Iowa Dept Human Services Five Year Audit 2005 Thru 2011

• Topics: Misconduct/Corruption, Corrections Audits

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OFFICE OF AUDITOR OF STATE
ST AT E OF IOWA
State Capitol Building
Des Moines, Iowa 50319-0004
Telephone (515) 281-5834

David A. Vaudt, CPA
Auditor of State

Facsimile (515) 242-6134

NEWS RELEASE
FOR RELEASE

October 18, 2012

Contact: Andy Nielsen
515/281-5834

Auditor of State David A. Vaudt today released a combined report on the institutions
under the control of the Iowa Department of Human Services. The report includes findings and
recommendations and average cost per resident/patient information for the five years ended
June 30, 2011.
The average annualized cost per resident/patient at the nine institutions under the
control of the Iowa Department of Human Services ranged from $92,764 at the State Training
School – Eldora to $301,855 at the Woodward Resource Center and $421,601 at the Mental
Health Institute - Cherokee for the year ended June 30, 2011. Total general fund expenditures
for the nine institutions increased 5.72% during the five year period to approximately $220
million, the average number of residents/patients decreased 15.6%, from 1,137 to 960, and the
average daily cost per resident/patient increased 25.2%, from $501.40 to $627.80, over the
same period.
Copies of the report are available for review in the Office of Auditor of State and on the
Auditor of State’s web site at http://auditor.iowa.gov/reports/1262-8990-BR00.pdf.

###

COMBINED REPORT ON THE INSTITUTIONS UNDER THE
CONTROL OF THE IOWA DEPARTMENT OF HUMAN SERVICES
SCHEDULES
FINDINGS AND RECOMMENDATIONS
JUNE 30, 2011

 Office of 

AUDITOR
OF STATE

State Capitol Building  Des Moines, Iowa



David A. Vaudt, CPA
Auditor of State

Table of Contents
Page
Auditor of State’s Report

Overview

4-6

Schedules:

Schedule

Average Cost Per Resident/Patient Information by Institution Fiscal Years 2007 through 2011
Average Cost Per Resident/Patient Information – Graphs:
Total Expenditures
Average Number of Residents/Patients
Average Annualized Cost per Resident/Patient
General Fund Expenditures by Institution - 2007
General Fund Expenditures by Institution - 2008
General Fund Expenditures by Institution - 2009
General Fund Expenditures by Institution - 2010
General Fund Expenditures by Institution - 2011
Resident/Patient Population Statistics - 2011

8-11

2
3
4
5
6
7

13
14
15
16-17
18-19
20-21
22-23
24-25
26-27

Findings and Recommendations:
Mental Health Institute - Clarinda
Mental Health Institute - Mount Pleasant
Mental Health Institute - Cherokee
Mental Health Institute - Independence
Woodward Resource Center
Glenwood Resource Center
State Juvenile Home - Toledo
State Training School - Eldora
Civil Commitment Unit for Sexual Offenders

1262-8990-BR00

28-29
30
31
32
33-34
35
36
37
38

OFFICE OF AUDITOR OF STATE
ST AT E OF IOWA
State Capitol Building
Des Moines, Iowa 50319-0004
Telephone (515) 281-5834

David A. Vaudt, CPA
Auditor of State

Facsimile (515) 242-6134

October 9, 2012
To the Council Members of the
Iowa Department of Human Services:
The Institutions under the control of the Iowa Department of Human Services are a part of
the State of Iowa and, as such, have been included in our audits of the State’s Comprehensive
Annual Financial Report (CAFR) and the State’s Single Audit Report for the year ended June 30,
2011.
In conducting our audits, we became aware of certain aspects concerning the various
Institutions’ operations for which we believe corrective action is necessary. As a result, we have
developed recommendations which are reported on the following pages. We believe you should be
aware of these recommendations, which include recommendations pertaining to internal control
and compliance with statutory requirements and other matters. These recommendations have
been discussed with applicable Institution personnel and their responses to these
recommendations are included in this report. While we have expressed our conclusions on the
Institutions’ responses, we did not audit the Institutions’ responses and, accordingly, we express
no opinion on them.
We have also included certain unaudited financial and other information for the
Institutions under the control of the Iowa Department of Human Services for the five years ended
June 30, 2011 to report an average cost per resident/patient at each Institution as required by
Chapter 11.28 of the Code of Iowa.
This report, a public record by law, is intended solely for the information and use of the
officials and employees of the Iowa Department of Human Services, the Institutions under the
control of the Iowa Department of Human Services, citizens of the State of Iowa and other parties
to whom the Iowa Department of Human Services may report. This report is not intended to be
and should not be used by anyone other than these specified parties.
We would like to acknowledge the many courtesies and assistance extended to us by
personnel of the Institutions during the course of our audits. Should you have questions
concerning any of the above matters, we shall be pleased to discuss them with you at your
convenience. Individuals who participated in our audits of the Institutions are listed on pages 29,
30, 31, 32, 34, 35, 36, 37 and 38 and they are available to discuss these matters with you.

