FAC Explorer

Audit 321161

FY End
2023-06-30
Total Expended
$27.77M
Findings
6
Programs
5
Organization: Box Butte General Hospital (NE)
Year: 2023 Accepted: 2024-09-26
Auditor: Dohman Akerlund & Eddy LLC

Organization Exclusion Status:

Findings

ID Ref Severity Repeat Requirement
498451 2023-002 Material Weakness - N
498452 2023-003 Material Weakness - L
498453 2023-003 Material Weakness - L
1074893 2023-002 Material Weakness - N
1074894 2023-003 Material Weakness - L
1074895 2023-003 Material Weakness - L

Programs

ALN Program Spent Major Findings
10.766 Community Facilities Loans and Grants $26.22M Yes 2
93.498 Provider Relief Fund and American Rescue Plan (arp) Rural Distribution $989,162 Yes 1
93.697 Testing and Mitigation for Rural Health Clinics $300,000 - 0
93.391 Activities to Support State, Tribal, Local and Territorial (stlt) Health Department Response to Public Health Or Healthcare Crises $250,000 - 0
93.301 Small Rural Hospital Improvement Grant Program $12,836 - 0

Contacts

Name Title Type
N2JJXUTVFUW3 Michael O'Dell Auditee
3087626660 Kurt Moural Auditor
No contacts on file

Notes to SEFA

Title: A.    Basis of Presentation Accounting Policies: The accompanying schedule of expenditures of federal awards includes the federal awards activity of the Hospital under programs of the federal government for the year ended June 30, 2023. The accompanying schedule presents total expenditures in accordance with Title 2 U.S. Code of Federal Regulations Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (Uniform Guidance). Therefore, the amounts presented in this schedule may differ from the amounts presented in, or used in, the preparation of the basic financial statements. De Minimis Rate Used: N Rate Explanation: NOT APPLICABLE FOR THE PROGRAMS The accompanying schedule of expenditures of federal awards includes the federal awards activity of the Hospital under programs of the federal government for the year ended June 30, 2023. The accompanying schedule presents total expenditures in accordance with Title 2 U.S. Code of Federal Regulations Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (Uniform Guidance). Therefore, the amounts presented in this schedule may differ from the amounts presented in, or used in, the preparation of the basic financial statements.
Title: B. Summary of Significant Accounting Policies Accounting Policies: The accompanying schedule of expenditures of federal awards includes the federal awards activity of the Hospital under programs of the federal government for the year ended June 30, 2023. The accompanying schedule presents total expenditures in accordance with Title 2 U.S. Code of Federal Regulations Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (Uniform Guidance). Therefore, the amounts presented in this schedule may differ from the amounts presented in, or used in, the preparation of the basic financial statements. De Minimis Rate Used: N Rate Explanation: NOT APPLICABLE FOR THE PROGRAMS The accompanying schedule of expenditures of federal awards includes the federal activity of the Hospital under programs of the federal government for the year ended June 30, 2023 and is presented on the accrual basis of accounting. Such expenditures are recognized following the cost principles contained in the Uniform Guidance.
Title: C. Provider Relief Fund Reporting Accounting Policies: The accompanying schedule of expenditures of federal awards includes the federal awards activity of the Hospital under programs of the federal government for the year ended June 30, 2023. The accompanying schedule presents total expenditures in accordance with Title 2 U.S. Code of Federal Regulations Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (Uniform Guidance). Therefore, the amounts presented in this schedule may differ from the amounts presented in, or used in, the preparation of the basic financial statements. De Minimis Rate Used: N Rate Explanation: NOT APPLICABLE FOR THE PROGRAMS The Hospital received amounts from the U.S. Department of Health and Human Services (HHS) through the Provider Relief Fund and American Rescue Plan Rural Distribution (PRF) program (Federal Financial Assistance Listing #93.498). PRF amounts are to be reported based on the dates actually received. Period 1 reporting encompassed amounts received from April 10, 2020 through June 30, 2020 with a measurement date for use of funds through June 30, 2021. Period 2 reporting includes amounts received from July 1, 2020 through December 31, 2020 with a measurement date for use of funds through December 31, 2021. Period 3 reporting includes amounts received from January 1, 2021 through June 30, 2021 with a measurement date for use of funds through June 30, 2022. Period 4 reporting includes amounts received from July 1, 2021 to December 31, 2021 with a measurement date for use of funds through December 31, 2022. Period 5 reporting includes amounts received from January 1, 2022 to June 30, 2022 with a measurement date for use of funds through June 30, 2023. Accordingly, the amounts included on the accompanying schedule of expenditures of federal awards are for PRF subject to periods 4 and 5 reporting.
Title: D. Loans Accounting Policies: The accompanying schedule of expenditures of federal awards includes the federal awards activity of the Hospital under programs of the federal government for the year ended June 30, 2023. The accompanying schedule presents total expenditures in accordance with Title 2 U.S. Code of Federal Regulations Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (Uniform Guidance). Therefore, the amounts presented in this schedule may differ from the amounts presented in, or used in, the preparation of the basic financial statements. De Minimis Rate Used: N Rate Explanation: NOT APPLICABLE FOR THE PROGRAMS The balance of loans outstanding at June 30, 2023 consists of:
Title: E. Indirect Cost Rate Accounting Policies: The accompanying schedule of expenditures of federal awards includes the federal awards activity of the Hospital under programs of the federal government for the year ended June 30, 2023. The accompanying schedule presents total expenditures in accordance with Title 2 U.S. Code of Federal Regulations Part 200, Uniform Administrative Requirements, Cost Principles, and Audit Requirements for Federal Awards (Uniform Guidance). Therefore, the amounts presented in this schedule may differ from the amounts presented in, or used in, the preparation of the basic financial statements. De Minimis Rate Used: N Rate Explanation: NOT APPLICABLE FOR THE PROGRAMS The Hospital has not elected to use the 10% de minimus indirect cost rate as allowed under the Uniform Guidance.

