Title: 1. Organization
Accounting Policies: Basis of Presentation
The accompanying schedule of expenditures of federal awards (the “Schedule”) includes the Department of Health and Human Services federal grant expenditures for the System. The information in the Schedule is presented in accordance with the requirements of Title 2 U.S. Code of Federal Regulations Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (Uniform Guidance). Because the schedule presents only a selected portion of the operations of the System, it is not intended to and does not present the balance sheet, results of operations and changes in net assets or cash flows for the System.
Expenditures reported in the Schedule are reported on the accrual basis of accounting. Such expenditures are recognized following the cost principles contained in the Uniform Guidance, wherein certain types of expenditures are not allowable or are limited as to reimbursement. The System has elected not to use the 10 percent de minimis indirect cost rate as allowed under the Uniform Guidance.
As outlined in the May 2023 OMB Compliance Supplement, the amounts reported in the accompanying Schedule related to the COVID-19 Provider Relief Fund (PRF) and American Rescue Plan (ARP) Rural Distribution, Assistance Listing No. 93.498, are reported based upon the PRF reporting portal submission guidelines established by the Health Resource and Service Administration (HRSA). Six separate reporting periods were established by HRSA based on the dates of receipt of PRF payments. The accompanying Schedule includes those qualifying expenditures and lost revenues that were reported in the HRSA PRF portal for Period 4.
Use of Estimates
The preparation of the Schedule in conformity with generally accepted accounting principles requires management to make estimates and assumptions that affect certain reported amounts and disclosures. Accordingly, actual results could differ from those estimates and assumptions.
De Minimis Rate Used: N
Rate Explanation: The System has elected not to use the 10 percent de minimis indirect cost rate as allowed under the Uniform Guidance.
Garrett County Memorial Hospital (the System), doing business as Garrett Regional Medical Center, is an instrumentality of Garrett County, Maryland. The System was organized for charitable purposes and is exempt from income taxes as an instrumentality of Garrett County. In 2003, the System formed and became the sole member of Professional Emergency Physician Services, LLC (PEPS), which is a limited liability company. The purpose of PEPS is to provide professional emergency services solely to the System. In 2017, the System formed and became sole member of Garrett Anesthesia Services, LLC (GAS) and Specialty Physicians of Garrett County, LLC (SPE). GAS was created to provide anesthesia services to patients undergoing surgical procedures at the System. SPE is designed to facilitate the recruitment of physicians to provide specialty services for the benefit of patients served by the System. PEPS, GAS and SPE are subsidiaries of the System (collectively, the subsidiaries).
In August 2015, the System entered into a clinical program affiliation with West Virginia University Hospitals, Inc., doing business as WVU Medicine (collectively referred to as the Affiliation). Under the Affiliation, the System remains an independent organization in terms of governance and financial responsibility. Given their proximity and their shared common goals and objectives focused on the delivery of high-quality, accessible, affordable healthcare for their communities and patient populations, the Affiliation was adopted to establish and recognize the collaborative relationship. Through the collaborative relationship, the Affiliation aims to achieve coordination in education, research and patient care to enhance the health and wellness of the communities served by the Affiliation. The Affiliation looks to explore, develop and implement opportunities for clinical and operational collaboration deemed to be in the mutual best interest of the organizations and the populations they serve, along with striving to reduce the total cost of care.
In further recognition of their collaborative efforts, the System entered into a Management Agreement with WVU Medicine effective January 1, 2018. This effort was focused on creating a combined oversight related to the position of President and Chief Executive Officer for the System, and another WVU Medicine critical access hospital located regionally in a neighboring county in West Virginia. This operational decision was in support of continued programmatic clinical services collaboration between the regional hospitals, and to achieve operational cost savings. The Management Agreement further expanded into information technology directorship support services in 2019.
A Letter of Intent by and among the Board of County Commissioners of Garrett County, The Board of Governors of Garrett County Memorial Hospital, Garrett Regional Medical Center, and West Virginia University Health System and GRMC, Inc., a newly formed nonprofit corporation whose sole member is West Virginia United Health System, Inc., has been presented whereas the parties are interested in entering into an Operating Lease and Agreement whereby the System will be leased to GRMC, Inc. In the July 2021 public meeting of the Board of Garrett County Commissioners, County Attorney Gorman E. Getty presented the Letter of Intent for the potential lease of the county-owned hospital property. The Board of County Commissioners unanimously approved and signed the Letter of Intent. Then, the Letter of Intent was presented, approved and signed at the West Virginia University Health System Board of Directors’ August 2021 meeting. Finally, the Letter of Intent was presented, approved and signed at the March 2022 Board of Governors of Garrett County Memorial Hospital meeting. Effective July 1, 2022, the Operating and Lease Agreement went into effect between the Board of County Commissioners of Garrett County and GRMC, Inc. for all county-owned hospital property, with the exception of $2,500,000 (Cash Withhold Amount) and three parcels of land approximating 105 acres with carrying value of approximately $1,024,000 as of June 30, 2022. The Cash Withhold Amount is reported as assets whose use is limited by the Board of Governors as of June 30, 2022. The Cash Withhold Amount is to be retained by the Board of Governors to support the System and Board of Governors during the term of the Lease Agreement. The initial term of the lease will be a period of 15 years ending on June 30, 2037.
