Federal program: U.S. Department of Health and Human Services—ALN 93.498, Provider Relief Fund
and American Rescue Plan (ARP) Rural Distribution
Criteria: Specific criteria are established by the U.S. Department of Health and Human Services (HHS)
with respect to allowable cost and reporting requirements for this program, including:
-Funds shall reimburse the recipient only for health care related expenses or lost revenues that
are attributable to coronavirus.
-Entities may elect to calculate and report lost revenue using one of three options. For entities electing
to report lost revenues using Option iii, the alternative method used to calculate lost revenue should
be consistent with a narrative description of the methodology as submitted in the PRF reporting
portal.
Condition: In the Medical Center’s Period 5 reporting in the PRF reporting portal, the Medical Center
reported lost revenue using Option iii for each reporting entity included in the schedule of expenditures of
federal awards that received PRF. The alternative method used to calculate lost revenues was budget-toactual
revenues for the period from January 2020 through August 2020 and year-over-year actual
revenues for the period from September 2020 through August 2021. In the lost revenue calculation for the
third quarter of calendar year 2021 for two of the Medical Center’s reporting entities, the Medical Center
understated actual revenues by $1,095,540 in total.
Context: The Medical Center did not report lost revenues for the third quarter of 2021 for any entity,
because actual revenue exceeded the prior year’s actual revenue for each entity. Had the correct
amounts of actual revenue been reported for the third quarter of 2021, actual revenue for the quarter still
would have exceeded the prior year’s actual revenue for each entity and no lost revenue would be
reported.
Cause: In preparing the Period 5 reports, management used preliminary estimates of revenue for the
month of August 2021 in error. Review processes were performed before the reports were submitted, but
these reviews did not detect and correct the errors before submission.
Effect: The Medical Center’s Period 5 reporting in the PRF reporting portal included an inaccurate
amount of actual revenue for the third quarter of calendar year 2021 for two reporting entities, which was
not consistent with methodology described in the Option iii narrative submitted. The PRF reporting
correctly reported no lost revenue for the quarter.
Questioned costs: None.
Repeat finding: Yes, the misreporting of actual revenues for the third quarter of 2021 for all of the
Medical Center’s reporting entities was also included in finding 2022-001 in the prior year. This error was
corrected in the Period 4 and/or Period 5 reports for the Medical Center’s reporting entities except for two
reporting entities.
Recommendation: We recommend that management’s review of the lost revenue calculations and
reporting in the PRF reporting portal include review of documentation supporting each dollar amount
included in lost revenue calculation.
Views of responsible officials of the auditee: Management agrees with the finding and the auditor’s
recommendation.
Federal program: U.S. Department of Health and Human Services—ALN 93.498, Provider Relief Fund
and American Rescue Plan (ARP) Rural Distribution
Criteria: Specific criteria are established by the U.S. Department of Health and Human Services (HHS)
with respect to allowable cost and reporting requirements for this program, including:
-Funds shall reimburse the recipient only for health care related expenses or lost revenues that
are attributable to coronavirus.
-Entities may elect to calculate and report lost revenue using one of three options. For entities electing
to report lost revenues using Option iii, the alternative method used to calculate lost revenue should
be consistent with a narrative description of the methodology as submitted in the PRF reporting
portal.
Condition: In the Medical Center’s Period 5 reporting in the PRF reporting portal, the Medical Center
reported lost revenue using Option iii for each reporting entity included in the schedule of expenditures of
federal awards that received PRF. The alternative method used to calculate lost revenues was budget-toactual
revenues for the period from January 2020 through August 2020 and year-over-year actual
revenues for the period from September 2020 through August 2021. In the lost revenue calculation for the
third quarter of calendar year 2021 for two of the Medical Center’s reporting entities, the Medical Center
understated actual revenues by $1,095,540 in total.
Context: The Medical Center did not report lost revenues for the third quarter of 2021 for any entity,
because actual revenue exceeded the prior year’s actual revenue for each entity. Had the correct
amounts of actual revenue been reported for the third quarter of 2021, actual revenue for the quarter still
would have exceeded the prior year’s actual revenue for each entity and no lost revenue would be
reported.
Cause: In preparing the Period 5 reports, management used preliminary estimates of revenue for the
month of August 2021 in error. Review processes were performed before the reports were submitted, but
these reviews did not detect and correct the errors before submission.
Effect: The Medical Center’s Period 5 reporting in the PRF reporting portal included an inaccurate
amount of actual revenue for the third quarter of calendar year 2021 for two reporting entities, which was
not consistent with methodology described in the Option iii narrative submitted. The PRF reporting
correctly reported no lost revenue for the quarter.
Questioned costs: None.
Repeat finding: Yes, the misreporting of actual revenues for the third quarter of 2021 for all of the
Medical Center’s reporting entities was also included in finding 2022-001 in the prior year. This error was
corrected in the Period 4 and/or Period 5 reports for the Medical Center’s reporting entities except for two
reporting entities.
Recommendation: We recommend that management’s review of the lost revenue calculations and
reporting in the PRF reporting portal include review of documentation supporting each dollar amount
included in lost revenue calculation.
Views of responsible officials of the auditee: Management agrees with the finding and the auditor’s
recommendation.
Federal program: U.S. Department of Health and Human Services—ALN 93.498, Provider Relief Fund
and American Rescue Plan (ARP) Rural Distribution
Criteria: Specific criteria are established by the U.S. Department of Health and Human Services (HHS)
with respect to allowable cost and reporting requirements for this program, including:
-Funds shall reimburse the recipient only for health care related expenses or lost revenues that
are attributable to coronavirus.
-Entities may elect to calculate and report lost revenue using one of three options. For entities electing
to report lost revenues using Option iii, the alternative method used to calculate lost revenue should
be consistent with a narrative description of the methodology as submitted in the PRF reporting
portal.
Condition: In the Medical Center’s Period 5 reporting in the PRF reporting portal, the Medical Center
reported lost revenue using Option iii for each reporting entity included in the schedule of expenditures of
federal awards that received PRF. The alternative method used to calculate lost revenues was budget-toactual
revenues for the period from January 2020 through August 2020 and year-over-year actual
revenues for the period from September 2020 through August 2021. In the lost revenue calculation for the
third quarter of calendar year 2021 for two of the Medical Center’s reporting entities, the Medical Center
understated actual revenues by $1,095,540 in total.
