Audit 23599

Title: COVID-19 Provider Relief Fund and American Rescue Plan Rural Distribution Accounting Policies: The accompanying schedule of expenditures of federal awards (the Schedule) includes the federal grant activity of the New York Society for the Relief of the Ruptured and Crippled, Maintaining the Hospital for the Special Surgery (the Hospital) and is presented on the accrual basis of accounting. The information on 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 (the Uniform Guidance). Therefore, some amounts presented in this schedule may differ from amounts presented in, or used in the preparation of, the consolidated financial statements of the Hospital. For purposes of the Schedule, federal awards include any assistance provided by a federal agency directly or indirectly in the form of grants, contracts, cooperative agreements, loan and loan guarantees, or other non-cash assistance. In accordance with applicable requirements, certain programs may be presented in a fiscal period based on the program-specific guidance (see Note 3). Therefore, some amounts presented in the Schedule may differ from amounts presented in, or used in the preparation of, the Hospitals consolidated financial statements. Negative amounts represent adjustments or credits to amounts reported as expenditures in prior years. Direct and indirect costs are charged to awards in accordance with cost principles contained in the United States Department of Health and Human Services Cost Principles for Hospitals at 45 CFR Part 75 Appendix IX for awards subject to the Uniform Guidance. Under these cost principles, certain types of expenditures are not allowable or are limited as to reimbursement. De Minimis Rate Used: N Rate Explanation: The Uniform Guidance provides for a 10% de minimis indirect cost rate election; however, the Hospital did not make this election as the Hospital uses a negotiated indirect cost rate. In accordance with the U.S. Department of Health and Human Services requirements specific to Assistance Listing No. 93.498, COVID-19 Provider Relief Fund and American Rescue Plan Rural Distribution, the amount presented on the accompanying Schedule for the year ended December 31, 2022 for Assistance Listing No. 93.498 relates to Provider Relief Fund (PRF) payments received from January 1, 2021 through December 31, 2021 used for PRF-eligible activity for the period January 1, 2020 through December 31, 2022. This payment receipt period and activity period and the resulting amount presented on the accompanying Schedule for the year ended December 31, 2022 reconciles to the PRF information previously reported to the Health Resources and Services Administration (HRSA) for PRF Reporting Periods 3 and 4 as follows: Reporting period 3: The Hospital did not receive PRF payments during Reporting Period 3. Reporting period 4: [see Notes to the Schedule for chart/table] The expenses attributable to Coronavirus Disease 2019 and lost revenues incurred by the Hospital during the period of availability through PRF Reporting Period 4 (January 1, 2020 through December 31, 2022) are in excess of the distributions received in PRF Reporting Periods 1 and 2 (which addressed payments received during April 10, 2020 to December 31, 2020, and previously reported on the Schedule of Expenditures of Federal Awards for the year ended December 31, 2021) and distributions received from July 1, 2021 through December 31, 2021 and, therefore, the amounts presented in the table included within the Notes to the Schedule and on the accompanying Schedule are limited to the amount of such distributions. The Hospital also received PRF payments subsequent to December 31, 2021 which are required to be reported in subsequent HRSA PRF Reporting Periods and, accordingly, pursuant to the requirements specific to Assistance Listing No. 93.498, activity related to such payments is excluded from the accompanying Schedule.