Title: Contingency
Accounting Policies: The Schedule has been prepared on the accrual basis of accounting. The Schedule includes all federal and state grants, and contracts entered into by the System that had activity during the year ended December 31, 2022 and should be read in conjunction with the Systems consolidated financial statements. 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) and the State Single Audit Guidelines for Wisconsin. 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 System and federal agencies use a facilities and administrative cost rate to charge facilities and administrative costs to individual sponsored projects. The rate is the result of a number of complex cost allocation procedures that the System uses to allocate its facilities and administrative costs to both sponsored and nonsponsored activities. The costs allocated to sponsored projects are divided by the direct costs of sponsored projects to arrive at a rate. The U.S. Department of Health and Human Services (DHHS) must approve the rate before the System can use it to charge facilities and administrative costs to federally sponsored projects. The System has elected not to use the 10% de minimis indirect cost rate allowed under Uniform Guidance.Under Uniform Guidance and State Single Audit Guidelines for Wisconsin, tests of compliance with laws and regulations related to specific program requirements are required for each federal and state award program that is considered a major program for the System. Because the Schedule presents only a selected portion of the operations of the System, it is not intended to and does not present the financial position, changes in net assets or cash flows of the System. As outlined in the April 2022 OMB Compliance Supplement, the amounts reported in the Schedule related to the Provider Relief Fund (PRF), Assistance Listing No. 93.498, are reported based upon the PRF reporting portal submission guidelines established by the Health Resource and Service Administration (HRSA). 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: Payment Received Period (Payments Exceeding $10,000 in Aggregate Received), Deadline to Use Funds, Reporting Time Period Period 1 April 10, 2020 to June 30,2020, June 30, 2021, July 1, 2021 to September 30, 2021 Period 2 July 1, 2020 to December 31, 2020, December 31, 2021, January 1, 2022 to March 31, 2022, Period 3, January 1, 2021 to June 30, 2021, June 30, 2022, July 1, 2022 to September 30, 2022, Period 4, July 1, 2021 to December 31, 2021, December 31, 2022, January 1, 2023 to March 31, 2023, Period 5, January 1 2022 to June 30, 2022, June 30, 2023, July 1, 2023 to September 30, 2023, Period 6, July 1, 2022 to December 31, 2022, December 31, 2023, January 1, 2024 to March 31, 2024. The accompanying Schedule of Expenditures of Federal Awards (SEFA) includes those qualifying expenditures and lost revenues that were reported in the HRSA PRF portal for Period 3 and 4. During the years ended December 31, 2022 and 2021, the System recognized approximately $3,920,000 and $24,420,000, respectively, related to Period 3 and 4 funding.
De Minimis Rate Used: N
Rate Explanation: The auditee did not use the de minimis cost rate.
All federal and state financial assistance programs are subject to review and audit by the grantor agencies. Such audits could lead to requests for reimbursements to the grantor agencies for costs disallowed under the terms of the programs. Management believes disallowances, if any, will not be material.
Title: Categorization of Expenditures
Accounting Policies: The Schedule has been prepared on the accrual basis of accounting. The Schedule includes all federal and state grants, and contracts entered into by the System that had activity during the year ended December 31, 2022 and should be read in conjunction with the Systems consolidated financial statements. 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) and the State Single Audit Guidelines for Wisconsin. 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 System and federal agencies use a facilities and administrative cost rate to charge facilities and administrative costs to individual sponsored projects. The rate is the result of a number of complex cost allocation procedures that the System uses to allocate its facilities and administrative costs to both sponsored and nonsponsored activities. The costs allocated to sponsored projects are divided by the direct costs of sponsored projects to arrive at a rate. The U.S. Department of Health and Human Services (DHHS) must approve the rate before the System can use it to charge facilities and administrative costs to federally sponsored projects. The System has elected not to use the 10% de minimis indirect cost rate allowed under Uniform Guidance.Under Uniform Guidance and State Single Audit Guidelines for Wisconsin, tests of compliance with laws and regulations related to specific program requirements are required for each federal and state award program that is considered a major program for the System. Because the Schedule presents only a selected portion of the operations of the System, it is not intended to and does not present the financial position, changes in net assets or cash flows of the System. As outlined in the April 2022 OMB Compliance Supplement, the amounts reported in the Schedule related to the Provider Relief Fund (PRF), Assistance Listing No. 93.498, are reported based upon the PRF reporting portal submission guidelines established by the Health Resource and Service Administration (HRSA). 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: Payment Received Period (Payments Exceeding $10,000 in Aggregate Received), Deadline to Use Funds, Reporting Time Period Period 1 April 10, 2020 to June 30,2020, June 30, 2021, July 1, 2021 to September 30, 2021 Period 2 July 1, 2020 to December 31, 2020, December 31, 2021, January 1, 2022 to March 31, 2022, Period 3, January 1, 2021 to June 30, 2021, June 30, 2022, July 1, 2022 to September 30, 2022, Period 4, July 1, 2021 to December 31, 2021, December 31, 2022, January 1, 2023 to March 31, 2023, Period 5, January 1 2022 to June 30, 2022, June 30, 2023, July 1, 2023 to September 30, 2023, Period 6, July 1, 2022 to December 31, 2022, December 31, 2023, January 1, 2024 to March 31, 2024. The accompanying Schedule of Expenditures of Federal Awards (SEFA) includes those qualifying expenditures and lost revenues that were reported in the HRSA PRF portal for Period 3 and 4. During the years ended December 31, 2022 and 2021, the System recognized approximately $3,920,000 and $24,420,000, respectively, related to Period 3 and 4 funding.
