FAC Explorer

Audit 8319

FY End
2023-06-30
Total Expended
$19.86M
Findings
8
Programs
5
Organization: Greene County Medical Center (IA)
Year: 2023 Accepted: 2023-12-22
Auditor: Eide Bailly LLP

Organization Exclusion Status:

Findings

ID Ref Severity Repeat Requirement
6397 2023-004 Significant Deficiency Yes AB
6398 2023-004 Significant Deficiency Yes AB
6399 2023-004 Significant Deficiency Yes AB
6400 2023-005 Significant Deficiency Yes ABL
582839 2023-004 Significant Deficiency Yes AB
582840 2023-004 Significant Deficiency Yes AB
582841 2023-004 Significant Deficiency Yes AB
582842 2023-005 Significant Deficiency Yes ABL

Programs

ALN Program Spent Major Findings
10.766 Community Facilities Loans and Grants $1.00M Yes 1
93.498 Provider Relief Fund $806,374 Yes 1
93.155 Rural Health Research Centers $218,631 - 0
93.323 Epidemiology and Laboratory Capacity for Infectious Diseases (elc) $31,760 - 0
93.268 Immunization Cooperative Agreements $7,575 - 0

Contacts

Name Title Type
WKJUXM9JEWS4 Mark Wall Auditee
5153860115 Renee Gravalin Auditor
No contacts on file

