Audit 300930

FY End
2023-06-30
Total Expended
$50.00M
Findings
2
Programs
24
Organization: Hospital Sisters Health System (IL)
Year: 2023 Accepted: 2024-03-29
Auditor: Kpmg LLP

Organization Exclusion Status:

Checking exclusion status...

Findings

ID Ref Severity Repeat Requirement
390068 2023-001 Significant Deficiency - B
966510 2023-001 Significant Deficiency - B

Programs

ALN Program Spent Major Findings
93.498 Provider Relief Fund $37.74M Yes 0
97.036 Disaster Grants - Public Assistance (presidentially Declared Disasters) $5.21M - 0
10.855 Distance Learning and Telemedicine Loans and Grants $855,138 - 0
84.268 Federal Direct Student Loans $851,624 - 0
93.994 Maternal and Child Health Services Block Grant to the States $265,900 - 0
84.425 Education Stabilization Fund $249,652 - 0
93.889 National Bioterrorism Hospital Preparedness Program $243,362 - 0
93.461 Covid-19 Testing for the Uninsured $199,269 - 0
84.063 Federal Pell Grant Program $163,034 - 0
93.395 Cancer Treatment Research $142,200 Yes 0
93.155 Rural Health Research Centers $94,967 - 0
93.958 Block Grants for Community Mental Health Services $21,868 - 0
84.007 Federal Supplemental Educational Opportunity Grants $16,117 - 0
93.301 Small Rural Hospital Improvement Grant Program $11,938 - 0
84.033 Federal Work-Study Program $11,936 - 0
93.912 Rural Health Care Services Outreach, Rural Health Network Development and Small Health Care Provider Quality Improvement $4,770 - 0
93.959 Block Grants for Prevention and Treatment of Substance Abuse $1,944 - 0
93.658 Foster Care_title IV-E $1,166 - 0
84.181 Special Education-Grants for Infants and Families $1,065 - 0
93.399 Cancer Control $1,000 Yes 0
93.853 Extramural Research Programs in the Neurosciences and Neurological Disorders $395 - 0
93.667 Social Services Block Grant $220 - 0
93.558 Temporary Assistance for Needy Families $117 - 0
93.645 Stephanie Tubbs Jones Child Welfare Services Program $55 - 0

Contacts

Name Title Type
QPCQDKA2MMJ7 Robin Barber Auditee
2174929184 Andrea Chung Auditor
No contacts on file

