Audit 414865

2023-004 Provider Relief Fund Reporting of Lost Revenue Federal Agency Department of Health and Human Services Federal Assistance Listing Number 93.498 – Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Award Numbers Not applicable Criteria [X] Compliance Finding [ ] Significant Deficiency [X] Material Weakness Under the terms and conditions of the award, the recipient certifies it will report actual net patient service revenues for the periods reported on in its reporting of actual net patient service revenues for its calculation of lost revenues due to coronavirus. Condition Patient service revenues were not reported net of contractual adjustments and bad debt. Context This finding appears to be an isolated problem. Cause The Hospital prepared its lost revenue calculations using gross patient service revenues without including contractual adjustments and bad debt. Effect The actual patient service revenues for 2023 did not reflect the correct amounts to be used in its lost revenue calculations. If net patient service revenues had been reported, the Hospital would still have sufficient expenses to use all of the Provider Relief Fund amounts received. Therefore, there is no effect on the Hospital’s retention of the Provider Relief Funds. Recommendation We recommend the Hospital’s management correct its lost revenue calculation for any future reporting for the Provider Relief Fund. Views of responsible officials and planned corrective actions Net Patient Revenues by Financial Class are not available in the Meditech system and can only be estimated. In the event there is another PHE that results in more than $750,000 received by facility, Net Patient Revenue will be calculated and reported.

2023-005 Procurement Program Information Federal Organization Federal Communications Commission Assistance Listing Numbers 32.006 COVID-19 Telehealth Program Award Numbers CA2067511 Criteria [ ] Compliance Finding [ ] Significant Deficiency [X] Material Weakness Entities receiving federal awards must have documented policies and procedures that comply with the procurement standards set out at 2 CFR 200.318 through 200.327. They must use their own documented procurement procedures, which reflect applicable state and local laws and regulations, provided that the procurements also conform to applicable federal statutes and the procurement requirements identified in 2 CFR Part 200. Condition The Hospital did not have a documented procurement policy in place that complied with the Uniform Guidance requirements. Cause Management had not researched and implemented the procurement policy requirements prescribed by the Uniform Guidance, resulting in the Hospital not having a documented procurement policy in place. Effect The absence of a documented procurement policy that complies with Uniform Guidance increases the risk of noncompliance with federal procurement requirements and may result in questioned costs or disallowed expenditures. Questioned Costs None. Context During our testing of procurement compliance, we reviewed the Hospital’s policies and procedures to determine compliance with Uniform Guidance requirements. We noted that the Hospital had not adopted a documented procurement policy addressing the procurement standard required. Recommendation We recommend that management develop, adopt, and implement a documented procurement policy that complies with Uniform Guidance requirements. Management should also establish procedures to ensure procurement transactions are documented and performed in accordance with federal requirements. Views of responsible officials and planned corrective action Management is in agreement with this finding and will implement the suggested actions as outlined in the corrective action plan.

2023-006 Suspension and Debarment Program Information Federal Organization Federal Communications Commission Assistance Listing Numbers 32.006 COVID-19 Telehealth Program Award Numbers CA2067511 Criteria [ ] Compliance Finding [X] Significant Deficiency [ ] Material Weakness Title 2 CFR 200.214 and Title 2 CFR 180.300 require that organizations “verify that the person with whom you intend to do business is not excluded or disqualified” before entering into covered transactions (procurement contracts, purchase orders, or agreements greater than or equal to $25,000) with persons or vendors. Condition The Hospital did not maintain adequate documentation of the required search to verify that vendors were not suspended or debarred before awarding federally funded contracts. Cause The Hospital did not follow its documented policies and procedures. Effect The Hospital may enter into covered transactions with vendors that are suspended or debarred, resulting in noncompliance with federal regulations and potential questioned costs. Questioned Costs None. Context During our testing of suspension and debarment, we noted that the Hospital had not maintained adequate documentation to verifying a SAM.gov search. Recommendation Verification should be documented and retained to demonstrate compliance with applicable federal requirements. Views of responsible officials and planned corrective action Management is in agreement with this finding and will implement the suggested actions as outlined in the corrective action plan.