CN-640000-HB391.pdf

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Subject: Contract HB391: Has been sent to the provider for electronic signature

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Certificate Pages: 5 Initials: 0 Rashena Itwaru-Womack

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Rashena.Itwaru-Womack@flhealth.gov

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4/4/2022 9:58:38 AM

Holder: Rashena Itwaru-Womack

Rashena.Itwaru-Womack@flhealth.gov

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Signer Events Signature Timestamp Eric Kern ericmkern@usf.edu

Director, Sponsored Research

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Viewed: 4/4/2022 10:53:01 AM

Signed: 4/4/2022 12:15:32 PM

Electronic Record and Signature Disclosure:

Accepted: 4/4/2022 10:53:01 AM ID: 460e0dab-622e-4b4f-af8e-39814a12b03c

Mark Lander

Mark.Lander@flhealth.gov

Administrator

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Signed by link sent to Mark.Lander@flhealth.gov

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Sent: 4/4/2022 12:15:34 PM

Viewed: 4/4/2022 1:19:36 PM

Signed: 4/4/2022 1:23:20 PM

Electronic Record and Signature Disclosure:

Accepted: 4/4/2022 1:19:36 PM ID: 75815a65-b041-4fa4-a53a-2a60383083bf

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MELISSA ITHURRASPE

MELISSA.ITURRASPE@flhealth.gov

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Sent: 4/4/2022 10:05:21 AM

Viewed: 4/4/2022 10:29:29 AM

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Not Offered via DocuSign

Carbon Copy Events Status Timestamp Robert Morales

Robert.Morales@flhealth.gov

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Sent: 4/4/2022 10:05:21 AM

Viewed: 4/4/2022 10:08:16 AM

Electronic Record and Signature Disclosure:

Accepted: 1/31/2022 4:47:09 PM ID: 96ac6a91-af5f-4ea9-8450-e3686400edab

Silvia Alvarez silviaa@usf.edu

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Electronic Record and Signature Disclosure created on: 3/24/2017 1:05:43 PM Parties agreed to: Eric Kern, Mark Lander, Robert Morales

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DEPARTMENT OF HEALTH - FLORIDA ACCOUNTABILITY CONTRACT TRACKING SYSTEM

To make selections from boxes marked SELECT, double click within the space, click an option in the menu list, then click the MOVE arrow to move the option to the top of the list (move your choice above SELECT in the list). Finally, click OK.

PART I: OVERALL CONTRACT INFORMATION

TOTAL CONTRACT AMOUNT: A. $90,000

MAIN CONTRACT INFORMATION CONTRACT PROCUREMENT INFORMATION

FLAIR CONTRACT 10 HB391 ADVANCED AUTHORIZED No SHORT TITLE HEALTH EQUITY WORK PLAN COMPETITIVE PROCUREMENT No

NATIONAL INITIATIVE TO

ADDESS COVID-19 HEALTH

DISPARITIES AMONG

LONG TITLE POPULATIONS AT HIGH RISK PROCUREMENT CODE L - GOVAGENCY AND UNDESERVED, INCLUDING

RACIAL, ETHNIC MINORITIES,

AND RURAL COMMUNITIES IN

FLORIDA

AGENCY UNIQUE 10 HB391 (ENTER FLAIR EXEM PT (if yes, justification required) Yes CONTRACT 10) ORIGINAL AMOUNT $90,000.00 EXEMPTION CODE L- Other Governmer CONTRACT TYPE SC-Standard Agreement STATE TERM 10 CONTRACT STATUS Select EXEMPTION JUSTIFICATION DATE OF EXECUTION 04/04/2022 Florida Dept of Health - Hillsborough has numerous existing BEGINNING DATE 02/15/2022 relationships with the University if South Florida. We have ORIGINAL END DATE 613012022 elected to use our government exemption for the provision of

NEW ENDING DATE health services due to the wealth of knowledge and expertise

STATUTORY AUTHORITY

USF has and the high-risk patients serviced.

FINANCIAL ASSISTANCE Yes

CFDA# 93.354, AGENCY REFERENCE # -ITB, RFP, ITN, , RFA

CSFA# 64.052, , BUSINESS CASE Select RECIPIENT TYPE Public Universities (In or Out of Stat DATE COMPLETED DO NOT PUBLISH THIS (This should always be left blank)

CONTRACT ON THE FACTS

PUBLIC WEBSITE

SERVICE AREA 29 LEGAL CHALLENGES TO PROCUREMENT Select

ADMINISTRATIVE COST INFORMATION LEGAL CHALLENGE DESCRIPTION

ADMIN. COST ALLOWED No

ADMIN.PERCENTAGE 0.00%

ADMIN COST AMOUNT $0.00

PERIODIC INCREASE No

PERCENTAGE ALLOWED 0.00% OUTSOURCING I CAPITAL IMPROVEMENTS

CONTRACT MANAGER INFORMATION PREVIOUS STATE FUNCTION No

LAST

Iithurraspe FIRST NAME Melissa INSOURCING CONSIDERED No NAME PHONE I 813-559-4179 EXTENSION CAPITAL IMPROVEMENT No