De Minimis Rate Used: N
Rate Explanation: The auditee did not use the de minimis cost rate.
The categorization of expenditures by program included in the schedule of expenditures of federal and state 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 December 31, 2022 reflects Assistance Listing changes through April 2022.
Title: 1.Scope of Audit Pursuant to the Uniform Guidance
Accounting Policies: The Schedule has been prepared on the accrual basis of accounting. The Schedule includes all federal and state grants, and contracts entered into by the System that had activity during the year ended December 31, 2022 and should be read in conjunction with the Systems consolidated financial statements. 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) and the State Single Audit Guidelines for Wisconsin. 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 System and federal agencies use a facilities and administrative cost rate to charge facilities and administrative costs to individual sponsored projects. The rate is the result of a number of complex cost allocation procedures that the System uses to allocate its facilities and administrative costs to both sponsored and nonsponsored activities. The costs allocated to sponsored projects are divided by the direct costs of sponsored projects to arrive at a rate. The U.S. Department of Health and Human Services (DHHS) must approve the rate before the System can use it to charge facilities and administrative costs to federally sponsored projects. The System has elected not to use the 10% de minimis indirect cost rate allowed under Uniform Guidance.Under Uniform Guidance and State Single Audit Guidelines for Wisconsin, tests of compliance with laws and regulations related to specific program requirements are required for each federal and state award program that is considered a major program for the System. Because the Schedule presents only a selected portion of the operations of the System, it is not intended to and does not present the financial position, changes in net assets or cash flows of the System. As outlined in the April 2022 OMB Compliance Supplement, the amounts reported in the Schedule related to the Provider Relief Fund (PRF), Assistance Listing No. 93.498, are reported based upon the PRF reporting portal submission guidelines established by the Health Resource and Service Administration (HRSA). 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: Payment Received Period (Payments Exceeding $10,000 in Aggregate Received), Deadline to Use Funds, Reporting Time Period Period 1 April 10, 2020 to June 30,2020, June 30, 2021, July 1, 2021 to September 30, 2021 Period 2 July 1, 2020 to December 31, 2020, December 31, 2021, January 1, 2022 to March 31, 2022, Period 3, January 1, 2021 to June 30, 2021, June 30, 2022, July 1, 2022 to September 30, 2022, Period 4, July 1, 2021 to December 31, 2021, December 31, 2022, January 1, 2023 to March 31, 2023, Period 5, January 1 2022 to June 30, 2022, June 30, 2023, July 1, 2023 to September 30, 2023, Period 6, July 1, 2022 to December 31, 2022, December 31, 2023, January 1, 2024 to March 31, 2024. The accompanying Schedule of Expenditures of Federal Awards (SEFA) includes those qualifying expenditures and lost revenues that were reported in the HRSA PRF portal for Period 3 and 4. During the years ended December 31, 2022 and 2021, the System recognized approximately $3,920,000 and $24,420,000, respectively, related to Period 3 and 4 funding.
De Minimis Rate Used: N
Rate Explanation: The auditee did not use the de minimis cost rate.
