93.866 Aging Research 1,101,363 1,098,891 2,472 93.946 Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs 80,039 78,033 2,006 93.994 Maternal and Child Health Services Block Grant to the States 171,995 168,656 3,339 The Role of Oral Care in Nonventilator Hospital-Acquired Pneumonia (NVHAP) Prevention 148,388 – 148,388 Total $ 13,864,545 $ 13,482,752 $ 381,793 Identification as a repeat finding, if applicable: The finding is not a repeat finding from the prior year. 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: Award amounts were changed on the Schedule after management’s review was executed. Management acknowledges that implementing the new Enterprise Resource Planning (ERP) system, in 2023 presented changes to the SEFA reporting. Management has identified and addressed the reporting issues within the new system to ensure that the grant totals are appropriately captured in the SEFA. Endeavor will enhance grant management award processes by revising its procedures and adding additional controls to monitor for accuracy of the core data. Management will reinforce the importance of timeliness and accuracy of the Schedule reporting totals to facilitate accurate reporting.
Finding 2023-001 – Reporting Information of the federal program: Federal Grantor: Department of Defense (DOD) Assistance Listing No.: 12.420, Military Medical Research and Development Pass-Through Grantor: Johns Hopkins University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.172, Human Genome Research Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.226, Research on Healthcare Costs, Quality and Outcomes Pass-Through Grantor: The Regents of the University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.242, Mental Health Research Grants Pass-Through Grantor: Rutgers State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.307, Minority Health and Health Disparities Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.310, Trans-NIH Research Support Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.350, National Center for Advancing Translational Sciences Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.351, Research Infrastructure Program Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.361, Nursing Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.368, 21st Century Cures Act – Precision Medicine Initiative Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.394, Cancer Detection and Diagnosis Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.395, Cancer Treatment Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.396, Cancer Biology Research Pass-Through Grantor: Tulane University, Louisiana State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.397, Cancer Centers Support Grants Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.667, Social Services Block Grant Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.837, Cardiovascular Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.838, Lung Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.847, Diabetes, Digestive, and Kidney Diseases Extramural Research Pass-Through Grantors: Northwestern University, Duke University, University of Washington, The Regents of University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.853, Extramural Research Programs in the Neurosciences and Neurological Disorders Pass-Through Grantor: Rush University Medical Center Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.855, Allergy, Immunology and Transplantation Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.859, Biomedical Research and Research Training Pass-Through Grantor: University of Wisconsin – Madison Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.865, Child Health and Human Development Extramural Research Pass-Through Grantors: Northwestern University, University of Washington, The Regents of the University of California Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.866, Aging Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.946, Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.994, Maternal and Child Health Services Block Grant to the States Pass-Through Grantor: Northwestern Memorial Hospital 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).” 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 grants related to the Research and Development Cluster were misstated by $233,405 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. In addition, an award which was not a federal grant award with expenditures of $148,388 was included on the preliminary Schedule provided by management. 