Audit 316188

2023 – 003 Federal agency: U.S. Department of Health and Human Services Other Programs Federal program title: Provider Relief Funding and American Rescue Plan Rural Payments Assistance Listing Number: 93.498 Pass-Through Agency: N/A Pass-Through Number(s): N/A Award Period: Period 4 Type of Finding: Significant Deficiency in Internal Control Compliance Requirement: Allowable Costs Criteria or specific requirement: Surrounding reporting activities, the Medical Center’s internal controls should be designed to assure all reporting completed under program guidelines. Condition: During our testing, we identified the Hospital did not have internal controls and documentation procedures in place to ensure reporting was completed in accordance with HHS guidelines. Questioned costs: None Context: During our testing, it was identified that the Medical Center used the PRF funds to pay interest on the outstanding USDA loan and other professional insurance, however at the time they did not specifically document how these costs were necessary to respond to Covid-19. Cause: The Hospital was amidst a pandemic and failed to document the rationale at the time of incurring the costs. Effect: The auditor noted no instances of noncompliance with the costs incurred; however, the internal controls around compliance over reporting were not effective. Repeat Finding: N/A Recommendation: We recommend the Medical Center design controls to ensure documentation is completed timely and sufficiently on how costs are necessary to respond to COVID-19. Views of responsible officials: There is no disagreement with the audit finding. Management has identified a sufficient amount of additional COVID-19 related expenses that were not reported to cover the finding amounts.

2023 – 003 Federal agency: U.S. Department of Health and Human Services Other Programs Federal program title: Provider Relief Funding and American Rescue Plan Rural Payments Assistance Listing Number: 93.498 Pass-Through Agency: N/A Pass-Through Number(s): N/A Award Period: Period 4 Type of Finding: Significant Deficiency in Internal Control Compliance Requirement: Allowable Costs Criteria or specific requirement: Surrounding reporting activities, the Medical Center’s internal controls should be designed to assure all reporting completed under program guidelines. Condition: During our testing, we identified the Hospital did not have internal controls and documentation procedures in place to ensure reporting was completed in accordance with HHS guidelines. Questioned costs: None Context: During our testing, it was identified that the Medical Center used the PRF funds to pay interest on the outstanding USDA loan and other professional insurance, however at the time they did not specifically document how these costs were necessary to respond to Covid-19. Cause: The Hospital was amidst a pandemic and failed to document the rationale at the time of incurring the costs. Effect: The auditor noted no instances of noncompliance with the costs incurred; however, the internal controls around compliance over reporting were not effective. Repeat Finding: N/A Recommendation: We recommend the Medical Center design controls to ensure documentation is completed timely and sufficiently on how costs are necessary to respond to COVID-19. Views of responsible officials: There is no disagreement with the audit finding. Management has identified a sufficient amount of additional COVID-19 related expenses that were not reported to cover the finding amounts.