Audit 304266

FY End
2023-12-31
Total Expended
$37.29M
Findings
2
Programs
13
Organization: Summa Health (OH)
Year: 2023 Accepted: 2024-04-23
Auditor: Rsm US LLP

Organization Exclusion Status:

Checking exclusion status...

Contacts

Name Title Type
SXKGCMQJS7K6 Dawn Ahner Auditee
2348677016 Lori Kalic Auditor
No contacts on file

Notes to SEFA

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 wherein certain types of expenditures are not allowable or are limited as to reimbursement. De Minimis Rate Used: N Rate Explanation: Summa has not elected to use the 10% 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 Summa Health and Subsidiaries (Summa) under programs of the federal government for the year ended December 31, 2023. 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 (Uniform Guidance). Because the Schedule presents only a selected portion of the operations of Summa, it is not intended to and does not present the financial position, changes in net assets, or cash flows of Summa.
Title: Subrecipients 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 wherein certain types of expenditures are not allowable or are limited as to reimbursement. De Minimis Rate Used: N Rate Explanation: Summa has not elected to use the 10% de minimis indirect cost rate as allowed under the Uniform Guidance. Of the federal expenditures presented in the Schedule, Summa did not provide any amounts to subrecipients.
Title: Non-cash Assistance, Insurance, Loans and Loan Guarantees Outstanding 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 wherein certain types of expenditures are not allowable or are limited as to reimbursement. De Minimis Rate Used: N Rate Explanation: Summa has not elected to use the 10% de minimis indirect cost rate as allowed under the Uniform Guidance. Summa did not receive any non-cash assistance during the year ended December 31, 2023. There were no federal awards expended for insurance or any loans or loan guarantees outstanding as of December 31, 2023.
Title: Provider Relief Fund and American Rescue Plan Rural Distribution 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 wherein certain types of expenditures are not allowable or are limited as to reimbursement. De Minimis Rate Used: N Rate Explanation: Summa has not elected to use the 10% de minimis indirect cost rate as allowed under the Uniform Guidance. During the year ended December 31, 2022, Summa received amounts from the U.S. Department of Health & Human Services (HHS) through the Provider Relief Fund and American Rescue Plan Rural Distribution program (PRF)(93.498). In accordance with HHS guidance, this funding was included on the Schedule for the year ended December 31, 2023. The Schedule reflects distributions in the amount of $35,053,685 received by Summa during the year ended December 31, 2022, which were reported by the entities as follows:

Finding Details

Finding 2023-01—Reporting Identification of federal program: Assistance Listing No. 93.498—COVID-19 Provider Relief Fund (PRF) and American Rescue Plan (ARP) Rural Distribution Criteria or specific requirement: Section 200.303 of Title 2 U.S. Code of Federal Regulations Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (Uniform Guidance) states the following regarding internal control: “The non-Federal entity must: (a) Establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non-Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award.” The U.S. Department of Health and Human Services (HHS) requires the nonfederal entity to report lost revenue in order to support that funding received has been appropriately earned. HHS provided specific guidance in the June 11, 2021, Post-Payment Notice on how to complete the required reporting of lost revenue in the HRSA Reporting Portal. Condition: Summa’s reporting submission did not follow the published HRSA guidance related to the reporting of lost revenue. Cause: Summa had designed and implemented internal controls over the calculation of lost revenue, however, these internal controls were not precise enough to identify an error in the calculation of lost revenue. Effect or potential effect: Noncompliance with HRSA reporting guidance could result in the submission of an inaccurate report. Questioned cost: None Context: We inspected the reconciliation of lost revenue for Summa Health TIN 34-1887844 noting that the lost revenue calculation was overstated by approximately $1.1 million and $3.0 million for Q3 2020 and Q4 2020, respectively. Recommendation: HRSA does not allow reporting entities to amend a previously submitted report after the reporting period has passed and period 6 is the last reporting period associated with this funding. The internal calculation should be revised to accurately reflect the lost revenue incurred for Q3 2020 in the event supporting documentation is requested by HRSA to support the funding received has been appropriately earned. Views of responsible officials: Summa concurs with this finding. See pages 53-54 for corrective action plan.
Finding 2023-01—Reporting Identification of federal program: Assistance Listing No. 93.498—COVID-19 Provider Relief Fund (PRF) and American Rescue Plan (ARP) Rural Distribution Criteria or specific requirement: Section 200.303 of Title 2 U.S. Code of Federal Regulations Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (Uniform Guidance) states the following regarding internal control: “The non-Federal entity must: (a) Establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non-Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award.” The U.S. Department of Health and Human Services (HHS) requires the nonfederal entity to report lost revenue in order to support that funding received has been appropriately earned. HHS provided specific guidance in the June 11, 2021, Post-Payment Notice on how to complete the required reporting of lost revenue in the HRSA Reporting Portal. Condition: Summa’s reporting submission did not follow the published HRSA guidance related to the reporting of lost revenue. Cause: Summa had designed and implemented internal controls over the calculation of lost revenue, however, these internal controls were not precise enough to identify an error in the calculation of lost revenue. Effect or potential effect: Noncompliance with HRSA reporting guidance could result in the submission of an inaccurate report. Questioned cost: None Context: We inspected the reconciliation of lost revenue for Summa Health TIN 34-1887844 noting that the lost revenue calculation was overstated by approximately $1.1 million and $3.0 million for Q3 2020 and Q4 2020, respectively. Recommendation: HRSA does not allow reporting entities to amend a previously submitted report after the reporting period has passed and period 6 is the last reporting period associated with this funding. The internal calculation should be revised to accurately reflect the lost revenue incurred for Q3 2020 in the event supporting documentation is requested by HRSA to support the funding received has been appropriately earned. Views of responsible officials: Summa concurs with this finding. See pages 53-54 for corrective action plan.