Fiscal Health Checkbook

The Fiscal Health Checkbook A Guide of Ryan White HIV/AIDS Program Administrators

Achieving Fiscal Health

For more information about Fiscal Health contact Jacqueline Coleman, MEd, MSM via e-mail: training@healthhiv.org or telephone: 202.507.4732

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The Fiscal Health Checkbook: 150 Tips + 20 Bonus Bits

Fiscal Health Checkbook A Guide of Ryan White HIV/AIDS Program Administrators

www.healthhiv.org

Fiscal Health

Introduction HealthHIV’s Fiscal Health: Systems to Sustainability program ensures the fiscal sustainability of Ryan White funded grantees by building organizational fiscal management capacity.

Through Fiscal Health, HealthHIV trains AIDS Service Organizations to diversify and improve income streams, as well as develop and enhance operational fiscal systems through multiple training activities, including on-site group trainings, one-on-one learning, and online education.

The Fiscal Health Checkbook: 150 Tips + 20 Bonus Bits

Table of Contents Top 10 Tips for Effective Fiscal Monitoring …

Making the Grade

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Top Ten Facilitators for Resilient Health Care Organizations

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Top Ten Tips for Transitioning Health Care Organizations

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Top 10 Fiscal Sustainability Improvements List

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Nonprofit Organization Fiscal Sustainability Checklist

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Top 10 Federal Grant Compliance Pitfalls

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Top Ten Nonprofit Program Monitoring Checklist

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Top 10 Reasons to Engage Your Organization in Periodic Strategic Planning

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■ 7a. Organizational Capacity Analysis

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■ 7b. SWOT Table

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Top 10 Reasons Organizations Should Engage in Business Planning in this Changing Health Care Landscape

■ 8a. Nokware-SWOT Table[1]

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Top 10 Revenue Generation and Income Diversification Tips

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Top 10 Tips on Understanding Program Income Issues

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Top 10 Issues Related to Administrative/Indirect Cost

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Top 10 List of Fiscal Monitoring Strategies for Ryan White HIV/AIDS Program Grantees

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Top 10 List of Eligibility Determination (ED) Strategies for Ryan White HIV/AIDS Program Direct Service Grantees and Subgrantees

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Top 10 List of Client Fee Strategies for Ryan White HIV/AIDS Program Grantees)

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Top 10 List of Third Party Reimbursement Strategies for Ryan White HIV/AIDS Program Direct Service Grantees and Subgrantees

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Top 10 Tips for Effective Fiscal Monitoring‌ Making the Grade 1. View any monitoring activities as opportunities rather than threats.

2. Have a thorough understanding of program expectations, requirements, and monitoring standards.

3. Ensure separate functions in a manner appropriate to organization size in order to safeguard assets and maintain financial stability, including an annual independent financial audit and corrective action plan addressing all findings, questioned costs, reportable conditions and material weaknesses cited.

4. Develop a budget that reflects the costs of operations, expenses, and revenues necessary to accomplish service delivery plan.

5. Utilizing budgets and comparative financial expense reports with sufficient detail to document appropriateness of allocations and expenditures, review reports and ensure that allocations are within limitations on uses of funding and ensure that budgets and expenditures do not include any unallowable costs.

6. Create and document a policy for the establishment of a schedule of charges, client eligibility determination procedures for imposition of charges, and with a system for tracking charges, payments and adjustments to ensure policy is being correctly and consistently applied in accordance with policies and federal requirements.

7. Establish and implement a process to ensure maximization of third party reimbursements, provide for routine screening of clients for program eligibility and the capability to produce required reporting on billings, collections from third party payers, and tracking of program income.

8. Ensure adequacy of fiscal systems to generate needed budgets and expenditure reports, including accounting policies and procedures, budgets, accounting systems and reports.

9. Have systems, policies and procedures in place to determine allowable and reasonable costs, with methodologies for allocating costs among different funding sources in sufficient detail to allow for meaningful analysis.

10. Establish and monitoring of financial performance measures as a part of your Quality Management process to evaluate progress from benchmark to an established goal and provide opportunity to revise strategies to turn the direction of a performance trend.

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Top 10 Facilitators for Resilient Health Care Organizations 1. Effective coordination of care through highly effective teams who use information, people, and resources to achieve the best clinical outcomes for patients, and clients.

2. Communication and synergy between the fiscal department and program/clinical service departments is a lifeline of a resilient health care organization.

3. Employment of reliability tools to measure health-related processes, procedures, and services, ensuring performance of intended functions in the required time under commonly occurring conditions.

4. Highly reliable organizations redesign for success in order to mitigate failures.

5. Resilient organizations are tightly coupled; that is, team members depend on each other to perform tasks across teams.

6. These organizational types are rely completely on team strength and resources.

7. Reliable teams defer to expertise, which can be located internally or externally to the organization.

8. Specific considerations are complex communications networks, multiple decision makers, and adoption of a culture of quality.

9. These organization examine their entire system to seek ways to enhance levels of performance, efficiency, and patient safety.