Notes to SEFA

Title: Basis of Presentation Accounting Policies: The accompanying schedule of expenditures of federal and state awards (the Schedule) summarizes the federal and state awards expended by Hospital Sisters Health System and Subsidiaries (HSHS) for the year ended June 30, 2023. For purposes of the Schedule, federal and state awards include all grants, contracts, loans, and loan guarantee agreements entered into directly between HSHS and agencies and departments of the federal government and the State of Wisconsin. For the year ended June 30, 2023, HSHS had no expenditures in the form of noncash assistance, and no federally provided insurance in effect. Expenditures for federal and state award programs are recognized on the accrual basis of accounting. De Minimis Rate Used: Both Rate Explanation: Expenditures consist of direct and indirect costs. Direct costs are those that can be easily identified with an individual federal or state sponsored program. The salary of a social worker or a sponsored program and the materials consumed by the program are examples of direct costs. Unlike direct costs, indirect costs cannot easily be identified with an individual federal or state sponsored program. Indirect costs consist of expenses incurred for such items as administration, plant maintenance, and building and equipment depreciation. The federal or state agencies use an indirect cost rate to charge indirect costs to individual federal or state programs. The rate is the result of a number of cost allocation procedures that HSHS uses to allocate its indirect costs to both sponsored and nonsponsored activities. The costs allocated to sponsored programs are divided by the direct costs of sponsored programs to arrive at a rate. the U.S. Department of Public Health and Human Services (DHHS) must approve the rate before HSHS can use it to charge indirect costs to federal or state sponsored programs. HSHS has elected to use the 10% de minimis indriect cost rate allowed under Uniform Guidance, except for St. Vincent Hospital, which utilizes a separate negotiated rate. The accompanying schedule of expenditures of federal and state awards (the Schedule) summarizes the federal and state awards expended by Hospital Sisters Health System and Subsidiaries (HSHS) for the year ended June 30, 2023. For purposes of the Schedule, federal and state awards include all grants, contracts, loans, and loan guarantee agreements entered into directly between HSHS and agencies and departments of the federal government and the State of Wisconsin. For the year ended June 30, 2023, HSHS had no expenditures in the form of noncash assistance, and no federally provided insurance in effect. Expenditures for federal and state award programs are recognized on the accrual basis of accounting. Awards have been classified into major and nonmajor programs in accordance with the provisions 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 Guidance. HSHS’ major federal programs consist of the following: COVID‑19 – Provider Relief Funds – The Provider Relief Fund (PRF) program is administered by the Health Resources and Services Administration to support eligible providers during the COVID 19 pandemic and was approved for funding originally under the Coronavirus Aid, Relief and Economic Securities Act. Funds were provided to eligible providers to support healthcare related expenses or lost revenues attributable to the Coronavirus without application but rather with terms and conditions. These terms and conditions required acceptance through an online portal or the funds were to be returned. HSHS accepted the terms and conditions. The accompanying schedule of expenditures of Federal awards includes PRF for Periods 4 and 5 defined as payments received between July 1, 2022 to June 30, 2023. Tax Identification Numbers (TIN) for HSHS include: HSHS is 37‑1058692, SJS is 37‑0661238, SEO is 37‑0663567, SMD is 37‑0661244, SAE is 37‑0661233, SJB is 37‑1208459, SFL is 37‑0661236, SJH is 37‑0663568, HFG is 37‑0792770, GSS is 37‑0512290, SVGB is 39‑0817529, SHEC is 39‑0807060, SMGB is 39‑0818682, SNS is 39‑0808480, SJCF is 39‑0810545, SCO is 39‑0848401, HMI is 26‑3956318, and PCC is 37‑1071858. Research and Development Cluster – Includes awards from the U.S. Department of Health and Human Services for research and development of cancer treatment primarily under cancer treatment research and cancer control. HSHS’ major state program consists of the following: Opioid treatment program – Includes awards to provide intake services, detox, residential care, initial evaluations, IOP, individual appointments, aftercare program, urine drug testing, case management, and discharge planning.
Title: Federal and State Award Expenditures Accounting Policies: The accompanying schedule of expenditures of federal and state awards (the Schedule) summarizes the federal and state awards expended by Hospital Sisters Health System and Subsidiaries (HSHS) for the year ended June 30, 2023. For purposes of the Schedule, federal and state awards include all grants, contracts, loans, and loan guarantee agreements entered into directly between HSHS and agencies and departments of the federal government and the State of Wisconsin. For the year ended June 30, 2023, HSHS had no expenditures in the form of noncash assistance, and no federally provided insurance in effect. Expenditures for federal and state award programs are recognized on the accrual basis of accounting. De Minimis Rate Used: Both Rate Explanation: Expenditures consist of direct and indirect costs. Direct costs are those that can be easily identified with an individual federal or state sponsored program. The salary of a social worker or a sponsored program and the materials consumed by the program are examples of direct costs. Unlike direct costs, indirect costs cannot easily be identified with an individual federal or state sponsored program. Indirect costs consist of expenses incurred for such items as administration, plant maintenance, and building and equipment depreciation. The federal or state agencies use an indirect cost rate to charge indirect costs to individual federal or state programs. The rate is the result of a number of cost allocation procedures that HSHS uses to allocate its indirect costs to both sponsored and nonsponsored activities. The costs allocated to sponsored programs are divided by the direct costs of sponsored programs to arrive at a rate. the U.S. Department of Public Health and Human Services (DHHS) must approve the rate before HSHS can use it to charge indirect costs to federal or state sponsored programs. HSHS has elected to use the 10% de minimis indriect cost rate allowed under Uniform Guidance, except for St. Vincent Hospital, which utilizes a separate negotiated rate. Expenditures consist of direct and indirect costs. Direct costs are those that can be easily identified with an individual federal or state sponsored program. The salary of a social worker or a sponsored program and the materials consumed by the program are examples of direct costs. Unlike direct costs, indirect costs cannot easily be identified with an individual federal or state sponsored program. Indirect costs are the costs of services and resources that benefit many sponsored programs, as well as nonsponsored projects and activities. Indirect costs consist of expenses incurred for such items as administration, plant maintenance, and building and equipment depreciation. The federal or state agencies use an indirect cost rate to charge indirect costs to individual federal or state programs. The rate is the result of a number of cost allocation procedures that HSHS uses to allocate its indirect costs to both sponsored and nonsponsored activities. The costs allocated to sponsored programs are divided by the direct costs of sponsored programs to arrive at a rate. The U.S. Department of Health and Human Services (DHHS) must approve the rate before HSHS can use it to charge indirect costs to federal or state sponsored programs. HSHS has elected to use the 10% de minimis indirect cost rate allowed under Uniform Guidance, except for St. Vincent Hospital, which utilizes a separate negotiated rate.
Title: Federal Student Loan Programs Accounting Policies: The accompanying schedule of expenditures of federal and state awards (the Schedule) summarizes the federal and state awards expended by Hospital Sisters Health System and Subsidiaries (HSHS) for the year ended June 30, 2023. For purposes of the Schedule, federal and state awards include all grants, contracts, loans, and loan guarantee agreements entered into directly between HSHS and agencies and departments of the federal government and the State of Wisconsin. For the year ended June 30, 2023, HSHS had no expenditures in the form of noncash assistance, and no federally provided insurance in effect. Expenditures for federal and state award programs are recognized on the accrual basis of accounting. De Minimis Rate Used: Both Rate Explanation: Expenditures consist of direct and indirect costs. Direct costs are those that can be easily identified with an individual federal or state sponsored program. The salary of a social worker or a sponsored program and the materials consumed by the program are examples of direct costs. Unlike direct costs, indirect costs cannot easily be identified with an individual federal or state sponsored program. Indirect costs consist of expenses incurred for such items as administration, plant maintenance, and building and equipment depreciation. The federal or state agencies use an indirect cost rate to charge indirect costs to individual federal or state programs. The rate is the result of a number of cost allocation procedures that HSHS uses to allocate its indirect costs to both sponsored and nonsponsored activities. The costs allocated to sponsored programs are divided by the direct costs of sponsored programs to arrive at a rate. the U.S. Department of Public Health and Human Services (DHHS) must approve the rate before HSHS can use it to charge indirect costs to federal or state sponsored programs. HSHS has elected to use the 10% de minimis indriect cost rate allowed under Uniform Guidance, except for St. Vincent Hospital, which utilizes a separate negotiated rate. HSHS is responsible only for the performance of certain administrative duties with respect to the Federal Family Education Loan programs, and accordingly, these loans are not included in its consolidated financial statements, and it is not practical to determine the balance of loans outstanding to students and former students of HSHS under these programs at June 30, 2023.