DAVID A. VAUDT, CPA
Auditor of State
cc:

WARREN G. JENKINS, CPA
Chief Deputy Auditor of State

Honorable Terry E. Branstad, Governor
David Roederer, Director, Department of Management
Glen P. Dickinson, Director, Legislative Services Agency
3

Iowa Department of Human Services
Overview

Background
In accordance with Chapter 218 of the Code of Iowa, the Iowa Department of Human Services has
the authority to control, manage, direct and operate the following institutions:
Mental Health Institute - Clarinda – The Institute has been serving the citizens of
Southwest Iowa since 1888. The function of this Institute is to promote good mental
health practices and to provide high level care for persons with mental illness. Levels of
care provided are adult in-patient psychiatric and gero-psychiatric.
Mental Health Institute - Mount Pleasant – The Institute was established on February 2,
1861. Major goals and objectives of the Institute are to be responsive to the communityoriented patient care needs of the population it serves, without duplicating services
already provided in the community. Levels of care provided are adult in-patient
psychiatric and dual diagnosis.
Mental Health Institute - Cherokee – The Institute was founded in 1902. The Institute is
responsible for furnishing psychiatric services to citizens of Northwest Iowa counties to
the extent such services are not provided by other sources. Levels of care provided are
adult in-patient psychiatric and child and adolescent in-patient psychiatric.
Mental Health Institute - Independence – The Institute was established on May 1, 1873.
The Institute is a fully accredited psychiatric care hospital and provides treatment for
mentally ill adults, adolescents and children. Levels of care provided are adult inpatient psychiatric, child and adolescent in-patient psychiatric and psychiatric-medical
institute for children.
Woodward Resource Center – The Resource Center was established in 1917. The Center is
a residential facility for the mentally retarded and provides treatment, training,
instruction, care, habilitation and support of persons with an intellectual disability or
other disabilities in the State.
Glenwood Resource Center – The Resource Center was established on September 1, 1876.
The Center is a residential facility for the mentally retarded and provides treatment,
training, instruction, care, habilitation and support of persons with an intellectual
disability or other disabilities in the State.
State Juvenile Home - Toledo – The Juvenile Home was established on October 21, 1920.
This Institution is a structured, non-secure co-ed facility serving juveniles under 17 who
are residents of the State of Iowa in need of assistance. The residents are committed by
the juvenile courts as dependent or neglected or are committed voluntarily through
application to the County Board of Supervisors and the Iowa Department of Human
Services. The children become wards of the State to receive educational, medical,
diagnostic treatment and limited employment programs to help them attain productive
and satisfying citizenship in a free society.
State Training School - Eldora – The Training School was established in 1868. The
Institution is a minimum security facility for boys between the ages of twelve and
eighteen who have been adjudicated delinquent by the juvenile courts of the State of
Iowa. Effective January 1, 1992, a diagnosis and evaluation center and other units were
established to provide juvenile delinquents a program which focuses upon appropriate
developmental skills, treatment, placement and rehabilitation.

Iowa Department of Human Services
Overview

Civil Commitment Unit for Sexual Offenders (CCUSO) – The Civil Commitment Unit for
Sexual Offenders was established in 1999. The Unit provides treatment for sexually
violent predators in a secure facility located in Cherokee, Iowa. The residents have
completed their criminal sentences, have been identified as a high risk for a repeat
offense and are committed through a civil action by order of the courts.
As mentioned on the previous page, different levels of care are provided at each of the Mental
Health Institutes. They are:
Adult In-patient Psychiatric – This program, licensed as a hospital, represents traditional,
in-hospital psychiatric care for persons 18 years of age and older. It includes 24-hour
nursing care and 24-hour medical and psychiatric on call coverage.
Child and Adolescent In-patient Psychiatric – This program, licensed as a hospital,
represents traditional, in-hospital psychiatric care for persons under 18 years of age. It
includes a required educational component and 24-hour nursing care and 24-hour
medical and psychiatric on-call coverage.
Gero-Psychiatric – This program, licensed as nursing home care, represents 24-hour
custodial care for persons declared disabled or over age 65. There is some level of 24hour nursing care and periodic medical and psychiatric care. Generally, these persons
are beyond the capacity of community providers to care for.
Psychiatric-Medical Institute for Children (PMIC) – This program, licensed as a PMIC,
represents 24-hour care and behavior management for persons 12 to 17 years of age
requiring intensive behavioral treatment modalities. There is periodic nursing and
psychiatric coverage.
Generally, these children are beyond the care of privately
administered PMIC’s in the state.
Dual Diagnosis – This program represents a 28-day residential substance dependence
treatment program for persons with co-morbid mental illness. There is periodic nursing,
medical and psychiatric coverage. It is the only program for this population in the state
of Iowa.
Scope and Methodology
We have calculated an average cost per resident/patient at each Institution for the five
years ended June 30, 2011 based on their general fund expenditures. Certain reclassifications
and changes have been made to these expenditures to provide comparable averages between
Institutions. Therefore, expenditure amounts and cost per resident/patient averages may differ
from those used for statewide financial statement purposes. These reclassifications and changes
are as follows:
(1) Operating transfers, primarily reimbursements to other state agencies for services,
have been reclassified as expenditures for purposes of this report.
(2) At the inception of a capital lease, total principal payments are recorded as
expenditures and as other financing sources for statewide purposes. For purposes of
this report, we have included only the current year principal and interest payments
as expenditures.
(3) Canteen operations have been excluded from general fund expenditures since the
canteen is a self-supporting operation at each Institution.
(4) Non-cash assistance, consisting of USDA commodities, has been excluded from
general fund expenditures.
5