Finding Details

Finding 2023-002
FINDING 2023-002 DEBT SERVICE COVERAGE RATIO COMPLAINCE Federal programs Federal Assistance Listing Number 10.766 U.S. Department of Agriculture (USDA) Direct Award, Community Facilities Loans and Grants Material Weakness Criteria The Hospital is required to maintain a debt service coverage ratio of 1.5. Condition The Hospital’s debt service coverage ratio for the year ended June 30, 2023 was 1.1, resulting in the Hospital not being in compliance with the 1.5 requirement. Cause The Hospital implemented a new accounting and electronic health record (EHR) system in May of 2023 and experienced significant delays in being able to bill and process claims. The delays had a negative impact on overall operating results as additional accounts receivable allowances for both contractual adjustments and bad debts were necessary at June 30, 2023. Effect The Hospital was unable to meet the required 1.5 debt service coverage ratio. Questioned costs None. Perspective/Context The majority of the implementation issues were outside of Hospital management’s control and directly related to issues associated with the accounting and EHR system vendor. Hospital management also notified its USDA representatives and received a waiver from the required 1.5 debt service coverage ratio for the period ended June 30, 2023. Recommendation We suggest Hospital management continue working with its accounting and EHR system vendor to resolve issues affecting its operating results. Views of responsible officials and planned corrective actions The implementation of the new electronic health records created a delay in operational workflow processes which required vendor modifications and corrections to the system. This delayed submitting insurance claims for reimbursement which continued throughout fiscal year 2024. Operations have now stabilized and the debt service coverage ratio is expected to be in compliance in fiscal year 2025.
Finding 2023-003
FINDING 2023-003 COMPLETION AND TIMELY FILING OF SINGLE AUDIT REPORTS Federal programs Federal Assistance Listing Number 10.766 U.S. Department of Agriculture (USDA) Direct Award, Community Facilities Loans and Grants Federal Assistance Listing Number 93.498 U.S. Department of Health and Human Services COVID-19 Provider Relief Fund (PRF) and American Rescue Plan (ARP) Rural Distribution Material Weakness Criteria The Hospital is required to have its financial statement and compliance audits completed and filed with the Federal Audit Clearinghouse nine months after the end of the audit period. Condition The Hospital’s financial statement and compliance audits for the June 30, 2023 reporting period were not filed within the required timeline. Cause The Hospital implemented a new accounting and electronic health record (EHR) system in May of 2023 and incurred significant issues with the implementation resulting in both the financial statement and compliance audits being significantly delayed. Effect The Hospital was unable to meet the required nine month filing deadline. Questioned costs None. Perspective/Context The majority of the implementation issues were outside of Hospital management’s control and directly related to issues associated with the accounting and EHR system vendor. Hospital management also notified various parties that the financial statement and compliance audits would be delayed due to the implementation issues. Recommendation We suggest Hospital management continue working with its accounting and EHR system vendor to resolve issues to assure timely filing requirements will be met in future periods. Views of responsible officials and planned corrective actions The financial statement and compliance audit will be filed with the Federal Audit Clearinghouse shortly after issuance.
Finding 2023-003
FINDING 2023-003 COMPLETION AND TIMELY FILING OF SINGLE AUDIT REPORTS Federal programs Federal Assistance Listing Number 10.766 U.S. Department of Agriculture (USDA) Direct Award, Community Facilities Loans and Grants Federal Assistance Listing Number 93.498 U.S. Department of Health and Human Services COVID-19 Provider Relief Fund (PRF) and American Rescue Plan (ARP) Rural Distribution Material Weakness Criteria The Hospital is required to have its financial statement and compliance audits completed and filed with the Federal Audit Clearinghouse nine months after the end of the audit period. Condition The Hospital’s financial statement and compliance audits for the June 30, 2023 reporting period were not filed within the required timeline. Cause The Hospital implemented a new accounting and electronic health record (EHR) system in May of 2023 and incurred significant issues with the implementation resulting in both the financial statement and compliance audits being significantly delayed. Effect The Hospital was unable to meet the required nine month filing deadline. Questioned costs None. Perspective/Context The majority of the implementation issues were outside of Hospital management’s control and directly related to issues associated with the accounting and EHR system vendor. Hospital management also notified various parties that the financial statement and compliance audits would be delayed due to the implementation issues. Recommendation We suggest Hospital management continue working with its accounting and EHR system vendor to resolve issues to assure timely filing requirements will be met in future periods. Views of responsible officials and planned corrective actions The financial statement and compliance audit will be filed with the Federal Audit Clearinghouse shortly after issuance.
