Audit 47261

Department of Health and Human Services Federal Financial Assistance Listing / CFDA #93.498 COVID-19 Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Applicable Federal Award Number and Year- Period 1 TIN #38-3807713 Reporting Material Weakness in Internal Control Over Compliance and Material Noncompliance Activities Allowed or Unallowed and Allowable Costs/Cost Principles Material Weakness in Internal Control Over Compliance Criteria: 2 CFR 200.303(a) establishes that the auditee must establish and maintain effective internal control over the federal award that provides assurance that the entity is managing the federal award in compliance with federal statutes, regulations, and terms and conditions of the federal award. Condition: The Medical Center tracked patient care revenues internally within a spreadsheet. The revenues included on the spreadsheet and the Period 1 report to HRSA, which were utilized to calculate lost revenues, contained an error. Cause: The Medical Center?s internal control to review and approve accurate patient care revenues, which were utilized to calculate lost revenues, did not identify and correct the errors included in the report submitted to HRSA for Period 1 on a timely manner. Effect: The reporting to HRSA for Period 1 included errors in the reporting of patient care revenue and lost revenues. The result of the errors was an increase in eligible lost revenues available under the program. Questioned Costs: None. While there were errors identified on the Period 1 report to HRSA, the result was an increase in eligible lost revenues under the program. Context: All 10 key line items related to the calculation of lost revenues attributable to coronavirus based on an Option 1 ? 2019 Actuals calculation were tested. The Medical Center did not reflect adjustments required as a result of the audit of the fiscal year 2020 financial statements. The adjustments reduced patient care revenue by $433,089 and potentially impact up to 4 key line items. Ultimately, the impact of correcting patient care revenues for the audit adjustments is expected to increase lost revenues. Repeat Finding from Prior Years: No Recommendation: We recommend the Medical Center modify internal control policies to ensure any errors in the schedule or the report are identified prior to reporting. The patient care revenues reported should include all audit and other adjustments that could have an impact on the calculation of lost revenues. Views of Responsible Officials: Management agrees with the finding.

Department of Health and Human Services Federal Financial Assistance Listing / CFDA #93.498 COVID-19 Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Applicable Federal Award Number and Year- Period 1 TIN #38-3807713 Reporting Material Weakness in Internal Control Over Compliance and Material Noncompliance Activities Allowed or Unallowed and Allowable Costs/Cost Principles Material Weakness in Internal Control Over Compliance Criteria: 2 CFR 200.303(a) establishes that the auditee must establish and maintain effective internal control over the federal award that provides assurance that the entity is managing the federal award in compliance with federal statutes, regulations, and terms and conditions of the federal award. Condition: The Medical Center tracked eligible expenses internally within a spreadsheet. The spreadsheet included errors in the calculation of allowable expenditures, which were included on the Period 1 report to the Health Resources and Services Administration (HRSA). Cause: The Medical Center?s internal control to review and approve eligible expenditures did not identify and correct the errors included in the report submitted to HRSA for Period 1 on a timely manner. Effect: The reporting to HRSA for Period 1 included errors in the reporting of expenses. The result of the errors was an increase in eligible expenditures under the program. Questioned Costs: None. While there were errors identified on the Period 1 report to HRSA, the result was an increase in eligible expenditures under the program. Context: The Total Other Provider Relief Fund Expenses amount on the Period 1 report to HRSA agreed to an underlying schedule of expenses. A sample of 25 expenditures out of a population of 123 were tested. There were errors in 21 items tested. After updating the calculations to correct the errors identified, the result was an understatement of allowable expenses available to include on the Period 1 report to HRSA. Repeat Finding from Prior Years: No Recommendation: We recommend the Medical Center modify internal control policies to ensure any errors in the schedule or the report are identified prior to reporting. The expenses claimed should be based on accurate calculations and underlying data. Views of Responsible Officials: Management agrees with the finding.

Department of Health and Human Services Federal Financial Assistance Listing / CFDA #93.498 COVID-19 Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Applicable Federal Award Number and Year- Period 1 TIN #38-3807713 Reporting Material Weakness in Internal Control Over Compliance and Material Noncompliance Activities Allowed or Unallowed and Allowable Costs/Cost Principles Material Weakness in Internal Control Over Compliance Criteria: 2 CFR 200.303(a) establishes that the auditee must establish and maintain effective internal control over the federal award that provides assurance that the entity is managing the federal award in compliance with federal statutes, regulations, and terms and conditions of the federal award. Condition: The Medical Center tracked patient care revenues internally within a spreadsheet. The revenues included on the spreadsheet and the Period 1 report to HRSA, which were utilized to calculate lost revenues, contained an error. Cause: The Medical Center?s internal control to review and approve accurate patient care revenues, which were utilized to calculate lost revenues, did not identify and correct the errors included in the report submitted to HRSA for Period 1 on a timely manner. Effect: The reporting to HRSA for Period 1 included errors in the reporting of patient care revenue and lost revenues. The result of the errors was an increase in eligible lost revenues available under the program. Questioned Costs: None. While there were errors identified on the Period 1 report to HRSA, the result was an increase in eligible lost revenues under the program. Context: All 10 key line items related to the calculation of lost revenues attributable to coronavirus based on an Option 1 ? 2019 Actuals calculation were tested. The Medical Center did not reflect adjustments required as a result of the audit of the fiscal year 2020 financial statements. The adjustments reduced patient care revenue by $433,089 and potentially impact up to 4 key line items. Ultimately, the impact of correcting patient care revenues for the audit adjustments is expected to increase lost revenues. Repeat Finding from Prior Years: No Recommendation: We recommend the Medical Center modify internal control policies to ensure any errors in the schedule or the report are identified prior to reporting. The patient care revenues reported should include all audit and other adjustments that could have an impact on the calculation of lost revenues. Views of Responsible Officials: Management agrees with the finding.

Department of Health and Human Services Federal Financial Assistance Listing / CFDA #93.498 COVID-19 Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Applicable Federal Award Number and Year- Period 1 TIN #38-3807713 Reporting Material Weakness in Internal Control Over Compliance and Material Noncompliance Activities Allowed or Unallowed and Allowable Costs/Cost Principles Material Weakness in Internal Control Over Compliance Criteria: 2 CFR 200.303(a) establishes that the auditee must establish and maintain effective internal control over the federal award that provides assurance that the entity is managing the federal award in compliance with federal statutes, regulations, and terms and conditions of the federal award. Condition: The Medical Center tracked eligible expenses internally within a spreadsheet. The spreadsheet included errors in the calculation of allowable expenditures, which were included on the Period 1 report to the Health Resources and Services Administration (HRSA). Cause: The Medical Center?s internal control to review and approve eligible expenditures did not identify and correct the errors included in the report submitted to HRSA for Period 1 on a timely manner. Effect: The reporting to HRSA for Period 1 included errors in the reporting of expenses. The result of the errors was an increase in eligible expenditures under the program. Questioned Costs: None. While there were errors identified on the Period 1 report to HRSA, the result was an increase in eligible expenditures under the program. Context: The Total Other Provider Relief Fund Expenses amount on the Period 1 report to HRSA agreed to an underlying schedule of expenses. A sample of 25 expenditures out of a population of 123 were tested. There were errors in 21 items tested. After updating the calculations to correct the errors identified, the result was an understatement of allowable expenses available to include on the Period 1 report to HRSA. Repeat Finding from Prior Years: No Recommendation: We recommend the Medical Center modify internal control policies to ensure any errors in the schedule or the report are identified prior to reporting. The expenses claimed should be based on accurate calculations and underlying data. Views of Responsible Officials: Management agrees with the finding.