Iowa Department of Human Services
Overview

Median stay information was not calculated or presented in the accompanying average cost
per resident/patient schedule for the resource centers or juvenile facilities since the median stay
tends to be for a much longer period.
The average annualized cost per resident/patient is calculated using the average number of
occupied resident beds. Since the median stay at the Mental Health Institutes tends to be less
than the stay at the other Institutions, the cost per stay was calculated for each of the Mental
Health Institutes. This represents the average cost for the median stay of each patient admitted.
Summary Observation
The Mental Health Institute – Cherokee provides significant outpatient services not
performed by other Institutions. Adequate statistical data on outpatient services, including the
amount and cost of services provided by year, was not readily available. Accordingly, the cost per
resident/patient information at the Mental Health Institute - Cherokee is not comparable to other
Institutions and may not be comparable between years at the Mental Health Institute - Cherokee.
The amount of support services the Mental Health Institute – Cherokee provided for the Civil
Commitment Unit for Sexual Offenders is reported as reallocated support services costs on
Schedules 2, 3, 4, 5 and 6 on pages 16 through 25.
The Woodward Resource Center and the Glenwood Resource Center also provide significant
supported community living services, respite and supported employment services which are paid
through Iowa Medicaid and Community Based Services (HCBS) Waivers. The cost of providing
these services is included in the cost per resident calculation. However, the number of
individuals served is not included in the average number of residents.
The average annualized cost per resident/patient ranged from $92,764 at the State
Training School – Eldora to $301,855 at the Woodward Resource Center and $421,601 at the
Mental Health Institute – Cherokee for fiscal year 2011.
Total general fund expenditures increased 5.72%, from $208,083,701 in 2007 to
$219,981,354 in 2011, the average number of residents/patients decreased 15.6%, from 1,137 to
960, and the average daily cost per resident/patient increased 25.2%, from $501.40 to $627.80,
over the same period.
Median stay ranged from 9 days to 44 days at the four Mental Health Institutes for fiscal
year 2011.

Iowa Department of Human Services

Institutions Under the Control of the Iowa Department of Human Services
Average Cost Per Resident/Patient by Institution
(Unaudited)
For the Last Five Fiscal Years

Year ended June
Average
Average
Average Annualized
Number of Number
Cost per
Residents/ of EmResident/
Patients
ployees
Patient
Mental Health Institute - Clarinda

Mental Health Institute - Mt. Pleasant

Mental Health Institute - Cherokee
Mental Health Institute - Independence

Cost
per
Stay

176,892

484.64

$ 10,177

101

132,795

363.82

10,187

213

344,165

942.92

13,201

283

243,051

665.89

31,963

Woodward Resource Center

248

697

221,510

606.88

Glenwood Resource Center

338

920

217,387

595.58

State Juvenile Home - Toledo

118

104,366

285.93

State Training School - Eldora

173

197

79,748

218.49

100,552

275.49

1,137

2,698

183,011

501.40

Civil Commitment Unit for Sexual Offenders
Total

30, 2007
Average
Daily
Cost per Median
Resident/ Stay
Patient
(Days)

Schedule 1

Average
Number of
Residents/
Patients

Year ended June
Average
Average
Annualized
Number
Cost per
of EmResident/
ployees
Patient

30, 2008
Average
Daily
Cost per Median
Resident/ Stay
Patient
(Days)

Cost
per
Stay

Average
Number of
Residents/
Patients

Year ended June 30, 2009
Average
Average
Average Annualized
Daily
Number
Cost per
Cost per Median
of EmResident/
Resident/ Stay
ployees
Patient
Patient
(Days)

196,548

538.49

$ 10,231

106

144,064

394.70

11,052

212

362,275

992.53

12,903

280

259,768

711.69

25,621

235

717

247,023

326

927

209,599

574.24

$ 4,594

107

137,009

375.37

9,760

205

376,881

1,032.55

14,456

278

273,346

748.89

27,709

676.77

218

729

288,813

791.27

242,674

664.86

314

932

260,964

714.97

118

117,810

322.77

123

125,631

344.19

166

194

89,716

245.80

160

201

96,100

263.29

108,292

296.69

114,036

312.43

1,104

2,731

201,716

552.65

1,072

2,759

217,557

596.05

Cost
per
Stay

Institutions Under the Control of the Iowa Department of Human Services
Average Cost Per Resident/Patient by Institution
(Unaudited)
For the Last Five Fiscal Years

Average
Number of
Residents/
Patients

Year ended June 30, 2010
Average
Average
Average Annualized
Daily
Number
Cost per
Cost per Median
of EmResident/
Resident/ Stay
ployees
Patient
Patient
(Days)

Mental Health Institute - Clarinda

Mental Health Institute - Mt. Pleasant

Mental Health Institute - Cherokee
Mental Health Institute - Independence

182,805

500.83

120,963

331.41

9,279

194

387,690

1,062.17

15,932

262

274,225

751.30

36,062

Woodward Resource Center

205

724

318,359

872.22

Glenwood Resource Center

300

922

269,879

739.39

State Juvenile Home - Toledo

114

115,320

315.95

State Training School - Eldora

141

188

99,726

273.22

121,179

332.00

1,031

2,675

223,456

612.21

Civil Commitment Unit for Sexual Offenders
Total

Cost
per
Stay

4,508

Schedule 1

Average
Number of
Residents/
Patients

Year ended June 30, 2011
Average
Average
Average Annualized
Daily
Number
Cost per
Cost per Median
of EmResident/
Resident/ Stay
ployees
Patient
Patient
(Days)

