FAC Explorer

Audit 5069

FY End
2023-06-30
Total Expended
$2.98M
Findings
4
Programs
6
Organization: Delaware County Memorial Hospital D/b/a Regional Medical Center (IA)
Year: 2023 Accepted: 2023-12-04
Auditor: Eide Bailly LLC

Organization Exclusion Status:

Findings

ID Ref Severity Repeat Requirement
3131 2023-002 Material Weakness - L
3132 2023-003 Significant Deficiency - ABL
579573 2023-002 Material Weakness - L
579574 2023-003 Significant Deficiency - ABL

Programs

ALN Program Spent Major Findings
93.498 Provider Relief Fund $2.56M Yes 2
93.155 Rural Health Research Centers $254,631 - 0
93.074 Hospital Preparedness Program (hpp) and Public Health Emergency Preparedness (phep) Aligned Cooperative Agreements $45,680 - 0
10.766 Community Facilities Loans and Grants $44,292 - 0
93.268 Immunization Cooperative Agreements $9,100 - 0
93.323 Epidemiology and Laboratory Capacity for Infectious Diseases (elc) $4,836 - 0

Contacts

Name Title Type
LC5KQD7X1MW5 Nathan Pickel Auditee
5639277568 Renee Gravalin Auditor
No contacts on file

Notes to SEFA

Title: COVID-19 Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Accounting Policies: Basis of Presentation The accompanying Schedule of Expenditures of Federal Awards (Schedule) includes the federal award activity of Delaware County Memorial Hospital, d/b/a Regional Medical Center (Medical Center) under programs of the federal government for the year ended June 30, 2023. The information 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 (Uniform Guidance). Because the Schedule presents only a selected portion of the operations of the Medical Center, it is not intended to and does not present the financial position, changes in net assets, or cash flows of the Medical Center. Significant Accounting Policies Expenditures reported on the Schedule are reported on the accrual basis of accounting, with the exception for the COVID‐19 HRSA Claims Reimbursement for the Uninsured Program and the Coverage Assistance Fund, which are recorded based on when the claim is deemed eligible as evidenced by the receipt of monies from the federal agency. When applicable, such expenditures are recognized following the cost principles contained in the Uniform Guidance, wherein certain types of expenditures are not allowable or are limited as to reimbursement. No federal financial assistance has been provided to a subrecipient. De Minimis Rate Used: N Rate Explanation: The Medical Center does not draw for indirect administrative expenses and has not elected to use the 10% de minimis cost rate. The Medical Center received amounts from the U.S. Department of Health and Human Services (HHS) through the Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution (PRF) program (Federal Financial Assistance Listing #93.498) during the year ended June 30, 2022. The Medical Center incurred eligible expenses (including lost revenue) and, therefore recognized revenue totaling $2,556,126 for the year ended June 30, 2022 on the financial statements. In accordance with the 2023 Compliance Supplement, the PRF expenditures recognized on the Schedule are based on the reporting to HHS for Periods 4 and 5, defined as payments received during July 1, 2021 to June 30, 2022 of $2,556,126, plus interest earned of $146, as required under the PRF program. The amount of PRF expenditures included in the Schedule requires management to make estimates and assumptions that affect the reported amounts. Accordingly, such expenditures are considered a significant estimate. Estimates and assumptions may include reducing actual expenses by amounts that have been reimbursed or are obligated to be reimbursed by other sources and estimating marginal increases in expenses related to coronavirus. Actual amounts could differ from those estimates.

