FAC Explorer

Audit 20105

FY End
2022-09-30
Total Expended
$7.99M
Findings
4
Programs
3
Organization: Midland County Hospital District (TX)
Year: 2022 Accepted: 2023-06-28
Auditor: Forvis LLP

Organization Exclusion Status:

Findings

ID Ref Severity Repeat Requirement
24394 2022-001 Material Weakness - ABL
24395 2022-002 Significant Deficiency Yes ABL
600836 2022-001 Material Weakness - ABL
600837 2022-002 Significant Deficiency Yes ABL

Programs

ALN Program Spent Major Findings
93.498 Covid-19 Provider Relief Fund and American Rescue Plan (arp) Rural Distribution $5.09M Yes 2
93.461 Covid-19 Hrsa Covid-19 Claims Reimbursement for the Uninsured Program and the Covid-19 Coverage Assistance Fund $2.63M Yes 0
97.036 Disaster Grants - Public Assistance (presidentially Declared Disasters) $270,419 - 0

Contacts

Name Title Type
CHGEEXTCMRM9 Marie Castro Auditee
4322211523 Danielle Zimmerman Auditor
No contacts on file

Notes to SEFA

Title: Note 1: Basis of Presentation Accounting Policies: Expenditures reported on 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. Negative amounts, if any, shown on the Schedule represent adjustments or credits made in the normal course of business to amounts reported as expenditures in prior years. De Minimis Rate Used: N Rate Explanation: The District has elected not to use the 10 percent de minimis indirect cost rate allowed under the Uniform Guidance. The accompanying schedule of expenditures of federal awards (the Schedule) includes the federal award activity of Midland County Hospital District (the District) under programs of the federal government for the year ended September 30, 2022. The information in this 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 District, it is not intended to and does not present the financial position, changes in net position or cash flows of the District.The schedule includes the expenditures of the following entities:1.)Midland County Hospital District (75-1584559)2.)Premier Family I, Inc. (75-2656723) 3.)MMH Physicians (TIN 47-5554737)
Title: Note 4: Federal Loan Programs Accounting Policies: Expenditures reported on 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. Negative amounts, if any, shown on the Schedule represent adjustments or credits made in the normal course of business to amounts reported as expenditures in prior years. De Minimis Rate Used: N Rate Explanation: The District has elected not to use the 10 percent de minimis indirect cost rate allowed under the Uniform Guidance. The District did not have any federal loan programs during the year ended September 30, 2022.
Title: Note 5: Personal Protective Equipment (PPE) (Unaudited) Accounting Policies: Expenditures reported on 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. Negative amounts, if any, shown on the Schedule represent adjustments or credits made in the normal course of business to amounts reported as expenditures in prior years. De Minimis Rate Used: N Rate Explanation: The District has elected not to use the 10 percent de minimis indirect cost rate allowed under the Uniform Guidance. For the year ended September 30, 2022, the District received $0 donated PPE in response to the COVID-19 pandemic.
Title: Note 6: FEMA Expenditures Accounting Policies: Expenditures reported on 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. Negative amounts, if any, shown on the Schedule represent adjustments or credits made in the normal course of business to amounts reported as expenditures in prior years. De Minimis Rate Used: N Rate Explanation: The District has elected not to use the 10 percent de minimis indirect cost rate allowed under the Uniform Guidance. Non-federal entities must record expenditures for Federal Emergency Agency (FEMA) projects on theSchedule when: 1) FEMA has approved the non-federal entitys project worksheet and, 2) the nonfederal entity has incurred eligible expenditures. The 2022 expenditures for Federal AssistanceListing Number 97.036 were incurred by the District prior to fiscal year 2022 and the project worksheet was approved in fiscal year 2022.

