Audit 327792

FY End

2022-06-30

Total Expended

$15.12M

Findings

2

Programs

3

Organization: Pennsylvania Mountains Care Network (PA)

Year: 2022 Accepted: 2024-11-08

Auditor: Baker Tilly US

Organization Exclusion Status:

Checking exclusion status...

ID	Ref	Severity	Repeat	Requirement
505129	2021-002	Material Weakness	-	L
1081571	2021-002	Material Weakness	-	L

ALN	Program	Spent	Major	Findings
93.498	Provider Relief Fund	$14.97M	Yes	1
93.461	Covid-19 Testing for the Uninsured	$140,062	-	0
93.889	National Bioterrorism Hospital Preparedness Program	$6,858	-	0

Contacts

Name	Title	Type
J6JTLQLKVSV9	Michael Ickowski, Mba, CPA	Auditee
7243577013	Debra K. Bowes, CPA	Auditor
No contacts on file

Notes to SEFA

Title: Basis of Presentation Accounting Policies: Expenditures reported on the Schedule are reported on the accrual basis of accounting, with the exception of expenditures associated with the Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution (PRF). 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. PRF expenditures are reported based upon the timing of reporting periods in accordance with guidance provided by the Health Resources and Services Administration (HRSA). De Minimis Rate Used: N Rate Explanation: The System did not elect to use the 10% de minimis indirect cost rate allowed under Uniform Guidance. The accompanying schedule of expenditures of federal awards (the Schedule) includes the federal award activity of Pennsylvania Mountains Care Network (the System) for the year ended June 30, 2021. As disclosed in Note 1 to the consolidated financial statements, the System is comprised of Indiana Regional Medical Center and its controlled entities (collectively, IRMC) and Punxsutawney Area Hospital and its controlled entity (collectively, PAH). The information in this 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 (Uniform Guidance). Therefore, some amounts may differ from amounts presented in, or used in the preparation of the consolidated financial statements. Because the Schedule presents only a selected portion of the operations of the System, it is not intended to and does not present the financial position, changes in net assets or cash flows of the System.

Title: Provider Relief Fund and American Rescue Planj (ARP) Rural Distribution Accounting Policies: Expenditures reported on the Schedule are reported on the accrual basis of accounting, with the exception of expenditures associated with the Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution (PRF). 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. PRF expenditures are reported based upon the timing of reporting periods in accordance with guidance provided by the Health Resources and Services Administration (HRSA). De Minimis Rate Used: N Rate Explanation: The System did not elect to use the 10% de minimis indirect cost rate allowed under Uniform Guidance. For the U.S. Department of Health and Human Services (HHS) awards related to the PRF program, HHS has indicated the amounts on the Schedule be reported corresponding to reporting requirements of the HRSA PRF Reporting Portal. Payments from HHS for PRF are assigned to "Payment Received Periods" (each, a Period) based upon the date each payment from the PRF was received. Each Period has a specified Period of Availability and timing of reporting requirements. Entities report into the HRSA PRF Reporting Portal after each Period's deadline to use the funds (i.e., after the end of the Period of Availability). The Schedule includes $14,972,846 received from HHS between April 10, 2020 through June 30, 2020. In accordance with guidance from HHS, these amounts are presented as Period 1, as follows: (See Notes to the SEFA for chart/table) Such amounts were recognized in the consolidated statements of operations as follows during the years ended June 30: (See Notes to the SEFA for chart/table) The above amounts for the year ended June 30, 2020 were included in each of the stand-alone financial statements of IRMC and PAH, as consolidated financial statements were not prepared at the System level until the year ended June 30, 2021. Due to the PRF Reporting requirements, these amounts are not the total PRF received and/or recognized as COVID-19 grant income in the year presented in the Schedule. The Schedule includes the following entities that received PRF funds: (See the Notes to the SEFA for chart/table)

Finding Details

Finding 2021-002

Federal Program: COVID-19: Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Program Assistance Listing Number: 93.498 Federal Agency: U.S. Department of Health and Human Services Award Number: N/A Award Year: 2020 Compliance Requirement: Reporting Questioned Costs: Not determinable Criteria: Non-federal entities in receipt of federal funds must comply with the requirements of 2 CFR 200.303(a), which requires an entity to establish and maintain effective internal control over the Federal award to ensure compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. Recipients of Provider Relief Funds (PRF) payments must also comply with the reporting requirements described in the PRF terms and conditions and specified in directions issued by the U.S. Department of Health and Human Services. Condition and Context: The System did not complete the PRF Period 1 reporting in accordance with the U.S. Department of Health and Human Services guidance. The System did not enter the correct amounts from its data supporting lost revenues for all quarters; it also did not enter the correct amounts from its data supporting eligible expenditures. The adjustments needed within the PRF reports to correct the errors decreased year over year lost revenues from $21,664,944 to $11,771,346 and decreased eligible expenditures from $7,527,194 to $4,334,813, on total distributions of PRF funding of $14,972,846. In summary, the data supporting amounts for lost revenues and eligible expenses totals $16,104,159 on total distributions of PRF funding of $14,972,846 in this reporting period. Effect: The amounts reported to Health Resources & Services Administration (HRSA) were not in accordance with established U.S. Department of Health and Human Services reporting guidance. Cause: Errors in the lost revenues and eligible expenditures presented in the Period 1 report submissions were not detected by the Sytem's internal control process. Recommendation: We recommend that management implement procedures to ensure that the most recent guidance is reviewed and understood and that information used in preparation of the reports is reviewed, with errors addressed, prior to reporting. Planned Corrective Actions and View of Responsible Officials: System management agrees with the finding and has updated its lost revenue calculation. Management attempted to update lost revenue amounts with filing of its Period 4 reports; however, additional data entry errors were made.

Finding 2021-002

Federal Program: COVID-19: Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Program Assistance Listing Number: 93.498 Federal Agency: U.S. Department of Health and Human Services Award Number: N/A Award Year: 2020 Compliance Requirement: Reporting Questioned Costs: Not determinable Criteria: Non-federal entities in receipt of federal funds must comply with the requirements of 2 CFR 200.303(a), which requires an entity to establish and maintain effective internal control over the Federal award to ensure compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. Recipients of Provider Relief Funds (PRF) payments must also comply with the reporting requirements described in the PRF terms and conditions and specified in directions issued by the U.S. Department of Health and Human Services. Condition and Context: The System did not complete the PRF Period 1 reporting in accordance with the U.S. Department of Health and Human Services guidance. The System did not enter the correct amounts from its data supporting lost revenues for all quarters; it also did not enter the correct amounts from its data supporting eligible expenditures. The adjustments needed within the PRF reports to correct the errors decreased year over year lost revenues from $21,664,944 to $11,771,346 and decreased eligible expenditures from $7,527,194 to $4,334,813, on total distributions of PRF funding of $14,972,846. In summary, the data supporting amounts for lost revenues and eligible expenses totals $16,104,159 on total distributions of PRF funding of $14,972,846 in this reporting period. Effect: The amounts reported to Health Resources & Services Administration (HRSA) were not in accordance with established U.S. Department of Health and Human Services reporting guidance. Cause: Errors in the lost revenues and eligible expenditures presented in the Period 1 report submissions were not detected by the Sytem's internal control process. Recommendation: We recommend that management implement procedures to ensure that the most recent guidance is reviewed and understood and that information used in preparation of the reports is reviewed, with errors addressed, prior to reporting. Planned Corrective Actions and View of Responsible Officials: System management agrees with the finding and has updated its lost revenue calculation. Management attempted to update lost revenue amounts with filing of its Period 4 reports; however, additional data entry errors were made.