Audit 23972

FY End
2022-09-30
Total Expended
$184.39M
Findings
2
Programs
4
Year: 2022 Accepted: 2023-06-29

Organization Exclusion Status:

Checking exclusion status...

Findings

ID Ref Severity Repeat Requirement
37199 2022-001 Significant Deficiency - N
613641 2022-001 Significant Deficiency - N

Programs

ALN Program Spent Major Findings
10.766 Community Facilities Loans and Grants $139.49M Yes 1
93.498 Provider Relief Fund $42.36M Yes 0
93.461 Covid-19 Testing for the Uninsured $1.84M - 0
93.697 Covid-19 Testing for Rural Health Clinics $700,000 - 0

Contacts

Name Title Type
KJ3FUJ4JD2K9 James Dupe Auditee
9103092348 Kevin Leder Auditor
No contacts on file

Notes to SEFA

Title: Loan Program 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 for all awards. Under these principles, certain types of expenditures are not allowable or are limited as to reimbursement. Any negative amounts shown on the Schedule represent adjustments or credits made in the normal course of business to amounts reported as expenditures in prior years. The combined financial statements reflect revenue recognized from COVID-19 Provider Relief Funds of approximately $8,155,000 and $80,191,000 for the years ended September 30, 2022 and 2021, respectively. The SEFA includes COVID-19 Provider Relief Funds of approximately $42,358,000. Approximately $10,476,000 and $31,882,000 were received in Period 2 and Period 3, respectively, in accordance with the requirements of the compliance supplement for assistance listing number 93.498. All of $42,358,000 was recognized in the financial statements for the year ended September 30, 2021. De Minimis Rate Used: Y Rate Explanation: Cumberland County Hospital System, Inc. has elected to use 10-percent de minimis indirect cost rate as allowed under the Uniform Guidance. In March 2013, Hoke Healthcare obtained permanent financing for Health Pavilion Hoke from the United States Department of Agriculture (USDA) in the form of a $38,448,000, fixed rate, 40-year direct loan (the phase 1 Direct loan). The USDA also provided permanent financing for Phase 2 through its Community Facilities Direct Loan and Guaranteed Loan Program through a fixed-rate, 40-year, $30,000,000 direct loan (the Phase 2 Direct Loan) and a fixed-rate, 30-year, $27,311,000 guaranteed loan (the Guaranteed Loan). As of September 30, 2022, the outstanding balance of the total loan was $82,108,700. In 2011, Harnett Health obtained a construction loan of $63,000,000 from a financial institution. In March 2013, Harnett Health entered into an additional series of obligations for eight notes payable to the USDA. The proceeds of the USDA notes were used to pay off the construction loan noted above. As of September 30, 2022, the outstanding balance of the total loan was $54,696,416.In accordance with 2 CFR 200.502, since the federal government is at risk for loans until the debt is repaid, the value of federal awards expended under loan programs in a given period is calculated as the value of new loans made or received during the fiscal year, plus the balance of loans from previous years for which the federal government imposes continuing compliance requirements, plus any interest subsidy, cash, or administrative cost allowance. As of September 30, 2022, the expenditures included in the Schedule consist of the highest outstanding loan balance during the fiscal year.
Title: 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 for all awards. Under these principles, certain types of expenditures are not allowable or are limited as to reimbursement. Any negative amounts shown on the Schedule represent adjustments or credits made in the normal course of business to amounts reported as expenditures in prior years. The combined financial statements reflect revenue recognized from COVID-19 Provider Relief Funds of approximately $8,155,000 and $80,191,000 for the years ended September 30, 2022 and 2021, respectively. The SEFA includes COVID-19 Provider Relief Funds of approximately $42,358,000. Approximately $10,476,000 and $31,882,000 were received in Period 2 and Period 3, respectively, in accordance with the requirements of the compliance supplement for assistance listing number 93.498. All of $42,358,000 was recognized in the financial statements for the year ended September 30, 2021. De Minimis Rate Used: Y Rate Explanation: Cumberland County Hospital System, Inc. has elected to use 10-percent de minimis indirect cost rate as allowed under the Uniform Guidance. The accompanying schedule of expenditures of federal awards (the Schedule) includes the federal award activity of Cumberland County Hospital System, Inc. dba: Cape Fear Valley Health System (the Health System), 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 2 CFR 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 Health System, it is not intended to and does not present the net position, changes in net assets, or cash flows of the Health System.