Cost
per
Stay

207,391

568.19

134,204

367.68

10,663

157

421,601

1,155.07

13,861

233

345,732

947.21

41,677

201

711

301,855

827.00

286

883

276,437

757.36

103

141,266

387.03

143

169

92,764

254.15

123,141

337.37

960

2,516

229,147

627.80

5,114

Iowa Department of Human Services

Institutions Under the Control of the Iowa Department of Human Services
Average Cost Per Resident by Institution
Total Expenditures
(Unaudited)
For the Last Five Fiscal Years

$ 60,000,000
55,000,000
50,000,000
Total Expenditures

45,000,000

o 2007

40,000,000
30,000,000

• 2008
• 2009

25,000,000

o 2010

20,000,000

•

35,000,000

2011

15,000,000
10,000,000
5,000,000
Clarinda

Mt. Pleasant

Cherokee

Independence

$ 90,000,000

Total Expenditures

80,000,000
70,000,000

60,000,000

o 2007

50,000,000

• 2008
• 2009

40,000,000
30,000,000

o 2010

20,000,000

•

10,000,000
Woodward

Glenwood

Toledo

Eldora

CCUSO

2011

Institutions Under the Control of the Iowa Department of Human Services
Average Cost Per Resident by Institution
Average Number of Residents
(Unaudited)
For the Last Five Fiscal Years

500
400

2007

D
2008

350

2009

300

2010

250

2011

200
150
100
50
Clarinda

Mt. Pleasant

Cherokee

Independence

500

Average Number of Residents

450

450
400

2007

350

2008

300

2009
2010

250

2011

200
150
100
50
-

Woodward

Glenwood

Toledo

Eldora

CCUSO

Institutions Under the Control of the Iowa Department of Human Services
Average Cost Per Resident by Institution
Average Annual Cost per Resident
(Unaudited)

Average Annualized Cost per Resident

For the Last Five Fiscal Years

$ 450,000
420,000
390,000
360,000
330,000
300,000
270,000
240,000
210,000
180,000
150,000
120,000
90,000
60,000
30,000
-

2007

D
2008
2009
2010

2011

Clarinda

Average Annualized Cost per Resident

Mt. Pleasant

Cherokee

Independence

330,000
300,000
270,000
240,000
210,000

2007

180,000

2008

2009

150,000

2010

120,000

2011

90,000
60,000
30,000
Woodward

Glenwood

Toledo

Eldora

CCUSO

Institutions Under the Control of the Iowa Department of Human Services
General Fund Expenditures by Institution
(Unaudited)
Year ended June 30, 2007

Pe rsonal se rvice s

Me ntal He alth

Woodward

Institute -

Re source

Clarinda

Mount Ple asant

Che roke e

Inde pe nde nce

Ce nte r

6,974,408

6,607,924

13,097,593

17,987,635

32,341

21,055

61,512

47,868

163,525

Supplie s and mate rials

784,206

474,112

953,231

929,528

3,761,111

Contractual se rvice s

534,099

636,244

1,408,683

1,874,328

4,818,602

Capital outlay

164,335

93,516

164,310

55,466

1,895,961

Claims and misce llane ous

709

3,144

492

147,097

Lice nse s, pe rmits and re funds

732

154

7,082

870

2,016

8,490,830

7,834,894

15,688,627

20,902,399

54,934,382

Trave l

Aid to individuals
Total be fore re allocations

Re allocate d support se rvice s
costs (se e page 6)

(1,922,019)

Total

13,766,608

44,147,216

Schedule 2

State

Civil

Gle nwood

Juve nile

Training

Commitme nt

Re source

Home -

School -

Unit for Se xual

Ce nte r

Tole do

Eldora

Offe nde rs

Total

55,176,264

6,787,256

11,267,363

4,502,835

235,937

20,081

69,613

34,646

166,548,494
686,578

5,649,422

598,421

706,984

27,255

13,884,270

8,331,823

736,550

1,439,726

129,846

19,909,901

3,583,845

94,876

301,082

19,305

6,372,696

497,445

5,135

8,167

549

662,765

2,186

2,572

3,385

16,981

2,016

73,476,922

8,244,891

13,796,320

4,714,436

208,083,701

1,922,019
6,636,455

Institutions Under the Control of the Iowa Department of Human Services
General Fund Expenditures by Institution
(Unaudited)
Year ended June 30, 2008

Pe rsonal se rvice s

Me ntal He alth

Woodward

Institute -

Re source

Clarinda

Mount Ple asant

Che roke e

Inde pe nde nce

Ce nte r

7,391,770

7,216,650

13,682,846

18,417,624

40,638

33,797

43,114

58,315

495,664

Supplie s and mate rials

990,920

532,517

977,555

987,342

3,634,099

Contractual se rvice s

554,287

773,252

1,535,253

2,031,591

4,946,799

63,397

86,227

231,219

323,034

1,689,921

126

405

1,409

1,035

140,380

1,010

505

1,578

407

9,041,223

8,643,858

16,471,901

21,820,519

58,050,366

Trave l

Capital outlay
Claims and misce llane ous
Lice nse s, pe rmits and re funds
Aid to individuals
Total be fore re allocations

Re allocate d support se rvice s
costs (se e page 6)

(1,980,918)

