Title: 2. Food and Nutrition Awards
Accounting Policies: The accompanying Schedule of Expenditures of Federal Awards (the Schedule) includes the federal grant activities of Northwell Health, Inc. and its member corporations and other affiliated entities (collectively, Northwell) and is presented on the accrual basis of accounting. The information on the 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 (the Uniform Guidance). Therefore, some amounts presented in the Schedule may differ from amounts presented in, or used in the preparation of, the consolidated financial statements of Northwell. For purposes of the Schedule, federal awards include any assistance provided by a federal agency directly or indirectly in the form of grants, contracts, cooperative agreements, loan and loan guarantees, or other non-cash assistance. In accordance with applicable requirements, certain programs may be presented in a fiscal period based on the program-specific guidance (see Notes 4, 5 and 6).
Direct and indirect costs are charged to awards in accordance with cost principles contained in the United States Department of Health and Human Services (HHS) Cost Principles for Hospitals at 45 CFR Part 75 Appendix IX for Uniform Guidance awards. Under these cost principles, certain types of expenditures are not allowable or are limited as to reimbursement.
The Uniform Guidance provides for a 10% de minimis indirect cost rate election; however, Northwell did not make this election and uses a negotiated indirect cost rate.
De Minimis Rate Used: N
Rate Explanation: The auditee did not use the de minimis cost rate.
During the year ended December 31, 2023, Northwell participated in the New York State Department of Health, Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) through the provision of nutritional counseling and the distribution of food vouchers. The United States Department of Agriculture, the federal agency that sponsors the WIC program under Federal Assistance Listing Number (ALN) 10.557, has determined that WIC food instruments are considered “property in lieu of money” and, therefore, should be reported as federal awards received by Northwell.
The total amount reported as federal awards on the Schedule represents the value of food vouchers redeemed in the amount of $8,087,950 plus administrative costs of $2,266,945 for the year ended December 31, 2023. In addition to the federal funds received for the WIC program, in 2023, 87.7% of the WIC program’s total administrative and nutritional counseling costs and none of the food voucher costs were funded by the State of New York Department of Health. Such amounts are excluded from the Schedule.
Title: 3. Vaccines for Children Program
Accounting Policies: The accompanying Schedule of Expenditures of Federal Awards (the Schedule) includes the federal grant activities of Northwell Health, Inc. and its member corporations and other affiliated entities (collectively, Northwell) and is presented on the accrual basis of accounting. The information on the 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 (the Uniform Guidance). Therefore, some amounts presented in the Schedule may differ from amounts presented in, or used in the preparation of, the consolidated financial statements of Northwell. For purposes of the Schedule, federal awards include any assistance provided by a federal agency directly or indirectly in the form of grants, contracts, cooperative agreements, loan and loan guarantees, or other non-cash assistance. In accordance with applicable requirements, certain programs may be presented in a fiscal period based on the program-specific guidance (see Notes 4, 5 and 6).
Direct and indirect costs are charged to awards in accordance with cost principles contained in the United States Department of Health and Human Services (HHS) Cost Principles for Hospitals at 45 CFR Part 75 Appendix IX for Uniform Guidance awards. Under these cost principles, certain types of expenditures are not allowable or are limited as to reimbursement.
The Uniform Guidance provides for a 10% de minimis indirect cost rate election; however, Northwell did not make this election and uses a negotiated indirect cost rate.
De Minimis Rate Used: N
Rate Explanation: The auditee did not use the de minimis cost rate.
During the year ended December 31, 2023, Northwell participated in the New York City Department of Health and Mental Hygiene Vaccines for Children Program (ALN 93.268) through the provision of vaccinations. HHS, the federal agency that sponsors this program, has determined that the vaccines administered are considered “property in lieu of money” and, therefore, should be reported as federal awards received by Northwell for purposes of presentation in the Schedule.
Title: 4. Federal Emergency Management Agency: Disaster Grants (ALN 97.036)
Accounting Policies: The accompanying Schedule of Expenditures of Federal Awards (the Schedule) includes the federal grant activities of Northwell Health, Inc. and its member corporations and other affiliated entities (collectively, Northwell) and is presented on the accrual basis of accounting. The information on the 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 (the Uniform Guidance). Therefore, some amounts presented in the Schedule may differ from amounts presented in, or used in the preparation of, the consolidated financial statements of Northwell. For purposes of the Schedule, federal awards include any assistance provided by a federal agency directly or indirectly in the form of grants, contracts, cooperative agreements, loan and loan guarantees, or other non-cash assistance. In accordance with applicable requirements, certain programs may be presented in a fiscal period based on the program-specific guidance (see Notes 4, 5 and 6).
Direct and indirect costs are charged to awards in accordance with cost principles contained in the United States Department of Health and Human Services (HHS) Cost Principles for Hospitals at 45 CFR Part 75 Appendix IX for Uniform Guidance awards. Under these cost principles, certain types of expenditures are not allowable or are limited as to reimbursement.
The Uniform Guidance provides for a 10% de minimis indirect cost rate election; however, Northwell did not make this election and uses a negotiated indirect cost rate.
De Minimis Rate Used: N
Rate Explanation: The auditee did not use the de minimis cost rate.
Northwell incurred certain expenditures related to Presidentially Declared Disasters: the COVID-19 pandemic and Hurricane Ida. Both events are eligible for reimbursement from the Federal Emergency Management Agency (FEMA) Disaster Grants – Public Assistance (Presidentially Declared Disasters) (ALN 97.036). In 2023, project worksheets for expenditures incurred in prior years of $116,991,367 were approved for reimbursement by FEMA, and included on the accompanying Schedule for the year ended December 31, 2023.