Finding Details

Finding 2022-001
2022-001 COVID-19 Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Federal Assistance Listing Number 93.498 U.S. Department of Health and Human Services Criteria: Reporting (45 CFR 75.342) and Activities Allowed or Unallowed and Allowable Costs/Cost Principles (Pub. L. No. 116-136, 134 Stat. 563 and Pub. L. No. 116-139, 134 Stat. 622 and 623). Condition: The District included certain COVID-19 related expenditures as requests for financial assistance from other agencies. Questioned costs: None Context: Certain expenses reported by the District in the period 2 PRF report were also provided to other agencies as a request for financial assistance. A portion of the request to the second source was approved and funded subsequent to September 30, 2022, thus a portion of the Period 2 PRF expenses could be reimbursed by both PRF and the second source. The total amount to be approved and granted by the secondary source has not yet been finalized. Cause: Internal controls of compliance were not in place to ensure the District did not allocate expenses to more than one funding source. Effect: Expenses were allocated to more than one funding source. Identification as a repeat finding: Not a repeat finding. Recommendation: Policies and procedures over federal grant reporting should be modified to ensure distributions are not used to reimbursed expenses that have been reimbursed from other sources or that other sources are obligated to reimburse. Views of responsible officials and planned corrective actions: See attached corrective action plan for the District?s response to finding.
Finding 2022-002
2022-002 COVID-19 Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Federal Assistance Listing Number 93.498 U.S. Department of Health and Human Services Criteria: Reporting (45 CFR 75.342) and Activities Allowed or Unallowed and Allowable Costs/Cost Principles (Pub. L. No. 116-136, 134 Stat. 563 and Pub. L. No. 116-139, 134 Stat. 622 and 623). Condition: The Period 2 Provider Relief Fund report was submitted that had errors in the lost revenue calculation under Option 1. Questioned costs: Unknown Context: The District incorrectly excluded certain excluded Medicaid supplemental payments, and the District did not include negative contractual allowances when entering net revenue by payor into the reporting portal. Cause: The District did not properly calculate lost revenue in their calculation. Internal controls of compliance were not in place to ensure the District properly calculated prepared the report. Effect: Errors were made in reporting quarterly total revenue/net charges for patient care for 2019, 2020 and 2021. Lost revenue was not accurately reported. Identification as a repeat finding: Repeat finding, 2021-001 and 2021-002 Recommendation: Policies and procedures over federal grant reporting should be modified to ensure reports are prepared using complete and accurate information. Views of responsible officials and planned corrective actions: See attached corrective action plan for the District?s response to finding.
Finding 2022-001
2022-001 COVID-19 Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Federal Assistance Listing Number 93.498 U.S. Department of Health and Human Services Criteria: Reporting (45 CFR 75.342) and Activities Allowed or Unallowed and Allowable Costs/Cost Principles (Pub. L. No. 116-136, 134 Stat. 563 and Pub. L. No. 116-139, 134 Stat. 622 and 623). Condition: The District included certain COVID-19 related expenditures as requests for financial assistance from other agencies. Questioned costs: None Context: Certain expenses reported by the District in the period 2 PRF report were also provided to other agencies as a request for financial assistance. A portion of the request to the second source was approved and funded subsequent to September 30, 2022, thus a portion of the Period 2 PRF expenses could be reimbursed by both PRF and the second source. The total amount to be approved and granted by the secondary source has not yet been finalized. Cause: Internal controls of compliance were not in place to ensure the District did not allocate expenses to more than one funding source. Effect: Expenses were allocated to more than one funding source. Identification as a repeat finding: Not a repeat finding. Recommendation: Policies and procedures over federal grant reporting should be modified to ensure distributions are not used to reimbursed expenses that have been reimbursed from other sources or that other sources are obligated to reimburse. Views of responsible officials and planned corrective actions: See attached corrective action plan for the District?s response to finding.
Finding 2022-002
2022-002 COVID-19 Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Federal Assistance Listing Number 93.498 U.S. Department of Health and Human Services Criteria: Reporting (45 CFR 75.342) and Activities Allowed or Unallowed and Allowable Costs/Cost Principles (Pub. L. No. 116-136, 134 Stat. 563 and Pub. L. No. 116-139, 134 Stat. 622 and 623). Condition: The Period 2 Provider Relief Fund report was submitted that had errors in the lost revenue calculation under Option 1. Questioned costs: Unknown Context: The District incorrectly excluded certain excluded Medicaid supplemental payments, and the District did not include negative contractual allowances when entering net revenue by payor into the reporting portal. Cause: The District did not properly calculate lost revenue in their calculation. Internal controls of compliance were not in place to ensure the District properly calculated prepared the report. Effect: Errors were made in reporting quarterly total revenue/net charges for patient care for 2019, 2020 and 2021. Lost revenue was not accurately reported. Identification as a repeat finding: Repeat finding, 2021-001 and 2021-002 Recommendation: Policies and procedures over federal grant reporting should be modified to ensure reports are prepared using complete and accurate information. Views of responsible officials and planned corrective actions: See attached corrective action plan for the District?s response to finding.