Notes to SEFA

Title: Community Facility Loans and Grants Program Accounting Policies: The accompanying Schedule of Expenditures of Federal Awards (Schedule) includes the federal award activity of Greene County 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 position, or cash flows of the Medical Center. Expenditures reported on the Schedule are reported on the accrual basis of accounting. 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. Expenditures reported on this Schedule consist of the beginning of the year outstanding loan balance of the Medical Center’s USDA direct loan of $16,362,904, as well as $1,417,343, which is 90% of the beginning of the year outstanding balance of the Medical Center’s USDA guaranteed loans. If applicable, advances made on the loans during the year are reported on the Schedule. The Medical Center made no advances on the loans during the year ended June 30, 2023, but it did receive and spend a grant for $1,000,000 during the year ended June 30, 2023. The Medical Center’s outstanding loan balances for the direct loan and the guaranteed loans as of June 30, 2023, are $16,050,457 and $1,490,057, respectively.
Title: Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Accounting Policies: The accompanying Schedule of Expenditures of Federal Awards (Schedule) includes the federal award activity of Greene County 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 position, or cash flows of the Medical Center. Expenditures reported on the Schedule are reported on the accrual basis of accounting. 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 $806,349 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 $806,349, plus interest earned of $25, 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 2023-004
Department of Agriculture Federal Financial Assistance Listing #10.766 Community Facilities Loans and Grants Activities Allowed or Unallowed and Allowable Costs/Cost Principles 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 the federal award that provides assurance that the entity is managing the federal award in compliance with federal statutes, regulations, and conditions of the federal award. Condition: The Medical Center excluded adjustments from the lost revenue calculation. Cause: The Medical Center did not have an internal control process in place to ensure the lost revenue calculation reported under the federal program was updated for all adjustments related to cost report settlements. Effect: Without adjusting for cost report settlements, the lost revenue calculation was inaccurate. Questioned Costs: There were no questioned costs related to the lost revenue calculation, as there was still enough lost revenue to support the grant and the matching portion of the grant. Context: The entire lost revenue calculation was tested. Repeat Finding from Prior Years: No Recommendation: We recommend the Medical Center enhance internal control policies to ensure that the lost revenue calculation properly includes and excludes all relevant information. Views of Responsible Officials: Management agrees with the finding.
Finding 2023-004
Department of Agriculture Federal Financial Assistance Listing #10.766 Community Facilities Loans and Grants Activities Allowed or Unallowed and Allowable Costs/Cost Principles 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 the federal award that provides assurance that the entity is managing the federal award in compliance with federal statutes, regulations, and conditions of the federal award. Condition: The Medical Center excluded adjustments from the lost revenue calculation. Cause: The Medical Center did not have an internal control process in place to ensure the lost revenue calculation reported under the federal program was updated for all adjustments related to cost report settlements. Effect: Without adjusting for cost report settlements, the lost revenue calculation was inaccurate. Questioned Costs: There were no questioned costs related to the lost revenue calculation, as there was still enough lost revenue to support the grant and the matching portion of the grant. Context: The entire lost revenue calculation was tested. Repeat Finding from Prior Years: No Recommendation: We recommend the Medical Center enhance internal control policies to ensure that the lost revenue calculation properly includes and excludes all relevant information. Views of Responsible Officials: Management agrees with the finding.
Finding 2023-004
Department of Agriculture Federal Financial Assistance Listing #10.766 Community Facilities Loans and Grants Activities Allowed or Unallowed and Allowable Costs/Cost Principles 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 the federal award that provides assurance that the entity is managing the federal award in compliance with federal statutes, regulations, and conditions of the federal award. Condition: The Medical Center excluded adjustments from the lost revenue calculation. Cause: The Medical Center did not have an internal control process in place to ensure the lost revenue calculation reported under the federal program was updated for all adjustments related to cost report settlements. Effect: Without adjusting for cost report settlements, the lost revenue calculation was inaccurate. Questioned Costs: There were no questioned costs related to the lost revenue calculation, as there was still enough lost revenue to support the grant and the matching portion of the grant. Context: The entire lost revenue calculation was tested. Repeat Finding from Prior Years: No Recommendation: We recommend the Medical Center enhance internal control policies to ensure that the lost revenue calculation properly includes and excludes all relevant information. Views of Responsible Officials: Management agrees with the finding.
Finding 2023-005
Department of Health and Human Services Federal Financial Assistance Listing #93.498 COVID‐19 Provider Relief Fund (PRF) and American Rescue Plan (ARP) Rural Distribution Applicable Federal Award Number and Year – Period 4 TIN #426037888 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 the federal award that provides assurance that the entity is managing the federal award in compliance with federal statutes, regulations, and conditions of the federal award. Condition: The Medical Center included expenses in the Department of Health and Human Services (HHS) special report for Period 4 that were transcribed incorrectly or were preliminary amounts instead of final expenses which caused the HHS special report to be inaccurate. In addition, there was no evidence of formal review and approval over tracking of expenditures that were claimed for the program. In addition, there was no evidence retained that the Medical Center’s special reports submitted to the Department of Health and Human Services for Period 4 TIN #426037888 were reviewed or approved by an individual separate from the preparer prior to submission. Cause: The Medical Center did not have an internal control process in place to ensure documentation of review and approval of the tracking of expenditures claimed under the federal program and the reports submitted to the Department of Health and Human Services. Effect: The lack of adequate policies governing review and approval increases the risk that employees participating in the federal awards administration may not be able to detect and correct noncompliance in a timely manner. Questioned Costs: None over the $25,000 limit. Context: A sample of 11 ($629,403) from a population of 24 items ($806,374) were tested for activities allowed or unallowed and allowable costs/cost principles. Key line items were tested on the Period 4 HHS special report. Repeat Finding from Prior Years: Yes Recommendation: We recommend the Medical Center enhance internal control policies to ensure that formal documentation of review and approval is obtained and retained, and review is thorough enough to catch mistakes. Views of Responsible Officials: Management agrees with the finding.
