Audit 410866

FY End
2025-12-31
Total Expended
$38.37M
Findings
1
Programs
18
Organization: Banner Health (AZ)
Year: 2025 Accepted: 2026-09-11

Organization Exclusion Status:

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Contacts

Name Title Type
SB35ENJFKK14 John Shaw Auditee
6028392223 Scott Enos Auditor
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Notes to SEFA

Banner Health and Subsidiaries (Banner) is a nonprofit corporation exempt from income taxes under Internal Revenue Code Section 501(c)(3) and applicable state income tax codes. Banner own, control, or lease hospitals, clinics, nursing homes, clinical laboratories, ambulatory surgery centers, urgent care centers, free-standing imaging centers, home health agencies, a captive insurance company, a foundation, an insurance division offering insurance products to Medicare, Medicaid, and commercial subscriber populations, and other health care-related organizations in six western states. Banner also holds controlling interests in several health care-related business ventures and non-controlling interests in several other entities that are accounted for under the equity method of accounting.
Basis of Accounting: The accompanying schedule of expenditures of federal awards (SEFA) includes the federal grant activity of Banner and is presented on the accrual basis of accounting. The information in the SEFA 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 SEFA may differ from amounts presented in, or used in the preparation of, the consolidated financial statements of Banner. For purposes of the SEFA, 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. The SEFA does not include payments received under the traditional Medicare and Medicaid reimbursement programs, as these programs are outside the scope of the Uniform Guidance.
The Uniform Guidance provides for a 15% de minimis indirect cost rate election; however, Banner did not make this election and uses a negotiated indirect cost rate or the rate in the grant agreement.
For the year ended December 31, 2025, Banner did not receive any donated goods or personal protective equipment received from federal sources that required recognition or disclosure in the notes to the SEFA.
In fiscal year 2025, Banner received approval from the Federal Emergency Management Agency for a project related to the reimbursement of eligible expenditures of $554,501 incurred in previous fiscal years. These previous years’ expenditures are included in the SEFA in the current year in accordance with guidance provided by the U.S. Department of Homeland Security.

Finding Details

Internal control deficiency and noncompliance over procurement. Identification of the federal program: Assistance Listing Number 21.027: • COVID-19 – Coronavirus State and Local Fiscal Recovery Funds • U.S. Department of the Treasury • Federal award identification number – Not available • Federal award year – June 30, 2023 to December 31, 2026 • Pass-through entity – State of Wyoming • Pass-through award identification number – ARPA-HHS-1132 Criteria or specific requirement (including statutory, regulatory or other citation): Title 2, Subtitle A, Chapter II, Part 200, Subpart D, Section 200.303 Internal controls. The non-Federal entity must: (a) Establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non-Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. These internal controls should be in compliance with guidance in “Standards for Internal Control in the Federal Government” issued by the Comptroller General of the United States or the “Internal Control Integrated Framework”, issued by the Committee of Sponsoring Organizations of the Treadway Commission (COSO). Title 2, Subtitle A, Chapter II, Part 200, Subpart D, 200.318 General procurement standards (i) the non-Federal entity must maintain records sufficient to detail the history of procurement. These records will include, but are not necessarily limited to, the following: Rationale for the method of procurement, selection of contract type, contractor selection or rejection, and the basis for the contract price. Title 2, Subtitle A, Chapter II, Part 200, Subpart D, 200.319 Competition (a) All procurement transactions for the acquisition of property or services required under a Federal award must be conducted in a manner providing full and open competition consistent with the standards of this section and 200.320. Title 2, Subtitle A, Chapter II, Part 200, Subpart D, 200.320 Methods of procurement to be followed. (b) Formal procurement methods. When the value of the procurement for property or services under a Federal financial assistance award exceeds the simplified acquisition threshold, or a lower threshold established by a non-Federal entity, formal procurement methods are required. Formal procurement methods require following documented procedures. Formal procurement methods also require public advertising. (2) Proposals. A procurement method in which either a fixed price or cost-reimbursement type contract is awarded. They are awarded in accordance with the following requirements: (i) Requests for proposals must be publicized and identify all evaluation factors and their relative importance. Proposals must be solicited from an adequate number of qualified offerors. Any response to publicized requests for proposals must be considered to the maximum extent practical; (ii) The non-Federal entity must have a written method for conducting technical evaluations of the proposals received and making selections; and (iii) Contracts must be awarded to the responsible offeror whose proposals is most advantageous to the non-Federal entity, with price and other factors considered. Condition: During our testing over procurement, we observed management did not have internal controls in place over formal procurements to ensure proposals were obtained through public advertising. Therefore, the formal procurement was not conducted in a manner providing full and open competition. Management did not maintain records sufficient to detail the history of procurement, including the rationale for the method of procurement, selection of contract type, contractor selection or rejection, and the basis for the contract price. Cause: Management did not have internal controls in place over the compliance requirements as stated in the criteria or specific requirement section above. Effect or potential effect: Procurements were not supported by internal controls to ensure proposals were obtained through public advertising to conduct them in a manner providing full and open competition and could potentially be awarded to offerors that are not the most advantageous to the non-Federal entity, with price and other factors considered. Questioned costs: $212,622 – Assistance Listing Number 21.027 – COVID-19 – Coronavirus State and Local Fiscal Recovery Funds – Federal award identification number – Not available – Pass-through award identification number – ARPA-HHS-1132 Questioned costs were computed as the entire population of procurement transactions subject to formal procurement compliance requirements. Questioned costs means a cost that is questioned by the auditor because of an audit finding: (1) which resulted from a violation or possible violation of a statute, regulation, or the terms and conditions of a Federal award, including for funds used to match Federal funds or (2) where the costs, at the time of the audit, are not supported by adequate documentation. Context: During our testing over procurements, we obtained a listing of expenditures that included $212,622 of procurement transactions subject to formal procurement compliance requirements. We observed management did not have internal controls in place to ensure the compliance requirements as stated in the criteria or specific requirement section above were performed. The costs charged to the program were for allowable activities; however, the procurement was not conducted in accordance with federal procurement requirements. Identification as a repeat finding, if applicable: No. Recommendation: Management should develop and implement internal controls over formal procurements to ensure proposals are obtained through public advertising to conduct them in a manner providing full and open competition. Management should maintain records for procurements to document the history of procurement, including the rationale for the method of procurement, selection of contract type, contractor selection or rejection, and the basis for the contract price. Views of responsible officials: Banner has a policy for the procurement of federally funded goods and services that fully complies with the Uniform Guidance standards, prescribed by the Office of Management and Budget, for managing federal awards. This policy was not followed when evaluating and selecting the general contractor for a Wyoming Medical Center construction project that was being partially funded (~25%) with federal funds. Specifically, proposals were not obtained through public advertising. The costs charged to the program were for allowable activities; however, the procurement was not conducted in accordance with federal procurement requirements. To ensure all protocols and controls are followed in compliance with Uniform Guidance standards, Banner will implement a process to notify all appropriate parties when federal funds are received or granted and provide education to key constituents on Uniform Guidance standards. Additionally, formal documentation supporting the rationale for selecting general contractors will be enhanced. Since this project is ongoing into 2026, this will be a duplicate finding on the 2026 Uniform Guidance audit.