Context: The Medical Center did not report lost revenues for the third quarter of 2021 for any entity,
because actual revenue exceeded the prior year’s actual revenue for each entity. Had the correct
amounts of actual revenue been reported for the third quarter of 2021, actual revenue for the quarter still
would have exceeded the prior year’s actual revenue for each entity and no lost revenue would be
reported.
Cause: In preparing the Period 5 reports, management used preliminary estimates of revenue for the
month of August 2021 in error. Review processes were performed before the reports were submitted, but
these reviews did not detect and correct the errors before submission.
Effect: The Medical Center’s Period 5 reporting in the PRF reporting portal included an inaccurate
amount of actual revenue for the third quarter of calendar year 2021 for two reporting entities, which was
not consistent with methodology described in the Option iii narrative submitted. The PRF reporting
correctly reported no lost revenue for the quarter.
Questioned costs: None.
Repeat finding: Yes, the misreporting of actual revenues for the third quarter of 2021 for all of the
Medical Center’s reporting entities was also included in finding 2022-001 in the prior year. This error was
corrected in the Period 4 and/or Period 5 reports for the Medical Center’s reporting entities except for two
reporting entities.
Recommendation: We recommend that management’s review of the lost revenue calculations and
reporting in the PRF reporting portal include review of documentation supporting each dollar amount
included in lost revenue calculation.
Views of responsible officials of the auditee: Management agrees with the finding and the auditor’s
recommendation.
Federal program: U.S. Department of Health and Human Services—ALN 93.498, Provider Relief Fund
and American Rescue Plan (ARP) Rural Distribution
Criteria: Specific criteria are established by the U.S. Department of Health and Human Services (HHS)
with respect to allowable cost and reporting requirements for this program, including:
-Funds shall reimburse the recipient only for health care related expenses or lost revenues that
are attributable to coronavirus.
-Entities may elect to calculate and report lost revenue using one of three options. For entities electing
to report lost revenues using Option iii, the alternative method used to calculate lost revenue should
be consistent with a narrative description of the methodology as submitted in the PRF reporting
portal.
Condition: In the Medical Center’s Period 5 reporting in the PRF reporting portal, the Medical Center
reported lost revenue using Option iii for each reporting entity included in the schedule of expenditures of
federal awards that received PRF. The alternative method used to calculate lost revenues was budget-toactual
revenues for the period from January 2020 through August 2020 and year-over-year actual
revenues for the period from September 2020 through August 2021. In the lost revenue calculation for the
third quarter of calendar year 2021 for two of the Medical Center’s reporting entities, the Medical Center
understated actual revenues by $1,095,540 in total.
Context: The Medical Center did not report lost revenues for the third quarter of 2021 for any entity,
because actual revenue exceeded the prior year’s actual revenue for each entity. Had the correct
amounts of actual revenue been reported for the third quarter of 2021, actual revenue for the quarter still
would have exceeded the prior year’s actual revenue for each entity and no lost revenue would be
reported.
Cause: In preparing the Period 5 reports, management used preliminary estimates of revenue for the
month of August 2021 in error. Review processes were performed before the reports were submitted, but
these reviews did not detect and correct the errors before submission.
Effect: The Medical Center’s Period 5 reporting in the PRF reporting portal included an inaccurate
amount of actual revenue for the third quarter of calendar year 2021 for two reporting entities, which was
not consistent with methodology described in the Option iii narrative submitted. The PRF reporting
correctly reported no lost revenue for the quarter.
Questioned costs: None.
Repeat finding: Yes, the misreporting of actual revenues for the third quarter of 2021 for all of the
Medical Center’s reporting entities was also included in finding 2022-001 in the prior year. This error was
corrected in the Period 4 and/or Period 5 reports for the Medical Center’s reporting entities except for two
reporting entities.
Recommendation: We recommend that management’s review of the lost revenue calculations and
reporting in the PRF reporting portal include review of documentation supporting each dollar amount
included in lost revenue calculation.
Views of responsible officials of the auditee: Management agrees with the finding and the auditor’s
recommendation.
Federal program: U.S. Department of Health and Human Services—ALN 93.498, Provider Relief Fund
and American Rescue Plan (ARP) Rural Distribution
Criteria: Specific criteria are established by the U.S. Department of Health and Human Services (HHS)
with respect to allowable cost and reporting requirements for this program, including:
-Funds shall reimburse the recipient only for health care related expenses or lost revenues that
are attributable to coronavirus.
-Entities may elect to calculate and report lost revenue using one of three options. For entities electing
to report lost revenues using Option iii, the alternative method used to calculate lost revenue should
be consistent with a narrative description of the methodology as submitted in the PRF reporting
portal.
Condition: In the Medical Center’s Period 5 reporting in the PRF reporting portal, the Medical Center
reported lost revenue using Option iii for each reporting entity included in the schedule of expenditures of
federal awards that received PRF. The alternative method used to calculate lost revenues was budget-toactual
revenues for the period from January 2020 through August 2020 and year-over-year actual
revenues for the period from September 2020 through August 2021. In the lost revenue calculation for the
third quarter of calendar year 2021 for two of the Medical Center’s reporting entities, the Medical Center
understated actual revenues by $1,095,540 in total.
Context: The Medical Center did not report lost revenues for the third quarter of 2021 for any entity,
because actual revenue exceeded the prior year’s actual revenue for each entity. Had the correct
amounts of actual revenue been reported for the third quarter of 2021, actual revenue for the quarter still
would have exceeded the prior year’s actual revenue for each entity and no lost revenue would be
reported.
Cause: In preparing the Period 5 reports, management used preliminary estimates of revenue for the
month of August 2021 in error. Review processes were performed before the reports were submitted, but
these reviews did not detect and correct the errors before submission.
Effect: The Medical Center’s Period 5 reporting in the PRF reporting portal included an inaccurate
amount of actual revenue for the third quarter of calendar year 2021 for two reporting entities, which was
not consistent with methodology described in the Option iii narrative submitted. The PRF reporting
correctly reported no lost revenue for the quarter.
Questioned costs: None.
Repeat finding: Yes, the misreporting of actual revenues for the third quarter of 2021 for all of the
Medical Center’s reporting entities was also included in finding 2022-001 in the prior year. This error was
corrected in the Period 4 and/or Period 5 reports for the Medical Center’s reporting entities except for two
reporting entities.