Finding 2023-004
Department of Agriculture Federal Financial Assistance Listing #10.766 Community Facilities Loans and Grants Activities Allowed or Unallowed and Allowable Costs/Cost Principles 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 the federal award that provides assurance that the entity is managing the federal award in compliance with federal statutes, regulations, and conditions of the federal award. Condition: The Medical Center excluded adjustments from the lost revenue calculation. Cause: The Medical Center did not have an internal control process in place to ensure the lost revenue calculation reported under the federal program was updated for all adjustments related to cost report settlements. Effect: Without adjusting for cost report settlements, the lost revenue calculation was inaccurate. Questioned Costs: There were no questioned costs related to the lost revenue calculation, as there was still enough lost revenue to support the grant and the matching portion of the grant. Context: The entire lost revenue calculation was tested. Repeat Finding from Prior Years: No Recommendation: We recommend the Medical Center enhance internal control policies to ensure that the lost revenue calculation properly includes and excludes all relevant information. Views of Responsible Officials: Management agrees with the finding.
Finding 2023-004
Department of Agriculture Federal Financial Assistance Listing #10.766 Community Facilities Loans and Grants Activities Allowed or Unallowed and Allowable Costs/Cost Principles 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 the federal award that provides assurance that the entity is managing the federal award in compliance with federal statutes, regulations, and conditions of the federal award. Condition: The Medical Center excluded adjustments from the lost revenue calculation. Cause: The Medical Center did not have an internal control process in place to ensure the lost revenue calculation reported under the federal program was updated for all adjustments related to cost report settlements. Effect: Without adjusting for cost report settlements, the lost revenue calculation was inaccurate. Questioned Costs: There were no questioned costs related to the lost revenue calculation, as there was still enough lost revenue to support the grant and the matching portion of the grant. Context: The entire lost revenue calculation was tested. Repeat Finding from Prior Years: No Recommendation: We recommend the Medical Center enhance internal control policies to ensure that the lost revenue calculation properly includes and excludes all relevant information. Views of Responsible Officials: Management agrees with the finding.
Finding 2023-004
Department of Agriculture Federal Financial Assistance Listing #10.766 Community Facilities Loans and Grants Activities Allowed or Unallowed and Allowable Costs/Cost Principles 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 the federal award that provides assurance that the entity is managing the federal award in compliance with federal statutes, regulations, and conditions of the federal award. Condition: The Medical Center excluded adjustments from the lost revenue calculation. Cause: The Medical Center did not have an internal control process in place to ensure the lost revenue calculation reported under the federal program was updated for all adjustments related to cost report settlements. Effect: Without adjusting for cost report settlements, the lost revenue calculation was inaccurate. Questioned Costs: There were no questioned costs related to the lost revenue calculation, as there was still enough lost revenue to support the grant and the matching portion of the grant. Context: The entire lost revenue calculation was tested. Repeat Finding from Prior Years: No Recommendation: We recommend the Medical Center enhance internal control policies to ensure that the lost revenue calculation properly includes and excludes all relevant information. Views of Responsible Officials: Management agrees with the finding.
Finding 2023-005
Department of Health and Human Services Federal Financial Assistance Listing #93.498 COVID‐19 Provider Relief Fund (PRF) and American Rescue Plan (ARP) Rural Distribution Applicable Federal Award Number and Year – Period 4 TIN #426037888 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 the federal award that provides assurance that the entity is managing the federal award in compliance with federal statutes, regulations, and conditions of the federal award. Condition: The Medical Center included expenses in the Department of Health and Human Services (HHS) special report for Period 4 that were transcribed incorrectly or were preliminary amounts instead of final expenses which caused the HHS special report to be inaccurate. In addition, there was no evidence of formal review and approval over tracking of expenditures that were claimed for the program. In addition, there was no evidence retained that the Medical Center’s special reports submitted to the Department of Health and Human Services for Period 4 TIN #426037888 were reviewed or approved by an individual separate from the preparer prior to submission. Cause: The Medical Center did not have an internal control process in place to ensure documentation of review and approval of the tracking of expenditures claimed under the federal program and the reports submitted to the Department of Health and Human Services. Effect: The lack of adequate policies governing review and approval increases the risk that employees participating in the federal awards administration may not be able to detect and correct noncompliance in a timely manner. Questioned Costs: None over the $25,000 limit. Context: A sample of 11 ($629,403) from a population of 24 items ($806,374) were tested for activities allowed or unallowed and allowable costs/cost principles. Key line items were tested on the Period 4 HHS special report. Repeat Finding from Prior Years: Yes Recommendation: We recommend the Medical Center enhance internal control policies to ensure that formal documentation of review and approval is obtained and retained, and review is thorough enough to catch mistakes. Views of Responsible Officials: Management agrees with the finding.