Audit 307192

Department of Health and Human Services Federal Assistance Listing #93.498 COVID‐19 Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Applicable Federal Award Number and Year – Period 4 TIN #840420041 Department of Agriculture Federal Financial Assistance Listing #10.766 Community Facilities Loans and Grants Cluster Preparation of Schedule of Expenditure of Federal Awards Material Weakness in Internal Control Over Compliance ‐ Other Criteria – Title 2 Code of Federal Regulations Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (Uniform Guidance) requires the Hospital to prepare a schedule of expenditures of federal awards (schedule). 2 CFR 200.303(a) establishes that the auditee must establish and maintain effective internal control over the federal award that provides assurance that the entity is managing the federal award in compliance with federal statutes, regulations, and conditions of the federal award. Condition – The Hospital does not have an internal control system designed to allow for a complete and accurate Schedule being audited. We were requested to draft the Schedule. Cause – Auditor assistance with preparation of the schedule is not unusual as the schedule has unique and specialized requirements and preparation is only required when the Hospital meets a specified threshold of federal expenditures. Effect – There is a reasonable possibility that the Hospital would not be able to draft the schedule and the accompanying notes to the schedule that is correct without the assistance of the auditors. Questioned Costs – None reported. Context – Sampling was not used. Repeat Finding from Prior Years – Yes, 2021‐004 Recommendation – While we recognize that this condition is not unusual for an organization with limited staffing, we recommend that management be aware of the reporting requirements relating to the Hospital’s schedule and internal controls that impact reporting. Views of Responsible Officials – Management agrees with the finding.

Department of Health and Human Services Federal Assistance Listing #93.498 COVID‐19 Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Applicable Federal Award Number and Year – Period 4 TIN #840420041 Department of Agriculture Federal Financial Assistance Listing #10.766 Community Facilities Loans and Grants Cluster Preparation of Schedule of Expenditure of Federal Awards Material Weakness in Internal Control Over Compliance ‐ Other Criteria – Title 2 Code of Federal Regulations Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (Uniform Guidance) requires the Hospital to prepare a schedule of expenditures of federal awards (schedule). 2 CFR 200.303(a) establishes that the auditee must establish and maintain effective internal control over the federal award that provides assurance that the entity is managing the federal award in compliance with federal statutes, regulations, and conditions of the federal award. Condition – The Hospital does not have an internal control system designed to allow for a complete and accurate Schedule being audited. We were requested to draft the Schedule. Cause – Auditor assistance with preparation of the schedule is not unusual as the schedule has unique and specialized requirements and preparation is only required when the Hospital meets a specified threshold of federal expenditures. Effect – There is a reasonable possibility that the Hospital would not be able to draft the schedule and the accompanying notes to the schedule that is correct without the assistance of the auditors. Questioned Costs – None reported. Context – Sampling was not used. Repeat Finding from Prior Years – Yes, 2021‐004 Recommendation – While we recognize that this condition is not unusual for an organization with limited staffing, we recommend that management be aware of the reporting requirements relating to the Hospital’s schedule and internal controls that impact reporting. Views of Responsible Officials – Management agrees with the finding.

Department of Health and Human Services Federal Assistance Listing #93.498 COVID‐19 Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Applicable Federal Award Number and Year – Period 4 TIN #840420041 Department of Agriculture Federal Financial Assistance Listing #10.766 Community Facilities Loans and Grants Cluster Preparation of Schedule of Expenditure of Federal Awards Material Weakness in Internal Control Over Compliance ‐ Other Criteria – Title 2 Code of Federal Regulations Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (Uniform Guidance) requires the Hospital to prepare a schedule of expenditures of federal awards (schedule). 2 CFR 200.303(a) establishes that the auditee must establish and maintain effective internal control over the federal award that provides assurance that the entity is managing the federal award in compliance with federal statutes, regulations, and conditions of the federal award. Condition – The Hospital does not have an internal control system designed to allow for a complete and accurate Schedule being audited. We were requested to draft the Schedule. Cause – Auditor assistance with preparation of the schedule is not unusual as the schedule has unique and specialized requirements and preparation is only required when the Hospital meets a specified threshold of federal expenditures. Effect – There is a reasonable possibility that the Hospital would not be able to draft the schedule and the accompanying notes to the schedule that is correct without the assistance of the auditors. Questioned Costs – None reported. Context – Sampling was not used. Repeat Finding from Prior Years – Yes, 2021‐004 Recommendation – While we recognize that this condition is not unusual for an organization with limited staffing, we recommend that management be aware of the reporting requirements relating to the Hospital’s schedule and internal controls that impact reporting. Views of Responsible Officials – Management agrees with the finding.

