East Liberty Family Health Care CenterNon-Profit

Finding 2025-001: Internal Control Over Financial Reporting Criteria and Condition: Internal controls over financial reporting should be designed and in place to prevent,detect, and correct material misstatement in the financial statements in a timely manner. The internal controlswere unable to prevent, detect, and correct several material errors in the preparation of the financial statementsas of and for the year ended June 30, 2025, in a timely manner. This resulted in resulted in numerous significantadjustments related to assets, liabilities, net assets, revenue, and expenses. Cause: Existing internal controls over financial reporting require that management perform meaningful analysis ofinternal records and general ledger accounts on a regular basis. Management is not performing a meaningfulanalysis of internal records and the general ledger, which results in financial statements that contain a significantnumber of material errors. Questioned Costs: None Recommendations: We recommend that management develop formal policies and procedures to identifymaterial misstatements, which should include performing meaningful analysis of internal records and generalledger accounts on a regular basis. This will allow management to timely identify unusual trends in internalrecords and general ledger accounts that could be indicative of errors that cause the Center’s financial statementsto be misstated.

Finding 2025-002: Sliding Fee Discounts Criteria and Condition: Health centers must prepare and apply a sliding fee discount schedule so that theamounts owed for health center services by eligible patients are adjusted (discounted) based on the patient’sability to pay. The adjustments extended to the patients are based on Federal Poverty Guidelines that take intoconsideration the annual income earned by the individuals and families. For thirty-nine sliding fee discountapplicants tested the Center could not provide full documentation required for the applications. For another ninesliding fee discount applicants tested the Center improperly applied the program for an immaterial difference. Questioned Costs: None Cause: Existing internal controls over compliance are not effective at ensuring that sliding fee discountapplications for patients are retained on file or ensuring that patient eligibility for sliding fee discounts areaccurately determined. Effect: Of the sixty patients reviewed that had received sliding fee discounts, thirty-nine did not have the properdocumentation maintained and were written off from sliding fee adjustments and another nine had compliancefindings for improper application of the Organization’s sliding fee program noted for the year ended June 30, 2025. Recommendations: We recommend that management implement a checklist to ensure that all informationrequired to fill out a patient’s sliding fee discount application is obtained, that the determination of a patient’seligibility for a sliding fee discount is independently reviewed and approved by a supervisor, and that a patient’sapplication is properly retained.

Finding 2024-001: Internal Control Over Financial Reporting Criteria and Condition: Internal controls over financial reporting should be designed and in place to prevent, detect, and correct material misstatement in the financial statements in a timely manner. The internal controls were unable to prevent, detect, and correct several material errors in the preparation of the financial statements as of and for the year ended June 30, 2024, in a timely manner. This resulted in resulted in numerous significant adjustments related to assets, liabilities, net assets, revenue, and expenses. Cause: Existing internal controls over financial reporting require that management perform meaningful analysis of internal records and general ledger accounts on a regular basis. Management is not performing a meaningful analysis of internal records and the general ledger, which results in financial statements that contain a significant number of material errors. Questioned Costs: None Recommendations: We recommend that management develop formal policies and procedures to identify material misstatements, which should include performing meaningful analysis of internal records and general ledger accounts on a regular basis. This will allow management to timely identify unusual trends in internal records and general ledger accounts that could be indicative of errors that cause the Center’s financial statements to be misstated. Views of Responsible Officials and Planned Corrective Actions: Management is taking steps to improve monitoring of the financial reporting process and to ensure meaningful analysis of financial records is occurring on a regular basis. Management has been identifying areas of improvement within the finance department and is in the process of implementing new procedures that will improve the accuracy and timeliness of financial reporting.

Finding 2024-002: Sliding Fee Discounts Criteria and Condition: Health centers must prepare and apply a sliding fee discount schedule so that the amounts owed for health center services by eligible patients are adjusted (discounted) based on the patient’s ability to pay. The adjustments extended to the patients are based on Federal Poverty Guidelines that take into consideration the annual income earned by the individuals and families. For thirty-nine sliding fee discount applicants tested the Center could not provide full documentation required for the applications. For another nine sliding fee discount applicants tested the Center improperly applied the program for an immaterial difference. Questioned Costs: None Cause: Existing internal controls over compliance are not effective at ensuring that sliding fee discount applications for patients are retained on file or ensuring that patient eligibility for sliding fee discounts are accurately determined. Effect: Of the sixty patients reviewed that had received sliding fee discounts, thirty-nine did not have the proper documentation maintained and were written off from sliding fee adjustments and another nine had compliance findings for improper application of the Organization’s sliding fee program noted for the year ended June 30, 2024. Recommendations: We recommend that management implement a checklist to ensure that all information required to fill out a patient’s sliding fee discount application is obtained, that the determination of a patient’s eligibility for a sliding fee discount is independently reviewed and approved by a supervisor, and that a patient’s application is properly retained. Views of Responsible Officials and Planned Corrective Actions: Management is taking steps to improve the internal controls over compliance over the sliding fee discount and redesigned the program effective January 1, 2025.

Finding 2023-001: Internal Control Over Financial Reporting Criteria and Condition: Internal controls over financial reporting should be designed and in place to prevent, detect, and correct material misstatement in the financial statements in a timely manner. The internal controls were unable to prevent, detect, and correct several material errors in the preparation of the financial statements as of and for the year ended June 30, 2023, in a timely manner. This resulted in resulted in numerous significant adjustments related to assets, liabilities, net assets, revenue, and expenses. Cause: Existing internal controls over financial reporting require that management perform meaningful analysis of internal records and general ledger accounts on a regular basis. Management is not performing a meaningful analysis of internal records and the general ledger, which results in financial statements that contain a significant number of material errors. Questioned Costs: None Recommendations: We recommend that management develop formal policies and procedures to identify material misstatements, which should include performing meaningful analysis of internal records and general ledger accounts on a regular basis. This will allow management to timely identify unusual trends in internal records and general ledger accounts that could be indicative of errors that cause the Center’s financial statements to be misstated. Views of Responsible Officials and Planned Corrective Actions: Management is taking steps to improve monitoring of the financial reporting process and to ensure meaningful analysis of financial records is occurring on a regular basis. Management has hired an experienced Chief Financial Officer for the finance department, has begun identifying areas of improvement within the finance department, and is in the process of implementing new procedures that will improve the accuracy and timeliness of financial reporting.