There may be adjustments to existing or future applications to account for reductions as FEMA completes authorization and appropriations of the funds. Other FEMA project worksheets have been submitted by Northwell but were not approved in 2023. Northwell will continue to finalize the project worksheets previously submitted to FEMA and intends to submit additional applications for funding for costs incurred; however, the ultimate amount that Northwell may be reimbursed is uncertain.
Title: 5. CDBG – Disaster Recovery Grants – Pub. L. No 113-2 Cluster: Hurricane Sandy Community Development Block Grant Disaster Recovery Grants (CDBG-DR) (Federal Assistance Listing Number 14.269)
Accounting Policies: The accompanying Schedule of Expenditures of Federal Awards (the Schedule) includes the federal grant activities of Northwell Health, Inc. and its member corporations and other affiliated entities (collectively, Northwell) and is presented on the accrual basis of accounting. The information on the 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 (the Uniform Guidance). Therefore, some amounts presented in the Schedule may differ from amounts presented in, or used in the preparation of, the consolidated financial statements of Northwell. For purposes of the Schedule, federal awards include any assistance provided by a federal agency directly or indirectly in the form of grants, contracts, cooperative agreements, loan and loan guarantees, or other non-cash assistance. In accordance with applicable requirements, certain programs may be presented in a fiscal period based on the program-specific guidance (see Notes 4, 5 and 6).
Direct and indirect costs are charged to awards in accordance with cost principles contained in the United States Department of Health and Human Services (HHS) Cost Principles for Hospitals at 45 CFR Part 75 Appendix IX for Uniform Guidance awards. Under these cost principles, certain types of expenditures are not allowable or are limited as to reimbursement.
The Uniform Guidance provides for a 10% de minimis indirect cost rate election; however, Northwell did not make this election and uses a negotiated indirect cost rate.
De Minimis Rate Used: N
Rate Explanation: The auditee did not use the de minimis cost rate.
Northwell incurred costs in prior years as part of the CDBG – Disaster Recovery Grants – Pub. L. No 113-2 Cluster: Hurricane Sandy Community Development Block Grant Disaster Recovery Grants. A portion of the costs incurred are federally funded. During 2023, the grant contract was amended to extend the contract period and the federal funding to be paid by Department of Housing and Urban Development (HUD) for additional costs incurred. As a result, costs totaling $1,279,03 incurred in prior years are included on the accompanying Schedule for the year ended December 31, 2023 under Federal Assistance Listing Number 14.269, along with other costs which were approved in 2023 for expenditures incurred in 2023.
Title: 6. COVID-19 – Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution
Accounting Policies: The accompanying Schedule of Expenditures of Federal Awards (the Schedule) includes the federal grant activities of Northwell Health, Inc. and its member corporations and other affiliated entities (collectively, Northwell) and is presented on the accrual basis of accounting. The information on the 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 (the Uniform Guidance). Therefore, some amounts presented in the Schedule may differ from amounts presented in, or used in the preparation of, the consolidated financial statements of Northwell. For purposes of the Schedule, federal awards include any assistance provided by a federal agency directly or indirectly in the form of grants, contracts, cooperative agreements, loan and loan guarantees, or other non-cash assistance. In accordance with applicable requirements, certain programs may be presented in a fiscal period based on the program-specific guidance (see Notes 4, 5 and 6).
Direct and indirect costs are charged to awards in accordance with cost principles contained in the United States Department of Health and Human Services (HHS) Cost Principles for Hospitals at 45 CFR Part 75 Appendix IX for Uniform Guidance awards. Under these cost principles, certain types of expenditures are not allowable or are limited as to reimbursement.
The Uniform Guidance provides for a 10% de minimis indirect cost rate election; however, Northwell did not make this election and uses a negotiated indirect cost rate.
De Minimis Rate Used: N
Rate Explanation: The auditee did not use the de minimis cost rate.
In accordance with the HHS requirements specific to ALN 93.498, COVID-19 – Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution (PRF), the amount presented on the accompanying Schedule for the year ended December 31, 2023 relates to PRF payments received from January 1, 2022 through June 30, 2022 used for lost revenues and health care related expenses for the period January 1, 2020 through June 30, 2023. The amounts presented reconcile to the PRF information previously reported to the Health Resources and Services Administration (HRSA) for PRF Reporting Period 5 as follows:
Name of Reporting Entity for
HRSA Reporting Period 5 PRF Report Total PRF Payments for Period 5 PRF Report Total Amount Reported on the Accompanying Schedule for the Year Ended December 31, 2023
North Shore University Hospital $ 37,452,567 $ 37,452,567
Lenox Hill Hospital 13,989,856 13,989,856
Peconic Bay Primary Medical Care PC 1,734,300 1,734,300
Northwell Health, Inc. 1,235,174 1,235,174
Total PRF activity for the year ended December 31, 2023 $ 54,411,897 $ 54,411,897
The lost revenues and health care related expenses attributable to COVID-19 incurred by Northwell during the period of availability for PRF Reporting Period 5 (January 1, 2020 through June 30, 2023) are in excess of the general distributions received from January 1, 2022 through June 30, 2022, therefore, the amounts presented in the table above and on the accompanying Schedule are limited to the amount of such distributions. Northwell did not receive PRF payments beyond June 30, 2022 for PRF Reporting Period 6 and, accordingly, has reported all funding received pursuant to the requirements specific to Federal Assistance Listing Number 93.498.