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: The table below reflects the preliminary and adjusted assistance listing balances on the Schedule (only assistance listing programs which changed are included below): Assistance Listing No. Name of Federal Program Preliminary Schedule Adjusted Schedule Change 12.420 Military Medical Research and Development $ 241,025 $ 224,418 $ 16,607 93.172 Human Genome Research 14,874 15,121 (247) 93.226 Research on Healthcare Costs, Quality and Outcomes 251,325 248,842 2,483 93.242 Mental Health Research Grants 1,616,503 1,617,376 (873) 93.307 Minority Health and Health Disparities Research 17,323 15,122 2,201 93.310 Trans-NIH Research Support 313,459 313,490 (31) 93.350 National Center for Advancing Translational Sciences 516,734 518,429 (1,695) 93.351 Research Infrastructure Program 242,436 232,058 10,378 93.361 Nursing Research 8,745 7,645 1,100 93.368 21st Century Cures Act – Precision Medicine Initiative 100,324 94,609 5,715 93.394 Cancer Detection and Diagnosis Research 847,959 816,528 31,431 93.395 Cancer Treatment Research 438,349 439,286 (937) 93.396 Cancer Biology Research 93,919 88,642 5,277 93.397 Cancer Centers Support Grants 15,552 14,078 1,474 93.667 Social Services Block Grant 19,619 27,170 (7,551) 93.837 Cardiovascular Diseases Research 193,160 188,850 4,310 93.838 Lung Diseases Research 482,934 471,427 11,507 93.847 Diabetes, Digestive, and Kidney Diseases Extramural Research 1,075,493 1,035,041 40,452 93.853 Extramural Research Programs in the Neurosciences and Neurological Disorders 1,645,025 1,596,611 48,414 93.855 Allergy, Immunology and Transplantation Research 73,869 72,630 1,239 93.859 Biomedical Research and Research Training 363,336 366,791 (3,455) 93.865 Child Health and Human Development Extramural Research 3,790,797 3,733,008 57,789 93.866 Aging Research 1,101,363 1,098,891 2,472 93.946 Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs 80,039 78,033 2,006 93.994 Maternal and Child Health Services Block Grant to the States 171,995 168,656 3,339 The Role of Oral Care in Nonventilator Hospital-Acquired Pneumonia (NVHAP) Prevention 148,388 – 148,388 Total $ 13,864,545 $ 13,482,752 $ 381,793 Identification as a repeat finding, if applicable: The finding is not a repeat finding from the prior year. 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: Award amounts were changed on the Schedule after management’s review was executed. Management acknowledges that implementing the new Enterprise Resource Planning (ERP) system, in 2023 presented changes to the SEFA reporting. Management has identified and addressed the reporting issues within the new system to ensure that the grant totals are appropriately captured in the SEFA. Endeavor will enhance grant management award processes by revising its procedures and adding additional controls to monitor for accuracy of the core data. Management will reinforce the importance of timeliness and accuracy of the Schedule reporting totals to facilitate accurate reporting.
Finding 2023-001 – Reporting Information of the federal program: Federal Grantor: Department of Defense (DOD) Assistance Listing No.: 12.420, Military Medical Research and Development Pass-Through Grantor: Johns Hopkins University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.172, Human Genome Research Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.226, Research on Healthcare Costs, Quality and Outcomes Pass-Through Grantor: The Regents of the University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.242, Mental Health Research Grants Pass-Through Grantor: Rutgers State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.307, Minority Health and Health Disparities Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.310, Trans-NIH Research Support Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.350, National Center for Advancing Translational Sciences Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.351, Research Infrastructure Program Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.361, Nursing Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.368, 21st Century Cures Act – Precision Medicine Initiative Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.394, Cancer Detection and Diagnosis Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.395, Cancer Treatment Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.396, Cancer Biology Research Pass-Through Grantor: Tulane University, Louisiana State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.397, Cancer Centers Support Grants Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.667, Social Services Block Grant Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.837, Cardiovascular Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.838, Lung Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.847, Diabetes, Digestive, and Kidney Diseases Extramural Research Pass-Through Grantors: Northwestern University, Duke University, University of Washington, The Regents of University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.853, Extramural Research Programs in the Neurosciences and Neurological Disorders Pass-Through Grantor: Rush University Medical Center Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.855, Allergy, Immunology and Transplantation Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.859, Biomedical Research and Research Training Pass-Through Grantor: University of Wisconsin – Madison Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.865, Child Health and Human Development Extramural Research Pass-Through Grantors: Northwestern University, University of Washington, The Regents of the University of California Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.866, Aging Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.946, Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.994, Maternal and Child Health Services Block Grant to the States Pass-Through Grantor: Northwestern Memorial Hospital 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).” 