Finding 2023-001: Internal Control Over Financial Reporting Criteria and Condition: Internal controls over financial reporting should be designed and in place to prevent, detect, and correct material misstatement in the financial statements in a timely manner. The internal controls were unable to prevent, detect, and correct several material errors in the preparation of the financial statements as of and for the year ended June 30, 2023, in a timely manner. This resulted in resulted in numerous significant adjustments related to assets, liabilities, net assets, revenue, and expenses. Cause: Existing internal controls over financial reporting require that management perform meaningful analysis of internal records and general ledger accounts on a regular basis. Management is not performing a meaningful analysis of internal records and the general ledger, which results in financial statements that contain a significant number of material errors. Questioned Costs: None Recommendations: We recommend that management develop formal policies and procedures to identify material misstatements, which should include performing meaningful analysis of internal records and general ledger accounts on a regular basis. This will allow management to timely identify unusual trends in internal records and general ledger accounts that could be indicative of errors that cause the Center’s financial statements to be misstated. Views of Responsible Officials and Planned Corrective Actions: Management is taking steps to improve monitoring of the financial reporting process and to ensure meaningful analysis of financial records is occurring on a regular basis. Management has hired an experienced Chief Financial Officer for the finance department, has begun identifying areas of improvement within the finance department, and is in the process of implementing new procedures that will improve the accuracy and timeliness of financial reporting.

Finding 2023-001: Internal Control Over Financial Reporting Criteria and Condition: Internal controls over financial reporting should be designed and in place to prevent, detect, and correct material misstatement in the financial statements in a timely manner. The internal controls were unable to prevent, detect, and correct several material errors in the preparation of the financial statements as of and for the year ended June 30, 2023, in a timely manner. This resulted in resulted in numerous significant adjustments related to assets, liabilities, net assets, revenue, and expenses. Cause: Existing internal controls over financial reporting require that management perform meaningful analysis of internal records and general ledger accounts on a regular basis. Management is not performing a meaningful analysis of internal records and the general ledger, which results in financial statements that contain a significant number of material errors. Questioned Costs: None Recommendations: We recommend that management develop formal policies and procedures to identify material misstatements, which should include performing meaningful analysis of internal records and general ledger accounts on a regular basis. This will allow management to timely identify unusual trends in internal records and general ledger accounts that could be indicative of errors that cause the Center’s financial statements to be misstated. Views of Responsible Officials and Planned Corrective Actions: Management is taking steps to improve monitoring of the financial reporting process and to ensure meaningful analysis of financial records is occurring on a regular basis. Management has hired an experienced Chief Financial Officer for the finance department, has begun identifying areas of improvement within the finance department, and is in the process of implementing new procedures that will improve the accuracy and timeliness of financial reporting.

Finding 2023-002: Timely Single Audit Submission Criteria and Condition: Single Audits must be completed and submitted to the Federal Audit Clearinghouse within the earlier of 30 calendar days after receipt of the issued auditors’ report. or nine months after the end of the audit period. The Center did not timely complete the Single Audit and submit to the Federal Audit Clearinghouse within nine months form the end of the audit period. Context: Information required to complete the financial statements was not prepared and ready to audit in a timely manner. This resulted in the financial statements and Single Audit to not be finalized and issued in order to be submitted to the Federal Audit Clearinghouse within nine months of the end of the audit period. Effect: The data collection form and reporting package for the Single Audit for the year ended June 30, 2023 were not submitted within the specified timeframe resulting in award drawdown restrictions. Questioned Costs: None Cause: Internal controls over reporting and compliance were not effective at ensuring that the required reports were being completed and submitted in a timely manner. Recommendations: We recommend that management improve their reporting processes and controls to ensure that the Single Audit is completed and submitted to the Federal Audit Clearinghouse in a timely manner. Views of Responsible Officials and Planned Corrective Actions: Management is taking steps to improve the internal controls over financial reporting and compliance to ensure that reporting can be completed in an accurate and timely manner. These changes include updates of internal processes and the hiring of key members of financial management.

Finding 2023-002: Timely Single Audit Submission Criteria and Condition: Single Audits must be completed and submitted to the Federal Audit Clearinghouse within the earlier of 30 calendar days after receipt of the issued auditors’ report. or nine months after the end of the audit period. The Center did not timely complete the Single Audit and submit to the Federal Audit Clearinghouse within nine months form the end of the audit period. Context: Information required to complete the financial statements was not prepared and ready to audit in a timely manner. This resulted in the financial statements and Single Audit to not be finalized and issued in order to be submitted to the Federal Audit Clearinghouse within nine months of the end of the audit period. Effect: The data collection form and reporting package for the Single Audit for the year ended June 30, 2023 were not submitted within the specified timeframe resulting in award drawdown restrictions. Questioned Costs: None Cause: Internal controls over reporting and compliance were not effective at ensuring that the required reports were being completed and submitted in a timely manner. Recommendations: We recommend that management improve their reporting processes and controls to ensure that the Single Audit is completed and submitted to the Federal Audit Clearinghouse in a timely manner. Views of Responsible Officials and Planned Corrective Actions: Management is taking steps to improve the internal controls over financial reporting and compliance to ensure that reporting can be completed in an accurate and timely manner. These changes include updates of internal processes and the hiring of key members of financial management.

Finding 2023-002: Timely Single Audit Submission Criteria and Condition: Single Audits must be completed and submitted to the Federal Audit Clearinghouse within the earlier of 30 calendar days after receipt of the issued auditors’ report. or nine months after the end of the audit period. The Center did not timely complete the Single Audit and submit to the Federal Audit Clearinghouse within nine months form the end of the audit period. Context: Information required to complete the financial statements was not prepared and ready to audit in a timely manner. This resulted in the financial statements and Single Audit to not be finalized and issued in order to be submitted to the Federal Audit Clearinghouse within nine months of the end of the audit period. Effect: The data collection form and reporting package for the Single Audit for the year ended June 30, 2023 were not submitted within the specified timeframe resulting in award drawdown restrictions. Questioned Costs: None Cause: Internal controls over reporting and compliance were not effective at ensuring that the required reports were being completed and submitted in a timely manner. Recommendations: We recommend that management improve their reporting processes and controls to ensure that the Single Audit is completed and submitted to the Federal Audit Clearinghouse in a timely manner. Views of Responsible Officials and Planned Corrective Actions: Management is taking steps to improve the internal controls over financial reporting and compliance to ensure that reporting can be completed in an accurate and timely manner. These changes include updates of internal processes and the hiring of key members of financial management.

Finding 2023-003: Sliding Fee Discounts Criteria and Condition: Health centers must prepare and apply a sliding fee discount schedule so that the amounts owed for health center services by eligible patients are adjusted (discounted) based on the patient’s ability to pay. The adjustments extended to the patients are based on Federal Poverty Guidelines that take into consideration the annual income earned by the individuals and families. There were no documents maintained to support the sliding fee discounts applied to twenty-four patient accounts. As a result, there is no way to verify if the discount applied was representative of the patients’ poverty levels. Lastly, four patients were assigned the incorrect poverty level resulting in services not being discounted properly. Questioned Costs: None Cause: Existing internal controls over compliance are not effective at ensuring that sliding fee discount applications for patients are retained on file or ensuring that patient eligibility for sliding fee discounts are accurately determined. Effect: Of the forty patients reviewed that had received sliding fee discounts, twenty-four compliance findings were noted for the year ended June 30, 2023. Recommendations: We recommend that management implement a checklist to ensure that all information required to fill out a patient’s sliding fee discount application is obtained, that the determination of a patient’s eligibility for a sliding fee discount is independently reviewed and approved by a supervisor, and that a patient’s application is properly retained. Views of Responsible Officials and Planned Corrective Actions: Management is taking steps to improve the internal controls over compliance over the sliding fee discount.