Title: 2. Summary of Significant Accounting Policies
Accounting Policies: Basis of Presentation
The accompanying schedule of expenditures of federal awards (the “Schedule”) includes the Department of Health and Human Services federal grant expenditures for the System. The information in the Schedule is presented in accordance with the requirements of Title 2 U.S. Code of Federal Regulations Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (Uniform Guidance). Because the schedule presents only a selected portion of the operations of the System, it is not intended to and does not present the balance sheet, results of operations and changes in net assets or cash flows for the System.
Expenditures reported in the Schedule are reported on the accrual basis of accounting. Such expenditures are recognized following the cost principles contained in the Uniform Guidance, wherein certain types of expenditures are not allowable or are limited as to reimbursement. The System has elected not to use the 10 percent de minimis indirect cost rate as allowed under the Uniform Guidance.
As outlined in the May 2023 OMB Compliance Supplement, the amounts reported in the accompanying Schedule related to the COVID-19 Provider Relief Fund (PRF) and American Rescue Plan (ARP) Rural Distribution, Assistance Listing No. 93.498, are reported based upon the PRF reporting portal submission guidelines established by the Health Resource and Service Administration (HRSA). Six separate reporting periods were established by HRSA based on the dates of receipt of PRF payments. The accompanying Schedule includes those qualifying expenditures and lost revenues that were reported in the HRSA PRF portal for Period 4.
Use of Estimates
The preparation of the Schedule in conformity with generally accepted accounting principles requires management to make estimates and assumptions that affect certain reported amounts and disclosures. Accordingly, actual results could differ from those estimates and assumptions.
De Minimis Rate Used: N
Rate Explanation: The System has elected not to use the 10 percent de minimis indirect cost rate as allowed under the Uniform Guidance.
Basis of Presentation
The accompanying schedule of expenditures of federal awards (the “Schedule”) includes the Department of Health and Human Services federal grant expenditures for the System. The information in the Schedule is presented in accordance with the requirements of Title 2 U.S. Code of Federal Regulations Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (Uniform Guidance). Because the schedule presents only a selected portion of the operations of the System, it is not intended to and does not present the balance sheet, results of operations and changes in net assets or cash flows for the System.
Expenditures reported in the Schedule are reported on the accrual basis of accounting. Such expenditures are recognized following the cost principles contained in the Uniform Guidance, wherein certain types of expenditures are not allowable or are limited as to reimbursement. The System has elected not to use the 10 percent de minimis indirect cost rate as allowed under the Uniform Guidance.
As outlined in the May 2023 OMB Compliance Supplement, the amounts reported in the accompanying Schedule related to the COVID-19 Provider Relief Fund (PRF) and American Rescue Plan (ARP) Rural Distribution, Assistance Listing No. 93.498, are reported based upon the PRF reporting portal submission guidelines established by the Health Resource and Service Administration (HRSA). Six separate reporting periods were established by HRSA based on the dates of receipt of PRF payments.
Each reporting period has a specific period of availability which begins on January 1, 2020 and extends through specified deadlines, as indicated below:
The accompanying Schedule includes those qualifying expenditures and lost revenues that were reported in the HRSA PRF portal for Period 4.
Use of Estimates
The preparation of the Schedule in conformity with generally accepted accounting principles requires management to make estimates and assumptions that affect certain reported amounts and disclosures. Accordingly, actual results could differ from those estimates and assumptions.
Title: 3. Grant Contingencies
Accounting Policies: Basis of Presentation
The accompanying schedule of expenditures of federal awards (the “Schedule”) includes the Department of Health and Human Services federal grant expenditures for the System. The information in the Schedule is presented in accordance with the requirements of Title 2 U.S. Code of Federal Regulations Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (Uniform Guidance). Because the schedule presents only a selected portion of the operations of the System, it is not intended to and does not present the balance sheet, results of operations and changes in net assets or cash flows for the System.
Expenditures reported in the Schedule are reported on the accrual basis of accounting. Such expenditures are recognized following the cost principles contained in the Uniform Guidance, wherein certain types of expenditures are not allowable or are limited as to reimbursement. The System has elected not to use the 10 percent de minimis indirect cost rate as allowed under the Uniform Guidance.
