CLINICA SIERRA VISTANon-Profit

2025-002 Cash Management Program Information Federal Organization U.S Department of Health and Human Services Assistance Listing Numbers 93.224 & 93.527 Health Center Program Cluster Award Numbers H80CS00540-23, H8GCS48292, H8LCS51370 Criteria Title 2 CFR 200.305 requires that organizations “must minimize the time elapsing between the transfer of funds from the United States Treasury or the pass-through entity and the disbursement by the non-federal entity whether the payment is made by electronic funds transfer, or issuance or redemption of checks, warrants, or payment by other means.” [X] Compliance Finding [ ] Significant Deficiency [X] Material Weakness Condition The Organization was not able to provide documentation for certain cash draws made from the Payment Management System (PMS) to show that expenditures were incurred or expected to be incurred within a minimal amount of time. This finding appears to be a systemic issue. Cause The Organization did not always maintain documentation of the qualifying expenditures used to support amounts drawn from the payment management system. Effect The Organization may not have minimized the timing between draws from the PMS and the related payments for expenditures incurred as required. Questioned Costs $0. Although the auditee did not retain documentation of the expenditures supporting certain draws, our testing indicated that the total program expenditures for the period were sufficient to cover all draws of federal funds under the program in the period. Context For two of six draws tested, the Organization was not able to provide documentation to show that expenses were incurred prior to or within a reasonable time after the draws. Recommendation We recommend the Organization implement controls requiring all draws from the PMS to be based on detailed reports of expenditures claimed for reimbursement and retain this documentation, along with the supporting invoices and payroll reports supporting the expenditures. In addition, we recommend that the listing of expenditures be reviewed by appropriate personnel to ensure that the expenditures claimed are allowable and cash payments for the expenditures are made before the date of the draw or within a reasonable time after the draw. Views of responsible officials and planned corrective action Management is in agreement with this finding and will take corrective action as outlined below.

2025-003 Procurement Program Information Federal Organizations U.S Department of Health and Human Services U.S Department of Agriculture (passed through California Department of Public Health) Assistance Listing Numbers 93.224 & 93.527 Health Center Program Cluster 10.557 WIC Special Supplemental Nutrition Program for Women, Infants, and Children Award Numbers H80CS00540-23, H8GCS48292, H8LCS51370, 22-10237 A05 Criteria Entities receiving federal awards must have and use their documented procurement policies. Title 2 CFR 200.320 outlines the acceptable methods of procurement and establishes the maximum thresholds allowed. Purchases below the simplified acquisition threshold, but above the micro-purchase threshold, require price or rate quotations to be obtained from an adequate number of qualified sources. [X] Compliance Finding [ ] Significant Deficiency [X] Material Weakness Condition The Organization did not maintain documentation that competitive price quotations or bids performed, as required by policy and the Uniform Guidance for purchases above the micro purchase threshold. This finding appears to be a systemic issue. Cause Management did not follow its established procurement policy and documentation was not maintained evidencing its compliance with the policy. Effect The Organization may overpay for goods and services due to selecting vendors without appropriate consideration of the competitive bids and cost analysis. Questioned Costs $0. Although the auditee did not retain documentation of required competition (such as bids or price quotes) for contracts, as required under the entity’s written procurement procedures and the Uniform Guidance procurement standards in 2 CFR part 200, our testing indicated that the costs charged to the federal program under this contract were otherwise allowable under the applicable cost principles, adequately supported by other documentation, and reasonable in amount. Context We tested procurement transactions from each program. Of these transactions, four of thirteen tested under assistance listing numbers 93.224 and 93.527, and six of twenty-five tested under assistance listing number 10.557, were missing evidence of proper competitive procurement procedures being performed. Recommendation We recommend the Organization retain supporting documentation of competitive procurement for all transactions greater than the micro-purchase threshold when the expenditures will be charged to a federal award. Views of responsible officials and planned corrective action Management is in agreement with this finding and will take corrective action as outlined below.