DATE OF LAST DOH CERTIFICATION: 8/16/2021 CAPITAL IMPROVEMENT DESCRIPTION

DATE OF ADV. ACCOUNTABILITY or 2/412021 FCCM

VENDOR INFORMATION

VENDOR 10 VF-59-3102112

VENDOR NAME University of South Florida VALUE OF IMPROVEMENT $0.00

ADDRESS 4019 E. Fowler Ave., Suite 100 UNAMORTIZED VALUE $0.00 CITY 1ST ATEIZIP Tampa,FL 33617

FISCAL YEAR END 6/30/2021

CONTACT PERSON Eric Kern, M.B.A CONTACT E-MAIL RSCH-Awards@USF.EDU I ADDRESS

Page I 1 DH 1122, 02/2020 - previous editions may not be used

PHONE NUMBER I 813-974-2897 I I

GENERAL CONTRACT DESCRIPTION (PUBLIC VIEW)

This contract helps support the Office of Minority Health and Health Equity (OMHHE) in advancing health equity (HE) and improving health outcomes for racial and ethnic minority populations through health promotion, partnership engagement, education and outreach and implementation of focused initiatives as authorized by section 381.735, Florida Statutes.

PART II: CONTRACT ACTIONS

Contract Actions are all actions related to the contract after the initial execution of the agreement with the provider. In addition to amendments, extensions and renewals, these actions include budget, and contract manager changes.

Action Agency Action Effective Execution New End Brief Description Type Reference # Amount Date Date Date

New Contract $90,000.00 02/15/2022 THIS CONTRACT WILL HELP SUPPORT THE OFFICE

OF MINORITY HEALTH AND HEALTH EQUITY IN

ADVANCING HEALTH EQUITY AND HEALTH

OUTCOMES

select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00

Page I 2 DH 1122,08/2021 - previous editions may not be used select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00 select $0.00

, '.' . ,', PART III: CONTRA.CT BUDGET

, Fiscal Year 2021·2022 .' ACCouN1,COOE AMOUNT ' TYPE . EO V "·OcA OBJECT EFF AMD u GF· , SF· FJO BE IBI CAT ' 'YR iii', COOE DATE, , REF . , 64 20 2 141001 64200700 29 10077 2022 $55,000.00 RE REDCH 751000 02115120

7 22

64 20 2 141001 64200700 29 10077 ' 2022 $35,000.00 RE HDG21 780000 02115120

7 22

$0.00 $0.00 $0.00

FISCAL YEAR TOTAL AMOUNT $90,000.00

F~IYear' . '. (

, ',7 ACCOUNT coos .: .

V OBJECT EFF AMD , ,q, . .: AMOUNT TYPE EO ' ocA i~Lh GF SF flO . BE . '!IBI CAT YR .. R ....• ; CODe I' DATE lu;F .

$0.00 $0.00 $0.00 $0.00 $0.00

FISCAL YEAR TOTAL AMOUNT $0.00

Fiscal Yeai' .

;',1:1 ~ ACCOUNT CODE ' AMOUNT TYPE EO V DCA QBJECT EFF AMD,:'

11 ' GF 'SF . FlO' .BE IBI CAT YR R CODE DAlE REF

$0.00 $0.00 $0.00 $0.00

FISCAL YEAR TOTAL AMOUNT $0.00

Fiscal Year - :. .~ ACCOUtfT CODe AMOUNT TYPE EO V OCA OBJECT EFF AMD

L1 I~Gf SF . FlO . BE c IBI CAT . YR R CODE DATE REF,· $0.00 $0.00 $0.00 $0.00

FISCAL YEAR TOTAL AMOUNT $0.00

Fiscal.Year .

Ill, ," , .. ' ACCOUNT CODE V OBJECT EFF AMD' lL1 cGF' SF. FlO BE IBI CAT ' YR, AMOUNT TYPE EO R OCA CODE DATE REF'/.

$0.00 $0.00 $0.00

FISCAL YEAR TOTAL AMOUNT $0.00

GRAND TOTAL I $0.00

I ORGANIZATION EXPENDITURE CODE

Page I 3 DH 1122, 08/2021 . previous editions may not be used

I PRIMARY ORGANIZA nON

EXPENDITURE CODE

L1 I L2 I L3 I L4 I L5 L1 I L2 I L3 I L4 I L5

I I I I I I I I

PART IV: ENCUMBRANCE

This page must reflect the encumbrance needs for the current Fiscal Year action identified on Part II of this DH1122 only. Please do not include historical encumbrance entries or future fiscal year entries.