All federal and state grant expenditures of Marshfield Clinic Health System, Inc. and subsidiaries (the System) are included in the scope of the audit except those awarded to Family Health Center of Marshfield, Inc., an entity sponsored by the System. The System acquired Dickinson County Healthcare System (Dickinson) in February 2022. The audit was performed in accordance with the provisions of the OMB Uniform Guidance Compliance Supplement (Compliance Supplement) and the State Single Audit Guidelines of Wisconsin. Compliance testing of all requirements, as described in the Compliance Supplement, was performed for the grant programs noted below. The Schedule of Expenditures of Federal and State Awards (the Schedule) includes all federal and state grants to the System that had activity during the year ended December 31, 2022, except those awarded to Family Health Center of Marshfield, Inc. A separate audit in accordance with OMB Uniform Guidance is completed for Family Health Center of Marshfield, Inc. In February 2022, the System became the sole corporate member of Dickinson County Healthcare System (MMC-Dickinson) through a member substitution. MMC-Dickinsons federal and state grant awards are included in the consolidated System Schedule for the year ended December 31, 2022. Prior to acquisition, MMC-Dickinson had a separate Single Audit for the year-ended December 31, 2021. Managements corrective action plans include the plans related to the prior year 2021 MMC-Dickinson Single Audit.Federal and state expenditures include all grants, contracts, and similar agreements entered into directly between the System and agencies and departments of the federal government and all awards to the System by other governmental entities and not-for-profit organizations pursuant to federal grants, contracts, and similar agreements. The Schedule summarizes expenditures by the following:?Major and nonmajor federal programs?Primary federal funding agency?Direct award agreements between the System and federal granting agencies?Pass-through federal award agreements between the System and nonfederal granting agencies?Direct award agreements between the System and state granting agencies?Pass-through state award agreements between the System and nonstate granting agenciesExpenditures consist of direct costs and facilities and administrative costs. Direct costs are those that can be easily identified with an individual federally sponsored project. The salary of a principal investigator of a sponsored research project and the materials consumed by the project are examples of direct costs.Unlike direct costs, facilities and administrative costs cannot be easily identified with an individual sponsored project. Facilities and administrative costs are the costs of services and resources that benefit many sponsored projects as well as nonsponsored projects and activities. Expenses incurred for administration, library, building maintenance, and building and equipment depreciation are examples of facilities and administrative costs.There were no noncash expenditures or federally provided insurance related to the Systems federal award programs during the year ended December 31, 2022
Title: 3.Audits Performed by Other Organizations
Accounting Policies: The Schedule has been prepared on the accrual basis of accounting. The Schedule includes all federal and state grants, and contracts entered into by the System that had activity during the year ended December 31, 2022 and should be read in conjunction with the Systems consolidated financial statements. 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) and the State Single Audit Guidelines for Wisconsin. 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 System and federal agencies use a facilities and administrative cost rate to charge facilities and administrative costs to individual sponsored projects. The rate is the result of a number of complex cost allocation procedures that the System uses to allocate its facilities and administrative costs to both sponsored and nonsponsored activities. The costs allocated to sponsored projects are divided by the direct costs of sponsored projects to arrive at a rate. The U.S. Department of Health and Human Services (DHHS) must approve the rate before the System can use it to charge facilities and administrative costs to federally sponsored projects. The System has elected not to use the 10% de minimis indirect cost rate allowed under Uniform Guidance.Under Uniform Guidance and State Single Audit Guidelines for Wisconsin, tests of compliance with laws and regulations related to specific program requirements are required for each federal and state award program that is considered a major program for the System. Because the Schedule presents only a selected portion of the operations of the System, it is not intended to and does not present the financial position, changes in net assets or cash flows of the System. As outlined in the April 2022 OMB Compliance Supplement, the amounts reported in the Schedule related to the Provider Relief Fund (PRF), Assistance Listing No. 93.498, are reported based upon the PRF reporting portal submission guidelines established by the Health Resource and Service Administration (HRSA). 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: Payment Received Period (Payments Exceeding $10,000 in Aggregate Received), Deadline to Use Funds, Reporting Time Period Period 1 April 10, 2020 to June 30,2020, June 30, 2021, July 1, 2021 to September 30, 2021 Period 2 July 1, 2020 to December 31, 2020, December 31, 2021, January 1, 2022 to March 31, 2022, Period 3, January 1, 2021 to June 30, 2021, June 30, 2022, July 1, 2022 to September 30, 2022, Period 4, July 1, 2021 to December 31, 2021, December 31, 2022, January 1, 2023 to March 31, 2023, Period 5, January 1 2022 to June 30, 2022, June 30, 2023, July 1, 2023 to September 30, 2023, Period 6, July 1, 2022 to December 31, 2022, December 31, 2023, January 1, 2024 to March 31, 2024. The accompanying Schedule of Expenditures of Federal Awards (SEFA) includes those qualifying expenditures and lost revenues that were reported in the HRSA PRF portal for Period 3 and 4. During the years ended December 31, 2022 and 2021, the System recognized approximately $3,920,000 and $24,420,000, respectively, related to Period 3 and 4 funding.