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 grants related to the Research and Development Cluster were misstated by $233,405 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. In addition, an award which was not a federal grant award with expenditures of $148,388 was included on the preliminary Schedule provided by management. 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: The table below reflects the preliminary and adjusted assistance listing balances on the Schedule (only assistance listing programs which changed are included below): Assistance Listing No. Name of Federal Program Preliminary Schedule Adjusted Schedule Change 12.420 Military Medical Research and Development $ 241,025 $ 224,418 $ 16,607 93.172 Human Genome Research 14,874 15,121 (247) 93.226 Research on Healthcare Costs, Quality and Outcomes 251,325 248,842 2,483 93.242 Mental Health Research Grants 1,616,503 1,617,376 (873) 93.307 Minority Health and Health Disparities Research 17,323 15,122 2,201 93.310 Trans-NIH Research Support 313,459 313,490 (31) 93.350 National Center for Advancing Translational Sciences 516,734 518,429 (1,695) 93.351 Research Infrastructure Program 242,436 232,058 10,378 93.361 Nursing Research 8,745 7,645 1,100 93.368 21st Century Cures Act – Precision Medicine Initiative 100,324 94,609 5,715 93.394 Cancer Detection and Diagnosis Research 847,959 816,528 31,431 93.395 Cancer Treatment Research 438,349 439,286 (937) 93.396 Cancer Biology Research 93,919 88,642 5,277 93.397 Cancer Centers Support Grants 15,552 14,078 1,474 93.667 Social Services Block Grant 19,619 27,170 (7,551) 93.837 Cardiovascular Diseases Research 193,160 188,850 4,310 93.838 Lung Diseases Research 482,934 471,427 11,507 93.847 Diabetes, Digestive, and Kidney Diseases Extramural Research 1,075,493 1,035,041 40,452 93.853 Extramural Research Programs in the Neurosciences and Neurological Disorders 1,645,025 1,596,611 48,414 93.855 Allergy, Immunology and Transplantation Research 73,869 72,630 1,239 93.859 Biomedical Research and Research Training 363,336 366,791 (3,455) 93.865 Child Health and Human Development Extramural Research 3,790,797 3,733,008 57,789 93.866 Aging Research 1,101,363 1,098,891 2,472 93.946 Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs 80,039 78,033 2,006 93.994 Maternal and Child Health Services Block Grant to the States 171,995 168,656 3,339 The Role of Oral Care in Nonventilator Hospital-Acquired Pneumonia (NVHAP) Prevention 148,388 – 148,388 Total $ 13,864,545 $ 13,482,752 $ 381,793 Identification as a repeat finding, if applicable: The finding is not a repeat finding from the prior year. 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: Award amounts were changed on the Schedule after management’s review was executed. Management acknowledges that implementing the new Enterprise Resource Planning (ERP) system, in 2023 presented changes to the SEFA reporting. Management has identified and addressed the reporting issues within the new system to ensure that the grant totals are appropriately captured in the SEFA. Endeavor will enhance grant management award processes by revising its procedures and adding additional controls to monitor for accuracy of the core data. Management will reinforce the importance of timeliness and accuracy of the Schedule reporting totals to facilitate accurate reporting.
Finding 2023-001 – Reporting Information of the federal program: Federal Grantor: Department of Defense (DOD) Assistance Listing No.: 12.420, Military Medical Research and Development Pass-Through Grantor: Johns Hopkins University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.172, Human Genome Research Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.226, Research on Healthcare Costs, Quality and Outcomes Pass-Through Grantor: The Regents of the University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.242, Mental Health Research Grants Pass-Through Grantor: Rutgers State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.307, Minority Health and Health Disparities Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.310, Trans-NIH Research Support Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.350, National Center for Advancing Translational Sciences Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.351, Research Infrastructure Program Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.361, Nursing Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.368, 21st Century Cures Act – Precision Medicine Initiative Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.394, Cancer Detection and Diagnosis Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.395, Cancer Treatment Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.396, Cancer Biology Research Pass-Through Grantor: Tulane University, Louisiana State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.397, Cancer Centers Support Grants Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.667, Social Services Block Grant Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.837, Cardiovascular Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.838, Lung Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.847, Diabetes, Digestive, and Kidney Diseases Extramural Research Pass-Through Grantors: Northwestern University, Duke University, University of Washington, The Regents of University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.853, Extramural Research