Contract Number: HB391 Current Encumbrance Balance: $90,000.00

Encumbrance Need: Establish Encumbrance for New Contract

CURRENT FISCAL YEAR 2021-2022

ORGANIZATION CODE

L1 L2 L3 L4 L5 EO VR OBJECT CODE . VENDOR 1.0. WI AMOUNT OCA EFFECTIVE DATE SEQUENCE #

64 36 29 751000 VF-59-13102112 $55,000.00 REDCH 02/15/2022

36 29 780000 VF-59-13102112 $35,000.00 HDG21 02/15/2022

I 64

-Signatures are required when the encumbrance change does not involve an amendment or renewal to the contract Examples include increasing/reducing/revising an encumbrance, closing an encumbrance, or establishing the encumbrance for a New Fiscal Year of a rnutn-vear contract t/}_ / nri. { Date

Bureau/Program Budget Coordinator Signature Date

Division Budget Administrator Signature Date

Business Office/Central Office Budget Analyst

Signature Date

··An encumbrance change requires submission of Parts I, II. III, and IV of the DH1122.

Page 14 DH 1122, 08/2021 - previous editions may not be used

REQUIREMENTS: This section of the DH1122 is required when someone other than the contract manager is responsible for entering the contract deliverable information into FACTS.

.. PART V: CONTRACT DELIVERABLES

Del.iverabre # 1 CONTRACT WIDE CONSEQUENCES No

COMMODITY CODE/SERVICE TYPE 86000000

MAJOR DELIVERABLE USF shall submit a HE Activity Planning Log to the Department DESCRIPTION METHOD OF PAYMENT Fixed Price-Unit Cost

MAJOR DELIVERABLE PRICE $0.00

NON-PRICE JUSTIFICATION 1. Price.Cannot be determined

PAGE REFERENCE 4

PERFORMANCE METRICS USF shall submit a HE Activity Log (Exhibit C) within 15 days from the end of each quarter to the Department.

FINANCIAL CONSEQUENCES The Department shall reduce the contract payables up to 5% should USF fail to meet reporting deadlines for a monthly report required in this contract.

DELIVERABLE NUMBER 1

;. Deliverable # 2 .'

CONTRACT WIDE CONSEQUENCES No COMMOelTY CODE/SERVICE TYPE 86000000 MAJOR DELIVERABLE USF shall submit HE Coalition and HE Plan Task Force meeting agendas DESCRIPTION METHOD OF PAYMENT Fixed Price-Unit Cost

MAJOR DELIVERABLE PRICE $0.00

NON-PRICE JUSTIFICATION 1. Price Cannot be determined

PAGE REFERENCE 4

PERFORMANCE METRICS USF shall submit HE Coalition and He Plan Task Force meeting agendas (Exhibit D),presentations, and similar the Department within 15 days from the end of the month.

FINANCIAL CONSEQUENCES The Department shall reduce the contract payables up to 5% should USF fail to meet reporting deadlines for a monthly report required in this contract.

DELIVERABLE NUMBER 2

Qleliverable # 3

CONTRACT WIDE CONSEQUENCES No

COMMODITY. CODE/SERVICE TYPE 86000000

MAJOR DELIVERABLE USF shall submit HE Coalition and HE Plan Task Force meeting minutes DESCRIPTION METHOD OF PAYMENT Fixed Price-Unit Cost

MAJOR DELIVERABLE PRICE $0.00

NON-PRICE JUSTIFICATION 1. Price Cannot be determined

PAGE REFERENCE 4

USF shall submit HE Coalition and He Plan Task Force meeting minutes (Exhibit E), PERFORMANCE METRICS presentations, and similar documentation fo the Department within 15 days from the end of the month.

FINANCIAL CONSEQUENCES The Department shall reduce the contract payables up to 5% should USF fail to meet reportinq deadlines for a monthly report required in this contract.

DELIVERABLE NUMBER 2

Page I 5 DH 1122, 08/2021 - previous editions may not be used

Deliverable # 4 CONTRACT WIDE CONSEQUENCES No

COMMODITY CODE/SERVICE TYPE 86000000

MAJOR DELIVERABLE USF shall submit monthly progress reports DESCRIPTION METHOD OF PAYMENT Fixed Price-Unit Cost

MAJOR DELIVERABLE PRICE $0.00

NON-PRICE JUSTIFICATION 1. Price. Cannot be determined

PAGE REFERENCE 4

USF shall submit a Monthly Progress Report (Exhibit B ) to the Department, due by the 15th of the following month, documenting the development of the HE Plan, activities conducted related to the HE Plan, HE Coalition and HE Plan Task Force meeting outcomes and next steps, activities related to the promotion of health equity messaging in

PERFORMANCE METRICS the community, planning activities related to the National Minority Health Month promotional event, USF participation in meetings as requested by the Department, and documentation of disseminated resources, including frequency of written communications to appropriate partners, a list of disseminated resources, and a list of who resources were disseminated to.

FINANCIAL CONSEQUENCES The Department shall reduce the contract payables up to 5% should USF fail to meet reporting deadlines for a monthly report required in this contract.