10. They also implement well-designed information systems and work flow processes to facilitate clarity of information transfer and sharing across departments.

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Outstanding Participant Feedback

“I appreciated the real-world application opportunities of the materials presented. These trainings were well worth my time!”

- Tampa, Florida “The expert trainer did an excellent job in presenting the material such that it can be readily applied to my day-to-day work.”

- New Orleans, Louisiana “This training was excellent for nonprofits and also helped reinforce some of the state requirements with regard to monitoring, reporting & allowable costs.”

- Chicago, Illinois “It’s unusual to find this combination of excellent subject knowledge and great presentations and setting!”

- San Bernardino, California “The training sessions made complex topics understandable.”

- Columbia, South Carolina

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Fiscal Management Trainers Jacqueline Coleman, M.Ed, MSM, VisionQue, has over 20 years of experience training and assisting faith based and public health entities within the HIV/AIDS arena to maximize their service to consumers, clients and the community. Ms. Coleman’s professional interests and expertise focuses on organizational development, capacity building, leadership development, community building and training.

Paul Calabrese, CPA, Rubino & McGeehin, is a Senior Manager and provides accounting, consulting, and training to nonprofit organizations and government contracting clients. He was a senior auditor with the Defense Contract Audit Agency. He has more than 28 years of extensive experience with all facets of government cost accounting.

A. Michael Gellman, CPA, Rubino & McGeehin, concentrates his practice on exempt organizations, including trade associations, public charities, private foundations, private operating foundations, fraternal organizations, and political action committees. His work is largely focused on management advisory services, including: working budget systems integrated with event calendars and responsibility budgets, cash management systems and investment policies, management reports, membership dues, billing analysis and program analysis, trend analysis, forecasts and projections, system documentation, and preparation of the application for exemption under Internal Revenue Service guidelines as well as articles of incorporation and by-laws and design of boards of directors and committees.

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Introduction HealthHIV offers fiscal management group-level training and individualized consultation tailored specifically to the needs of healthcare nonprofits using an innovative approach to adult learning, knowledge acquisition, and skills building called Learning Communities.

A Tailored Training For Your Needs Gain expertise in: ■ Revenue generation ■ Income diversification ■ Program income ■ Revenue cycle management ■ Budgets and their link to strategic plans ■ Tracking the flow of funds in a business ■ Key elements of an adequate financial management system ■ Fundamentals of federal grants management ■ Components of an annual audit ■ Basic components of an accounting system and how they relate to financial statements ■ T he differences between accrual basis accounting and cash basis accounting ■ Nuances of the new federal forms 990 Series ■ Timekeeping practices ■ Indirect rate administration and negotiation ■ Contingency budgets ■ Estimating revenue and expense reserves

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Table of Contents Fiscal Management for Healthcare Nonprofits offers practical, financial management infrastructure skills building to not-for-profit organizations.

Trainings create a solid foundation by putting into place sound fiscal practices to support and sustain a stable organization.

Who Should Attend Trainings benefit individuals at all levels of expertise in nonprofit health organizations, health departments and other government-level agencies. These include: ■ Program Officers who manage multiple organizations ■ Executive Directors, CEOs and other nonfinancial managers ■ Program Mangers ■ Finance Directors and Fiscal Managers

About HealthHIV HealthHIV is a national HIV nonprofit that advances effective prevention, care and support for people living with, or at risk for, HIV/AIDS through education, technical assistance, and health services research to organizations, communities and professionals.

HealthHIV designs and implements training and educational programs responsive to the needs of clinical, community-based, and faith-based organizations providing services at risk for, or living with, HIV by: ■ Implementing educational programs focusing on performance improvement; ■ Creating trainings based on adult learning principles; ■ Developing curricula responsive to user needs; and ■ Delivering trainings using state-of-the-art technology.

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Program Outline

Income Diversification/Revenue Generation for Organizational Financial Sustainability ■ E xpanding knowledge and tools for sustainability and fund development ■ I mplementing best practices to improve transparency and financial governance ■ A ssessing existing functions and programs on a profit centered basis ■ U sing selected impact factors to develop a matrix map of the current business models

Fundamentals of Financial Management ■ Defining accounting terminology ■ Tracking the flow of funds in a business ■ Five concepts of a financial conversation ■ Developing and interpreting statements of position ■ Developing and interpreting statements of activity ■ Improving revenue cycle management

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Fiscal Management and Accountability for Nonprofits ■ Basic components of a healthy financial management system ■ Basic financial statements ■ Internal accounting controls ■ Balancing mission and financial resources ■ Financial accountability

- Sarbanes-Oxley: Considerations for nonprofits

- Fiduciary accountability

- Staff management

Federal Grant Compliance: Managing Finances for Program Success ■ Federal grants management (OMB A-110) ■ Cost accounting principles ■ External audits and surveillance ■ Earned program income opportunities and donations

Budget Empowerment for Nonprofits ■ Behavioral-based budgeting ■ 12 steps of effective budget building for nonprofits ■ Critical budget considerations and common budget pitfalls

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