Finding 2023-003: Sliding Fee Discounts Criteria and Condition: Health centers must prepare and apply a sliding fee discount schedule so that the amounts owed for health center services by eligible patients are adjusted (discounted) based on the patient’s ability to pay. The adjustments extended to the patients are based on Federal Poverty Guidelines that take into consideration the annual income earned by the individuals and families. There were no documents maintained to support the sliding fee discounts applied to twenty-four patient accounts. As a result, there is no way to verify if the discount applied was representative of the patients’ poverty levels. Lastly, four patients were assigned the incorrect poverty level resulting in services not being discounted properly. Questioned Costs: None Cause: Existing internal controls over compliance are not effective at ensuring that sliding fee discount applications for patients are retained on file or ensuring that patient eligibility for sliding fee discounts are accurately determined. Effect: Of the forty patients reviewed that had received sliding fee discounts, twenty-four compliance findings were noted for the year ended June 30, 2023. Recommendations: We recommend that management implement a checklist to ensure that all information required to fill out a patient’s sliding fee discount application is obtained, that the determination of a patient’s eligibility for a sliding fee discount is independently reviewed and approved by a supervisor, and that a patient’s application is properly retained. Views of Responsible Officials and Planned Corrective Actions: Management is taking steps to improve the internal controls over compliance over the sliding fee discount.

Finding 2023-003: Sliding Fee Discounts Criteria and Condition: Health centers must prepare and apply a sliding fee discount schedule so that the amounts owed for health center services by eligible patients are adjusted (discounted) based on the patient’s ability to pay. The adjustments extended to the patients are based on Federal Poverty Guidelines that take into consideration the annual income earned by the individuals and families. There were no documents maintained to support the sliding fee discounts applied to twenty-four patient accounts. As a result, there is no way to verify if the discount applied was representative of the patients’ poverty levels. Lastly, four patients were assigned the incorrect poverty level resulting in services not being discounted properly. Questioned Costs: None Cause: Existing internal controls over compliance are not effective at ensuring that sliding fee discount applications for patients are retained on file or ensuring that patient eligibility for sliding fee discounts are accurately determined. Effect: Of the forty patients reviewed that had received sliding fee discounts, twenty-four compliance findings were noted for the year ended June 30, 2023. Recommendations: We recommend that management implement a checklist to ensure that all information required to fill out a patient’s sliding fee discount application is obtained, that the determination of a patient’s eligibility for a sliding fee discount is independently reviewed and approved by a supervisor, and that a patient’s application is properly retained. Views of Responsible Officials and Planned Corrective Actions: Management is taking steps to improve the internal controls over compliance over the sliding fee discount.

Finding 2023-001: Internal Control Over Financial Reporting Criteria and Condition: Internal controls over financial reporting should be designed and in place to prevent, detect, and correct material misstatement in the financial statements in a timely manner. The internal controls were unable to prevent, detect, and correct several material errors in the preparation of the financial statements as of and for the year ended June 30, 2023, in a timely manner. This resulted in resulted in numerous significant adjustments related to assets, liabilities, net assets, revenue, and expenses. Cause: Existing internal controls over financial reporting require that management perform meaningful analysis of internal records and general ledger accounts on a regular basis. Management is not performing a meaningful analysis of internal records and the general ledger, which results in financial statements that contain a significant number of material errors. Questioned Costs: None Recommendations: We recommend that management develop formal policies and procedures to identify material misstatements, which should include performing meaningful analysis of internal records and general ledger accounts on a regular basis. This will allow management to timely identify unusual trends in internal records and general ledger accounts that could be indicative of errors that cause the Center’s financial statements to be misstated. Views of Responsible Officials and Planned Corrective Actions: Management is taking steps to improve monitoring of the financial reporting process and to ensure meaningful analysis of financial records is occurring on a regular basis. Management has hired an experienced Chief Financial Officer for the finance department, has begun identifying areas of improvement within the finance department, and is in the process of implementing new procedures that will improve the accuracy and timeliness of financial reporting.

Finding 2023-001: Internal Control Over Financial Reporting Criteria and Condition: Internal controls over financial reporting should be designed and in place to prevent, detect, and correct material misstatement in the financial statements in a timely manner. The internal controls were unable to prevent, detect, and correct several material errors in the preparation of the financial statements as of and for the year ended June 30, 2023, in a timely manner. This resulted in resulted in numerous significant adjustments related to assets, liabilities, net assets, revenue, and expenses. Cause: Existing internal controls over financial reporting require that management perform meaningful analysis of internal records and general ledger accounts on a regular basis. Management is not performing a meaningful analysis of internal records and the general ledger, which results in financial statements that contain a significant number of material errors. Questioned Costs: None Recommendations: We recommend that management develop formal policies and procedures to identify material misstatements, which should include performing meaningful analysis of internal records and general ledger accounts on a regular basis. This will allow management to timely identify unusual trends in internal records and general ledger accounts that could be indicative of errors that cause the Center’s financial statements to be misstated. Views of Responsible Officials and Planned Corrective Actions: Management is taking steps to improve monitoring of the financial reporting process and to ensure meaningful analysis of financial records is occurring on a regular basis. Management has hired an experienced Chief Financial Officer for the finance department, has begun identifying areas of improvement within the finance department, and is in the process of implementing new procedures that will improve the accuracy and timeliness of financial reporting.

Finding 2023-001: Internal Control Over Financial Reporting Criteria and Condition: Internal controls over financial reporting should be designed and in place to prevent, detect, and correct material misstatement in the financial statements in a timely manner. The internal controls were unable to prevent, detect, and correct several material errors in the preparation of the financial statements as of and for the year ended June 30, 2023, in a timely manner. This resulted in resulted in numerous significant adjustments related to assets, liabilities, net assets, revenue, and expenses. Cause: Existing internal controls over financial reporting require that management perform meaningful analysis of internal records and general ledger accounts on a regular basis. Management is not performing a meaningful analysis of internal records and the general ledger, which results in financial statements that contain a significant number of material errors. Questioned Costs: None Recommendations: We recommend that management develop formal policies and procedures to identify material misstatements, which should include performing meaningful analysis of internal records and general ledger accounts on a regular basis. This will allow management to timely identify unusual trends in internal records and general ledger accounts that could be indicative of errors that cause the Center’s financial statements to be misstated. Views of Responsible Officials and Planned Corrective Actions: Management is taking steps to improve monitoring of the financial reporting process and to ensure meaningful analysis of financial records is occurring on a regular basis. Management has hired an experienced Chief Financial Officer for the finance department, has begun identifying areas of improvement within the finance department, and is in the process of implementing new procedures that will improve the accuracy and timeliness of financial reporting.