DELIVERABLE NUMBER 4

Deliverable # 5 CONTRACT WIDE CONSEQUENCES No

COMMODITY CODE/SERVICE TYPE 86000000

MAJOR DELIVERABLE USF shall submit a completed invoice

DESCRIPTION

METHOD OF PAYMENT Fixed Price-Unit Cost

MAJOR DELIVERABLE PRICE $0.00

NON-PRICE JUSTIFICATION 1. Price Cannot be determined

PAGE REFERENCE 4

PERFORMANCE METRICS USF shall provide the Department a completed invoice (Exhibit A) along with the Monthly Progess Report (Exhibit B) on a monthly basis, due by the 15th of the following month.

FINANCIAL CONSEQUENCES The Department shall reduce the contract payables up to 5% should USF fail to meet reporting deadlines for a monthly report required in this contract.

DELIVERABLE NUMBER 5

PART VI: AGENCY CONTRACT REVIEW

By signing this document, the parties certify that the provider selection process, contract negotiation, cost/price analysis, RFPIITBIITN and justification of need for advances have been performed and approved for this contract and that documentation supporting these activities is contained in the Contract Manager's file. This sign-off and approval further attests to the need for the services and signifies that the statement of work is clearly written, and expected results are quantifiable and measurable, and are clearly defined in the contract and meet departmental policy requirements contracting. It also signifies that the contract terms and conditions are in compliance with applicable federal, state, and/or other funding source requirements.

-IJ l ft~_' ,j {ZLl+Lz ( S' C J

I Ignature - ontract Manager Date

____L;(Yl~ 11., I 17-('Lf Signature - C tract I anager Supervisor Date I

**Disclaimer: I

CONTRACT ADMINISTRATOR

~ APPROVED 0 DISAPPROVED ~~ 1/7L2'2 I

Signature - Contract Administrator Date

Page I 6 DH 1122, 08/2021 - previous editions may not be used

Comments:

I" FINANCIAL

Budget sign-off and approval signifies the presence of budget authority to expend monies for services specified in the contract and the correctness of accounting codes.

1/10/2022 Date

D o APPROVED DISAPPROVED

Comments:

The subject contract is approved as to form and legality based on the documents provided to the undersigned. The contract is in compliance with applicable Florida law, particularly the provisions governing contracts as outlined in Chapter 287, Florida Statutes.

11 I ?/lfft7...

Date o DISAPPROVED 18. APPROVED

Comments:

This sign-off and approval is required if the contract involves the acquisition, development or use of hardware, software, telecommunications, network or other IT related items and or services.

o DISAPPROVED o APPROVED Signature Date

Comments:

OTHER ., -

This sign-off to be used for other approvals as required and/or desired (e.g. Staff Development, etc.)

o DISAPPROVED o APPROVED Signature Date

Comments:

PART VII: EXTEND.ED CONTRACT INFORMATION . r I Deliverable # 6 CONTRACT WIDE CONSEQUENCES No

COMMODITY CODE/SERVICE TYPE 86000000

MAJOR DELIVERABLE DESCRIPTION USF shall submit a draft of the HE Plan METHOD OF PAYMENT Fixed Price-Unit Cost

MAJOR DELIVERABLE PRICE $0.00

NON-PRICE JUSTIFICATION 1. Price Cannot be determined

PAGE REFERENCE 4

PERFORMANCE METRICS

USF shall submit a completed draft of the HE Plan (Exhibit G) to the Department by May 31,2022.

FINANCIAL CONSEQUENCES

The Department shall reduce the contract payables up to 5% should USF fail to meet reporting deadlines for a monthly report required in this contract.

DELIVERABLE NUMBER 6

Page 17 DH 1122, 08/2021 - previous editions may not be used

ATTACHMENT _____

Revised 09.2021 FDOH, Contracts and Grants Management Unit - Federal Compliance and Audit Management Section

AUDIT REQUIREMENTS FOR AWARDS OF STATE AND FEDERAL FINANCIAL ASSISTANCE

The administration of resources awarded by the Department of Health to recipient organization may be federal or state financial assistance as defined by 2 CFR § 200.40 and/or section 215.97, Florida Statutes, and may be subject to audits and/or monitoring by the Department of Health, as described in this section. For this agreement, the Department of Health has determined the following relationship exist:

1. ________ Vendor/Contractor (215.97(z), F.S.) and (2 CFR § 200.23). Funds used for goods and services for the Department of Health’s own use and creates a procurement relationship with Recipient which is not subject to single audit act compliance requirements for the Federal/State program as a result of this contract agreement.

A vendor/contractor agreement may also be used with an established Service Organization (SO) that is serving as a Third-Party Administrator and in this case, is subject to SSAE18 audit reporting requirements (see Part III.

Other Audit Requirements).

2. ________ Recipient/Subrecipient of state financial assistance (215.97(o)(y), F.S.). Funds may be expended only for allowable costs resulting from obligations incurred during the specified contract period. In addition, any balance of unobligated funds which has been advanced or paid must be refunded to the Department of Health as the state awarding agency. As well as funds paid in excess of the amount to which the recipient/subrecipient is entitled under the terms and conditions of the contract must be refunded to the Department of Health.