Total

14,490,983

47,143,096

Schedule 3

State

Civil

Gle nwood

Juve nile

Training

Commitme nt

Re source

Home -

School -

Unit for Se xual

Ce nte r

Tole do

Eldora

Offe nde rs

Total

60,378,764

7,221,028

12,104,745

5,091,505

440,068

33,390

60,763

65,017

1,270,766

6,366,174

695,767

752,121

106,345

15,042,840

8,314,399

759,312

1,554,480

274,163

20,743,536

3,073,359

236,224

400,995

169,134

6,273,510

532,949

6,139

14,524

1,678

698,645

5,939

1,676

5,222

16,422

226

79,111,878

8,953,536

14,892,850

5,707,842

222,693,973

1,980,918
7,688,760

178,648,028

Institutions Under the Control of the Iowa Department of Human Services
General Fund Expenditures by Institution
(Unaudited)
Year ended June 30, 2009

Me ntal He alth Me ntal He alth Me ntal He alth Me ntal He alth

Pe rsonal se rvice s

Woodward

Institute -

Re source

Clarinda

Mt. Ple asant

Che roke e

Inde pe nde nce

Ce nte r

7,529,126

7,385,240

13,819,279

19,051,691

84,462

22,152

44,692

73,630

580,285

Supplie s and mate rials

897,809

580,518

1,222,413

965,007

4,149,086

Contractual se rvice s

591,079

979,587

950,191

2,077,976

6,129,541

Capital outlay

119,038

73,686

307,189

240,646

1,901,365

Claims and misce llane ous

359

840

331

3,149

147,139

Lice nse s, pe rmits and re funds

465

780

2,309

607

540

9,222,338

9,042,563

16,344,875

22,414,408

62,961,270

Trave l

Aid to individuals
Total

Re allocate d support se rvice s
costs (se e page 6)

(2,023,410)

Total

14,321,465

50,053,247

Schedule 4

State

Civil

Gle nwood

Juve nile

Training

Commitme nt

Re source

Home -

School -

Unit for Se xual

Ce nte r

Tole do

Eldora

Offe nde rs

Total

62,500,842

7,651,720

12,287,820

5,827,528

254,567

17,633

55,147

7,240

1,139,808

6,584,419

677,889

855,556

786,475

16,719,172

9,289,745

659,861

1,849,605

195,958

22,723,543

2,785,072

29,723

307,860

53,657

5,818,236

520,882

4,332

18,818

569

696,419

7,116

4,288

1,167

16,732

540

81,942,643

9,045,446

15,375,973

6,871,427

233,220,943

2,023,410
8,894,837

186,106,493

Institutions Under the Control of the Iowa Department of Human Services
General Fund Expenditures by Institution
(Unaudited)
Year ended June 30, 2010

Me ntal He alth Me ntal He alth Me ntal He alth Me ntal He alth

Pe rsonal se rvice s

Woodward

Institute -

Re source

Clarinda

Mt. Ple asant

Che roke e

Inde pe nde nce

Ce nte r

7,250,076

6,921,068

13,496,617

18,320,418

50,362,160

52,181

77,156

59,239

78,724

1,159,313

Supplie s and mate rials

652,037

490,945

1,075,399

777,745

4,726,391

Contractual se rvice s

594,108

914,448

1,202,746

2,122,178

7,172,716

42,725

183,274

121,510

86,222

1,742,716

Claims and misce llane ous

225

331

1,688

1,690

99,756

Lice nse s, pe rmits and re funds

466

895

2,565

528

1,183

8,591,818

8,588,405

15,958,094

21,389,542

65,263,580

Trave l

Capital outlay

Aid to individuals
Total

Re allocate d support se rvice s
costs (se e page 6)

(2,776,626)

Total

$ 13,181,468

Schedule 5

State

Civil

Gle nwood

Juve nile

Training

Commitme nt

Re source

Home -

School -

Unit for Se xual

Ce nte r

Tole do

Eldora

Offe nde rs

Total

61,197,320

7,198,717

11,598,464

5,900,877

1,079,322

70,078

100,344

10,653

2,687,010

6,130,446

671,346

579,128

729,698

15,833,135

9,275,428

653,344

1,552,170

267,289

23,754,427

2,704,880

49,760

214,712

9,050

5,154,849

573,001

3,765

13,260

146

693,862

3,354

2,026

3,343

13,177

1,183

80,963,751

8,649,036

14,061,421

6,917,713

230,383,360

2,776,626
9,694,339

182,245,717

Institutions Under the Control of the Iowa Department of Human Services
General Fund Expenditures by Institution
(Unaudited)
Year ended June 30, 2011

Me ntal He alth Me ntal He alth

Pe rsonal se rvice s

Me ntal He alth Me ntal He alth

Woodward

Institute -

Re source

Clarinda

Mount Ple asant

Che roke e

Inde pe nde nce

Ce nte r

7,216,774

6,796,196

11,634,175

17,158,403

22,401

10,006

55,509

27,055

380,352

Supplie s and mate rials

523,233

461,404

905,510

799,733

4,479,918

Contractual se rvice s

498,036

1,025,590

1,399,542

2,091,352

4,809,727

34,698

159,299

144,081

318,639

804,932

1,165

945

108,933

425

780

2,077

985

2,293

8,295,621

8,454,846

14,140,762

20,398,204

60,672,788

Trave l

Capital outlay
Claims and misce llane ous
Lice nse s, pe rmits and re funds
Aid to individuals
Total be fore re allocations

Re allocate d support se rvice s
costs (se e page 6)

(2,757,545)