Department of Agriculture Federal Financial Assistance Listing #10.766 Community Facilities Loans and Grants Cluster Special Tests and Provisions Significant Deficiency in Internal Control Over Compliance Criteria – 2 CFR 200.303(a) establishes that the auditee must establish and maintain effective internal control over the federal award that provides assurance that the entity is managing the federal award in compliance with federal statutes, regulations, and conditions of the federal awards. Condition – During our testing, there was no formal review separate from the preparer over the reserve fund reconciliations for the federal program. In addition, there was lack of review of the quarterly internal monitoring of the Hospital’s debt covenants. Cause – The Hospital did not have an adequate internal control policy in place to ensure review and approval over the reserve funds and quarterly internal monitoring of the debt covenants. Effect – The lack of adequate policies governing review increases the risk that employees participating in the federal award administration may not be able to detect and correct noncompliance in a timely manner. Questioned Costs – None reported. Context – Sampling was not used. Repeat Finding from Prior Years – No Recommendation – We recommend the Hospital enhance internal control policies to ensure that formal documentation of reviews is present. Views of Responsible Officials – Management agrees with the finding.

Department of Agriculture Federal Financial Assistance Listing #10.766 Community Facilities Loans and Grants Cluster Special Tests and Provisions Significant Deficiency in Internal Control Over Compliance Criteria – 2 CFR 200.303(a) establishes that the auditee must establish and maintain effective internal control over the federal award that provides assurance that the entity is managing the federal award in compliance with federal statutes, regulations, and conditions of the federal awards. Condition – During our testing, there was no formal review separate from the preparer over the reserve fund reconciliations for the federal program. In addition, there was lack of review of the quarterly internal monitoring of the Hospital’s debt covenants. Cause – The Hospital did not have an adequate internal control policy in place to ensure review and approval over the reserve funds and quarterly internal monitoring of the debt covenants. Effect – The lack of adequate policies governing review increases the risk that employees participating in the federal award administration may not be able to detect and correct noncompliance in a timely manner. Questioned Costs – None reported. Context – Sampling was not used. Repeat Finding from Prior Years – No Recommendation – We recommend the Hospital enhance internal control policies to ensure that formal documentation of reviews is present. Views of Responsible Officials – Management agrees with the finding.

Department of Health and Human Services Federal Assistance Listing #93.498 COVID‐19 Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Applicable Federal Award Number and Year – Period 4 TIN #840420041 Department of Agriculture Federal Financial Assistance Listing #10.766 Community Facilities Loans and Grants Cluster Preparation of Schedule of Expenditure of Federal Awards Material Weakness in Internal Control Over Compliance ‐ Other Criteria – Title 2 Code of Federal Regulations Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (Uniform Guidance) requires the Hospital to prepare a schedule of expenditures of federal awards (schedule). 2 CFR 200.303(a) establishes that the auditee must establish and maintain effective internal control over the federal award that provides assurance that the entity is managing the federal award in compliance with federal statutes, regulations, and conditions of the federal award. Condition – The Hospital does not have an internal control system designed to allow for a complete and accurate Schedule being audited. We were requested to draft the Schedule. Cause – Auditor assistance with preparation of the schedule is not unusual as the schedule has unique and specialized requirements and preparation is only required when the Hospital meets a specified threshold of federal expenditures. Effect – There is a reasonable possibility that the Hospital would not be able to draft the schedule and the accompanying notes to the schedule that is correct without the assistance of the auditors. Questioned Costs – None reported. Context – Sampling was not used. Repeat Finding from Prior Years – Yes, 2021‐004 Recommendation – While we recognize that this condition is not unusual for an organization with limited staffing, we recommend that management be aware of the reporting requirements relating to the Hospital’s schedule and internal controls that impact reporting. Views of Responsible Officials – Management agrees with the finding.