3. ________ Recipient/Subrecipient of federal financial assistance (2 CFR § 200.40) . Funds paid in excess of the amount to which the recipient/subrecipient is entitled under the terms and conditions of the contract must be refunded to the Department of Health as the Pass-Through state awarding agency. In addition, the recipient/subrecipient may not earn or keep any profit resulting from Federal financial assistance, unless explicitly authorized by the terms and conditions of the Federal award or this agreement.

Note: A vendor/contractor vs. recipient/subrecipient determination must conclude with the completion of Exhibit 2 to identify the recipient’s audit’s relationship with the department.

MONITORING

In addition to reviews of audits conducted in accordance with 2 CFR Part 200, Subpart F (formerly A-133) - Audit Requirements, and section 215.97, Florida Statutes (F.S.), as revised (see AUDITS below), monitoring procedures may include, but not be limited to, on-site visits by Department of Health staff, limited scope audits as defined by 2 CFR §200.425, or other procedures. By entering into this agreement, the recipient agrees to comply and cooperate with any monitoring procedures or processes deemed appropriate by the Department of Health. In the event the Department of Health determines that a limited scope audit of the recipient is appropriate, the recipient agrees to comply with any additional instructions provided by Department of Health staff to the recipient regarding such audit.

The recipient further agrees to comply and cooperate with any inspections, reviews, investigations, or audits deemed necessary by the Chief Financial Officer (CFO) or Auditor General.

Contract #HB391

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AUDIT GUIDANCE

PART I: FEDERALLY FUNDED

This part is applicable if Recipient is a State or local government or a non-profit organization as defined in 2 CFR §200.90, §200.64, and §200.70.

1. If a recipient expends $750,000 or more in Federal awards during its fiscal year, the recipient must have a single or program-specific audit conducted in accordance with the provisions of 2 CFR 200, Subpart F - Audit Requirements. EXHIBIT 1 to this form lists the federal resources awarded through the Department of Health by this agreement. In determining the federal awards expended in its fiscal year, the recipient shall consider all sources of federal awards, including federal resources received from the Department of Health. The determination of amounts of federal awards expended should be in accordance with the guidelines established in 2 CFR §§200.502-503. An audit of the recipient conducted by the Auditor General in accordance with the provisions of 2 CFR §200.514 will meet the requirements of this Part.

2. In connection with the audit requirements addressed in Part I, paragraph 1, Recipient shall fulfill the requirements relative to auditee responsibilities as provided in 2 CFR §§ 200.508-.512.

3. If a recipient expends less than $750,000 in Federal awards in its fiscal year, the recipient is not required to have an audit conducted in accordance with the provisions of 2 CFR 200, Subpart F - Audit Requirements. If the recipient expends less than $750,000 in federal awards in its fiscal year and elects to have an audit conducted in accordance with the provisions of 2 CFR 200, Subpart F - Audit Requirements, the cost of the audit must be paid from non-federal resources (i.e., the cost of such an audit must be paid from recipient resources obtained from other than federal entities).

Note: Audits conducted in accordance with this part shall cover the entire organization for the organization’s fiscal year.

Compliance findings related to contracts with the Department of Health shall be based on the contract agreement’s requirements, including any rules, regulations, or statutes referenced in the contract. The financial statements shall disclose whether the matching requirement was met for each applicable contract. All questioned costs and liabilities due to the Department of Health shall be fully disclosed in the audit report with reference to the Department of Health contract involved. If not otherwise disclosed as required by 2 CFR § 200.510, the schedule of expenditures of Federal awards shall identify expenditures by funding source and contract number for each contract with the Department of Health in effect during the audit period.

Financial reporting packages required under this part must be submitted within the earlier of 30 days after receipt of the audit report or 9 months after the end of Recipient’s fiscal year end.

PART II: STATE FUNDED

This part is applicable if the recipient is a nonstate entity as defined by section 215.97(1)(n), Florida Statutes.

1. If a recipient expends a total amount of state financial assistance equal to or in excess of $750,000 in any fiscal year of such recipient (for fiscal years ending June 30, 2017 or thereafter), recipient must have a State single or project-specific audit for such fiscal year in accordance with section 215.97, Florida Statutes;

applicable rules of the Department of Financial Services; Chapter 10.550 (local governmental entities) or Chapter 10.650 (nonprofit and for-profit organizations), Rules of the Auditor General. EXHIBIT I to this contract indicates state financial assistance awarded through the Department of Health by this contract. In determining the state financial assistance expended in its fiscal year, recipient shall consider all sources of state financial assistance, including state financial assistance received from the Department of Health, other state agencies, and other nonstate entities. State financial assistance does not include Federal direct or pass-through awards and resources received by a nonstate entity for Federal program matching requirements.

2. In connection with the audit requirements addressed in Part II, paragraph 1, recipient shall ensure that the audit complies with the requirements of section 215.97(8), Florida Statutes. This includes submission of a financial reporting package as defined by section 215.97(2), Florida Statutes, and Chapter 10.550 (local governmental entities) or Chapter 10.650 (nonprofit and for-profit organizations), Rules of the Auditor General.