Total

$ 11,383,217

50,087,941

Schedule 6

State

Civil

Gle nwood

Juve nile

Training

Commitme nt

Re source

Home -

School -

Unit for Se xual

Ce nte r

Tole do

Eldora

Offe nde rs

Total

61,427,351

7,022,669

11,085,766

6,124,755

692,274

11,896

37,574

63,732

1,300,799

6,712,830

678,049

624,520

799,415

15,984,612

8,264,636

682,848

1,333,028

180,936

20,285,695

1,453,278

77,944

167,607

47,202

3,207,680

506,136

1,980

12,745

825

632,841

4,584

595

3,958

13,404

2,293

79,061,089

8,475,981

13,265,198

7,216,865

219,981,354

2,757,545
9,974,410

178,554,030

Institutions Under the Control of the Iowa Department of Human Services
Resident/Patient Population Statistics
(Unaudited)
Year ended June 30, 2011

Population be ginning of year

Me ntal

He alth

Me ntal
He alth

Woodward

Institute -

Re source

Clarinda

Mt. Ple asant

Che roke e

Inde pe nde nce

Ce nte r

203

105

616

274

130

152

155

109

Home visits

205

Limite d le ave s

Te mporary me dical transfe rs

Unauthorize d de parture s

175

777

429

463

184

760

429

239

15
4

Admissions:
First admissions
Re admissions
Re turns:

Total admissions

Re le ase d:
Discharges
De aths

Home visits

205

Limite d le ave s

Te mporary me dical transfe rs

Unauthorize d de parture s

Othe r

184

780

432

465

Population e nd of year

193

Ave rage numbe r of re side nts/patie nts

201

Total re le ase d

Schedule 7

State

Civil

Gle nwood

Juve nile

Training

Commitme nt

Re source

Home -

School -

Unit for Se xual

Ce nte r

Tole do

Eldora

Offe nde rs

289

129

250

409

165

582

258

108

409

165

149

594

257

277

130

286

143

Findings and Recommendations for Mental Health Institute - Clarinda
June 30, 2011

Segregation of Duties – One important aspect of internal control is the segregation of
duties among employees to prevent an individual employee from handling duties which are
incompatible. When duties are properly segregated, the activities of one employee act as a
check of those of another. Mail is not opened and distributed by someone other than
accounting personnel.
A list of receipts is not prepared by the mail opener.
Responsibilities for collection and deposit preparation functions are not segregated from
those for recording and accounting for cash receipts for the Sales and Collection,
Contingent Fund, Patient and Entertainment Funds.
Bank reconciliations are not
reviewed by an independent person or there was no written evidence of who performed the
independent review.
Recommendation – We realize segregation of duties is difficult with a limited number of office
employees. However, the Institution should review its control procedures to obtain the
maximum internal control possible under the circumstances utilizing currently available
personnel.
Response – The Institution will continue to review its internal control policies, including
utilization of staff outside the business office to assist in recording and accounting for
cash receipts.
Conclusion – Response accepted.

(2) Bank Reconciliations – Monthly bank to book reconciliations were not performed timely and
reconciliations are not reviewed by an independent person.
Recommendation – Proper book to bank reconciliation procedures should be performed
timely as a control over cash reporting. The reconciliations should be reviewed by an
independent person and the reviews should be evidenced by the reviewer’s signature or
initials and the date reviewed.
Response – The Institution is in the process of reviewing our banking procedures and will
include a review of the bank reconciliations in the changes we are making to the
procedures.
Conclusion – Response accepted.
(3) Capital Assets – Chapter 7A.30 of the Code of Iowa requires each agency of the state to
maintain a written, detailed and up-to-date inventory of property under its charge, control
and management. The Institution is required to keep an up-to-date and accurate asset
listing to track and maintain control over capital assets. This includes properly classifying
additions and deletions for equipment and vehicles throughout the fiscal year, making
additions and deletions to the capital asset listing and ensuring items are properly tagged.
28

Findings and Recommendations for Mental Health Institute - Clarinda
June 30, 2011

The following items were noted:


There is no written guideline for cost allocation of assets between Clarinda MHI and
Clarinda Department of Corrections (DOC) identifying whether the asset belongs to
the MHI or the DOC.



One asset tested did not have a State tag ID affixed to the asset.

Recommendation – The Institution should establish guidelines for cost allocation and
identifying capital assets between Clarinda MHI and Clarinda DOC. The Institution
should review policies and procedures to ensure all applicable capital assets purchased
and maintained are properly tagged with the State tag ID number.
Response – The Institution will review its policies for capital assets; including the cost
allocation of capital assets. We will also review our policy on tagging assets; particularly
those in areas not suited for paper tags.
Conclusion – Response accepted.
(4) Cancelling Supporting Documentation – Supporting documentation for 17 of 23 items was
not cancelled to prevent reuse.
Recommendation – The Institution should establish policies and procedures to require and
ensure supporting documentation is properly cancelled to prevent reuse
Response – The Institution will review its payment and revenue processes to include
cancelling all supporting documentation.
Conclusion – Response accepted.
Findings Related to Statutory Requirements and Other Matters:
No matters were noted.
Staff:
Questions or requests for further assistance should be directed to:
Marlys K. Gaston, CPA, Manager
Tracey L. Gerrish, Staff Auditor
Andrew E. Nielsen, CPA, Deputy Auditor of State
Other individuals who participated in the audits include:
Ryan T. Jelsma, Staff Auditor
Cory A. Lee, Assistant Auditor
Jamie T. Reuter, Assistant Auditor