De Minimis Rate Used: N
Rate Explanation: The auditee did not use the de minimis cost rate.
There were no audits of the Systems federal or state award programs performed by other organizations or grantor agencies during the year ended December 31, 2022.
Title: 5.Loans Outstanding
Accounting Policies: The Schedule has been prepared on the accrual basis of accounting. The Schedule includes all federal and state grants, and contracts entered into by the System that had activity during the year ended December 31, 2022 and should be read in conjunction with the Systems consolidated financial statements. 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) and the State Single Audit Guidelines for Wisconsin. 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 System and federal agencies use a facilities and administrative cost rate to charge facilities and administrative costs to individual sponsored projects. The rate is the result of a number of complex cost allocation procedures that the System uses to allocate its facilities and administrative costs to both sponsored and nonsponsored activities. The costs allocated to sponsored projects are divided by the direct costs of sponsored projects to arrive at a rate. The U.S. Department of Health and Human Services (DHHS) must approve the rate before the System can use it to charge facilities and administrative costs to federally sponsored projects. The System has elected not to use the 10% de minimis indirect cost rate allowed under Uniform Guidance.Under Uniform Guidance and State Single Audit Guidelines for Wisconsin, tests of compliance with laws and regulations related to specific program requirements are required for each federal and state award program that is considered a major program for the System. Because the Schedule presents only a selected portion of the operations of the System, it is not intended to and does not present the financial position, changes in net assets or cash flows of the System. As outlined in the April 2022 OMB Compliance Supplement, the amounts reported in the Schedule related to the Provider Relief Fund (PRF), Assistance Listing No. 93.498, are reported based upon the PRF reporting portal submission guidelines established by the Health Resource and Service Administration (HRSA). 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: Payment Received Period (Payments Exceeding $10,000 in Aggregate Received), Deadline to Use Funds, Reporting Time Period Period 1 April 10, 2020 to June 30,2020, June 30, 2021, July 1, 2021 to September 30, 2021 Period 2 July 1, 2020 to December 31, 2020, December 31, 2021, January 1, 2022 to March 31, 2022, Period 3, January 1, 2021 to June 30, 2021, June 30, 2022, July 1, 2022 to September 30, 2022, Period 4, July 1, 2021 to December 31, 2021, December 31, 2022, January 1, 2023 to March 31, 2023, Period 5, January 1 2022 to June 30, 2022, June 30, 2023, July 1, 2023 to September 30, 2023, Period 6, July 1, 2022 to December 31, 2022, December 31, 2023, January 1, 2024 to March 31, 2024. The accompanying Schedule of Expenditures of Federal Awards (SEFA) includes those qualifying expenditures and lost revenues that were reported in the HRSA PRF portal for Period 3 and 4. During the years ended December 31, 2022 and 2021, the System recognized approximately $3,920,000 and $24,420,000, respectively, related to Period 3 and 4 funding.
De Minimis Rate Used: N
Rate Explanation: The auditee did not use the de minimis cost rate.
A subsidiary with a loan under the Community Facilities Loans and Grant program was acquired by the System on February 1, 2022. Expenditures relating to this program are reported in the Schedule at the balance as of February 1, 2022 plus advances made from February 1, 2022 through December 31, 2022. The outstanding balance at December 31, 2022 was $16,287,116.