3. If a recipient expends less than $750,000 in state financial assistance in its fiscal year (for fiscal years ending June 30, ,2017 or thereafter), an audit conducted in accordance with the provisions of section 215.97, Florida Statutes, is not required. In the event that a recipient expends less than $750,000 in state financial assistance in its fiscal year and elects to have an audit conducted in accordance with the provisions of section 215.97, Florida Statutes, the cost of the audit must be paid from the nonstate entity’s resources (i.e., the cost of such an audit must be paid from recipient resources obtained from other than state funds).

Note: An audit conducted in accordance with this part shall cover the entire organization for the organization’s fiscal year.

Compliance findings related to contracts with the Department of Health shall be based on the contract’s requirements, including any applicable rules, regulations, or statutes. The financial statements shall disclose whether the matching requirement was met for each applicable contract. All questioned costs and liabilities due to the Department of Health shall be fully disclosed in the audit report with reference to the Department of Health contract involved. If not otherwise disclosed as required by Florida Administrative Code Rule 69I-5.003, the schedule of expenditures of state financial assistance shall identify expenditures by contract number for each contract with the Department of Health in effect during the audit period.

Financial reporting packages required under this part must be submitted within 45 days after delivery of the audit report, but no later than 9 months after recipient’s fiscal year end for local governmental entities. Non-profit or for-profit organizations are required to be submitted within 45 days after delivery of the audit report, but no later than 9 months after recipient’s fiscal year end. Notwithstanding the applicability of this portion, the Department of Health retains all right and obligation to monitor and oversee the performance of this contract as outlined throughout this document and pursuant to law.

FDOH, Contracts and Grants Management Unit - Federal Compliance and Audit Management Section Contract #__________

PART III: OTHER AUDIT REQUIREMENTS

This part is applicable to a contractor, vendor and/or provider organization serving as a third-party administrator on behalf of FDOH programs and is classified or determined in the FDOH contract agreement to be a Service Organization (SO).

If the contracted entity is determined to be a Service Organization (SO), the entity must perform an attestation to the System Organization Controls (SOC) and submit to FDOH a “Statement on Standards for Attestation Engagements (SSAE18) audit report within the assigned timeframe as agreed upon in the SO’s contract agreement.

The hired Auditor must make an evaluation consistent with the FDOH contract terms and conditions to determine which SSAE18 report types to perform for the required SOC types. Below are the options available for the SSAE18 reports;

TYPES:

1. SOC 1 – A report on controls over financial reporting.

➢ Type 1 Report - Report on the fairness of the presentation of management’s description of the service organization’s system and the suitability of the design of the controls to achieve the related control objectives included in the description as of a specified date.

➢ Type 2 Report - Report on the fairness of the presentation of management’s description of the service organization’s system and the suitability of the design and operating effectiveness of the controls to achieve the related control objectives included in the description throughout a specified period. (Auditor conducts testing)

2. SOC 2 – A report on controls that may be relevant to security, availability, processing Integrity, confidentiality or privacy. These reports are intended to meet the needs of a broad range of users that need detailed information and assurance about the controls at a service organization relevant to security, availability, and processing integrity of the systems the service organization uses to process users’ data and the confidentiality and privacy of the information processed by these systems. These reports can play an important role in:

• Oversight of the organization

• Vendor management programs

• Internal corporate governance and risk management processes

• Regulatory oversight

➢ Type 1 Report - Report on the fairness of the presentation of management’s description of the service organization’s system and the suitability of the design of the controls to achieve the related control objectives included in the description as of a specified date.

➢ Type 2 Report - Report on the fairness of the presentation of management’s description of the service organization’s system and the suitability of the design and operating effectiveness of the controls to achieve the related control objectives included in the description throughout a specified period. (Auditor conducts testing)

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HB391

PART IV: REPORT SUBMISSION

1. Copies of single audit reporting packages for state financial assistance (CSFA) and federal financial assistance

(CFDA) conducted in accordance with 2 CFR § 200.512 and section 215.97(2), Florida Statutes, shall be submitted by or on behalf of recipient directly to:

A. The Department of Health as follows:

SingleAudits@flhealth.gov

Pursuant to 2 CFR § 200.521, and section 215.97(2), Florida Statutes, recipient shall submit an electronic copy of the reporting package and any management letter issued by the auditor to the Department of Health.

Audits must be submitted in accordance with the instructions set forth in Exhibit 3 hereto and accompanied by the “Single Audit Data Collection Form, Exhibit 4.” Files which exceed electronic email capacity may be submitted on a CD or other electronic storage medium and mailed to:

Florida Department of Health Contracts and Grants Management Unit Attention: FCAM, Single Audit Review 4052 Bald Cypress Way, Bin B01 Tallahassee, FL 32399-1701.

B. The Auditor General’s Office as follows:

One electronic copy email by or on behalf of recipient directly to the Auditor General’s Office at:

flaudgen_localgovt@aud.state.fl.us.