Recommendation: We recommend that management’s review of the lost revenue calculations and
reporting in the PRF reporting portal include review of documentation supporting each dollar amount
included in lost revenue calculation.
Views of responsible officials of the auditee: Management agrees with the finding and the auditor’s
recommendation.
Federal program: U.S. Department of Health and Human Services—ALN 93.498, Provider Relief Fund
and American Rescue Plan (ARP) Rural Distribution
Criteria: Specific criteria are established by the U.S. Department of Health and Human Services (HHS)
with respect to allowable cost and reporting requirements for this program, including:
-Funds shall reimburse the recipient only for health care related expenses or lost revenues that
are attributable to coronavirus.
Condition: In the Medical Center’s Period 5 reporting in the PRF reporting portal, for one reporting entity,
the Medical Center reported other PRF expenses of $855,130. These same expenses had previously
been reported in this reporting entity's Period 2 PRF reporting and, therefore, should not have been
reported again in Period 5.
Context: The $855,130 of duplicate PRF expenses identified were the only PRF expenses reported in
either Period 4 or Period 5 by any of the Medical Center’s reporting entities; therefore, the total amount of
likely questioned costs is the same as the known questioned costs of $855,130.
Cause: In preparing the Period 5 reports, management included in error PRF expenses that had
previously been reported in Period 2. Review processes were performed before the reports were
submitted, but these reviews did not detect and correct the error before submission.
Effect: The Medical Center’s Period 5 reporting in the PRF reporting portal included questioned costs for
one reporting entity. On that reporting entity’s submitted Period 5 report, total PRF expenses and lost
revenues available to be used for Period 5 exceeded PRF payments received by $3,810,237. After
correction of the error, total PRF expenses and lost revenues available to be used for Period 5 would still
exceed PRF payments received by $2,955,107. Thus, federal expenditures reported for ALN 93.498 in
the schedule of expenditures of federal awards for the year ended August 31, 2023, are unaffected by
this error.
Questioned costs: $855,130 of known and likely questioned costs for PRF expenses reported in Period
5.
Repeat finding: No.
Recommendation: We recommend that management’s review of the draft reporting in the PRF reporting
portal include review of documentation supporting all reported PRF expenses for the period and a review
and reconciliation of the PRF expenses previously reported in prior periods.
Views of responsible officials of the auditee: Management agrees with the finding and the auditor’s
recommendation.
Federal program: U.S. Department of Health and Human Services—ALN 93.498, Provider Relief Fund
and American Rescue Plan (ARP) Rural Distribution
Criteria: Specific criteria are established by the U.S. Department of Health and Human Services (HHS)
with respect to allowable cost and reporting requirements for this program, including:
-Funds shall reimburse the recipient only for health care related expenses or lost revenues that
are attributable to coronavirus.
Condition: In the Medical Center’s Period 5 reporting in the PRF reporting portal, for one reporting entity,
the Medical Center reported other PRF expenses of $855,130. These same expenses had previously
been reported in this reporting entity's Period 2 PRF reporting and, therefore, should not have been
reported again in Period 5.
Context: The $855,130 of duplicate PRF expenses identified were the only PRF expenses reported in
either Period 4 or Period 5 by any of the Medical Center’s reporting entities; therefore, the total amount of
likely questioned costs is the same as the known questioned costs of $855,130.
Cause: In preparing the Period 5 reports, management included in error PRF expenses that had
previously been reported in Period 2. Review processes were performed before the reports were
submitted, but these reviews did not detect and correct the error before submission.
Effect: The Medical Center’s Period 5 reporting in the PRF reporting portal included questioned costs for
one reporting entity. On that reporting entity’s submitted Period 5 report, total PRF expenses and lost
revenues available to be used for Period 5 exceeded PRF payments received by $3,810,237. After
correction of the error, total PRF expenses and lost revenues available to be used for Period 5 would still
exceed PRF payments received by $2,955,107. Thus, federal expenditures reported for ALN 93.498 in
the schedule of expenditures of federal awards for the year ended August 31, 2023, are unaffected by
this error.
Questioned costs: $855,130 of known and likely questioned costs for PRF expenses reported in Period
5.
Repeat finding: No.
Recommendation: We recommend that management’s review of the draft reporting in the PRF reporting
portal include review of documentation supporting all reported PRF expenses for the period and a review
and reconciliation of the PRF expenses previously reported in prior periods.
Views of responsible officials of the auditee: Management agrees with the finding and the auditor’s
recommendation.
Federal program: U.S. Department of Health and Human Services—ALN 93.498, Provider Relief Fund
and American Rescue Plan (ARP) Rural Distribution
Criteria: Specific criteria are established by the U.S. Department of Health and Human Services (HHS)
with respect to allowable cost and reporting requirements for this program, including:
-Funds shall reimburse the recipient only for health care related expenses or lost revenues that
are attributable to coronavirus.
Condition: In the Medical Center’s Period 5 reporting in the PRF reporting portal, for one reporting entity,
the Medical Center reported other PRF expenses of $855,130. These same expenses had previously
been reported in this reporting entity's Period 2 PRF reporting and, therefore, should not have been
reported again in Period 5.
Context: The $855,130 of duplicate PRF expenses identified were the only PRF expenses reported in
either Period 4 or Period 5 by any of the Medical Center’s reporting entities; therefore, the total amount of
likely questioned costs is the same as the known questioned costs of $855,130.
Cause: In preparing the Period 5 reports, management included in error PRF expenses that had
previously been reported in Period 2. Review processes were performed before the reports were
submitted, but these reviews did not detect and correct the error before submission.
Effect: The Medical Center’s Period 5 reporting in the PRF reporting portal included questioned costs for
one reporting entity. On that reporting entity’s submitted Period 5 report, total PRF expenses and lost
revenues available to be used for Period 5 exceeded PRF payments received by $3,810,237. After
correction of the error, total PRF expenses and lost revenues available to be used for Period 5 would still
exceed PRF payments received by $2,955,107. Thus, federal expenditures reported for ALN 93.498 in
the schedule of expenditures of federal awards for the year ended August 31, 2023, are unaffected by
this error.
Questioned costs: $855,130 of known and likely questioned costs for PRF expenses reported in Period
5.
Repeat finding: No.
Recommendation: We recommend that management’s review of the draft reporting in the PRF reporting
portal include review of documentation supporting all reported PRF expenses for the period and a review
and reconciliation of the PRF expenses previously reported in prior periods.