As outlined in the May 2023 OMB Compliance Supplement, the amounts reported in the accompanying Schedule related to the COVID-19 Provider Relief Fund (PRF) and American Rescue Plan (ARP) Rural Distribution, Assistance Listing No. 93.498, are reported based upon the PRF reporting portal submission guidelines established by the Health Resource and Service Administration (HRSA). Six separate reporting periods were established by HRSA based on the dates of receipt of PRF payments. The accompanying Schedule includes those qualifying expenditures and lost revenues that were reported in the HRSA PRF portal for Period 4.
Use of Estimates
The preparation of the Schedule in conformity with generally accepted accounting principles requires management to make estimates and assumptions that affect certain reported amounts and disclosures. Accordingly, actual results could differ from those estimates and assumptions.
De Minimis Rate Used: N
Rate Explanation: The System has elected not to use the 10 percent de minimis indirect cost rate as allowed under the Uniform Guidance.
The federal grant programs are subject to financial and compliance audits by the grantor or its representative. Such audits could lead to requests for reimbursement to the grantor agency for expenditures disallowed under terms of the grant. Management believes disallowances, if any, will not be material.
Title: 4. Categorization of Expenditures and Other Matters
Accounting Policies: Basis of Presentation
The accompanying schedule of expenditures of federal awards (the “Schedule”) includes the Department of Health and Human Services federal grant expenditures for the System. The information in the Schedule is presented in accordance with the requirements of Title 2 U.S. Code of Federal Regulations Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (Uniform Guidance). Because the schedule presents only a selected portion of the operations of the System, it is not intended to and does not present the balance sheet, results of operations and changes in net assets or cash flows for the System.
Expenditures reported in the Schedule are reported on the accrual basis of accounting. Such expenditures are recognized following the cost principles contained in the Uniform Guidance, wherein certain types of expenditures are not allowable or are limited as to reimbursement. The System has elected not to use the 10 percent de minimis indirect cost rate as allowed under the Uniform Guidance.
As outlined in the May 2023 OMB Compliance Supplement, the amounts reported in the accompanying Schedule related to the COVID-19 Provider Relief Fund (PRF) and American Rescue Plan (ARP) Rural Distribution, Assistance Listing No. 93.498, are reported based upon the PRF reporting portal submission guidelines established by the Health Resource and Service Administration (HRSA). Six separate reporting periods were established by HRSA based on the dates of receipt of PRF payments. The accompanying Schedule includes those qualifying expenditures and lost revenues that were reported in the HRSA PRF portal for Period 4.
Use of Estimates
The preparation of the Schedule in conformity with generally accepted accounting principles requires management to make estimates and assumptions that affect certain reported amounts and disclosures. Accordingly, actual results could differ from those estimates and assumptions.
De Minimis Rate Used: N
Rate Explanation: The System has elected not to use the 10 percent de minimis indirect cost rate as allowed under the Uniform Guidance.
The categorization of expenditures by program included in the schedule of expenditures of federal awards is based upon the grant documents. Changes in the categorization of expenditures occur based upon revisions to the Assistance Listing, which is issued in June and December of each year. The schedule of expenditures of federal awards for the year ended June 30, 2023 reflects Assistance Listing changes through May 2023.
Title: 5. Subsequent Events
Accounting Policies: Basis of Presentation
The accompanying schedule of expenditures of federal awards (the “Schedule”) includes the Department of Health and Human Services federal grant expenditures for the System. The information in the Schedule is presented in accordance with the requirements of Title 2 U.S. Code of Federal Regulations Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (Uniform Guidance). Because the schedule presents only a selected portion of the operations of the System, it is not intended to and does not present the balance sheet, results of operations and changes in net assets or cash flows for the System.
Expenditures reported in the Schedule are reported on the accrual basis of accounting. Such expenditures are recognized following the cost principles contained in the Uniform Guidance, wherein certain types of expenditures are not allowable or are limited as to reimbursement. The System has elected not to use the 10 percent de minimis indirect cost rate as allowed under the Uniform Guidance.
As outlined in the May 2023 OMB Compliance Supplement, the amounts reported in the accompanying Schedule related to the COVID-19 Provider Relief Fund (PRF) and American Rescue Plan (ARP) Rural Distribution, Assistance Listing No. 93.498, are reported based upon the PRF reporting portal submission guidelines established by the Health Resource and Service Administration (HRSA). Six separate reporting periods were established by HRSA based on the dates of receipt of PRF payments. The accompanying Schedule includes those qualifying expenditures and lost revenues that were reported in the HRSA PRF portal for Period 4.
Use of Estimates
The preparation of the Schedule in conformity with generally accepted accounting principles requires management to make estimates and assumptions that affect certain reported amounts and disclosures. Accordingly, actual results could differ from those estimates and assumptions.
De Minimis Rate Used: N
Rate Explanation: The System has elected not to use the 10 percent de minimis indirect cost rate as allowed under the Uniform Guidance.
The System has evaluated subsequent events through January 31, 2024, which is the date the Schedule was available to be issued.