Finding Details

Finding #2023-001 Type: Significant Deficiency Federal Agency: Department of Health and Human Services Program Name: Research and Development Cluster AL Number: 93.399 Grant Name: Cancer Research of Wisconsin and Northern Michigan (CROWN) Consortium Grant Identification Number: 5UG1CA239769-03 Federal Award Year: August 1, 2021 through July 31, 2022 Compliance Requirement: Allowable Costs/Cost Principles Criteria In accordance with the documentation standards of 2 CFR section 200.430(i), costs of compensation for personal services are allowable to the extent the total compensation for individual employees: a. Is reasonable for the services rendered and conforms to the established written policy of the non-federal entity consistently applied to both federal and non-federal activities; b. Follows an appointment made in accordance with a non-federal entity’s rules or written policies and meets the requirements of federal statute, where applicable; and c. Is determined and supported as provided in 2 CFR section 200.430(i), including that charges to federal awards for salaries and wages must be based on records that accurately reflect the work performed. Condition Found During testwork performed over the Research and Development Cluster, for 1 of 25 payroll items selected for testing we noted that a clerical error was made for an employee’s salary as 76% of their time was allocated to the grant, instead of the actual 0.76%. As such, $12,411 of the individual’s salary allocated to the grant was deemed unallowable. There are additional known questioned costs related to fringe and indirect costs, as the base upon which those calculations were applied was misstated for the above. Cause and Possible Asserted Effect The control to reconcile the costs allocated to the grant to supporting records did not operate effectively, resulting in incorrect charges being applied to the grant. Questioned Costs Statistically Valid Sample The sample was not intended to be, and was not, a statistically valid sample. Repeat Finding from Prior Year No Recommendation We recommend a control reconciling all costs allocated to the grant to supporting records be performed on a monthly basis. Views of Responsible Officials See attached correction plan at the end of this report.
Finding #2023-001 Type: Significant Deficiency Federal Agency: Department of Health and Human Services Program Name: Research and Development Cluster AL Number: 93.399 Grant Name: Cancer Research of Wisconsin and Northern Michigan (CROWN) Consortium Grant Identification Number: 5UG1CA239769-03 Federal Award Year: August 1, 2021 through July 31, 2022 Compliance Requirement: Allowable Costs/Cost Principles Criteria In accordance with the documentation standards of 2 CFR section 200.430(i), costs of compensation for personal services are allowable to the extent the total compensation for individual employees: a. Is reasonable for the services rendered and conforms to the established written policy of the non-federal entity consistently applied to both federal and non-federal activities; b. Follows an appointment made in accordance with a non-federal entity’s rules or written policies and meets the requirements of federal statute, where applicable; and c. Is determined and supported as provided in 2 CFR section 200.430(i), including that charges to federal awards for salaries and wages must be based on records that accurately reflect the work performed. Condition Found During testwork performed over the Research and Development Cluster, for 1 of 25 payroll items selected for testing we noted that a clerical error was made for an employee’s salary as 76% of their time was allocated to the grant, instead of the actual 0.76%. As such, $12,411 of the individual’s salary allocated to the grant was deemed unallowable. There are additional known questioned costs related to fringe and indirect costs, as the base upon which those calculations were applied was misstated for the above. Cause and Possible Asserted Effect The control to reconcile the costs allocated to the grant to supporting records did not operate effectively, resulting in incorrect charges being applied to the grant. Questioned Costs Statistically Valid Sample The sample was not intended to be, and was not, a statistically valid sample. Repeat Finding from Prior Year No Recommendation We recommend a control reconciling all costs allocated to the grant to supporting records be performed on a monthly basis. Views of Responsible Officials See attached correction plan at the end of this report.