Finding 2023-002: Timely Single Audit Submission Criteria and Condition: Single Audits must be completed and submitted to the Federal Audit Clearinghouse within the earlier of 30 calendar days after receipt of the issued auditors’ report. or nine months after the end of the audit period. The Center did not timely complete the Single Audit and submit to the Federal Audit Clearinghouse within nine months form the end of the audit period. Context: Information required to complete the financial statements was not prepared and ready to audit in a timely manner. This resulted in the financial statements and Single Audit to not be finalized and issued in order to be submitted to the Federal Audit Clearinghouse within nine months of the end of the audit period. Effect: The data collection form and reporting package for the Single Audit for the year ended June 30, 2023 were not submitted within the specified timeframe resulting in award drawdown restrictions. Questioned Costs: None Cause: Internal controls over reporting and compliance were not effective at ensuring that the required reports were being completed and submitted in a timely manner. Recommendations: We recommend that management improve their reporting processes and controls to ensure that the Single Audit is completed and submitted to the Federal Audit Clearinghouse in a timely manner. Views of Responsible Officials and Planned Corrective Actions: Management is taking steps to improve the internal controls over financial reporting and compliance to ensure that reporting can be completed in an accurate and timely manner. These changes include updates of internal processes and the hiring of key members of financial management.

Finding 2023-002: Timely Single Audit Submission Criteria and Condition: Single Audits must be completed and submitted to the Federal Audit Clearinghouse within the earlier of 30 calendar days after receipt of the issued auditors’ report. or nine months after the end of the audit period. The Center did not timely complete the Single Audit and submit to the Federal Audit Clearinghouse within nine months form the end of the audit period. Context: Information required to complete the financial statements was not prepared and ready to audit in a timely manner. This resulted in the financial statements and Single Audit to not be finalized and issued in order to be submitted to the Federal Audit Clearinghouse within nine months of the end of the audit period. Effect: The data collection form and reporting package for the Single Audit for the year ended June 30, 2023 were not submitted within the specified timeframe resulting in award drawdown restrictions. Questioned Costs: None Cause: Internal controls over reporting and compliance were not effective at ensuring that the required reports were being completed and submitted in a timely manner. Recommendations: We recommend that management improve their reporting processes and controls to ensure that the Single Audit is completed and submitted to the Federal Audit Clearinghouse in a timely manner. Views of Responsible Officials and Planned Corrective Actions: Management is taking steps to improve the internal controls over financial reporting and compliance to ensure that reporting can be completed in an accurate and timely manner. These changes include updates of internal processes and the hiring of key members of financial management.

Finding 2023-002: Timely Single Audit Submission Criteria and Condition: Single Audits must be completed and submitted to the Federal Audit Clearinghouse within the earlier of 30 calendar days after receipt of the issued auditors’ report. or nine months after the end of the audit period. The Center did not timely complete the Single Audit and submit to the Federal Audit Clearinghouse within nine months form the end of the audit period. Context: Information required to complete the financial statements was not prepared and ready to audit in a timely manner. This resulted in the financial statements and Single Audit to not be finalized and issued in order to be submitted to the Federal Audit Clearinghouse within nine months of the end of the audit period. Effect: The data collection form and reporting package for the Single Audit for the year ended June 30, 2023 were not submitted within the specified timeframe resulting in award drawdown restrictions. Questioned Costs: None Cause: Internal controls over reporting and compliance were not effective at ensuring that the required reports were being completed and submitted in a timely manner. Recommendations: We recommend that management improve their reporting processes and controls to ensure that the Single Audit is completed and submitted to the Federal Audit Clearinghouse in a timely manner. Views of Responsible Officials and Planned Corrective Actions: Management is taking steps to improve the internal controls over financial reporting and compliance to ensure that reporting can be completed in an accurate and timely manner. These changes include updates of internal processes and the hiring of key members of financial management.

Finding 2023-003: Sliding Fee Discounts Criteria and Condition: Health centers must prepare and apply a sliding fee discount schedule so that the amounts owed for health center services by eligible patients are adjusted (discounted) based on the patient’s ability to pay. The adjustments extended to the patients are based on Federal Poverty Guidelines that take into consideration the annual income earned by the individuals and families. There were no documents maintained to support the sliding fee discounts applied to twenty-four patient accounts. As a result, there is no way to verify if the discount applied was representative of the patients’ poverty levels. Lastly, four patients were assigned the incorrect poverty level resulting in services not being discounted properly. Questioned Costs: None Cause: Existing internal controls over compliance are not effective at ensuring that sliding fee discount applications for patients are retained on file or ensuring that patient eligibility for sliding fee discounts are accurately determined. Effect: Of the forty patients reviewed that had received sliding fee discounts, twenty-four compliance findings were noted for the year ended June 30, 2023. Recommendations: We recommend that management implement a checklist to ensure that all information required to fill out a patient’s sliding fee discount application is obtained, that the determination of a patient’s eligibility for a sliding fee discount is independently reviewed and approved by a supervisor, and that a patient’s application is properly retained. Views of Responsible Officials and Planned Corrective Actions: Management is taking steps to improve the internal controls over compliance over the sliding fee discount.

Finding 2023-003: Sliding Fee Discounts Criteria and Condition: Health centers must prepare and apply a sliding fee discount schedule so that the amounts owed for health center services by eligible patients are adjusted (discounted) based on the patient’s ability to pay. The adjustments extended to the patients are based on Federal Poverty Guidelines that take into consideration the annual income earned by the individuals and families. There were no documents maintained to support the sliding fee discounts applied to twenty-four patient accounts. As a result, there is no way to verify if the discount applied was representative of the patients’ poverty levels. Lastly, four patients were assigned the incorrect poverty level resulting in services not being discounted properly. Questioned Costs: None Cause: Existing internal controls over compliance are not effective at ensuring that sliding fee discount applications for patients are retained on file or ensuring that patient eligibility for sliding fee discounts are accurately determined. Effect: Of the forty patients reviewed that had received sliding fee discounts, twenty-four compliance findings were noted for the year ended June 30, 2023. Recommendations: We recommend that management implement a checklist to ensure that all information required to fill out a patient’s sliding fee discount application is obtained, that the determination of a patient’s eligibility for a sliding fee discount is independently reviewed and approved by a supervisor, and that a patient’s application is properly retained. Views of Responsible Officials and Planned Corrective Actions: Management is taking steps to improve the internal controls over compliance over the sliding fee discount.