Department of Health and Human Services Federal Assistance Listing #93.498 COVID‐19 Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Applicable Federal Award Number and Year – Period 4 TIN #840420041 Department of Agriculture Federal Financial Assistance Listing #10.766 Community Facilities Loans and Grants Cluster Preparation of Schedule of Expenditure of Federal Awards Material Weakness in Internal Control Over Compliance ‐ Other Criteria – Title 2 Code of Federal Regulations Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (Uniform Guidance) requires the Hospital to prepare a schedule of expenditures of federal awards (schedule). 2 CFR 200.303(a) establishes that the auditee must establish and maintain effective internal control over the federal award that provides assurance that the entity is managing the federal award in compliance with federal statutes, regulations, and conditions of the federal award. Condition – The Hospital does not have an internal control system designed to allow for a complete and accurate Schedule being audited. We were requested to draft the Schedule. Cause – Auditor assistance with preparation of the schedule is not unusual as the schedule has unique and specialized requirements and preparation is only required when the Hospital meets a specified threshold of federal expenditures. Effect – There is a reasonable possibility that the Hospital would not be able to draft the schedule and the accompanying notes to the schedule that is correct without the assistance of the auditors. Questioned Costs – None reported. Context – Sampling was not used. Repeat Finding from Prior Years – Yes, 2021‐004 Recommendation – While we recognize that this condition is not unusual for an organization with limited staffing, we recommend that management be aware of the reporting requirements relating to the Hospital’s schedule and internal controls that impact reporting. Views of Responsible Officials – Management agrees with the finding.

Department of Health and Human Services Federal Assistance Listing #93.498 COVID‐19 Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Applicable Federal Award Number and Year – Period 4 TIN #840420041 Department of Agriculture Federal Financial Assistance Listing #10.766 Community Facilities Loans and Grants Cluster Preparation of Schedule of Expenditure of Federal Awards Material Weakness in Internal Control Over Compliance ‐ Other Criteria – Title 2 Code of Federal Regulations Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (Uniform Guidance) requires the Hospital to prepare a schedule of expenditures of federal awards (schedule). 2 CFR 200.303(a) establishes that the auditee must establish and maintain effective internal control over the federal award that provides assurance that the entity is managing the federal award in compliance with federal statutes, regulations, and conditions of the federal award. Condition – The Hospital does not have an internal control system designed to allow for a complete and accurate Schedule being audited. We were requested to draft the Schedule. Cause – Auditor assistance with preparation of the schedule is not unusual as the schedule has unique and specialized requirements and preparation is only required when the Hospital meets a specified threshold of federal expenditures. Effect – There is a reasonable possibility that the Hospital would not be able to draft the schedule and the accompanying notes to the schedule that is correct without the assistance of the auditors. Questioned Costs – None reported. Context – Sampling was not used. Repeat Finding from Prior Years – Yes, 2021‐004 Recommendation – While we recognize that this condition is not unusual for an organization with limited staffing, we recommend that management be aware of the reporting requirements relating to the Hospital’s schedule and internal controls that impact reporting. Views of Responsible Officials – Management agrees with the finding.

Department of Agriculture Federal Financial Assistance Listing #10.766 Community Facilities Loans and Grants Cluster Special Tests and Provisions Significant Deficiency in Internal Control Over Compliance Criteria – 2 CFR 200.303(a) establishes that the auditee must establish and maintain effective internal control over the federal award that provides assurance that the entity is managing the federal award in compliance with federal statutes, regulations, and conditions of the federal awards. Condition – During our testing, there was no formal review separate from the preparer over the reserve fund reconciliations for the federal program. In addition, there was lack of review of the quarterly internal monitoring of the Hospital’s debt covenants. Cause – The Hospital did not have an adequate internal control policy in place to ensure review and approval over the reserve funds and quarterly internal monitoring of the debt covenants. Effect – The lack of adequate policies governing review increases the risk that employees participating in the federal award administration may not be able to detect and correct noncompliance in a timely manner. Questioned Costs – None reported. Context – Sampling was not used. Repeat Finding from Prior Years – No Recommendation – We recommend the Hospital enhance internal control policies to ensure that formal documentation of reviews is present. Views of Responsible Officials – Management agrees with the finding.

Department of Agriculture Federal Financial Assistance Listing #10.766 Community Facilities Loans and Grants Cluster Special Tests and Provisions Significant Deficiency in Internal Control Over Compliance Criteria – 2 CFR 200.303(a) establishes that the auditee must establish and maintain effective internal control over the federal award that provides assurance that the entity is managing the federal award in compliance with federal statutes, regulations, and conditions of the federal awards. Condition – During our testing, there was no formal review separate from the preparer over the reserve fund reconciliations for the federal program. In addition, there was lack of review of the quarterly internal monitoring of the Hospital’s debt covenants. Cause – The Hospital did not have an adequate internal control policy in place to ensure review and approval over the reserve funds and quarterly internal monitoring of the debt covenants. Effect – The lack of adequate policies governing review increases the risk that employees participating in the federal award administration may not be able to detect and correct noncompliance in a timely manner. Questioned Costs – None reported. Context – Sampling was not used. Repeat Finding from Prior Years – No Recommendation – We recommend the Hospital enhance internal control policies to ensure that formal documentation of reviews is present. Views of Responsible Officials – Management agrees with the finding.