Programs in the Neurosciences and Neurological Disorders Pass-Through Grantor: Rush University Medical Center Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.855, Allergy, Immunology and Transplantation Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.859, Biomedical Research and Research Training Pass-Through Grantor: University of Wisconsin – Madison Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.865, Child Health and Human Development Extramural Research Pass-Through Grantors: Northwestern University, University of Washington, The Regents of the University of California Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.866, Aging Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.946, Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.994, Maternal and Child Health Services Block Grant to the States Pass-Through Grantor: Northwestern Memorial Hospital 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).” 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 grants related to the Research and Development Cluster were misstated by $233,405 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. In addition, an award which was not a federal grant award with expenditures of $148,388 was included on the preliminary Schedule provided by management. 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: The table below reflects the preliminary and adjusted assistance listing balances on the Schedule (only assistance listing programs which changed are included below): Assistance Listing No. Name of Federal Program Preliminary Schedule Adjusted Schedule Change 12.420 Military Medical Research and Development $ 241,025 $ 224,418 $ 16,607 93.172 Human Genome Research 14,874 15,121 (247) 93.226 Research on Healthcare Costs, Quality and Outcomes 251,325 248,842 2,483 93.242 Mental Health Research Grants 1,616,503 1,617,376 (873) 93.307 Minority Health and Health Disparities Research 17,323 15,122 2,201 93.310 Trans-NIH Research Support 313,459 313,490 (31) 93.350 National Center for Advancing Translational Sciences 516,734 518,429 (1,695) 93.351 Research Infrastructure Program 242,436 232,058 10,378 93.361 Nursing Research 8,745 7,645 1,100 93.368 21st Century Cures Act – Precision Medicine Initiative 100,324 94,609 5,715 93.394 Cancer Detection and Diagnosis Research 847,959 816,528 31,431 93.395 Cancer Treatment Research 438,349 439,286 (937) 93.396 Cancer Biology Research 93,919 88,642 5,277 93.397 Cancer Centers Support Grants 15,552 14,078 1,474 93.667 Social Services Block Grant 19,619 27,170 (7,551) 93.837 Cardiovascular Diseases Research 193,160 188,850 4,310 93.838 Lung Diseases Research 482,934 471,427 11,507 93.847 Diabetes, Digestive, and Kidney Diseases Extramural Research 1,075,493 1,035,041 40,452 93.853 Extramural Research Programs in the Neurosciences and Neurological Disorders 1,645,025 1,596,611 48,414 93.855 Allergy, Immunology and Transplantation Research 73,869 72,630 1,239 93.859 Biomedical Research and Research Training 363,336 366,791 (3,455) 93.865 Child Health and Human Development Extramural Research 3,790,797 3,733,008 57,789 93.866 Aging Research 1,101,363 1,098,891 2,472 93.946 Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs 80,039 78,033 2,006 93.994 Maternal and Child Health Services Block Grant to the States 171,995 168,656 3,339 The Role of Oral Care in Nonventilator Hospital-Acquired Pneumonia (NVHAP) Prevention 148,388 – 148,388 Total $ 13,864,545 $ 13,482,752 $ 381,793 Identification as a repeat finding, if applicable: The finding is not a repeat finding from the prior year. 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: Award amounts were changed on the Schedule after management’s review was executed. Management acknowledges that implementing the new Enterprise Resource Planning (ERP) system, in 2023 presented changes to the SEFA reporting. Management has identified and addressed the reporting issues within the new system to ensure that the grant totals are appropriately captured in the SEFA. Endeavor will enhance grant management award processes by revising its procedures and adding additional controls to monitor for accuracy of the core data. Management will reinforce the importance of timeliness and accuracy of the Schedule reporting totals to facilitate accurate reporting.
Finding 2023-001 – Reporting Information of the federal program: Federal Grantor: Department of Defense (DOD) Assistance Listing No.: 12.420, Military Medical Research and Development Pass-Through Grantor: Johns Hopkins University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.172, Human Genome Research Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.226, Research on Healthcare Costs, Quality and Outcomes Pass-Through Grantor: The Regents of the University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.242, Mental Health Research Grants Pass-Through Grantor: Rutgers State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.307, Minority Health and Health Disparities Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.310, Trans-NIH Research Support Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.350, National Center for Advancing Translational Sciences Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.351, Research Infrastructure Program Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.361, Nursing Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.368, 