Finding 2023-003: Sliding Fee Discounts Criteria and Condition: Health centers must prepare and apply a sliding fee discount schedule so that the amounts owed for health center services by eligible patients are adjusted (discounted) based on the patient’s ability to pay. The adjustments extended to the patients are based on Federal Poverty Guidelines that take into consideration the annual income earned by the individuals and families. There were no documents maintained to support the sliding fee discounts applied to twenty-four patient accounts. As a result, there is no way to verify if the discount applied was representative of the patients’ poverty levels. Lastly, four patients were assigned the incorrect poverty level resulting in services not being discounted properly. Questioned Costs: None Cause: Existing internal controls over compliance are not effective at ensuring that sliding fee discount applications for patients are retained on file or ensuring that patient eligibility for sliding fee discounts are accurately determined. Effect: Of the forty patients reviewed that had received sliding fee discounts, twenty-four compliance findings were noted for the year ended June 30, 2023. Recommendations: We recommend that management implement a checklist to ensure that all information required to fill out a patient’s sliding fee discount application is obtained, that the determination of a patient’s eligibility for a sliding fee discount is independently reviewed and approved by a supervisor, and that a patient’s application is properly retained. Views of Responsible Officials and Planned Corrective Actions: Management is taking steps to improve the internal controls over compliance over the sliding fee discount.

Finding 2023-001: Internal Control Over Financial Reporting Criteria and Condition: Internal controls over financial reporting should be designed and in place to prevent, detect, and correct material misstatement in the financial statements in a timely manner. The internal controls were unable to prevent, detect, and correct several material errors in the preparation of the financial statements as of and for the year ended June 30, 2023, in a timely manner. This resulted in resulted in numerous significant adjustments related to assets, liabilities, net assets, revenue, and expenses. Cause: Existing internal controls over financial reporting require that management perform meaningful analysis of internal records and general ledger accounts on a regular basis. Management is not performing a meaningful analysis of internal records and the general ledger, which results in financial statements that contain a significant number of material errors. Questioned Costs: None Recommendations: We recommend that management develop formal policies and procedures to identify material misstatements, which should include performing meaningful analysis of internal records and general ledger accounts on a regular basis. This will allow management to timely identify unusual trends in internal records and general ledger accounts that could be indicative of errors that cause the Center’s financial statements to be misstated. Views of Responsible Officials and Planned Corrective Actions: Management is taking steps to improve monitoring of the financial reporting process and to ensure meaningful analysis of financial records is occurring on a regular basis. Management has hired an experienced Chief Financial Officer for the finance department, has begun identifying areas of improvement within the finance department, and is in the process of implementing new procedures that will improve the accuracy and timeliness of financial reporting.

Finding 2023-001: Internal Control Over Financial Reporting Criteria and Condition: Internal controls over financial reporting should be designed and in place to prevent, detect, and correct material misstatement in the financial statements in a timely manner. The internal controls were unable to prevent, detect, and correct several material errors in the preparation of the financial statements as of and for the year ended June 30, 2023, in a timely manner. This resulted in resulted in numerous significant adjustments related to assets, liabilities, net assets, revenue, and expenses. Cause: Existing internal controls over financial reporting require that management perform meaningful analysis of internal records and general ledger accounts on a regular basis. Management is not performing a meaningful analysis of internal records and the general ledger, which results in financial statements that contain a significant number of material errors. Questioned Costs: None Recommendations: We recommend that management develop formal policies and procedures to identify material misstatements, which should include performing meaningful analysis of internal records and general ledger accounts on a regular basis. This will allow management to timely identify unusual trends in internal records and general ledger accounts that could be indicative of errors that cause the Center’s financial statements to be misstated. Views of Responsible Officials and Planned Corrective Actions: Management is taking steps to improve monitoring of the financial reporting process and to ensure meaningful analysis of financial records is occurring on a regular basis. Management has hired an experienced Chief Financial Officer for the finance department, has begun identifying areas of improvement within the finance department, and is in the process of implementing new procedures that will improve the accuracy and timeliness of financial reporting.

Finding 2023-001: Internal Control Over Financial Reporting Criteria and Condition: Internal controls over financial reporting should be designed and in place to prevent, detect, and correct material misstatement in the financial statements in a timely manner. The internal controls were unable to prevent, detect, and correct several material errors in the preparation of the financial statements as of and for the year ended June 30, 2023, in a timely manner. This resulted in resulted in numerous significant adjustments related to assets, liabilities, net assets, revenue, and expenses. Cause: Existing internal controls over financial reporting require that management perform meaningful analysis of internal records and general ledger accounts on a regular basis. Management is not performing a meaningful analysis of internal records and the general ledger, which results in financial statements that contain a significant number of material errors. Questioned Costs: None Recommendations: We recommend that management develop formal policies and procedures to identify material misstatements, which should include performing meaningful analysis of internal records and general ledger accounts on a regular basis. This will allow management to timely identify unusual trends in internal records and general ledger accounts that could be indicative of errors that cause the Center’s financial statements to be misstated. Views of Responsible Officials and Planned Corrective Actions: Management is taking steps to improve monitoring of the financial reporting process and to ensure meaningful analysis of financial records is occurring on a regular basis. Management has hired an experienced Chief Financial Officer for the finance department, has begun identifying areas of improvement within the finance department, and is in the process of implementing new procedures that will improve the accuracy and timeliness of financial reporting.

Finding 2023-002: Timely Single Audit Submission Criteria and Condition: Single Audits must be completed and submitted to the Federal Audit Clearinghouse within the earlier of 30 calendar days after receipt of the issued auditors’ report. or nine months after the end of the audit period. The Center did not timely complete the Single Audit and submit to the Federal Audit Clearinghouse within nine months form the end of the audit period. Context: Information required to complete the financial statements was not prepared and ready to audit in a timely manner. This resulted in the financial statements and Single Audit to not be finalized and issued in order to be submitted to the Federal Audit Clearinghouse within nine months of the end of the audit period. Effect: The data collection form and reporting package for the Single Audit for the year ended June 30, 2023 were not submitted within the specified timeframe resulting in award drawdown restrictions. Questioned Costs: None Cause: Internal controls over reporting and compliance were not effective at ensuring that the required reports were being completed and submitted in a timely manner. Recommendations: We recommend that management improve their reporting processes and controls to ensure that the Single Audit is completed and submitted to the Federal Audit Clearinghouse in a timely manner. Views of Responsible Officials and Planned Corrective Actions: Management is taking steps to improve the internal controls over financial reporting and compliance to ensure that reporting can be completed in an accurate and timely manner. These changes include updates of internal processes and the hiring of key members of financial management.