One paper copy mail to:

Auditor General’s Office Claude Pepper Building, Room 401 111 West Madison Street Tallahassee, Florida 32399-1450

2. In addition to item 1, electronic copies of reporting packages for federal financial assistance (CFDA) conducted in accordance with 2 CFR § 200.512 shall also be submitted by or on behalf of recipient directly to each of the following:

A. The Federal Audit Clearinghouse (FAC), the Internet Data Entry System (IDES) is the place to submit the Federal single audit reporting package, including form SF-SAC, for Federal programs. Single audit submission is required under the Single Audit Act of 1984 (amended in 1996) and 2 CFR § 200.36 and § 200.512. The Federal Audit Clearinghouse requires electronic submissions as the only accepted method for report compliances. FAC’s website address is: https://harvester.census.gov/facweb/

B. When applicable, other Federal agencies and pass-through entities in accordance with 2 CFR §200.331 and § 200.517.

3. Copies of SSAE18 reports and supporting documents shall be submitted by or on behalf of SO/Third Party Administrator directly to the FDOH designated Contract Manager (CM) as outlined in each SO contract agreement.

Note: Any reports, management letter, or other information required to be submitted to the Department of Health pursuant to this contract shall be submitted timely in accordance with 2 CFR § 200.512 and Florida Statutes, Chapter 10.550 (local governmental entities) or Chapter 10.650 (nonprofit and for-profit organizations), Rules of the Auditor General, as applicable.

Recipients, when submitting financial reporting packages to the Department of Health for audits done in accordance with 2 CFR §

500.512 or Chapter 10.550 (local governmental entities) or Chapter 10.650 (nonprofit and for-profit organizations), Rules of the Auditor General, should indicate the date that the reporting package was delivered to recipient in correspondence accompanying the reporting package.

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PART V: RECORD RETENTION

Recipient shall retain sufficient records demonstrating its compliance with the terms of this contract for a period of six years from the date the audit report is issued and shall allow the Department of Health or its designee, the CFO, or the Auditor General access to such records upon request. Recipient shall ensure that audit working papers are made available to the Department of Health, or its designee, CFO, or Auditor General upon request for a period of six years from the date the audit report is issued, unless extended in writing by the Department of Health.

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Contract #HB391FDOH, Contracts and Grants Management Unit - Federal Compliance and Audit Management Section

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EXHIBIT 1

2. STATE RESOURCES AWARDED TO THE RECIPIENT PURSUANT TO THIS AGREEMENT CONSIST OF THE

FOLLOWING:

State financial assistance subject to section 215.97, Florida Statutes: CSFA# ______Title_________________________

State financial assistance subject to section 215.97, Florida Statutes: CSFA# ______Title_________________________

TOTAL STATE FINANCIAL ASSISTANCE AWARDED PURSUANT TO SECTION 215.97, FLORIDA STATUTES

COMPLIANCE REQUIREMENTS APPLICABLE TO STATE RESOURCES AWARDED PURSUANT TO THIS AGREEMENT ARE AS

FOLLOWS:

Financial assistance not subject (exempt) to section 215.97, Florida Statutes or 2 CFR § 200.40: $______________

Financial assistance not subject (exempt) to section 215.97, Florida Statutes or 2 CFR § 200.40: $______________

Matching and Maintenance of Effort *

Matching resources for federal Agency(s):

Agency: _________________________CFDA#_________Title___________________________________ $______________

Maintenance of Effort (MOE):

Agency: _________________________CFDA#_________Title___________________________________ $______________

*Matching Resources, MOE, and Financial Assistance not subject to section 215.97, Florida Statutes or 2 CFR § 200.306 amounts should not be included by recipient when computing the threshold for single audit requirements totals. However, these amounts could be included under notes in the financial audit or footnoted in the Schedule of Expenditures of Federal Awards and State Financial Assistance (SEFA). Matching, MOE, and Financial Assistance not subject to section. 215.97, Florida Statutes or 2 CFR § 200.306 is not considered State or Federal Assistance.

ARE AS FOLLOWS:

COMPLIANCE REQUIREMENTS APPLICABLE TO THE FEDERAL RESOURCES AWARDED PURSUANT TO THIS AGREEMENT

TOTAL FEDERAL AWARDS $_____________

Federal Agency 2 ______________________CFDA# ________Title_________________________$______________

Federal Agency 1______________________ CFDA# ________Title_________________________$______________

FOLLOWING:

FEDERAL RESOURCES AWARDED TO THE SUBRECIPIENT PURSUANT TO THIS AGREEMENT CONSIST OF THE 1.

Federal Award Identification #:_______________________________________________________

Contract #: HB391

FDOH, Contracts and Grants Management Unit - Federal Compliance and Audit Management Section

Revised 09.2021

Contract #HB391

HDG21 93.354 Health Disparities 35,000.00

35,000.00

64.052 Health Disparities

55,000.00

55,000.00

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EXHIBIT 2

PART I: AUDIT RELATIONSHIP DETERMINATION

Recipients who receive state or federal resources may or may not be subject to the audit requirements of 2 CFR § 200.500, and/or section 215.97, Florida Statutes, recipients who are determined to be recipients or subrecipients of federal awards and/or state financial assistance may be subject to the audit requirements if the audit threshold requirements set forth in Part I and/or Part II of Exhibit 1 is met.