21st Century Cures Act – Precision Medicine Initiative Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.394, Cancer Detection and Diagnosis Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.395, Cancer Treatment Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.396, Cancer Biology Research Pass-Through Grantor: Tulane University, Louisiana State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.397, Cancer Centers Support Grants Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.667, Social Services Block Grant Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.837, Cardiovascular Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.838, Lung Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.847, Diabetes, Digestive, and Kidney Diseases Extramural Research Pass-Through Grantors: Northwestern University, Duke University, University of Washington, The Regents of University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.853, Extramural Research Programs in the Neurosciences and Neurological Disorders Pass-Through Grantor: Rush University Medical Center Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.855, Allergy, Immunology and Transplantation Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.859, Biomedical Research and Research Training Pass-Through Grantor: University of Wisconsin – Madison Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.865, Child Health and Human Development Extramural Research Pass-Through Grantors: Northwestern University, University of Washington, The Regents of the University of California Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.866, Aging Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.946, Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.994, Maternal and Child Health Services Block Grant to the States Pass-Through Grantor: Northwestern Memorial Hospital 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).” 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 grants related to the Research and Development Cluster were misstated by $233,405 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. In addition, an award which was not a federal grant award with expenditures of $148,388 was included on the preliminary Schedule provided by management. 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: The table below reflects the preliminary and adjusted assistance listing balances on the Schedule (only assistance listing programs which changed are included below): Assistance Listing No. Name of Federal Program Preliminary Schedule Adjusted Schedule Change 12.420 Military Medical Research and Development $ 241,025 $ 224,418 $ 16,607 93.172 Human Genome Research 14,874 15,121 (247) 93.226 Research on Healthcare Costs, Quality and Outcomes 251,325 248,842 2,483 93.242 Mental Health Research Grants 1,616,503 1,617,376 (873) 93.307 Minority Health and Health Disparities Research 17,323 15,122 2,201 93.310 Trans-NIH Research Support 313,459 313,490 (31) 93.350 National Center for Advancing Translational Sciences 516,734 518,429 (1,695) 93.351 Research Infrastructure Program 242,436 232,058 10,378 93.361 Nursing Research 8,745 7,645 1,100 93.368 21st Century Cures Act – Precision Medicine Initiative 100,324 94,609 5,715 93.394 Cancer Detection and Diagnosis Research 847,959 816,528 31,431 93.395 Cancer Treatment Research 438,349 439,286 (937) 93.396 Cancer Biology Research 93,919 88,642 5,277 93.397 Cancer Centers Support Grants 15,552 14,078 1,474 93.667 Social Services Block Grant 19,619 27,170 (7,551) 93.837 Cardiovascular Diseases Research 193,160 188,850 4,310 93.838 Lung Diseases Research 482,934 471,427 11,507 93.847 Diabetes, Digestive, and Kidney Diseases Extramural Research 1,075,493 1,035,041 40,452 93.853 Extramural Research Programs in the Neurosciences and Neurological Disorders 1,645,025 1,596,611 48,414 93.855 Allergy, Immunology and Transplantation Research 73,869 72,630 1,239 93.859 Biomedical Research and Research Training 363,336 366,791 (3,455) 93.865 Child Health and Human Development Extramural Research 3,790,797 3,733,008 57,789 93.866 Aging Research 1,101,363 1,098,891 2,472 93.946 Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs 80,039 78,033 2,006 93.994 Maternal and Child Health Services Block Grant to the States 171,995 168,656 3,339 The Role of Oral Care in Nonventilator Hospital-Acquired Pneumonia (NVHAP) Prevention 148,388 – 148,388 Total $ 13,864,545 $ 13,482,752 $ 381,793 Identification as a repeat finding, if applicable: The finding is not a repeat finding from the prior year. 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: Award amounts were changed on the Schedule after management’s review was executed. Management acknowledges that implementing the new Enterprise Resource Planning (ERP) system, in 2023 presented changes to the SEFA reporting. Management has identified and addressed the reporting issues within the new system to ensure that the grant totals are appropriately captured in the SEFA. Endeavor will enhance grant management award processes by revising its procedures and adding additional controls to monitor for accuracy of the core data. Management will reinforce the importance of timeliness and accuracy of the Schedule reporting totals to facilitate accurate reporting.