Finding Details

Finding 2023-002
Department of Health and Human Services Federal Assistance Listing #93.498 COVID‐19 Provider Relief Fund and American Rescue Plan Applicable Federal Award Number and Year – Period 4 TIN #426037649 Reporting Material Weakness in Internal Control Over Compliance and Material Noncompliance Criteria: 2 CFR 200.303(a) establishes that the auditee must establish and maintain effective internal control over federal awards that provides reasonable assurance that the Medical Center is managing the federal awards in compliance with federal statutes, regulations and terms and conditions of the federal award. Condition: The Medical Center did not exclude the prior audit’s questioned costs from the calculation of lost revenue. Cause: The Medical Center did not have an internal control process in place to ensure the lost revenue calculation reported under the federal program submitted to the Department of Health and Human Services for Period 4 properly excluded the prior audit’s questioned costs from the lost revenue reported. Effect: Without excluding the prior audit’s questioned costs from the lost revenue calculation, the HHS Period 4 Special Report submitted was not accurately completed. Questioned Costs: There were no questioned costs related to the lost revenue calculation, as no lost revenue was claimed to cover funds received. Context: Key line items were tested on the Period 4 Department of Health and Human Services Special Report. Repeat Finding from Prior Years: Yes, Finding #2021‐003 Recommendation: We recommend the Medical Center implement a control process which includes verifying that the lost revenue calculation reported properly includes and excludes all relevant information. Views of Responsible Officials: Management agrees with the finding.
Finding 2023-003
Department of Health and Human Services Federal Assistance Listing #93.498 COVID‐19 Provider Relief Fund and American Rescue Plan Applicable Federal Award Number and Year – Period 4 TIN #426037649 Activities Allowed or Unallowed and Allowable Costs/Cost Principles and Reporting Significant Deficiency in Internal Control Over Compliance Criteria: 2 CFR 200.303(a) establishes that the auditee must establish and maintain effective internal control over federal awards that provides reasonable assurance that the Medical Center is managing the federal awards in compliance with federal statutes, regulations and terms and conditions of the federal award. Condition: The Medical Center included expenses in excess of the Executive Level II limit in the detail of eligible expenditures. Cause: The Medical Center did not have an internal control process in place to ensure all employees with salaries over the Executive Level II limit had their wages reimbursed by the program limited to the Executive Level II limit. Effect: Without internal control process in place to ensure all employees with salaries over the Executive Level II limit had their wages reimbursed by the program limited to the Executive Level II limit, the allowable expenses was not accurately calculated. Questioned Costs: None over the $25,000 limit. Context: A nonstatistical sample of 65 ($20,973) from a population exceeding 250 items ($2,556,270) were tested for activities allowed or unallowed and allowable costs/cost principles. Repeat Finding from Prior Years: Yes, Finding #2021‐003 Recommendation: We recommend the Medical Center implement a control process which ensures that all employees with salaries over the Executive Level II limit have their wages reimbursed by the program limited to the Executive Level II limit. Views of Responsible Officials: Management agrees with the finding.
Finding 2023-002
Department of Health and Human Services Federal Assistance Listing #93.498 COVID‐19 Provider Relief Fund and American Rescue Plan Applicable Federal Award Number and Year – Period 4 TIN #426037649 Reporting Material Weakness in Internal Control Over Compliance and Material Noncompliance Criteria: 2 CFR 200.303(a) establishes that the auditee must establish and maintain effective internal control over federal awards that provides reasonable assurance that the Medical Center is managing the federal awards in compliance with federal statutes, regulations and terms and conditions of the federal award. Condition: The Medical Center did not exclude the prior audit’s questioned costs from the calculation of lost revenue. Cause: The Medical Center did not have an internal control process in place to ensure the lost revenue calculation reported under the federal program submitted to the Department of Health and Human Services for Period 4 properly excluded the prior audit’s questioned costs from the lost revenue reported. Effect: Without excluding the prior audit’s questioned costs from the lost revenue calculation, the HHS Period 4 Special Report submitted was not accurately completed. Questioned Costs: There were no questioned costs related to the lost revenue calculation, as no lost revenue was claimed to cover funds received. Context: Key line items were tested on the Period 4 Department of Health and Human Services Special Report. Repeat Finding from Prior Years: Yes, Finding #2021‐003 Recommendation: We recommend the Medical Center implement a control process which includes verifying that the lost revenue calculation reported properly includes and excludes all relevant information. Views of Responsible Officials: Management agrees with the finding.
Finding 2023-003
Department of Health and Human Services Federal Assistance Listing #93.498 COVID‐19 Provider Relief Fund and American Rescue Plan Applicable Federal Award Number and Year – Period 4 TIN #426037649 Activities Allowed or Unallowed and Allowable Costs/Cost Principles and Reporting Significant Deficiency in Internal Control Over Compliance Criteria: 2 CFR 200.303(a) establishes that the auditee must establish and maintain effective internal control over federal awards that provides reasonable assurance that the Medical Center is managing the federal awards in compliance with federal statutes, regulations and terms and conditions of the federal award. Condition: The Medical Center included expenses in excess of the Executive Level II limit in the detail of eligible expenditures. Cause: The Medical Center did not have an internal control process in place to ensure all employees with salaries over the Executive Level II limit had their wages reimbursed by the program limited to the Executive Level II limit. Effect: Without internal control process in place to ensure all employees with salaries over the Executive Level II limit had their wages reimbursed by the program limited to the Executive Level II limit, the allowable expenses was not accurately calculated. Questioned Costs: None over the $25,000 limit. Context: A nonstatistical sample of 65 ($20,973) from a population exceeding 250 items ($2,556,270) were tested for activities allowed or unallowed and allowable costs/cost principles. Repeat Finding from Prior Years: Yes, Finding #2021‐003 Recommendation: We recommend the Medical Center implement a control process which ensures that all employees with salaries over the Executive Level II limit have their wages reimbursed by the program limited to the Executive Level II limit. Views of Responsible Officials: Management agrees with the finding.