Finding 2023-002: Timely Single Audit Submission Criteria and Condition: Single Audits must be completed and submitted to the Federal Audit Clearinghouse within the earlier of 30 calendar days after receipt of the issued auditors’ report. or nine months after the end of the audit period. The Center did not timely complete the Single Audit and submit to the Federal Audit Clearinghouse within nine months form the end of the audit period. Context: Information required to complete the financial statements was not prepared and ready to audit in a timely manner. This resulted in the financial statements and Single Audit to not be finalized and issued in order to be submitted to the Federal Audit Clearinghouse within nine months of the end of the audit period. Effect: The data collection form and reporting package for the Single Audit for the year ended June 30, 2023 were not submitted within the specified timeframe resulting in award drawdown restrictions. Questioned Costs: None Cause: Internal controls over reporting and compliance were not effective at ensuring that the required reports were being completed and submitted in a timely manner. Recommendations: We recommend that management improve their reporting processes and controls to ensure that the Single Audit is completed and submitted to the Federal Audit Clearinghouse in a timely manner. Views of Responsible Officials and Planned Corrective Actions: Management is taking steps to improve the internal controls over financial reporting and compliance to ensure that reporting can be completed in an accurate and timely manner. These changes include updates of internal processes and the hiring of key members of financial management.

Finding 2023-002: Timely Single Audit Submission Criteria and Condition: Single Audits must be completed and submitted to the Federal Audit Clearinghouse within the earlier of 30 calendar days after receipt of the issued auditors’ report. or nine months after the end of the audit period. The Center did not timely complete the Single Audit and submit to the Federal Audit Clearinghouse within nine months form the end of the audit period. Context: Information required to complete the financial statements was not prepared and ready to audit in a timely manner. This resulted in the financial statements and Single Audit to not be finalized and issued in order to be submitted to the Federal Audit Clearinghouse within nine months of the end of the audit period. Effect: The data collection form and reporting package for the Single Audit for the year ended June 30, 2023 were not submitted within the specified timeframe resulting in award drawdown restrictions. Questioned Costs: None Cause: Internal controls over reporting and compliance were not effective at ensuring that the required reports were being completed and submitted in a timely manner. Recommendations: We recommend that management improve their reporting processes and controls to ensure that the Single Audit is completed and submitted to the Federal Audit Clearinghouse in a timely manner. Views of Responsible Officials and Planned Corrective Actions: Management is taking steps to improve the internal controls over financial reporting and compliance to ensure that reporting can be completed in an accurate and timely manner. These changes include updates of internal processes and the hiring of key members of financial management.

Finding 2023-003: Sliding Fee Discounts Criteria and Condition: Health centers must prepare and apply a sliding fee discount schedule so that the amounts owed for health center services by eligible patients are adjusted (discounted) based on the patient’s ability to pay. The adjustments extended to the patients are based on Federal Poverty Guidelines that take into consideration the annual income earned by the individuals and families. There were no documents maintained to support the sliding fee discounts applied to twenty-four patient accounts. As a result, there is no way to verify if the discount applied was representative of the patients’ poverty levels. Lastly, four patients were assigned the incorrect poverty level resulting in services not being discounted properly. Questioned Costs: None Cause: Existing internal controls over compliance are not effective at ensuring that sliding fee discount applications for patients are retained on file or ensuring that patient eligibility for sliding fee discounts are accurately determined. Effect: Of the forty patients reviewed that had received sliding fee discounts, twenty-four compliance findings were noted for the year ended June 30, 2023. Recommendations: We recommend that management implement a checklist to ensure that all information required to fill out a patient’s sliding fee discount application is obtained, that the determination of a patient’s eligibility for a sliding fee discount is independently reviewed and approved by a supervisor, and that a patient’s application is properly retained. Views of Responsible Officials and Planned Corrective Actions: Management is taking steps to improve the internal controls over compliance over the sliding fee discount.

Finding 2023-003: Sliding Fee Discounts Criteria and Condition: Health centers must prepare and apply a sliding fee discount schedule so that the amounts owed for health center services by eligible patients are adjusted (discounted) based on the patient’s ability to pay. The adjustments extended to the patients are based on Federal Poverty Guidelines that take into consideration the annual income earned by the individuals and families. There were no documents maintained to support the sliding fee discounts applied to twenty-four patient accounts. As a result, there is no way to verify if the discount applied was representative of the patients’ poverty levels. Lastly, four patients were assigned the incorrect poverty level resulting in services not being discounted properly. Questioned Costs: None Cause: Existing internal controls over compliance are not effective at ensuring that sliding fee discount applications for patients are retained on file or ensuring that patient eligibility for sliding fee discounts are accurately determined. Effect: Of the forty patients reviewed that had received sliding fee discounts, twenty-four compliance findings were noted for the year ended June 30, 2023. Recommendations: We recommend that management implement a checklist to ensure that all information required to fill out a patient’s sliding fee discount application is obtained, that the determination of a patient’s eligibility for a sliding fee discount is independently reviewed and approved by a supervisor, and that a patient’s application is properly retained. Views of Responsible Officials and Planned Corrective Actions: Management is taking steps to improve the internal controls over compliance over the sliding fee discount.

Finding 2023-003: Sliding Fee Discounts Criteria and Condition: Health centers must prepare and apply a sliding fee discount schedule so that the amounts owed for health center services by eligible patients are adjusted (discounted) based on the patient’s ability to pay. The adjustments extended to the patients are based on Federal Poverty Guidelines that take into consideration the annual income earned by the individuals and families. There were no documents maintained to support the sliding fee discounts applied to twenty-four patient accounts. As a result, there is no way to verify if the discount applied was representative of the patients’ poverty levels. Lastly, four patients were assigned the incorrect poverty level resulting in services not being discounted properly. Questioned Costs: None Cause: Existing internal controls over compliance are not effective at ensuring that sliding fee discount applications for patients are retained on file or ensuring that patient eligibility for sliding fee discounts are accurately determined. Effect: Of the forty patients reviewed that had received sliding fee discounts, twenty-four compliance findings were noted for the year ended June 30, 2023. Recommendations: We recommend that management implement a checklist to ensure that all information required to fill out a patient’s sliding fee discount application is obtained, that the determination of a patient’s eligibility for a sliding fee discount is independently reviewed and approved by a supervisor, and that a patient’s application is properly retained. Views of Responsible Officials and Planned Corrective Actions: Management is taking steps to improve the internal controls over compliance over the sliding fee discount.

Criteria and Condition: Internal controls over financial reporting should be designed and in place to prevent, detect, and correct material misstatement in the financial statements in a timely manner. The internal controls were unable to prevent, detect, and correct several material errors in the preparation of the financial statements as of and for the year ended June 30, 2022, in a timely manner. This resulted in resulted in numerous significant adjustments related to assets, liabilities, net assets, revenue, and expenditures. Cause: Existing internal controls over financial reporting require that management perform meaningful analysis of internal records and general ledger accounts on a regular basis. Management is not performing a meaningful analysis of internal records and the general ledger, which results in financial statements that contain a significant number of material errors. Questioned Costs: None Effect: A significant number of material audit adjustments were required to correct the financial statements as of and for the year ended June 30, 2022. Recommendations: We recommend that management develop formal policies and procedures to identify material misstatements, which should include performing meaningful analysis of internal records and general ledger accounts on a regular basis. This will allow management to timely identify unusual trends in internal records and general ledger accounts that could be indicative of errors that cause the Center’s financial statements to be misstated. Views of Responsible Officials and Planned Corrective Actions: Management is taking steps to improve monitoring of the financial reporting process and to ensure meaningful analysis of financial records is occurring on a regular basis. Management has hired an experienced Chief Financial Officer for the finance department, has begun identifying areas of improvement within the finance department, and is in the process of implementing new procedures that will improve the accuracy and timeliness of financial reporting.