Title: 7.Settlement of State of Wisconsin Department of Health Services (DHS) Cos
Accounting Policies: The Schedule has been prepared on the accrual basis of accounting. The Schedule includes all federal and state grants, and contracts entered into by the System that had activity during the year ended December 31, 2022 and should be read in conjunction with the Systems consolidated financial statements. 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) and the State Single Audit Guidelines for Wisconsin. 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 System and federal agencies use a facilities and administrative cost rate to charge facilities and administrative costs to individual sponsored projects. The rate is the result of a number of complex cost allocation procedures that the System uses to allocate its facilities and administrative costs to both sponsored and nonsponsored activities. The costs allocated to sponsored projects are divided by the direct costs of sponsored projects to arrive at a rate. The U.S. Department of Health and Human Services (DHHS) must approve the rate before the System can use it to charge facilities and administrative costs to federally sponsored projects. The System has elected not to use the 10% de minimis indirect cost rate allowed under Uniform Guidance.Under Uniform Guidance and State Single Audit Guidelines for Wisconsin, tests of compliance with laws and regulations related to specific program requirements are required for each federal and state award program that is considered a major program for the System. Because the Schedule presents only a selected portion of the operations of the System, it is not intended to and does not present the financial position, changes in net assets or cash flows of the System. As outlined in the April 2022 OMB Compliance Supplement, the amounts reported in the Schedule related to the Provider Relief Fund (PRF), Assistance Listing No. 93.498, are reported based upon the PRF reporting portal submission guidelines established by the Health Resource and Service Administration (HRSA). 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: Payment Received Period (Payments Exceeding $10,000 in Aggregate Received), Deadline to Use Funds, Reporting Time Period Period 1 April 10, 2020 to June 30,2020, June 30, 2021, July 1, 2021 to September 30, 2021 Period 2 July 1, 2020 to December 31, 2020, December 31, 2021, January 1, 2022 to March 31, 2022, Period 3, January 1, 2021 to June 30, 2021, June 30, 2022, July 1, 2022 to September 30, 2022, Period 4, July 1, 2021 to December 31, 2021, December 31, 2022, January 1, 2023 to March 31, 2023, Period 5, January 1 2022 to June 30, 2022, June 30, 2023, July 1, 2023 to September 30, 2023, Period 6, July 1, 2022 to December 31, 2022, December 31, 2023, January 1, 2024 to March 31, 2024. The accompanying Schedule of Expenditures of Federal Awards (SEFA) includes those qualifying expenditures and lost revenues that were reported in the HRSA PRF portal for Period 3 and 4. During the years ended December 31, 2022 and 2021, the System recognized approximately $3,920,000 and $24,420,000, respectively, related to Period 3 and 4 funding.
De Minimis Rate Used: N
Rate Explanation: The auditee did not use the de minimis cost rate.
The Systems settlement of DHS cost reimbursement awards presented for the year ended December 31, 2022 are summarized below. Certain awards summarized below may not agree to the amounts in the Schedule based on the difference of timing of reporting to DHS and the recognition of expenses on the Schedule. The indirect costs represent facilities and administrative costs allocated to the program based on a predetermined indirect cost rate negotiated with the U.S. Department of Health and Human Services. Community Aids System Reporting (CARS) ProfileAward TitleAward AmountAward PeriodPeriod of award within audit periodExpenditures reported to CARS for paymentSalary and wagesOther expensesIndirect costsTotal allowable costs128-010Congenital Disorders Program$37,5467/1/21-6/30/221/1/22-6/30/22$12,927$10,755$-$2,172$12,927128-010Congenital Disorders Program$37,5467/1/22-6/30/237/1/22-12/31/2212,55710,464-2,09312,557128-011Congenital Disorders Program$136,7247/1/21-6/30/221/1/22-6/30/2249,605-41,5258,08049,605128-011Congenital Disorders Program$136,7257/1/22-6/30/237/1/22-12/31/2255,819-46,5169,30355,819157-010WWWP$86,4477/1/21-6/30/221/1/22-6/30/2216,39316,33558-16,393157-120WWWP$11,3707/1/21-6/30/221/1/22-6/30/22630630--630531-282Alliance for Wisconsin$256,3459/30/21-9/29/221/1/22-9/29/22206,43318,154162,92825,351206,433533-016Alliance for Wisconsin Youth$337,8387/1/21-6/30/221/1/22-6/30/22324,602131,259139,66553,678324,602533-016Alliance for Wisconsin Youth $231,8387/1/22-6/30/237/1/22-12/31/2287,93164,9498,32714,65587,931$766,887$252,546$399,019$115,332$766,887