2025-004 Suspension and Debarment Program Information Federal Organizations U.S Department of Health and Human Services U.S Department of Agriculture (passed through California Department of Public Health) Assistance Listing Numbers 93.224 & 93.527 Health Center Program Cluster 10.557 WIC Special Supplemental Nutrition Program for Women, Infants, and Children Award Numbers H80CS00540-23, H8GCS48292, H8LCS51370, 22-10237 A05 Criteria Title 2 CFR 200.214 and Title 2 CFR 180.300 require that organizations “verify that the person with whom you intend to do business is not excluded or disqualified” before entering into covered transactions (procurement contracts, purchase orders, or agreements greater than or equal to $25,000) with persons or vendors. [ ] Compliance Finding [ ] Significant Deficiency [X] Material Weakness Condition The Organization entered into covered transactions without verification that vendors/contractors were not excluded from doing business with the federal government. This finding appears to be a systemic issue. Cause The Organization did not maintain documentation evidencing its compliance with its policy to verify that persons or entities contracted with were not listed on the exclusions list prior to entering into the contracts or purchase agreements. Effect The Organization may have entered into covered transactions with persons who have been suspended or debarred. Questioned Costs None noted. Context We tested four vendors with “covered transactions” under assistance listing numbers 93.224 and 93.527 and six under assistance listing number 10.557. All vendors selected were missing evidence of suspension and debarment checks being performed. However, we were able to independently verify that the vendors in question were not excluded through SAM.GOV. Recommendation We recommend the Organization perform vendor checks prior to entering into procurements meeting the covered transaction criteria, and retain documentation that the checks were performed and when they were performed. In addition, we recommend that the Organization update these checks on an annual basis. Views of responsible officials and planned corrective action Management is in agreement with this finding and will take corrective action as outlined below.

2023-002 Application of Sliding Fee Discount Program Information Federal Organization U.S Department of Health and Human Services Assistance Listing Numbers 93.224 & 93.527 Health Center Program Cluster Award Numbers H80CS00540-21, H8FCS41201, H8GCS48292 Criteria [X] Compliance Finding [ ] Significant Deficiency [ ] Material Weakness Title 2 U.S. Code of Federal Regulations (CFR) Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards, Subpart F, Compliance Supplement, Part 4, Compliance Requirement N, Special Tests and Provisions states, “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 patients ability to pay.” Condition During our testing of sliding fee discounts for health center patients qualifying for reduced-charge visits, we identified two incidents where the slide fee was applied to a patient’s account without a completed application on file. Context This finding appears to be an isolated incident. A sample size of 25 patients included two who did not have an application on file. Cause The Organization did not follow its policies and procedures set in place to ensure the sliding fee schedule discount is correctly determined and applied to patient accounts. Effect Patients may have been granted the incorrect sliding fee discount. Questioned Costs None identified Recommendation We recommend continued effort in training personnel to be properly trained on applying appropriate sliding fee discounts based on the Organization’s approved policy and in compliance with the OMB Compliance Supplement requirements. An appropriate level of review should be conducted on patient accounts to ensure proper document retention, application of sliding fee discounts, and third-party insurance billing. Views of responsible officials and planned corrective action Management is in agreement with the audit finding.

U.S. Department of Health and Human Services Health Center Program Cluster CFDA Numbers 93.224 and 93.527 Program Year 2018 ? 2019 Criteria or specific requirement ? Reporting in accordance with 45 CFR Sections 75.341 and 75.342. Condition ? The Organization is required to prepare and submit an annual Uniform Data System (UDS) report for each calendar year, an annual Federal Financial Report (FFR) for each grant year and quarterly Federal Cash Transactions Reports (FCTR) for each grant budget period. These reports are to be prepared using accurate financial information. Questioned costs ? None Context ? One report for each report type listed above was selected for testing with specific data from each report selected for testing. The sampling methodology used is not and is not intended to be statistically valid. Out of a population of 19 inputs tested on the UDS, FFR and FCTR, 2 of those inputs contained errors resulting in program income and unexpended program income being underreported on the annual FFR and 1 of those inputs contained errors resulting in grant drawdowns being underreported on the UDS. Effect ? Errors were made on the annual UDS and FFR reports. Cause ? The Organization miscalculated program income earned during the program year. This error caused the unexpended program income to also be miscalculated. These errors related to the annual FFR. The Organization also miscalculated the total health center program grant drawdowns during the program year. This error related to the annual UDS. Identification as repeat finding ? Not a repeat finding Recommendation ? The Organization should revise its policies and procedures over federal reporting to ensure reports are prepared using accurate information.