Views of responsible officials of the auditee: Management agrees with the finding and the auditor’s
recommendation.
Federal program: U.S. Department of Health and Human Services—ALN 93.498, Provider Relief Fund
and American Rescue Plan (ARP) Rural Distribution
Criteria: Specific criteria are established by the U.S. Department of Health and Human Services (HHS)
with respect to allowable cost and reporting requirements for this program, including:
-Funds shall reimburse the recipient only for health care related expenses or lost revenues that
are attributable to coronavirus.
Condition: In the Medical Center’s Period 5 reporting in the PRF reporting portal, for one reporting entity,
the Medical Center reported other PRF expenses of $855,130. These same expenses had previously
been reported in this reporting entity's Period 2 PRF reporting and, therefore, should not have been
reported again in Period 5.
Context: The $855,130 of duplicate PRF expenses identified were the only PRF expenses reported in
either Period 4 or Period 5 by any of the Medical Center’s reporting entities; therefore, the total amount of
likely questioned costs is the same as the known questioned costs of $855,130.
Cause: In preparing the Period 5 reports, management included in error PRF expenses that had
previously been reported in Period 2. Review processes were performed before the reports were
submitted, but these reviews did not detect and correct the error before submission.
Effect: The Medical Center’s Period 5 reporting in the PRF reporting portal included questioned costs for
one reporting entity. On that reporting entity’s submitted Period 5 report, total PRF expenses and lost
revenues available to be used for Period 5 exceeded PRF payments received by $3,810,237. After
correction of the error, total PRF expenses and lost revenues available to be used for Period 5 would still
exceed PRF payments received by $2,955,107. Thus, federal expenditures reported for ALN 93.498 in
the schedule of expenditures of federal awards for the year ended August 31, 2023, are unaffected by
this error.
Questioned costs: $855,130 of known and likely questioned costs for PRF expenses reported in Period
5.
Repeat finding: No.
Recommendation: We recommend that management’s review of the draft reporting in the PRF reporting
portal include review of documentation supporting all reported PRF expenses for the period and a review
and reconciliation of the PRF expenses previously reported in prior periods.
Views of responsible officials of the auditee: Management agrees with the finding and the auditor’s
recommendation.
Federal program: U.S. Department of Health and Human Services—ALN 93.498, Provider Relief Fund
and American Rescue Plan (ARP) Rural Distribution
Criteria: Specific criteria are established by the U.S. Department of Health and Human Services (HHS)
with respect to allowable cost and reporting requirements for this program, including:
-Funds shall reimburse the recipient only for health care related expenses or lost revenues that
are attributable to coronavirus.
Condition: In the Medical Center’s Period 5 reporting in the PRF reporting portal, for one reporting entity,
the Medical Center reported other PRF expenses of $855,130. These same expenses had previously
been reported in this reporting entity's Period 2 PRF reporting and, therefore, should not have been
reported again in Period 5.
Context: The $855,130 of duplicate PRF expenses identified were the only PRF expenses reported in
either Period 4 or Period 5 by any of the Medical Center’s reporting entities; therefore, the total amount of
likely questioned costs is the same as the known questioned costs of $855,130.
Cause: In preparing the Period 5 reports, management included in error PRF expenses that had
previously been reported in Period 2. Review processes were performed before the reports were
submitted, but these reviews did not detect and correct the error before submission.
Effect: The Medical Center’s Period 5 reporting in the PRF reporting portal included questioned costs for
one reporting entity. On that reporting entity’s submitted Period 5 report, total PRF expenses and lost
revenues available to be used for Period 5 exceeded PRF payments received by $3,810,237. After
correction of the error, total PRF expenses and lost revenues available to be used for Period 5 would still
exceed PRF payments received by $2,955,107. Thus, federal expenditures reported for ALN 93.498 in
the schedule of expenditures of federal awards for the year ended August 31, 2023, are unaffected by
this error.
Questioned costs: $855,130 of known and likely questioned costs for PRF expenses reported in Period
5.
Repeat finding: No.
Recommendation: We recommend that management’s review of the draft reporting in the PRF reporting
portal include review of documentation supporting all reported PRF expenses for the period and a review
and reconciliation of the PRF expenses previously reported in prior periods.
Views of responsible officials of the auditee: Management agrees with the finding and the auditor’s
recommendation.
Federal program: U.S. Department of the Treasury; Passed-through Illinois Department of Public Health-ALN 21.027, COVID-19 Coronavirus State and Local Fiscal Recovery Funds.
Criteria: In accordance with 2 CFR 200 200.510(b), the auditee must prepare a Schedule of Expenditures of Federal Awards (SEFA) for the period covered by the auditee's financial statements which must include the total federal awards expended as determined in accordance with 2 CFR 200.502.
Condition: The Medical Center's SEFA for the year ended August 31, 2023, which is supplementary information to the Medical Center's financial statements, was restated to include an additional $2,000,000 of federal expenditures for the Coronavirus State and Local Fiscal Recovery Funds, Assistance Listing Number 21.027. Management's processes and internal controls for ensuring that all federal funds expended by the Medical Center are captured and reported in the SEFA were inadquate to detect the omission of the $2,000,000 of federal expenditures.
Context: The additional $2,000,000 of federal expenditures increased the total federal expenditures for the Coronavirus State and Local Fiscal Recovery Funds, Assistance Listing Number 21.027 to $2,899,890. This resulted in the reissuance of the single audit report.
Cause: The additional federal program expenditures for the Coronavirus State and Local Fiscal Recovery Funds, Assistance Listing Number 21.027, were provided under a separate pass-through grant and were inadvertently omitted from the SEFA due to an oversight in the preparation of the SEFA resulting in part from and coinciding with the turnover of key personnel involved with and having oversight over the $2,000,000 award.
Effect: Improper reporting of federal expenditures can result in material errors on the SEFA leading to inaccurate major program determination. In this instance an error did result in the identification of an additional major program.
Repeat finding: No.
Recommendation: We recommend that management enhance its process and internal controls around the timely identification of federal awards and preparation of the SEFA to ensure completeness and accuracy of the SEFA.
Views of responsible officials of the auditee: Management agrees with the finding and the auditor's recommendation.
Federal Program: U.S. Department of the Treasury-ALN 21.027, Coronavirus State and Local Fiscal Recovery Funds.
Questioned costs: None.
See item 2023-004.
