Title: 1. Basis of Presentation
Accounting Policies: GAAP
De Minimis Rate Used: N
Rate Explanation: N/A
The accompanying Schedule of Expenditures of Federal Awards (the “Schedule”) presents the activities of the federal financial assistance programs of Maimonides Medical Center (the “Medical Center”) that have been financed by the U.S. government. 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 (the Uniform Guidance). Therefore, some amounts presented in the Schedule may differ from amounts presented in or used in preparation of the consolidated financial statements. All financial assistance received directly from federal agencies, as well as financial assistance passed through other governmental agencies or non-profit organizations, are included on the Schedule. The Schedule includes federal awards subject to the requirements of the Uniform Guidance as well as federal awards that were funded prior to the Uniform Guidance effective date of December 26, 2014. Direct and indirect costs are charged to awards in accordance with cost principles contained in the Department of Health and Human Services, U.S. Office of the Assistant Secretary Comptroller (“OASC”), OASC-3, A Guide for Hospitals. Under these cost principles, certain types of expenditures are not allowable or are limited as to reimbursement. The accompanying Schedule is presented on the accrual basis of accounting. Because the Schedule presents only a selected portion of the activities of the Medical Center, it is not intended to, and does not, present the consolidated financial position, results of operations, and changes in net assets or cash flows of the Medical Center. The Medical Center does not use the 10% de-minimis indirect cost rate for sponsored programs. The Medical Center charges indirect costs to federal awards based on award-specific rates as defined in each grant award. The Medical Center did not have any federal funds passed through to sub recipients, therefore this column is excluded from the Schedule. Assistance Listing Numbers are presented where available and applicable. The Schedule presents pass through entities that do not have an identifying number as not applicable (N/A).
Title: 2. Food and Nutrition Awards
Accounting Policies: GAAP
De Minimis Rate Used: N
Rate Explanation: N/A
During the year ended December 31, 2022, the Medical Center participated in the New York State Department of Health – Special Supplemental Nutrition Program for Women, Infants and Children (WIC) through the provision of nutritional counseling and the receipt and distribution of food vouchers. The U.S. Department of Agriculture, the federal agency that sponsors the WIC program, has determined that WIC food vouchers are considered “property in lieu of money” and, therefore, should be reported as federal awards expended by the Medical Center for the purpose of presentation in the Schedule. The amount reported in the Schedule for the WIC program under Assistance Listing Number 10.557 represents the federally funded value of food vouchers redeemed ($7,072,588) plus administrative costs ($1,650,640) for the year ended December 31, 2022. The WIC program may include, in addition to federal funds, support from New York State. The accompanying Schedule reflects expenditures that have been supported by federal funds, as determined based on communication of funding levels provided by the pass-through agency.
Title: 3. U.S. Department of Housing and Urban Development Mortgage Insurance Programs
Accounting Policies: GAAP
De Minimis Rate Used: N
Rate Explanation: N/A
The Medical Center has mortgage loans insured under the provisions of the U.S. Department of Housing and Urban Development – Federal Housing Administration (FHA) Sections 242 (Mortgage Insurance Hospitals) and 241 mortgage insurance programs (Supplemental Loan Insurance Multifamily Rental Housing). The U.S. Department of Housing and Urban Development (HUD) has determined that the mortgage insurance programs are to be considered a federal award (Assistance Listing Numbers 14.128 and 14.151) for purposes of compliance with the Uniform Guidance. At December 31, 2022, the Section 242 loan was paid in full. At December 31, 2022, the outstanding balance of the Section 241 loans was $187,704,060. Amounts presented on the Schedule related to these loans represent outstanding balances as of January 1, 2022. Pursuant to the agreements related to the mortgages, the Medical Center is, among other things, required to maintain a mortgage reserve fund, required to maintain a specific debt service coverage ratio and other financial ratios, and required to obtain approval from HUD to incur additional debt above specified levels if profitability requirements are not met. The mortgages are collateralized by substantially all of the property, buildings and equipment and gross receipts derived from operations.
Title: 4. Provider Relief Funds ("PRF") and American Rescue Plan ("ARP") Rural Distribution
Accounting Policies: GAAP
De Minimis Rate Used: N
Rate Explanation: N/A
The Schedule includes all Period 3 funds received between January 1, 2021 and June 30, 2021 and expended by June 30, 2022 along with Period 4 funds received between July 1, 2021 and December 31, 2021 and expended by December 31, 2022 as reported to HRSA via the PRF and ARP Rural Reporting Portal. PRF and ARP Rural funds were reported separately by entity (Medical Center, M2PC, and MMCH) that collectively amounted to $9,646,305 is included on the Schedule. The Medical Center received funding in Period 4 in the amount of $4,178,825, which was applied towards lost revenue. M2PC received funding in both Period 3 and Period 4 in the amount of $3,463,829 and $1,532,116, respectively, which was applied towards lost revenue in both periods. MMCH received funding in Period 4 in the amount of $471,535, which was applied towards lost revenue.
Title: 5. HRSA COVID-19 Testing and Treatment for the Uninsured ("Uninsured Program")
Accounting Policies: GAAP
De Minimis Rate Used: N
Rate Explanation: N/A
The Medical Center conducted COVID-19 testing and/or provided treatment for uninsured individuals with a COVID-19 primary diagnosis on or after February 4, 2020 and as such has requested claims reimbursement under Assistance Listing Number 93.461 Health Resources and Services Administration’s (“HRSA”) COVID-19 Claims Reimbursement to Health Care Providers and Facilities for Testing, Treatment and Vaccine Administration for the Uninsured program. The Medical Center has recorded $(306,424) on the Schedule which represents claims of $598,897 with service dates in fiscal year 2022 for which reimbursement was received in 2022, net of write-offs of $905,321 relating to claims submitted and reported in 2021 that were not reimbursed by HRSA. The Uninsured Program stopped accepting claims due to a lack of sufficient funds. No claims submitted after March 22, 2022 for testing or treatment and claims for vaccine administration after April 5, 2022, will be processed for adjudication and payment.
Title: 6. Federal Emergency Management Agency ("FEMA")
Accounting Policies: GAAP
De Minimis Rate Used: N
Rate Explanation: N/A
As of December 31, 2022, the Medical Center received approval for $1,178,388 of claims submitted to FEMA during 2022 under Assistance Listing Number 97.036. The claims submitted represented incurred eligible operating expenses attributed to the Medical Center’s response to COVID-19. This amount is included on the Schedule.
Title: 7. Vaccines for Children Program
Accounting Policies: GAAP
De Minimis Rate Used: N
Rate Explanation: N/A
During the year ended December 31, 2022, the Medical Center participated in the New York City Department of Health and Mental Hygiene – Vaccines for Children Program through the provision of vaccinations. The U.S. Department of Health and Human Services, the federal agency that sponsors this program under Assistance Listing 93.268, provides funds to the New York City Department of Health and Mental Hygiene to develop and operate programs designed to ensure effective delivery of vaccination services to eligible children through the enrolled providers of medical care to administer the vaccines. During 2022, the Medical Center, as a vaccinating provider, received $1,605,136 of vaccines to administer to eligible children. In accordance with the 2022 OMB Compliance Supplement, the value of the vaccines received by the Medical Center is not reported on the Schedule as the vaccines are not considered expenditures under a federal award for purposes of reporting by the Medical Center as a vaccinating provider.