Findings and Recommendations for Mental Health Institute – Mount Pleasant
June 30, 2011
Findings Reported in the State’s Single Audit Report:
No matters were noted.
Findings Reported in the State’s Report on Internal Control:
No matters were noted.
Other Findings Related to Internal Control:
Capital Assets – Chapter 7A.30 of the Code of Iowa requires each agency of the state to
maintain a written, detailed and up-to-date inventory of property under its charge, control
and management. The Institution is required to keep an up-to-date and accurate capital
asset listing to track and maintain control over capital assets. This includes properly
classifying additions and deletions for equipment and vehicles throughout the fiscal year,
making additions and deletions to the capital asset listing and ensuring items are properly
tagged. Four assets did not have State tags affixed to them.
Recommendation – The Institution should review policies and procedures to ensure all
applicable capital assets purchased and maintained are properly tagged with the State ID
number.
Response – The Institution will ensure all applicable capital assets purchased and
maintained by the Institution are properly tagged with a State ID number.
Conclusion – Response accepted.
Findings Related to Statutory Requirements and Other Matters:
No matters were noted.
Staff:
Questions or requests for further assistance should be directed to:
Brian R. Brustkern, CPA, Manager
Scott P. Boisen, Senior Auditor II
Andrew E. Nielsen, CPA, Deputy Auditor of State
Other individuals who participated in the audits include:
Tyler L. Carter, Staff Auditor
James H. Pitcher, Staff Auditor
Russell G. Jordan, CPA, Assistant Auditor
Eric L. Rath, Assistant Auditor
W. Brad Corley, Assistant Auditor

Findings and Recommendations for Mental Health Institute - Cherokee
June 30, 2011

Findings Reported in the State’s Single Audit Report:
No matters were noted.
Findings Reported in the State’s Report on Internal Control:
No matters were noted.
Other Findings Related to Internal Control:
No matters were noted.
Findings Related to Statutory Requirements and Other Matters:
No matters were noted.
Staff:
Questions or requests for further assistance should be directed to:
Deborah J. Moser, CPA, Manager
Kelly L. Hilton, Staff Auditor
Andrew E. Nielsen, CPA, Deputy Auditor of State
Other individuals who participated in the audits include:
Brett A. Hoffman, Staff Auditor
Hannah K. Haas, Assistant Auditor
Marijke J. Hodgson, Assistant Auditor
Andi J. Kaufman, CPA, Assistant Auditor
Jamie T. Reuter, Assistant Auditor

Findings and Recommendations for Mental Health Institute - Independence
June 30, 2011

Findings Reported in the State’s Single Audit Report:
No matters were noted.
Findings Reported in the State’s Report on Internal Control:
No matters were noted.
Other Findings Related to Internal Control:
Eligibility – Title XIX – The Institution is required to maintain patient files, including
documentation of patient eligibility for Title XIX funding which can be in a paper or
electronic format. Patient files did not contain evidence of proper determination of
eligibility, including reviews for continued eligibility during the fiscal year ended June 30,
2011. Documentation for patient eligibility was subsequently obtained in order to bill for
services.
Recommendation - The Institution should maintain patient files, including documentation
of patient eligibility for Title XIX funding, on a current basis.
Response - The Institution will comply with the recommendation. During the fiscal year
ended June 30, 2010, the Institution’s only Income Maintenance Worker separated
employment under the State Employee Retirement Incentive Program (SERIP). This
position was not immediately replaced. An Income Maintenance Worker was added to the
Institution staff during the fiscal year ended June 30, 2011 and has been maintaining
required documentation since then. This employee was also able to retrospectively
establish eligibility for Title XIX and update the patient files accordingly.
Conclusion – Response accepted.
Findings Related to Statutory Requirements and Other Matters:
No matters were noted.
Staff:
Questions or requests for further assistance should be directed to:
Suzanne R. Dahlstrom, CPA, Manager
Darryl J. Brumm, CPA, Senior Auditor II
Andrew E. Nielsen, CPA, Deputy Auditor of State
Other individuals who participated in the audits include:
Kelly L. Hilton, Staff Auditor
Brett A. Hoffman, Staff Auditor
Ryan T. Jelsma, Staff Auditor
James H. Pitcher, Staff Auditor
Emily K. Creighton, Assistant Auditor
Karie A. Meisgeier, CPA, Assistant Auditor
Andi J. Kaufman, CPA, Assistant Auditor

Findings and Recommendations for Woodward Resource Center
June 30, 2011

Findings Reported in the State’s Single Audit Report:
No matters were noted.
Finding Reported in the State’s Report on Internal Control:
No matters were noted.
Other Findings Related to Internal Control:
(1)

Capital Assets – Chapter 7A.30 of the Code of Iowa requires each agency to maintain a
written, detailed and up-to-date inventory of property under its charge and control. One
asset selected from the capital asset listing could not be located because the asset was
disposed of during the year, causing assets and accumulated depreciation to be
overstated by $17,100.
Recommendation – The Center should implement procedures to ensure the capital asset
listing is current and accurate.
Response – Woodward Resource Center acknowledges one item tested did not exist and was
on the capital asset listing, but has now been deleted.
Conclusion – Response accepted.

(2)

Reconciliation of Medicare D Billings – A reconciliation of Medicare D billings to payments
received is not performed.
Recommendation – A reconciliation of Medicare D billings to payments received should be
performed monthly to detect and correct billing errors.
Response – Woodward Resource Center will move forward with having the Pharmacy
provide the Business Office with a report to use for reconciling the billings and payments.
Conclusion – Response accepted.