Federal program: U.S. Department of Health and Human Services—ALN 93.498, Provider Relief Fund
and American Rescue Plan (ARP) Rural Distribution
Criteria: Specific criteria are established by the U.S. Department of Health and Human Services (HHS)
with respect to allowable cost and reporting requirements for this program, including:
-Funds shall reimburse the recipient only for health care related expenses or lost revenues that
are attributable to coronavirus.
-Entities may elect to calculate and report lost revenue using one of three options. For entities electing
to report lost revenues using Option iii, the alternative method used to calculate lost revenue should
be consistent with a narrative description of the methodology as submitted in the PRF reporting
portal.
Condition: In the Medical Center’s Period 5 reporting in the PRF reporting portal, the Medical Center
reported lost revenue using Option iii for each reporting entity included in the schedule of expenditures of
federal awards that received PRF. The alternative method used to calculate lost revenues was budget-toactual
revenues for the period from January 2020 through August 2020 and year-over-year actual
revenues for the period from September 2020 through August 2021. In the lost revenue calculation for the
third quarter of calendar year 2021 for two of the Medical Center’s reporting entities, the Medical Center
understated actual revenues by $1,095,540 in total.
Context: The Medical Center did not report lost revenues for the third quarter of 2021 for any entity,
because actual revenue exceeded the prior year’s actual revenue for each entity. Had the correct
amounts of actual revenue been reported for the third quarter of 2021, actual revenue for the quarter still
would have exceeded the prior year’s actual revenue for each entity and no lost revenue would be
reported.
Cause: In preparing the Period 5 reports, management used preliminary estimates of revenue for the
month of August 2021 in error. Review processes were performed before the reports were submitted, but
these reviews did not detect and correct the errors before submission.
Effect: The Medical Center’s Period 5 reporting in the PRF reporting portal included an inaccurate
amount of actual revenue for the third quarter of calendar year 2021 for two reporting entities, which was
not consistent with methodology described in the Option iii narrative submitted. The PRF reporting
correctly reported no lost revenue for the quarter.
Questioned costs: None.
Repeat finding: Yes, the misreporting of actual revenues for the third quarter of 2021 for all of the
Medical Center’s reporting entities was also included in finding 2022-001 in the prior year. This error was
corrected in the Period 4 and/or Period 5 reports for the Medical Center’s reporting entities except for two
reporting entities.
Recommendation: We recommend that management’s review of the lost revenue calculations and
reporting in the PRF reporting portal include review of documentation supporting each dollar amount
included in lost revenue calculation.
Views of responsible officials of the auditee: Management agrees with the finding and the auditor’s
recommendation.
Federal program: U.S. Department of Health and Human Services—ALN 93.498, Provider Relief Fund
and American Rescue Plan (ARP) Rural Distribution
Criteria: Specific criteria are established by the U.S. Department of Health and Human Services (HHS)
with respect to allowable cost and reporting requirements for this program, including:
-Funds shall reimburse the recipient only for health care related expenses or lost revenues that
are attributable to coronavirus.
-Entities may elect to calculate and report lost revenue using one of three options. For entities electing
to report lost revenues using Option iii, the alternative method used to calculate lost revenue should
be consistent with a narrative description of the methodology as submitted in the PRF reporting
portal.
Condition: In the Medical Center’s Period 5 reporting in the PRF reporting portal, the Medical Center
reported lost revenue using Option iii for each reporting entity included in the schedule of expenditures of
federal awards that received PRF. The alternative method used to calculate lost revenues was budget-toactual
revenues for the period from January 2020 through August 2020 and year-over-year actual
revenues for the period from September 2020 through August 2021. In the lost revenue calculation for the
third quarter of calendar year 2021 for two of the Medical Center’s reporting entities, the Medical Center
understated actual revenues by $1,095,540 in total.
Context: The Medical Center did not report lost revenues for the third quarter of 2021 for any entity,
because actual revenue exceeded the prior year’s actual revenue for each entity. Had the correct
amounts of actual revenue been reported for the third quarter of 2021, actual revenue for the quarter still
would have exceeded the prior year’s actual revenue for each entity and no lost revenue would be
reported.
Cause: In preparing the Period 5 reports, management used preliminary estimates of revenue for the
month of August 2021 in error. Review processes were performed before the reports were submitted, but
these reviews did not detect and correct the errors before submission.
Effect: The Medical Center’s Period 5 reporting in the PRF reporting portal included an inaccurate
amount of actual revenue for the third quarter of calendar year 2021 for two reporting entities, which was
not consistent with methodology described in the Option iii narrative submitted. The PRF reporting
correctly reported no lost revenue for the quarter.
Questioned costs: None.
Repeat finding: Yes, the misreporting of actual revenues for the third quarter of 2021 for all of the
Medical Center’s reporting entities was also included in finding 2022-001 in the prior year. This error was
corrected in the Period 4 and/or Period 5 reports for the Medical Center’s reporting entities except for two
reporting entities.
Recommendation: We recommend that management’s review of the lost revenue calculations and
reporting in the PRF reporting portal include review of documentation supporting each dollar amount
included in lost revenue calculation.
Views of responsible officials of the auditee: Management agrees with the finding and the auditor’s
recommendation.
Federal program: U.S. Department of Health and Human Services—ALN 93.498, Provider Relief Fund
and American Rescue Plan (ARP) Rural Distribution
Criteria: Specific criteria are established by the U.S. Department of Health and Human Services (HHS)
with respect to allowable cost and reporting requirements for this program, including:
-Funds shall reimburse the recipient only for health care related expenses or lost revenues that
are attributable to coronavirus.
-Entities may elect to calculate and report lost revenue using one of three options. For entities electing
to report lost revenues using Option iii, the alternative method used to calculate lost revenue should
be consistent with a narrative description of the methodology as submitted in the PRF reporting
portal.
Condition: In the Medical Center’s Period 5 reporting in the PRF reporting portal, the Medical Center
reported lost revenue using Option iii for each reporting entity included in the schedule of expenditures of
federal awards that received PRF. The alternative method used to calculate lost revenues was budget-toactual
revenues for the period from January 2020 through August 2020 and year-over-year actual
revenues for the period from September 2020 through August 2021. In the lost revenue calculation for the
third quarter of calendar year 2021 for two of the Medical Center’s reporting entities, the Medical Center
understated actual revenues by $1,095,540 in total.