Recipients who have been determined to be vendors are not subject to the audit requirements of 2 CFR § 200.501, and/or section 215.97, Florida Statutes. Recipients who are “higher education entities” as defined in Section 215.97(2)(h), Florida Statutes, and are recipients or subrecipients of state financial assistance, are also exempt from the audit requirements of Section 215.97(2)(a), Florida Statutes.

Regardless of whether the audit requirements are met, recipients who have been determined to be recipients or subrecipients of Federal awards and/or state financial assistance must comply with applicable programmatic and fiscal compliance requirements.

For the purpose of single audit compliance requirements, the Recipient has been determined to be:

_____Vendor/Contractor not subject to 2 CFR § 200.501 and/or section 215.97, Florida Statutes _____ Recipient/subrecipient subject to 2 CFR § 200.501and/or section 215.97, Florida Statutes _____ Exempt organization not subject to 2 CFR § 200.501; For Federal awards for-profit subrecipient organizations are exempt as specified in 2 CFR § 200.501(h).

_____ Exempt organization not subject to section 215.97, Florida Statutes, for state financial assistance projects, public universities, community colleges, district school boards, branches of state (Florida) government, and charter schools are exempt. Exempt organizations must comply with all compliance requirements set forth within the contract.

For other audit requirements, the Recipient has been determined to be:

_____ Service Organization (SO) subject to SSAE18 reporting requirements

NOTE: If a recipient is determined to be a recipient/subrecipient of federal and or state financial assistance and has been approved by the department to subcontract, it must comply with section 215.97(7), Florida Statutes, and Florida Administrative Code Rule 69I-.5006, [state financial assistance] and 2 CFR § 200.330 [federal awards].

PART II: FISCAL COMPLIANCE REQUIREMENTS

FEDERAL AWARDS OR STATE MATCHING FUNDS ON FEDERAL AWARDS. Recipients who receive Federal awards, state maintenance of effort funds, or state matching funds on Federal awards and who are determined to be a subrecipient must comply with the following fiscal laws, rules and regulations:

1. 2 CFR Part 200- Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards

2. Reference Guide for State Expenditures

3. Other fiscal requirements set forth in program laws, rules, and regulations

*Some Federal programs may be exempted from compliance with the Cost Principles Circulars as noted in the 2 CFR § 200.401(5)

(c).

**For funding passed through U.S. Health and Human Services, 45 CFR Part 92; for funding passed through U.S. Department of

Education, 34 CFR Part 80.

STATE FINANCIAL ASSISTANCE. Recipients who receive state financial assistance and who are determined to be a recipient/subrecipient must comply with the following fiscal laws, rules and regulations:

1. Section 215.97, Florida Statutes

2. Florida Administrative Code Chapter 69I-5,

3. State Projects Compliance Supplement

4. Reference Guide for State Expenditures

5. Other fiscal requirements set forth in program laws, rules and regulations

This document may be obtained online through the FlHealth website under Audit Guidance. *Enumeration of laws, rules and regulations herein is not exhaustive or exclusive. Funding to recipients will be held to applicable legal requirements whether or not outlined herein.

End of Text

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EXHIBIT 3

INSTRUCTIONS FOR ELECTRONIC SUBMISSION

OF SINGLE AUDIT REPORTS

Part I: Submission to FDOH

Single Audit reporting packages (“SARP”) must be submitted to the Department in an electronic format. This change will eliminate the need to submit multiple copies of the reporting package to the Contract Managers and various sections within the Department and will result in efficiencies and cost savings to recipient and the Department. Upon receipt, the SARP’s will be posted to a secure server and accessible to Department staff.

The electronic copy of the SARP should:

➢ Be in a Portable Document Format (PDF).

➢ Include the appropriate letterhead and signatures in the reports and management letters.

Be a single document. However, if the financial audit is issued separately from the Single Audit reports, the financial audit reporting package may be submitted as a single document and the Single Audit reports may be submitted as a single document. Documents which exceed 8 megabytes (MB) may be stored on a CD and mailed to: Contracts and Grants Management Unit, Attention: FCAM, Single Audit Review, 4052 Bald Cypress Way, Bin B01, Tallahassee, FL 32399-1701.

➢ Be an exact copy of the final, signed SARP provided by the Independent Audit firm.

➢ Not have security settings applied to the electronic file.

➢ Be named using the following convention: [fiscal year] [name of the audited entity exactly as stated within the audit report].pdf.

For example, if the SARP is for the 2016-17 fiscal year for the City of Gainesville, the document should be entitled 2016 City of Gainesville.pdf.

➢ Be accompanied by the attached “Single Audit Data…