Finding 2023-002
FINDING 2023-002 DEBT SERVICE COVERAGE RATIO COMPLAINCE Federal programs Federal Assistance Listing Number 10.766 U.S. Department of Agriculture (USDA) Direct Award, Community Facilities Loans and Grants Material Weakness Criteria The Hospital is required to maintain a debt service coverage ratio of 1.5. Condition The Hospital’s debt service coverage ratio for the year ended June 30, 2023 was 1.1, resulting in the Hospital not being in compliance with the 1.5 requirement. Cause The Hospital implemented a new accounting and electronic health record (EHR) system in May of 2023 and experienced significant delays in being able to bill and process claims. The delays had a negative impact on overall operating results as additional accounts receivable allowances for both contractual adjustments and bad debts were necessary at June 30, 2023. Effect The Hospital was unable to meet the required 1.5 debt service coverage ratio. Questioned costs None. Perspective/Context The majority of the implementation issues were outside of Hospital management’s control and directly related to issues associated with the accounting and EHR system vendor. Hospital management also notified its USDA representatives and received a waiver from the required 1.5 debt service coverage ratio for the period ended June 30, 2023. Recommendation We suggest Hospital management continue working with its accounting and EHR system vendor to resolve issues affecting its operating results. Views of responsible officials and planned corrective actions The implementation of the new electronic health records created a delay in operational workflow processes which required vendor modifications and corrections to the system. This delayed submitting insurance claims for reimbursement which continued throughout fiscal year 2024. Operations have now stabilized and the debt service coverage ratio is expected to be in compliance in fiscal year 2025.
Finding 2023-003
FINDING 2023-003 COMPLETION AND TIMELY FILING OF SINGLE AUDIT REPORTS Federal programs Federal Assistance Listing Number 10.766 U.S. Department of Agriculture (USDA) Direct Award, Community Facilities Loans and Grants Federal Assistance Listing Number 93.498 U.S. Department of Health and Human Services COVID-19 Provider Relief Fund (PRF) and American Rescue Plan (ARP) Rural Distribution Material Weakness Criteria The Hospital is required to have its financial statement and compliance audits completed and filed with the Federal Audit Clearinghouse nine months after the end of the audit period. Condition The Hospital’s financial statement and compliance audits for the June 30, 2023 reporting period were not filed within the required timeline. Cause The Hospital implemented a new accounting and electronic health record (EHR) system in May of 2023 and incurred significant issues with the implementation resulting in both the financial statement and compliance audits being significantly delayed. Effect The Hospital was unable to meet the required nine month filing deadline. Questioned costs None. Perspective/Context The majority of the implementation issues were outside of Hospital management’s control and directly related to issues associated with the accounting and EHR system vendor. Hospital management also notified various parties that the financial statement and compliance audits would be delayed due to the implementation issues. Recommendation We suggest Hospital management continue working with its accounting and EHR system vendor to resolve issues to assure timely filing requirements will be met in future periods. Views of responsible officials and planned corrective actions The financial statement and compliance audit will be filed with the Federal Audit Clearinghouse shortly after issuance.
Finding 2023-003
FINDING 2023-003 COMPLETION AND TIMELY FILING OF SINGLE AUDIT REPORTS Federal programs Federal Assistance Listing Number 10.766 U.S. Department of Agriculture (USDA) Direct Award, Community Facilities Loans and Grants Federal Assistance Listing Number 93.498 U.S. Department of Health and Human Services COVID-19 Provider Relief Fund (PRF) and American Rescue Plan (ARP) Rural Distribution Material Weakness Criteria The Hospital is required to have its financial statement and compliance audits completed and filed with the Federal Audit Clearinghouse nine months after the end of the audit period. Condition The Hospital’s financial statement and compliance audits for the June 30, 2023 reporting period were not filed within the required timeline. Cause The Hospital implemented a new accounting and electronic health record (EHR) system in May of 2023 and incurred significant issues with the implementation resulting in both the financial statement and compliance audits being significantly delayed. Effect The Hospital was unable to meet the required nine month filing deadline. Questioned costs None. Perspective/Context The majority of the implementation issues were outside of Hospital management’s control and directly related to issues associated with the accounting and EHR system vendor. Hospital management also notified various parties that the financial statement and compliance audits would be delayed due to the implementation issues. Recommendation We suggest Hospital management continue working with its accounting and EHR system vendor to resolve issues to assure timely filing requirements will be met in future periods. Views of responsible officials and planned corrective actions The financial statement and compliance audit will be filed with the Federal Audit Clearinghouse shortly after issuance.