Context: The Medical Center did not report lost revenues for the third quarter of 2021 for any entity,
because actual revenue exceeded the prior year’s actual revenue for each entity. Had the correct
amounts of actual revenue been reported for the third quarter of 2021, actual revenue for the quarter still
would have exceeded the prior year’s actual revenue for each entity and no lost revenue would be
reported.
Cause: In preparing the Period 5 reports, management used preliminary estimates of revenue for the
month of August 2021 in error. Review processes were performed before the reports were submitted, but
these reviews did not detect and correct the errors before submission.
Effect: The Medical Center’s Period 5 reporting in the PRF reporting portal included an inaccurate
amount of actual revenue for the third quarter of calendar year 2021 for two reporting entities, which was
not consistent with methodology described in the Option iii narrative submitted. The PRF reporting
correctly reported no lost revenue for the quarter.
Questioned costs: None.
Repeat finding: Yes, the misreporting of actual revenues for the third quarter of 2021 for all of the
Medical Center’s reporting entities was also included in finding 2022-001 in the prior year. This error was
corrected in the Period 4 and/or Period 5 reports for the Medical Center’s reporting entities except for two
reporting entities.
Recommendation: We recommend that management’s review of the lost revenue calculations and
reporting in the PRF reporting portal include review of documentation supporting each dollar amount
included in lost revenue calculation.
Views of responsible officials of the auditee: Management agrees with the finding and the auditor’s
recommendation.
Federal program: U.S. Department of Health and Human Services—ALN 93.498, Provider Relief Fund
and American Rescue Plan (ARP) Rural Distribution
Criteria: Specific criteria are established by the U.S. Department of Health and Human Services (HHS)
with respect to allowable cost and reporting requirements for this program, including:
-Funds shall reimburse the recipient only for health care related expenses or lost revenues that
are attributable to coronavirus.
-Entities may elect to calculate and report lost revenue using one of three options. For entities electing
to report lost revenues using Option iii, the alternative method used to calculate lost revenue should
be consistent with a narrative description of the methodology as submitted in the PRF reporting
portal.
Condition: In the Medical Center’s Period 5 reporting in the PRF reporting portal, the Medical Center
reported lost revenue using Option iii for each reporting entity included in the schedule of expenditures of
federal awards that received PRF. The alternative method used to calculate lost revenues was budget-toactual
revenues for the period from January 2020 through August 2020 and year-over-year actual
revenues for the period from September 2020 through August 2021. In the lost revenue calculation for the
third quarter of calendar year 2021 for two of the Medical Center’s reporting entities, the Medical Center
understated actual revenues by $1,095,540 in total.
Context: The Medical Center did not report lost revenues for the third quarter of 2021 for any entity,
because actual revenue exceeded the prior year’s actual revenue for each entity. Had the correct
amounts of actual revenue been reported for the third quarter of 2021, actual revenue for the quarter still
would have exceeded the prior year’s actual revenue for each entity and no lost revenue would be
reported.
Cause: In preparing the Period 5 reports, management used preliminary estimates of revenue for the
month of August 2021 in error. Review processes were performed before the reports were submitted, but
these reviews did not detect and correct the errors before submission.
Effect: The Medical Center’s Period 5 reporting in the PRF reporting portal included an inaccurate
amount of actual revenue for the third quarter of calendar year 2021 for two reporting entities, which was
not consistent with methodology described in the Option iii narrative submitted. The PRF reporting
correctly reported no lost revenue for the quarter.
Questioned costs: None.
Repeat finding: Yes, the misreporting of actual revenues for the third quarter of 2021 for all of the
Medical Center’s reporting entities was also included in finding 2022-001 in the prior year. This error was
corrected in the Period 4 and/or Period 5 reports for the Medical Center’s reporting entities except for two
reporting entities.
Recommendation: We recommend that management’s review of the lost revenue calculations and
reporting in the PRF reporting portal include review of documentation supporting each dollar amount
included in lost revenue calculation.
Views of responsible officials of the auditee: Management agrees with the finding and the auditor’s
recommendation.
Federal program: U.S. Department of Health and Human Services—ALN 93.498, Provider Relief Fund
and American Rescue Plan (ARP) Rural Distribution
Criteria: Specific criteria are established by the U.S. Department of Health and Human Services (HHS)
with respect to allowable cost and reporting requirements for this program, including:
-Funds shall reimburse the recipient only for health care related expenses or lost revenues that
are attributable to coronavirus.
-Entities may elect to calculate and report lost revenue using one of three options. For entities electing
to report lost revenues using Option iii, the alternative method used to calculate lost revenue should
be consistent with a narrative description of the methodology as submitted in the PRF reporting
portal.
Condition: In the Medical Center’s Period 5 reporting in the PRF reporting portal, the Medical Center
reported lost revenue using Option iii for each reporting entity included in the schedule of expenditures of
federal awards that received PRF. The alternative method used to calculate lost revenues was budget-toactual
revenues for the period from January 2020 through August 2020 and year-over-year actual
revenues for the period from September 2020 through August 2021. In the lost revenue calculation for the
third quarter of calendar year 2021 for two of the Medical Center’s reporting entities, the Medical Center
understated actual revenues by $1,095,540 in total.
Context: The Medical Center did not report lost revenues for the third quarter of 2021 for any entity,
because actual revenue exceeded the prior year’s actual revenue for each entity. Had the correct
amounts of actual revenue been reported for the third quarter of 2021, actual revenue for the quarter still
would have exceeded the prior year’s actual revenue for each entity and no lost revenue would be
reported.
Cause: In preparing the Period 5 reports, management used preliminary estimates of revenue for the
month of August 2021 in error. Review processes were performed before the reports were submitted, but
these reviews did not detect and correct the errors before submission.
Effect: The Medical Center’s Period 5 reporting in the PRF reporting portal included an inaccurate
amount of actual revenue for the third quarter of calendar year 2021 for two reporting entities, which was
not consistent with methodology described in the Option iii narrative submitted. The PRF reporting
correctly reported no lost revenue for the quarter.
Questioned costs: None.
Repeat finding: Yes, the misreporting of actual revenues for the third quarter of 2021 for all of the
Medical Center’s reporting entities was also included in finding 2022-001 in the prior year. This error was
corrected in the Period 4 and/or Period 5 reports for the Medical Center’s reporting entities except for two
reporting entities.