Finding Details

Federal Agency: United States Department of Agriculture Federal Program Title: Community Facilities Loans and Grants Federal Assistance Listing Number: 10.766 Type of Finding: Significant Deficiency in Internal Control over Compliance Period: October 1, 2021 ? September 30, 2022 Condition: The management did not have proper internal controls in place to ensure all investments are backed by the full faith and credit of the United States. Additionally, management did not have internal controls in place to ensure investment valuation is monitored to ascertain debt service reserve fund is at least 90% of the debt service reserve requirement. Criteria or specific requirement: The USDA Debt agreement requires that investment valuation be made by management twice a year to ensure debt service reserve fund is at least 90% of the debt service reserve requirement. Additionally, compliance requirement requires funds to be deposited in institutions insured by the state or federal government or invested in readily marketable securities backed by the full faith and credit of the United States. Effect: A lack of internal controls over these requirements cause the reserve balance to be potentially underfunded as well as the funds to be invested in securities that are not backed by the full faith and credit of the United States. Questioned costs: None Cause: The Cumberland County Hospital System did not have internal controls in place to ensure all investments are backed by the full faith and credit of the United States. Additionally, management did not have proper internal controls in place to ensure investment valuation is monitored to ascertain adequate debt reserve balance is maintained. Recommendation: We recommend management ensure that they have a process in place to ensure all investments are backed by the full faith and credit of the United States. Additionally, management should have proper internal controls in place to ensure investment valuation is monitored to ascertain adequate debt reserve balance is maintained in accordance with related USDA debt agreement. Views of responsible officials: The management will have all mutual funds sold and will deposit $290,000 into the debt reserve account to fully fund the balance to equal one payment.
Federal Agency: United States Department of Agriculture Federal Program Title: Community Facilities Loans and Grants Federal Assistance Listing Number: 10.766 Type of Finding: Significant Deficiency in Internal Control over Compliance Period: October 1, 2021 ? September 30, 2022 Condition: The management did not have proper internal controls in place to ensure all investments are backed by the full faith and credit of the United States. Additionally, management did not have internal controls in place to ensure investment valuation is monitored to ascertain debt service reserve fund is at least 90% of the debt service reserve requirement. Criteria or specific requirement: The USDA Debt agreement requires that investment valuation be made by management twice a year to ensure debt service reserve fund is at least 90% of the debt service reserve requirement. Additionally, compliance requirement requires funds to be deposited in institutions insured by the state or federal government or invested in readily marketable securities backed by the full faith and credit of the United States. Effect: A lack of internal controls over these requirements cause the reserve balance to be potentially underfunded as well as the funds to be invested in securities that are not backed by the full faith and credit of the United States. Questioned costs: None Cause: The Cumberland County Hospital System did not have internal controls in place to ensure all investments are backed by the full faith and credit of the United States. Additionally, management did not have proper internal controls in place to ensure investment valuation is monitored to ascertain adequate debt reserve balance is maintained. Recommendation: We recommend management ensure that they have a process in place to ensure all investments are backed by the full faith and credit of the United States. Additionally, management should have proper internal controls in place to ensure investment valuation is monitored to ascertain adequate debt reserve balance is maintained in accordance with related USDA debt agreement. Views of responsible officials: The management will have all mutual funds sold and will deposit $290,000 into the debt reserve account to fully fund the balance to equal one payment.