Criteria and Condition: Awardees must submit a quarterly Federal Financial Report Cash Transaction Report (“SF-425”) via the Payment Management System (“PMS”) within 30 days of the end of each calendar quarter. There is not sufficient evidence to verify that quarterly SF-425 reports were filed within 30 days of the end of each calendar quarter for the year ended June 30, 2022. Context: The Center was not able to provide copies of a timely filed quarterly SF-425 for any quarter for the year ended June 30, 2022. Effect: It appears that there were no quarterly SF-425 forms reporting cash draws and expenditures completed and submitted to PMS in a timely manner. Questioned Costs: None Cause: Internal controls over reporting and compliance were not effective at ensuring that the required reports were being accurately completed in a timely manner. Recommendations: We recommend that management improve their reporting processes and controls to ensure all SF-425 reports are submitted timely and accurately to PMS. Views of Responsible Officials and Planned Corrective Actions: Management is taking steps to improve the internal controls over the completion and submission of SF-425 reports to ensure that reporting can be completed in an accurate and timely manner. These changes include updates to internal processes and the hiring of key members of financial management.

Criteria and Condition: Single Audits must be completed and submitted to the Federal Audit Clearinghouse within the earlier of 30 calendar days after receipt of the issued auditors’ report. or nine months after the end of the audit period. The Center did not timely complete the Single Audit and submit to the Federal Audit Clearinghouse within nine months form the end of the audit period. Context: Information required to complete the financial statements was not prepared and ready to audit in a timely manner. This resulted in the financial statements and Single Audit to not be finalized and issued in order to be submitted to the Federal Audit Clearinghouse within nine months of the end of the audit period. Effect: The data collection form and reporting package for the Single Audit for the year ended June 30, 2022 were not submitted within the specified timeframe resulting in award drawdown restrictions. Questioned Costs: None Cause: Internal controls over reporting and compliance were not effective at ensuring that the required reports were being completed and submitted in a timely manner. Recommendations: We recommend that management improve their reporting processes and controls to ensure that the Single Audit is completed and submitted to the Federal Audit Clearinghouse in a timely manner. Views of Responsible Officials and Planned Corrective Actions: Management is taking steps to improve the internal controls over financial reporting and compliance to ensure that reporting can be completed in an accurate and timely manner. These changes include updates of internal processes and the hiring of key members of financial management.

Criteria and Condition: Health centers must prepare and apply a sliding fee discount schedule so that the amounts owed for health center services by eligible patients are adjusted (discounted) based on the patient’s ability to pay. The adjustments extended to the patients are based on Federal Poverty Guidelines that take into consideration the annual income earned by the individuals and families. There were no documents maintained to support the sliding fee discounts applied to four patient accounts. As a result, there is no way to verify if the discount applied was representative of the patients’ poverty levels. Lastly, four patients were assigned the incorrect poverty level resulting in services not being discounted properly. Questioned Costs: None Cause: Existing internal controls over compliance are not effective at ensuring that sliding fee discount applications for patients are retained on file or ensuring that patient eligibility for sliding fee discounts are accurately determined. Effect: Of the forty patients reviewed that had received sliding fee discounts, eight compliance findings were noted for the year ended June 30, 2022. Recommendations: We recommend that management implement a checklist to ensure that all information required to fill out a patient’s sliding fee discount application is obtained, that the determination of a patient’s eligibility for a sliding fee discount is independently reviewed and approved by a supervisor, and that a patient’s application is properly retained. Views of Responsible Officials and Planned Corrective Actions: Management is taking steps to improve the internal controls over compliance over the sliding fee discount.

Finding 2021-001: Internal Control Over Financial Reporting

Finding 2021-002: Federal Financial Reports

Finding 2021-003: Timely Single Audit Submission

Finding 2021-004: Sliding Fee Discounts

2020-002: CFDA 93.224 ? HEALTH CENTER PROGRAM, DEPARTMENT OF HEALTH AND HUMAN SERVICES Material Noncompliance, Sliding Fee Discounts Criteria: Health centers must prepare and apply a sliding fee discount schedule so that the amounts owed for health center services by eligible patients are adjusted (discounted) based on the patient?s ability to pay. The adjustments extended to the patients are based on Federal Poverty Guidelines that take into consideration the annual income earned by the individuals and families. Condition: There were no documents maintained to support the sliding fee discounts applied to four patient accounts. As a result, there is no way to verify if the discount applied was representative of the patients? poverty levels. Lastly, four patients were assigned the incorrect poverty level resulting in services being discounted improperly. Context: The finding was discovered after applying tests over the sliding fee discount requirement of the program. Four instances of noncompliance resulted from missing patient records, and four instances of noncompliance in the determination of patient eligibility for discounted services. Audit procedures also indicated that the internal controls over compliance with the sliding fee requirement were not effective in mitigating the risk of noncompliance. Effect: Of the forty patients reviewed that received sliding fee discounts, eight compliance findings were noted for the year ended June 30, 2020. Questioned Costs: None. Cause: Existing internal controls over compliance are not effective at ensuring that sliding fee discount applications for patients are retained on file or ensuring that patient eligibility for sliding fee discounts are accurately determined. Recommendations: We recommend that management implement a checklist to ensure that all information required to fill out a patient?s sliding fee discount application is obtained, that the determination of a patient?s eligibility for a sliding fee discount is independently reviewed and approved by a supervisor, and that a patient?s application is properly retained. View of Responsible Officials and Planned Corrective Actions: Management is taking steps to improve the internal controls over compliance over the sliding fee discount requirement of the program. A checklist will be implemented that requires the person gathering the patient applications to acknowledge that they have gathered all required patient information, requires a reviewer to acknowledge that a patient?s eligibility for a sliding fee discount has been independently reviewed, and both the preparer and reviewer acknowledge that the patient?s application has been properly filed.