Recommendation: We recommend that management’s review of the lost revenue calculations and
reporting in the PRF reporting portal include review of documentation supporting each dollar amount
included in lost revenue calculation.
Views of responsible officials of the auditee: Management agrees with the finding and the auditor’s
recommendation.
Federal program: U.S. Department of Health and Human Services—ALN 93.498, Provider Relief Fund
and American Rescue Plan (ARP) Rural Distribution
Criteria: Specific criteria are established by the U.S. Department of Health and Human Services (HHS)
with respect to allowable cost and reporting requirements for this program, including:
-Funds shall reimburse the recipient only for health care related expenses or lost revenues that
are attributable to coronavirus.
Condition: In the Medical Center’s Period 5 reporting in the PRF reporting portal, for one reporting entity,
the Medical Center reported other PRF expenses of $855,130. These same expenses had previously
been reported in this reporting entity's Period 2 PRF reporting and, therefore, should not have been
reported again in Period 5.
Context: The $855,130 of duplicate PRF expenses identified were the only PRF expenses reported in
either Period 4 or Period 5 by any of the Medical Center’s reporting entities; therefore, the total amount of
likely questioned costs is the same as the known questioned costs of $855,130.
Cause: In preparing the Period 5 reports, management included in error PRF expenses that had
previously been reported in Period 2. Review processes were performed before the reports were
submitted, but these reviews did not detect and correct the error before submission.
Effect: The Medical Center’s Period 5 reporting in the PRF reporting portal included questioned costs for
one reporting entity. On that reporting entity’s submitted Period 5 report, total PRF expenses and lost
revenues available to be used for Period 5 exceeded PRF payments received by $3,810,237. After
correction of the error, total PRF expenses and lost revenues available to be used for Period 5 would still
exceed PRF payments received by $2,955,107. Thus, federal expenditures reported for ALN 93.498 in
the schedule of expenditures of federal awards for the year ended August 31, 2023, are unaffected by
this error.
Questioned costs: $855,130 of known and likely questioned costs for PRF expenses reported in Period
5.
Repeat finding: No.
Recommendation: We recommend that management’s review of the draft reporting in the PRF reporting
portal include review of documentation supporting all reported PRF expenses for the period and a review
and reconciliation of the PRF expenses previously reported in prior periods.
Views of responsible officials of the auditee: Management agrees with the finding and the auditor’s
recommendation.
Federal program: U.S. Department of Health and Human Services—ALN 93.498, Provider Relief Fund
and American Rescue Plan (ARP) Rural Distribution
Criteria: Specific criteria are established by the U.S. Department of Health and Human Services (HHS)
with respect to allowable cost and reporting requirements for this program, including:
-Funds shall reimburse the recipient only for health care related expenses or lost revenues that
are attributable to coronavirus.
Condition: In the Medical Center’s Period 5 reporting in the PRF reporting portal, for one reporting entity,
the Medical Center reported other PRF expenses of $855,130. These same expenses had previously
been reported in this reporting entity's Period 2 PRF reporting and, therefore, should not have been
reported again in Period 5.
Context: The $855,130 of duplicate PRF expenses identified were the only PRF expenses reported in
either Period 4 or Period 5 by any of the Medical Center’s reporting entities; therefore, the total amount of
likely questioned costs is the same as the known questioned costs of $855,130.
Cause: In preparing the Period 5 reports, management included in error PRF expenses that had
previously been reported in Period 2. Review processes were performed before the reports were
submitted, but these reviews did not detect and correct the error before submission.
Effect: The Medical Center’s Period 5 reporting in the PRF reporting portal included questioned costs for
one reporting entity. On that reporting entity’s submitted Period 5 report, total PRF expenses and lost
revenues available to be used for Period 5 exceeded PRF payments received by $3,810,237. After
correction of the error, total PRF expenses and lost revenues available to be used for Period 5 would still
exceed PRF payments received by $2,955,107. Thus, federal expenditures reported for ALN 93.498 in
the schedule of expenditures of federal awards for the year ended August 31, 2023, are unaffected by
this error.
Questioned costs: $855,130 of known and likely questioned costs for PRF expenses reported in Period
5.
Repeat finding: No.
Recommendation: We recommend that management’s review of the draft reporting in the PRF reporting
portal include review of documentation supporting all reported PRF expenses for the period and a review
and reconciliation of the PRF expenses previously reported in prior periods.
Views of responsible officials of the auditee: Management agrees with the finding and the auditor’s
recommendation.
Federal program: U.S. Department of Health and Human Services—ALN 93.498, Provider Relief Fund
and American Rescue Plan (ARP) Rural Distribution
Criteria: Specific criteria are established by the U.S. Department of Health and Human Services (HHS)
with respect to allowable cost and reporting requirements for this program, including:
-Funds shall reimburse the recipient only for health care related expenses or lost revenues that
are attributable to coronavirus.
Condition: In the Medical Center’s Period 5 reporting in the PRF reporting portal, for one reporting entity,
the Medical Center reported other PRF expenses of $855,130. These same expenses had previously
been reported in this reporting entity's Period 2 PRF reporting and, therefore, should not have been
reported again in Period 5.
Context: The $855,130 of duplicate PRF expenses identified were the only PRF expenses reported in
either Period 4 or Period 5 by any of the Medical Center’s reporting entities; therefore, the total amount of
likely questioned costs is the same as the known questioned costs of $855,130.
Cause: In preparing the Period 5 reports, management included in error PRF expenses that had
previously been reported in Period 2. Review processes were performed before the reports were
submitted, but these reviews did not detect and correct the error before submission.
Effect: The Medical Center’s Period 5 reporting in the PRF reporting portal included questioned costs for
one reporting entity. On that reporting entity’s submitted Period 5 report, total PRF expenses and lost
revenues available to be used for Period 5 exceeded PRF payments received by $3,810,237. After
correction of the error, total PRF expenses and lost revenues available to be used for Period 5 would still
exceed PRF payments received by $2,955,107. Thus, federal expenditures reported for ALN 93.498 in
the schedule of expenditures of federal awards for the year ended August 31, 2023, are unaffected by
this error.
Questioned costs: $855,130 of known and likely questioned costs for PRF expenses reported in Period
5.
Repeat finding: No.
Recommendation: We recommend that management’s review of the draft reporting in the PRF reporting
portal include review of documentation supporting all reported PRF expenses for the period and a review
and reconciliation of the PRF expenses previously reported in prior periods.
