Finding Text
reports or supporting documentation, nor could they demonstrate that reporting requirements were consistently tracked, reviewed, or completed in a timely manner. As a result, we were unable to verify whether required reports were prepared accurately, submitted timely, or submitted at all during the audit period. Criteria Under 2 CFR 200.328 (Financial Reporting) and 2 CFR 200.329 (Monitoring and Reporting Program Performance), non-federal entities are required to submit accurate, complete, and timely financial and performance reports as specified in the terms and conditions of the federal award. Additionally, 2 CFR 200.303 (Internal Controls) requires that organizations maintain effective internal controls to ensure compliance with federal statutes, regulations, and award requirements, including reporting obligations. Cause These deficiencies appear to result from the absence of a formal reporting process, lack of oversight and monitoring of reporting requirements, and insufficient internal controls to ensure that required reports are prepared, reviewed, and submitted in accordance with federal guidelines. Effect The failure to prepare and submit required reports results in: ▪ Noncompliance with federal award requirements ▪ Increased risk that financial and program information reported to the granting agency is incomplete or inaccurate ▪ Potential for funding delays, suspension, or termination ▪ Increased exposure to regulatory scrutiny and audit findings ▪ Impaired ability of the awarding agency to monitor program performance and financial activity Questioned Costs Likely Questioned Costs: Undeterminable CARESTL HEALTH SCHEDULE OF FINDINGS AND QUESTIONED COSTS YEAR ENDED DECEMBER 31, 2022 46 SECTION III – FEDERAL AWARD FINDINGS AND QUESTION COSTS (Continued) The failure to prepare and submit required financial and performance reports constitutes a material weakness in internal control over compliance and results in noncompliance with federal reporting requirements. Recommendation We recommend that management: ▪ Establish a formal reporting calendar outlining all required financial and performance reports, including due dates ▪ Implement procedures to ensure reports are prepared accurately, reviewed, and submitted timely ▪ Maintain documentation of submitted reports, including confirmation of submission and supporting schedules ▪ Assign clear responsibility for reporting compliance and implement supervisory review controls ▪ Provide training to relevant personnel on federal reporting requirements Strengthening reporting processes will improve compliance, enhance transparency, and ensure that the organization meets its obligations under federal awards. Management Response Management respectfully disagrees with the conclusion that CareSTL Health failed to submit required financial and performance reports. All required federal grant reports, financial reports, and performance submissions were uploaded in full to the auditor portal on April 13, 2026. The documentation was downloaded directly from the Electronic Handbook in which the documents were originally submitted to HRSA. The circumstances described in the finding do not reflect a lack of internal controls or noncompliance with 2 CFR 200.328, 200.329, or 200.303. Rather, the perception of non submission appears to have resulted from timing constraints during the audit fieldwork period and the volume of overlapping federal requests occurring simultaneously. As noted in our financial management response to HRSA, the organization was navigating significant operational strain, including: ▪ An unexpected, unannounced full operational site visit that diverted key personnel ▪ Reimbursement only funding constraints that limited staffing capacity ▪ Multiple concurrent federal deadlines that compressed the audit preparation window Despite these challenges, CareSTL Health did submit all required reports, and documentation confirming submission was made available through the auditor portal. CARESTL HEALTH SCHEDULE OF FINDINGS AND QUESTIONED COSTS YEAR ENDED DECEMBER 31, 2022 47 SECTION III – FEDERAL AWARD FINDINGS AND QUESTION COSTS (Continued) Management agrees with the recommendations provided and views them as aligned with improvements already underway. To further strengthen reporting processes, the organization will: ▪ Establish a formal reporting calendar with all required federal due dates ▪ Implement procedures to ensure reports are prepared, reviewed, and submitted timely ▪ Maintain documentation of all submissions, including confirmations and supporting schedules ▪ Assign clear responsibility for reporting compliance and supervisory review ▪ Provide training to relevant personnel on federal reporting requirements These enhancements will reinforce our existing controls and ensure continued compliance, transparency, and timely reporting under all federal awards.