2020-003: CFDA 93.224 ? HEALTH CENTER PROGRAM, DEPARTMENT OF HEALTH AND HUMAN SERVICES Material Noncompliance, Federal Financial Reports Criteria: Awardees must submit a quarterly Federal Financial Report Cash Transaction Report (?SF-425?) via the Payment Management System (?PMS?) within 30 days of the end of each calendar quarter. Condition: There is no evidence that quarterly SF-425 reports were filed within 30 days at the end of each calendar quarter for the year ended June 30, 2020. Context: The client was unable to provide copies of one quarterly SF-425 report for the year ended June 30, 2020. Audit procedures also indicated that the internal controls over compliance with this reporting requirement were not effective in mitigating the risk of noncompliance. Effect: It appears that only three quarterly SF-425 reporting cash draws and expenditures were completed and submitted to PMS in a timely manner. Questioned Costs: None. Cause: Existing internal controls over reporting and compliance are not effective at ensuring that SF-425 reports are completed in an accurate and timely manner. Recommendations: We recommend that management make changes to their reporting processes and controls to ensure timely submission of SF-425 reports to PMS. Views of Responsible Officials and Planned Corrective Actions: Management is taking steps to improve the internal controls over the completion and submission of SF-425 reports to ensure that reporting can be completed in an accurate and timely manner. These changes include updates of internal processes and the hiring of key members of financial management.

2020-004: CFDA 93.224 ? HEALTH CENTER PROGRAM, DEPARTMENT OF HEALTH AND HUMAN SERVICES Material Noncompliance, Timely Single Audit Submission Criteria: Single audits must be completed and submitted to the Federal Audit Clearinghouse within the earlier of 30 calendar days after the receipt of the issued auditors? report, or nine months after the end of the audit period. Condition: The financial and single audit were not completed in a timely manner; this resulted in the single audit not being submitted to the Federal Audit Clearinghouse within nine months after the end of the audit period. Context: Information required to complete the consolidated financial statements was not received in time to complete and submit the single audit to the Federal Audit Clearinghouse within the specified timeframe. Audit procedures also indicated that the internal controls over compliance with reporting requirements were not effective in mitigating the risk of this noncompliance. Effect: The data collection form and reporting package for the single audit year ended June 30, 2020 were not submitted within the specified timeframe resulting in award drawdown restrictions. Questioned Costs: None. Cause: Existing internal controls over reporting and compliance are not effective at ensuring that reporting is completed in an accurate and timely manner. Recommendations: We recommend that management make changes to their reporting processes and controls to ensure timely single audit reporting to the Federal Audit Clearinghouse. View of Responsible Officials and Planned Corrective Actions: Management is taking steps to improve the internal controls over financial reporting and compliance to ensure that reporting can be completed in an accurate and timely manner. These changes include updates of internal processes and the hiring of key members of financial management.

2019-002: CFDA 93.224 - Community Health Centers, Department of Health and Human Services Material Noncompliance, Sliding Fee Discounts Criteria: Health centers must prepare and apply a sliding fee discount schedule so that the amounts owed for health center services by eligible patients are adjusted (discounted) based on the patient?s ability to pay. The adjustments extended to patients are based on federal poverty guidelines that take into consideration the annual income earned by individuals and families. Condition: There were no documents maintained to support the sliding fee discounts applied to one patient account. As a result, there is no way to verify if the discount applied was representative of the patient?s poverty level. Second, one patient was assigned the incorrect poverty level resulting in services being discounted improperly (in excess of what was required). Finally, one patient had inconsistencies in their sliding fee application; as a result, it is unclear if the patient was assigned the correct poverty level and if services are being properly discounted. Context: The finding was discovered after applying tests over the sliding fee discount requirement of the program. One instance of non-compliance resulted from missing patient records, and two instances of non-compliance in the determination of patient eligibility for discounted services. Audit procedures also indicated that the internal controls over compliance with the sliding fee requirement were not effective in mitigating the risk of non-compliance. Effect: Of the twenty-five patients reviewed that received sliding fee discounts, three compliance findings were noted for the year ended June 30, 2019. Questioned costs: None. Cause: Existing internal controls over compliance are not effective at ensuring that sliding fee discount applications for patients are retained on file or ensuring that patient eligibility for sliding fee discounts are accurately determined. Recommendations: We recommend that management implement a checklist to ensure that all information required to fill out a patient?s sliding fee application is obtained, that the determination of a patient?s eligibility for sliding fee discounts is independently reviewed and approved by a supervisor, and that a patient?s application is properly retained. Views of responsible officials and planned corrective actions: Management is taking steps to improve the internal controls over compliance over the sliding fee discount requirement of the program. A checklist will be implemented that requires the person gathering the patient applications to acknowledge that they have gathered all required patient information, requires a reviewer to acknowledge that a patient?s eligibility for sliding fee discounts has been independently reviewed, and both the preparer and reviewer acknowledge that the patient?s application has been properly filed.

2019-003: CFDA 93.224 - Community Health Centers, Department of Health and Human Services Material Noncompliance, Federal Financial Reports Criteria: Awardees must submit a quarterly Federal Financial Report Cash Transaction Report (SF-425) via the Payment Management System (PMS) within 30 days of the end of each calendar quarter. Condition: There is no evidence that quarterly SF-425 reports were filed within 30 days at the end of each calendar quarter for the year ended June 30, 2019. Context: The client was unable provide copies of any completed quarterly SF-425 reports for the year ended June 30, 2019. Audit procedures also indicated that the internal controls over compliance with this reporting requirement were not effective in mitigating the risk of non-compliance. Effect: It appears that no quarterly SF-425 reporting cash draws and expenditures were completed and submitted to PMS in a timely manner. Questioned costs: None. Cause: Existing internal controls over reporting and compliance are not effective at ensuring that SF-425 reports are completed in an accurate and timely manner. Recommendations: We recommend that management make changes to their reporting processes and controls to ensure timely submission of SF-425 reports to PMS. Views of responsible officials and planned corrective actions: Management is taking steps to improve the internal controls over the completion and submission of SF-425 reports to ensure that reporting can be completed in an accurate and timely manner. These changes include updates of internal processes and the replacement of a key member of management.

2019-004: CFDA 93.224 - Community Health Centers, Department of Health and Human Services Material Noncompliance, Timely Single Audit Submission Criteria: Single audits must be completed and submitted to the Federal Audit Clearinghouse within the earlier of 30 calendar days after the receipt of the issued auditor?s report, or nine months after the end of the audit period. Condition: The financial and single audit were not completed in a timely manner; this resulted in the single audit not being submitted to the Federal Audit Clearinghouse within nine months after the end of the audit period. Context: Information required to complete the consolidated financial statements was not received in time to complete and submit the single audit to the Federal Audit Clearinghouse within the specified timeframe. Audit procedures also indicated that the internal controls over compliance with reporting requirements were not effective in mitigating the risk of this non-compliance. Effect: The data collection form and reporting package for the single audit year ended June 30, 2019, were not submitted within the specified timeframe resulting in award drawdown restrictions.Questioned costs: None. Cause: Existing internal controls over reporting and compliance are not effective at ensuring that reporting is completed in an accurate and timely manner. Recommendations: We recommend that management make changes to their reporting processes and controls to ensure timely single audit reporting to the Federal Audit Clearinghouse. Views of responsible officials and planned corrective actions: Management is taking steps to improve the internal controls over financial reporting and compliance to ensure that reporting can be completed in an accurate and timely manner. These changes include updates of internal processes and the replacement of a key member of management.

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