Views of responsible officials of the auditee: Management agrees with the finding and the auditor’s
recommendation.
Federal program: U.S. Department of Health and Human Services—ALN 93.498, Provider Relief Fund
and American Rescue Plan (ARP) Rural Distribution
Criteria: Specific criteria are established by the U.S. Department of Health and Human Services (HHS)
with respect to allowable cost and reporting requirements for this program, including:
-Funds shall reimburse the recipient only for health care related expenses or lost revenues that
are attributable to coronavirus.
Condition: In the Medical Center’s Period 5 reporting in the PRF reporting portal, for one reporting entity,
the Medical Center reported other PRF expenses of $855,130. These same expenses had previously
been reported in this reporting entity's Period 2 PRF reporting and, therefore, should not have been
reported again in Period 5.
Context: The $855,130 of duplicate PRF expenses identified were the only PRF expenses reported in
either Period 4 or Period 5 by any of the Medical Center’s reporting entities; therefore, the total amount of
likely questioned costs is the same as the known questioned costs of $855,130.
Cause: In preparing the Period 5 reports, management included in error PRF expenses that had
previously been reported in Period 2. Review processes were performed before the reports were
submitted, but these reviews did not detect and correct the error before submission.
Effect: The Medical Center’s Period 5 reporting in the PRF reporting portal included questioned costs for
one reporting entity. On that reporting entity’s submitted Period 5 report, total PRF expenses and lost
revenues available to be used for Period 5 exceeded PRF payments received by $3,810,237. After
correction of the error, total PRF expenses and lost revenues available to be used for Period 5 would still
exceed PRF payments received by $2,955,107. Thus, federal expenditures reported for ALN 93.498 in
the schedule of expenditures of federal awards for the year ended August 31, 2023, are unaffected by
this error.
Questioned costs: $855,130 of known and likely questioned costs for PRF expenses reported in Period
5.
Repeat finding: No.
Recommendation: We recommend that management’s review of the draft reporting in the PRF reporting
portal include review of documentation supporting all reported PRF expenses for the period and a review
and reconciliation of the PRF expenses previously reported in prior periods.
Views of responsible officials of the auditee: Management agrees with the finding and the auditor’s
recommendation.
Federal program: U.S. Department of Health and Human Services—ALN 93.498, Provider Relief Fund
and American Rescue Plan (ARP) Rural Distribution
Criteria: Specific criteria are established by the U.S. Department of Health and Human Services (HHS)
with respect to allowable cost and reporting requirements for this program, including:
-Funds shall reimburse the recipient only for health care related expenses or lost revenues that
are attributable to coronavirus.
Condition: In the Medical Center’s Period 5 reporting in the PRF reporting portal, for one reporting entity,
the Medical Center reported other PRF expenses of $855,130. These same expenses had previously
been reported in this reporting entity's Period 2 PRF reporting and, therefore, should not have been
reported again in Period 5.
Context: The $855,130 of duplicate PRF expenses identified were the only PRF expenses reported in
either Period 4 or Period 5 by any of the Medical Center’s reporting entities; therefore, the total amount of
likely questioned costs is the same as the known questioned costs of $855,130.
Cause: In preparing the Period 5 reports, management included in error PRF expenses that had
previously been reported in Period 2. Review processes were performed before the reports were
submitted, but these reviews did not detect and correct the error before submission.
Effect: The Medical Center’s Period 5 reporting in the PRF reporting portal included questioned costs for
one reporting entity. On that reporting entity’s submitted Period 5 report, total PRF expenses and lost
revenues available to be used for Period 5 exceeded PRF payments received by $3,810,237. After
correction of the error, total PRF expenses and lost revenues available to be used for Period 5 would still
exceed PRF payments received by $2,955,107. Thus, federal expenditures reported for ALN 93.498 in
the schedule of expenditures of federal awards for the year ended August 31, 2023, are unaffected by
this error.
Questioned costs: $855,130 of known and likely questioned costs for PRF expenses reported in Period
5.
Repeat finding: No.
Recommendation: We recommend that management’s review of the draft reporting in the PRF reporting
portal include review of documentation supporting all reported PRF expenses for the period and a review
and reconciliation of the PRF expenses previously reported in prior periods.
Views of responsible officials of the auditee: Management agrees with the finding and the auditor’s
recommendation.
Federal program: U.S. Department of the Treasury; Passed-through Illinois Department of Public Health-ALN 21.027, COVID-19 Coronavirus State and Local Fiscal Recovery Funds.
Criteria: In accordance with 2 CFR 200 200.510(b), the auditee must prepare a Schedule of Expenditures of Federal Awards (SEFA) for the period covered by the auditee's financial statements which must include the total federal awards expended as determined in accordance with 2 CFR 200.502.
Condition: The Medical Center's SEFA for the year ended August 31, 2023, which is supplementary information to the Medical Center's financial statements, was restated to include an additional $2,000,000 of federal expenditures for the Coronavirus State and Local Fiscal Recovery Funds, Assistance Listing Number 21.027. Management's processes and internal controls for ensuring that all federal funds expended by the Medical Center are captured and reported in the SEFA were inadquate to detect the omission of the $2,000,000 of federal expenditures.
Context: The additional $2,000,000 of federal expenditures increased the total federal expenditures for the Coronavirus State and Local Fiscal Recovery Funds, Assistance Listing Number 21.027 to $2,899,890. This resulted in the reissuance of the single audit report.
Cause: The additional federal program expenditures for the Coronavirus State and Local Fiscal Recovery Funds, Assistance Listing Number 21.027, were provided under a separate pass-through grant and were inadvertently omitted from the SEFA due to an oversight in the preparation of the SEFA resulting in part from and coinciding with the turnover of key personnel involved with and having oversight over the $2,000,000 award.
Effect: Improper reporting of federal expenditures can result in material errors on the SEFA leading to inaccurate major program determination. In this instance an error did result in the identification of an additional major program.
Repeat finding: No.
Recommendation: We recommend that management enhance its process and internal controls around the timely identification of federal awards and preparation of the SEFA to ensure completeness and accuracy of the SEFA.
Views of responsible officials of the auditee: Management agrees with the finding and the auditor's recommendation.
Federal Program: U.S. Department of the Treasury-ALN 21.027, Coronavirus State and Local Fiscal Recovery Funds.
Questioned costs: None.
See item 2023-004.