FAC Explorer

Audit 30839

FY End
2022-06-30
Total Expended
$18.78M
Findings
6
Programs
9
Organization: Greene County Medical Center (IA)
Year: 2022 Accepted: 2023-03-12
Auditor: Eide Bailly LLP

Organization Exclusion Status:

Findings

ID Ref Severity Repeat Requirement
37265 2022-004 Material Weakness Yes P
37266 2022-004 Material Weakness Yes P
37267 2022-005 Material Weakness Yes ABL
613707 2022-004 Material Weakness Yes P
613708 2022-004 Material Weakness Yes P
613709 2022-005 Material Weakness Yes ABL

Programs

ALN Program Spent Major Findings
10.766 Community Facilities Loans and Grants $1.49M Yes 1
93.498 Provider Relief Fund $335,824 - 1
93.697 Covid-19 Testing for Rural Health Clinics $100,000 - 0
97.067 Homeland Security Grant Program $60,791 - 0
93.268 Immunization Cooperative Agreements $46,710 - 0
93.155 Rural Health Research Centers $36,000 - 0
93.323 Epidemiology and Laboratory Capacity for Infectious Diseases (elc) $31,249 - 0
93.354 Public Health Emergency Response: Cooperative Agreement for Emergency Response: Public Health Crisis Response $6,710 - 0
93.889 National Bioterrorism Hospital Preparedness Program $6,240 - 0

Contacts

Name Title Type
WKJUXM9JEWS4 Mark Wall Auditee
5153860115 Brian Unsen Auditor
No contacts on file

Notes to SEFA

Title: Loan/loan guarantee outstanding balances Accounting Policies: Expenditures reported on the Schedule are reported on the accrual basis of accounting. When applicable, 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. No federal financial assistance has been provided to a subrecipient. De Minimis Rate Used: N Rate Explanation: The auditee did not use the de minimis cost rate. COMMUNITY FACILITIES LOANS AND GRANTS (10.766) - Expenditures reported on this Schedule consist of the beginning of the year outstanding loan balance of the Medical Centers USDA direct loan of $16,668,026, as well as $1,490,852, which is 90% of the beginning of the year outstanding balance of the Medical Centers USDA guaranteed loans. If applicable, advances made on the loans during the year are reported on the Schedule. The Medical Center made no advances on the loans during the year ended June 30, 2022. The Medical Centers outstanding loan balances for the direct loan and the guaranteed loans as of June 30, 2022, are $16,362,904 and $1,574,825, respectively.
Title: Basis of Presentation Accounting Policies: Expenditures reported on the Schedule are reported on the accrual basis of accounting. When applicable, 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. No federal financial assistance has been provided to a subrecipient. De Minimis Rate Used: N Rate Explanation: The auditee did not use the de minimis cost rate. The accompanying Schedule of Expenditures of Federal Awards (Schedule) includes the federal award activity of Greene County Medical Center (Medical Center) under programs of the federal government for the year ended June 30, 2022. The information 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 the Medical Center, it is not intended to and does not present the financial position, changes in net position, or cash flows of the Medical Center.
Title: Provider Relief Fund and American Rescue Plan Funds Accounting Policies: Expenditures reported on the Schedule are reported on the accrual basis of accounting. When applicable, 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. No federal financial assistance has been provided to a subrecipient. De Minimis Rate Used: N Rate Explanation: The auditee did not use the de minimis cost rate. The Medical Center received amounts from the U.S. Department of Health and Human Services (HHS) through the Provider Relief Fund (PRF) program (Federal Financial Assistance Listing/CFDA #93.498) during the years ended June 30, 2020, 2021 and 2022. The PRF expenditures were not recognized on the Schedule until the expenditures were include in the reporting to HHS as required under the PRF program. The amount of PRF expenditures included in the Schedule requires management to make estimates and assumptions that affect the reported amounts. Accordingly, such expenditures are considered a significant estimate. Estimates and assumptions may include reducing actual expenses by amounts that have been reimbursed or are obligated to be reimbursed by other sources and estimating marginal increases in expenses related to coronavirus. Actual amounts could differ from those estimates.