Findings Related to Statutory Requirements and Other Matters:
Employee Evaluations – Annual employee performance evaluations should be performed.
Three of ten employees tested did not have a current performance evaluation in his or her
personnel file.
Recommendation – The Center should implement procedures to ensure employee
performance evaluations are performed annually.
Response – This has been corrected and reviewed with all supervisors at Woodward
Resource Center.
Conclusion – Response accepted.

Findings and Recommendations for Woodward Resource Center
June 30, 2011

Staff:
Questions or requests for further assistance should be directed to:
Michelle B. Meyer, CPA, Manager
Casey L. Johnson, Staff Auditor
Andrew E. Nielsen, CPA, Deputy Auditor of State
Other individuals who participated in the audits include:
Janet K. Mortvedt, CPA, Senior Auditor
Leanna J. Showman, Staff Auditor
Nancy J. Umsted, Assistant Auditor
Jamie T. Reuter, Assistant Auditor
Victor L. Kennedy, Assistant Auditor

Findings and Recommendations for Glenwood Resource Center
June 30, 2011

Findings Reported in the State’s Single Audit Report:
No matters were noted.
Findings Reported in the State’s Report on Internal Control:
No matters were noted.
Other Findings Related to Internal Control:
No matters were noted.
Findings Related to Statutory Requirements and Other Matters:
No matters were noted.
Staff:
Questions or requests for further assistance should be directed to:
Deborah J. Moser, CPA, Manager
Marta M. Sobieszkoda, Staff Auditor
Andrew E. Nielsen, CPA, Deputy Auditor of State
Other individuals who participated in the audits include:
Gabriel M. Stafford, CPA, Staff Auditor
Robert W. Endriss, Assistant Auditor
Adam B. Bartz, Assistant Auditor
Victor L. Kennedy, Assistant Auditor
Jason Ropte, Auditor Intern

Findings and Recommendations for State Juvenile Home - Toledo
June 30, 2011
Findings Reported in the State’s Single Audit Report:
No matters were noted.
Findings Reported in the State’s Report on Internal Control:
No matters were noted.
Other Findings Related to Internal Control:
No matters were noted.
Findings Related to Statutory Requirements and Other Matters:
No matters were noted.
Staff:
Questions or requests for further assistance should be directed to:
Brian R. Brustkern, CPA, Manager
Jenny R. Lawrence, Staff Auditor
Andrew E. Nielsen, CPA, Deputy Auditor of State
Other individuals who participated in the audits include:
Leanna J. Showman, Staff Auditor
Ryan T. Jelsma, Staff Auditor
Marijke Hodgson, Assistant Auditor
Andi J. Kaufman, CPA, Assistant Auditor
Stephen J. Hoffman, Auditor Intern

Findings and Recommendations for State Training School - Eldora
June 30, 2011

Findings Reported in the State’s Single Audit Report:
No matters were noted.
Findings Reported in the States Report on Internal Control:
No matters were noted.
Other Finding Related to Internal Control:
Capital Assets - The State Training School sold four vehicles during fiscal year 2011.
However, the gain on sale was incorrectly calculated and was overstated by $4,822.14 on
the GAAP package. Also, the current year depreciation was overstated by $139,198.08.
In addition, a prior year correction of $7,510.09 for accumulated depreciation was not
included in the current year, resulting in a total accumulated depreciation overstatement
of $146,708.17 on the GAAP package.
Recommendation – Chapter 7A.30 of the Code of Iowa requires each agency of the state to
maintain a written, detailed and up-to-date inventory of property under its charge and
control. Accumulated depreciation and any gains on sale of equipment should be
properly computed and reported on the GAAP package. Capital asset records should be
updated to adjust for these corrections.
Response – The business office staff shall make the recommended corrections to the capital
asset records in the GAAP package. Even though the GAAP package was meticulously
reviewed by the available staff, this review process missed the overstatement of
depreciation and the error in accumulated depreciation. The State Training School shall
incorporate additional reviews which will help ensure GAAP package reporting is as error
free as possible.
Conclusion – Response accepted.
Finding Related to Statutory Requirements and Other Matters:
No matters were noted.
Staff:
Questions or requests for further assistance should be directed to:
Brian R. Brustkern, CPA, Manager
Brett A. Hoffman, Staff Auditor
Andrew E. Nielsen, CPA, Deputy Auditor of State
Other individuals who participated in the audits include:
Justin M. Scherrman Staff Auditor
Kelly L. Hilton, Staff Auditor
Adam B. Bartz, Assistant Auditor
Laura E. Grinnell, Assistant Auditor
Cory A. Lee, Assistant Auditor

Findings and Recommendations for Civil Commitment Unit for Sexual Offenders - Cherokee
June 30, 2011

Findings Reported in the State’s Single Audit Report:
No matters were noted.
Findings Reported in the State’s Report on Internal Control:
No matters were noted.
Other Findings Related to Internal Control:
No matters were noted.
Findings Related to Statutory Requirements and Other Matters:
No matters were noted.
Staff:
Questions or requests for further assistance should be directed to:
Deborah J. Moser, CPA, Manager
Kelly L. Hilton, Staff Auditor
Andrew E. Nielsen, CPA, Deputy Auditor of State
Other individuals who participated in the audits include:
Brett A. Hoffman, Staff Auditor
Andi J. Kaufman, CPA, Assistant Auditor