Audit 377383

2022-004 [2021-006] – Single Audit Report Submission (Material Weakness) Federal Program Information: Funding agency: U.S. Department of Health and Human Services Title: Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Assistance listing number: 93.498 Award year: 2022 Award period: 2022 Criteria: Section 2 CFR 200.512(a) of the Uniform Guidance requires the single audit reporting package and data collection form be submitted 30 days after receipt of the auditor’s report or 9 months after the end of the fiscal year, whichever comes first. Condition: The single audit reporting package and data collection form were not submitted within the nine months after December 31, 2022. Cause: The Hospital experienced turnover and extended vacancies in key finance department positions which resulted in delays in the completion of its December 31, 2022 audit. Effect: The Hospital is not in compliance with Section 2 CFR 200.512(a) of the Uniform Guidance. Questioned Costs: None. Recommendation: We recommend the Hospital obtain the necessary resources to allow for completion of the annual financial report on a timely basis. Views of Responsible Officials: The audits are currently in progress sequentially by fiscal year.

2022-005 — Activities Allowed and Unallowed and Allowable Costs/Cost Principles (Significant Deficiency) Federal Program Information: Funding agency: U.S. Department of Health and Human Services Title: Provider Relief Fund and American Rescue Plan Rural Distribution Assistance listing number: 93.498 Award year: 2022 Award period: 2022 Criteria: The Uniform Guidance 2 CFR 200.302 requires that organizations maintain complete and detailed records that document the source and application of federal funds. Adequate recordkeeping is essential for financial accountability and compliance with accounting standards. Condition/Context: Of a sample of 25 transactions charged to the major program, 5 of the sampled transactions lacked itemized source documentation (such as receipts or invoices), 10 transactions lacked reconciliations tying expense to source documentation, and 3 transactions lacked evidence of review and approval by appropriate personnel. Cause: The Hospital experienced turnover and extended vacancies in key finance department positions. This contributed to insufficient oversight and a lack of adherence to internal controls over recordkeeping and expenditure approvals. Effect: The absence of itemized receipts and evidence of review and approval hinders the ability to verify the legitimacy and appropriateness of these transactions. This raises concerns about the accuracy of financial reporting and compliance with accounting standards and the Uniform Guidance and may increase the risk of questioned costs or ineligible expenditures going undetected. Questioned Costs: None. Recommendation: Management should enforce existing internal control procedures to ensure that all transactions are adequately documented with itemized receipts and properly reviewed and approved. Training should also be provided to staff responsible for recordkeeping to emphasize requirements for maintaining detailed documentation in accordance with Uniform Guidance. Views of Responsible Officials: Management will enforce existing internal control procedures and train staff to maintain appropriate documentation.

2022-006 — Reporting – HRSA (Significant Deficiency) Federal Program Information: Funding agency: U.S. Department of Health and Human Services Title: Provider Relief Fund and American Rescue Plan Rural Distribution Assistance listing number: 93.498 Award year: 2022 Award period: 2022 Criteria: Recipients of amounts from the Provider Relief Fund (PRF) must complete the required information in the Health Resources and Services Administration (HRSA) Provider Relief Fund Reporting Portal. Condition: The Hospital failed to submit required information to the HRSA Provider Relief Fund Reporting Portal. Cause: The Hospital experienced turnover and extended vacancies in key finance department positions which resulted in delays in the completion of Period 4 HRSA reporting. Effect: The Hospital is not in compliance with federal program reporting requirements. Questioned Costs: None. Recommendation: We recommend the Hospital obtain necessary resources to allow for completion of federal program reporting requirements. Views of Responsible Officials: All required PRF reporting has been submitted. Will comply should new or additional reporting requirements be added in the future.