Finding 2023-001 – Reporting Information of the federal program: Federal Grantor: Department of Defense (DOD) Assistance Listing No.: 12.420, Military Medical Research and Development Pass-Through Grantor: Johns Hopkins University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.172, Human Genome Research Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.226, Research on Healthcare Costs, Quality and Outcomes Pass-Through Grantor: The Regents of the University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.242, Mental Health Research Grants Pass-Through Grantor: Rutgers State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.307, Minority Health and Health Disparities Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.310, Trans-NIH Research Support Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.350, National Center for Advancing Translational Sciences Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.351, Research Infrastructure Program Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.361, Nursing Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.368, 21st Century Cures Act – Precision Medicine Initiative Pass-Through Grantor: University of Chicago Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.394, Cancer Detection and Diagnosis Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.395, Cancer Treatment Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.396, Cancer Biology Research Pass-Through Grantor: Tulane University, Louisiana State University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.397, Cancer Centers Support Grants Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.667, Social Services Block Grant Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.837, Cardiovascular Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.838, Lung Diseases Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.847, Diabetes, Digestive, and Kidney Diseases Extramural Research Pass-Through Grantors: Northwestern University, Duke University, University of Washington, The Regents of University of Michigan Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.853, Extramural Research Programs in the Neurosciences and Neurological Disorders Pass-Through Grantor: Rush University Medical Center Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.855, Allergy, Immunology and Transplantation Research Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.859, Biomedical Research and Research Training Pass-Through Grantor: University of Wisconsin – Madison Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.865, Child Health and Human Development Extramural Research Pass-Through Grantors: Northwestern University, University of Washington, The Regents of the University of California Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.866, Aging Research Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.946, Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs Pass-Through Grantor: Northwestern University Federal Grantor: United States Department of Health and Human Services (HHS) Assistance Listing No.: 93.994, Maternal and Child Health Services Block Grant to the States Pass-Through Grantor: Northwestern Memorial Hospital 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).” 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 grants related to the Research and Development Cluster were misstated by $233,405 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. In addition, an award which was not a federal grant award with expenditures of $148,388 was included on the preliminary Schedule provided by management. 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: The table below reflects the preliminary and adjusted assistance listing balances on the Schedule (only assistance listing programs which changed are included below): Assistance Listing No. Name of Federal Program Preliminary Schedule Adjusted Schedule Change 12.420 Military Medical Research and Development $ 241,025 $ 224,418 $ 16,607 93.172 Human Genome Research 14,874 15,121 (247) 93.226 Research on Healthcare Costs, Quality and Outcomes 251,325 248,842 2,483 93.242 Mental Health Research Grants 1,616,503 1,617,376 (873) 93.307 Minority Health and Health Disparities Research 17,323 15,122 2,201 93.310 Trans-NIH Research Support 313,459 313,490 (31) 93.350 National Center for Advancing Translational Sciences 516,734 518,429 (1,695) 93.351 Research Infrastructure Program 242,436 232,058 10,378 93.361 Nursing Research 8,745 7,645 1,100 93.368 21st Century Cures Act – Precision Medicine Initiative 100,324 94,609 5,715 93.394 Cancer Detection and Diagnosis Research 847,959 816,528 31,431 93.395 Cancer Treatment Research 438,349 439,286 (937) 93.396 Cancer Biology Research 93,919 88,642 5,277 93.397 Cancer Centers Support Grants 15,552 14,078 1,474 93.667 Social Services Block Grant 19,619 27,170 (7,551) 93.837 Cardiovascular Diseases Research 193,160 188,850 4,310 93.838 Lung Diseases Research 482,934 471,427 11,507 93.847 Diabetes, Digestive, and Kidney Diseases Extramural Research 1,075,493 1,035,041 40,452 93.853 Extramural Research Programs in the Neurosciences and Neurological Disorders 1,645,025 1,596,611 48,414 93.855 Allergy, Immunology and Transplantation Research 73,869 72,630 1,239 93.859 Biomedical Research and Research Training 363,336 366,791 (3,455) 93.865 Child Health and Human Development Extramural Research 3,790,797 3,733,008 57,789 93.866 Aging Research 1,101,363 1,098,891 2,472 93.946 Cooperative Agreements to Support State-Based Safe Motherhood and Infant Health Initiative Programs 80,039 78,033 2,006 93.994 Maternal and Child Health Services Block Grant to the States 171,995 168,656 3,339 The Role of Oral Care in Nonventilator Hospital-Acquired Pneumonia (NVHAP) Prevention 148,388 – 148,388 Total $ 13,864,545 $ 13,482,752 $ 381,793 Identification as a repeat finding, if applicable: The finding is not a repeat finding from the prior year. 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: Award amounts were changed on the Schedule after management’s review was executed. Management acknowledges that implementing the new Enterprise Resource Planning (ERP) system, in 2023 presented changes to the SEFA reporting. Management has identified and addressed the reporting issues within the new system to ensure that the grant totals are appropriately captured in the SEFA. Endeavor will enhance grant management award processes by revising its procedures and adding additional controls to monitor for accuracy of the core data. Management will reinforce the importance of timeliness and accuracy of the Schedule reporting totals to facilitate accurate reporting.