Finding Details

Finding 2022-004
Department of Agriculture Federal Financial Assistance Listing/CFDA #10.766 Community Facilities Loans and Grants Preparation of Schedule of Expenditures of Federal Awards Material Weakness in Internal Control Over Compliance - Other Criteria: Proper controls over financial reporting include the ability to prepare the Schedule of Expenditures of Federal Awards (Schedule) and accompanying notes to the Schedule. Condition: The Medical Center does not have an internal control system designed to provide for the preparation of the Schedule. As auditors, we were requested to assist with the preparation of 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 Medical Center meets a specified threshold of federal expenditures. Effect: There is a reasonable possibility that the Medical Center would not be able to draft 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 Recommendation: While we recognize that this condition is not unusual for an organization with limited staffing, we recommend management be aware of the financial reporting requirements relating to the Medical Center?s Schedule of Expenditures of Federal Awards and the internal controls that impact financial reporting. Views of Responsible Officials: Management agrees with the finding.
Finding 2022-004
Department of Agriculture Federal Financial Assistance Listing/CFDA #10.766 Community Facilities Loans and Grants Preparation of Schedule of Expenditures of Federal Awards Material Weakness in Internal Control Over Compliance - Other Criteria: Proper controls over financial reporting include the ability to prepare the Schedule of Expenditures of Federal Awards (Schedule) and accompanying notes to the Schedule. Condition: The Medical Center does not have an internal control system designed to provide for the preparation of the Schedule. As auditors, we were requested to assist with the preparation of 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 Medical Center meets a specified threshold of federal expenditures. Effect: There is a reasonable possibility that the Medical Center would not be able to draft 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 Recommendation: While we recognize that this condition is not unusual for an organization with limited staffing, we recommend management be aware of the financial reporting requirements relating to the Medical Center?s Schedule of Expenditures of Federal Awards and the internal controls that impact financial reporting. Views of Responsible Officials: Management agrees with the finding.
Finding 2022-005
Department of Health and Human Services Federal Financial Assistance Listing/CFDA #93.498 COVID-19 Provider Relief Fund (PRF) and American Rescue Plan (ARP) Rural Distribution Applicable Federal Award Number and Year ? Periods 2&3 TIN #426037888 Activities Allowed or Unallowed and Allowable Costs/Cost Principles and Reporting Material Weakness 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 award. Condition: There was no evidence of formal review and approval over tracking of expenditures that were claimed for the program. In addition, there was no evidence retained that the Medical Center?s special reports submitted to the Department of Health and Human Services for Periods 2 and 3 TIN #426037888 were reviewed or approved by an individual separate from the preparer prior to submission. Cause: The Medical Center did not have an internal control process in place to ensure documentation of review and approval of the tracking of expenditures claimed under the federal program and the reports submitted to the Department of Health and Human Services. Effect: The lack of adequate policies governing review and approval increases the risk that employees participating in the federal awards administration may not be able to detect and correct noncompliance in a timely. Questioned Costs: None reported. Repeat Finding from Prior Years: Yes Recommendation: We recommend the Medical Center enhance internal control policies to ensure that formal documentation of review and approval is obtained and retained. Views of Responsible Officials: Management agrees with the finding.
Finding 2022-004
Department of Agriculture Federal Financial Assistance Listing/CFDA #10.766 Community Facilities Loans and Grants Preparation of Schedule of Expenditures of Federal Awards Material Weakness in Internal Control Over Compliance - Other Criteria: Proper controls over financial reporting include the ability to prepare the Schedule of Expenditures of Federal Awards (Schedule) and accompanying notes to the Schedule. Condition: The Medical Center does not have an internal control system designed to provide for the preparation of the Schedule. As auditors, we were requested to assist with the preparation of 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 Medical Center meets a specified threshold of federal expenditures. Effect: There is a reasonable possibility that the Medical Center would not be able to draft 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 Recommendation: While we recognize that this condition is not unusual for an organization with limited staffing, we recommend management be aware of the financial reporting requirements relating to the Medical Center?s Schedule of Expenditures of Federal Awards and the internal controls that impact financial reporting. Views of Responsible Officials: Management agrees with the finding.
Finding 2022-004
Department of Agriculture Federal Financial Assistance Listing/CFDA #10.766 Community Facilities Loans and Grants Preparation of Schedule of Expenditures of Federal Awards Material Weakness in Internal Control Over Compliance - Other Criteria: Proper controls over financial reporting include the ability to prepare the Schedule of Expenditures of Federal Awards (Schedule) and accompanying notes to the Schedule. Condition: The Medical Center does not have an internal control system designed to provide for the preparation of the Schedule. As auditors, we were requested to assist with the preparation of 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 Medical Center meets a specified threshold of federal expenditures. Effect: There is a reasonable possibility that the Medical Center would not be able to draft 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 Recommendation: While we recognize that this condition is not unusual for an organization with limited staffing, we recommend management be aware of the financial reporting requirements relating to the Medical Center?s Schedule of Expenditures of Federal Awards and the internal controls that impact financial reporting. Views of Responsible Officials: Management agrees with the finding.
Finding 2022-005
Department of Health and Human Services Federal Financial Assistance Listing/CFDA #93.498 COVID-19 Provider Relief Fund (PRF) and American Rescue Plan (ARP) Rural Distribution Applicable Federal Award Number and Year ? Periods 2&3 TIN #426037888 Activities Allowed or Unallowed and Allowable Costs/Cost Principles and Reporting Material Weakness 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 award. Condition: There was no evidence of formal review and approval over tracking of expenditures that were claimed for the program. In addition, there was no evidence retained that the Medical Center?s special reports submitted to the Department of Health and Human Services for Periods 2 and 3 TIN #426037888 were reviewed or approved by an individual separate from the preparer prior to submission. Cause: The Medical Center did not have an internal control process in place to ensure documentation of review and approval of the tracking of expenditures claimed under the federal program and the reports submitted to the Department of Health and Human Services. Effect: The lack of adequate policies governing review and approval increases the risk that employees participating in the federal awards administration may not be able to detect and correct noncompliance in a timely. Questioned Costs: None reported. Repeat Finding from Prior Years: Yes Recommendation: We recommend the Medical Center enhance internal control policies to ensure that formal documentation of review and approval is obtained and retained. Views of Responsible Officials: Management agrees with the finding.