Audit 49542

Title: Basis of Presentation Accounting Policies: Expenditures reported in the Schedule are reported on the accrual basis of accounting. Such expenditures are recognized following the cost principles contained in Uniform Guidance, wherein certain types of expenditures are not allowable or are limited as to reimbursement. The System has elected not to use the 10-percent de minimis indirect cost rate as allowed under the Uniform Guidance.The System did not pass through any funding to subrecipients. De Minimis Rate Used: N Rate Explanation: The auditee did not use the de minimis cost rate. The accompanying consolidated schedule of expenditures of federal and state awards (the Schedule) includes the federal and state award activity of West Virginia University Health System and Controlled Entities (the System) under the programs of the federal and state governments for the year ended December 31, 2022. The information in this Schedule is presented in accordance with the requirements of Title 2 US Code of Federal Regulations Part 200, Uniform Administration Requirements, Cost Principles, and Audit Requirements for Federal Awards (Uniform Guidance). All federal and state awards received directly and indirectly from federal and state agencies are included in this Schedule. Because the Schedule presents only a selected portion of the operations of the System, it is not intended to and does not present the financial position, changes in net assets or cash flows of the System. The consolidated schedule of expenditures of federal and state awards includes all federal and state grants to the System that had activity during the year ended December 31, 2022, except those awarded to Wheeling Hospital, Inc. and Subsidiaries. A separate audit in accordance with OMB Uniform Guidance is completed for Wheeling Hospital, Inc. and Subsidiaries.As outlined in the May 2023 OMB Compliance Supplement, the amounts reported in the accompanying schedule related to the Provider Relief Fund and American Rescue Plan Rural Distribution (PRF), Assistance Listing No. 93.498, are reported based upon the PRF reporting portal submission guidelines established by the Health Resource and Service Administration (HRSA). Six separate reporting periods were established by HRSA based on the dates of receipt of PRF payments. Each reporting period has a specific period of availability which begins on January 1, 2020 and extends through specified deadlines, as indicated below: The accompanying schedule includes those qualifying expenditures and lost revenues that were reported in the HRSA PRF portal for Periods 3 and 4. During the years ended December 31, 2021 and 2020, the System recognized approximately $48,439,000 and $4,083,000, respectively.The accompanying Schedule also includes expenditures for COVID-19 Disaster Grants Public Assistance Assistance Listing No. 97.036 from December 31, 2021 and 2020, however the grant awards were approved during the year ended December 31, 2022.

Title: Contingencies Accounting Policies: Expenditures reported in the Schedule are reported on the accrual basis of accounting. Such expenditures are recognized following the cost principles contained in Uniform Guidance, wherein certain types of expenditures are not allowable or are limited as to reimbursement. The System has elected not to use the 10-percent de minimis indirect cost rate as allowed under the Uniform Guidance.The System did not pass through any funding to subrecipients. De Minimis Rate Used: N Rate Explanation: The auditee did not use the de minimis cost rate. The grant programs are subject to financial and compliance audits by the grantors or their representatives. Such audits could lead to requests for reimbursement to the grantor agencies for expenditures disallowed under terms of the grants. Management believes disallowances, if any, will not be material.

Title: Categorization of Expenditures and Other Matters Accounting Policies: Expenditures reported in the Schedule are reported on the accrual basis of accounting. Such expenditures are recognized following the cost principles contained in Uniform Guidance, wherein certain types of expenditures are not allowable or are limited as to reimbursement. The System has elected not to use the 10-percent de minimis indirect cost rate as allowed under the Uniform Guidance.The System did not pass through any funding to subrecipients. De Minimis Rate Used: N Rate Explanation: The auditee did not use the de minimis cost rate. The categorization of expenditures by program included in the consolidated schedule of expenditures of federal and state awards is based upon the grant documents. Changes in the categorization of expenditures occur based upon revisions to the Assistance Listing, which is issued in June and December of each year. The consolidated schedule of expenditures of federal awards for the year ended December 31, 2022 reflects Assistance Listing changes through April 2022.