2 CFR 200 § 200.332

Findings Citing § 200.332

Requirements for pass-through entities.

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About this section
Section 200.332 requires pass-through entities to verify that subrecipients are eligible for federal funding and to clearly identify subawards with specific information, such as the subrecipient's name, federal award details, and funding amounts. This affects organizations that distribute federal funds to ensure compliance and transparency in funding processes.
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FY End: 2023-09-30
Bmc Health System, Inc.
Compliance Requirement: M
Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaw...

Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaward modification. When some of this information is not available, the pass through entity must provide the best information available to describe the Federal award and subaward. Required information includes: (xii) Assistance Listings number and Title; the pass through entity must identify the dollar amount made available under each Federal award and the Assistance Listings Number at time of disbursement; (2 CFE section 200.332xxi) (b) Evaluate each subrecipient’s risk of noncompliance with Federal statutes, regulations, and the terms and conditions of the subaward for purposes of determining the appropriate subrecipient monitoring described in paragraphs (d) and (e) of this section, which may include consideration of such factors as: (1) The subrecipient’s prior experience with the same or similar subawards; (2) The results of previous audits including whether or not the subrecipient receives a Single Audit in accordance with Subpart F of this part, and the extent to which the same or similar subaward has been audited as a major program; (3) Whether the subrecipient has new personnel or new or substantially changed systems; and (4) The extent and results of Federal awarding agency monitoring (e.g., if the subrecipient also receives Federal awards directly from a Federal awarding agency). Additionally, 45 CFR section 75 303(a) states the non Federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. Condition When subawards are made to subrecipients, the pass through entities are required to communicate the dollar amount made available under each Federal award and the Assistance Listings Number (ALN) at time of disbursement. BMC does not have system in place to provide the ALN at the time of disbursement of funds. During the year ended September 30, 2023, the BMC passed through $18,031,446 of federal funding to subrecipients. In order to assess the subrecipient’s risk of non compliance, BMC has subrecipient monitoring policies and procedures in place which include the use of a risk assessment questionnaire. The risk assessment questionnaire includes considerations consistent with 2 CFR 200.332(b), including the entity’s prior experience and results of Single Audits, in addition to other factors. As part of our testing related subrecipient monitoring, we identified the following: 1. For 4 of 16 subrecipients selected for testwork BMC did not perform a risk assessment of the entity for purposes of determining the appropriate subrecipient monitoring related to the subaward. However, for these subrecipients, BMC did perform monitoring procedures, including review of invoices for reimbursement, review of Research Performance Progress Reports and review of Single Audit reports. Cause The condition found was primarily due to the monitoring procedures implemented by BMC do not include a review to ensure that a risk assessment is performed for each active subrecipient and BMC does not have a mechanism in place to provide the ALN at the time of disbursement of funds to the subrecipient. Possible Asserted Effect Failure to perform an annual risk assessment to determine appropriate subrecipient monitoring procedures may result in insufficient monitoring procedures being performed to detect subrecipient noncompliance with Federal statutes, regulations, and the terms and conditions of the award. Failure to adequately communicate award identification information could result in the subrecipient not being able to adequately track and report the subawards received resulting in errors being reported on the schedule of expenditures of federal awards within a subrecipient’s annual single audit report and not being able to comply with required terms and conditions of the federal award. Questioned Costs None. Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Recommendation We recommend BMC implement policies, procedures, and internal controls to ensure subrecipient risk assessments are performed for each subrecipient to determine the appropriate subrecipient monitoring is performed in accordance with 45 CFR 75.352(d) and 45 CFR 75.352(e). We recommend that BMC enhance its processes and internal controls over its reporting to the subrecipients of the federal program to ensure all award identification information required under 45 CFR 75.352(a) is provided to the subrecipients.

FY End: 2023-09-30
Bmc Health System, Inc.
Compliance Requirement: M
Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaw...

Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaward modification. When some of this information is not available, the pass through entity must provide the best information available to describe the Federal award and subaward. Required information includes: (xii) Assistance Listings number and Title; the pass through entity must identify the dollar amount made available under each Federal award and the Assistance Listings Number at time of disbursement; (2 CFE section 200.332xxi) (b) Evaluate each subrecipient’s risk of noncompliance with Federal statutes, regulations, and the terms and conditions of the subaward for purposes of determining the appropriate subrecipient monitoring described in paragraphs (d) and (e) of this section, which may include consideration of such factors as: (1) The subrecipient’s prior experience with the same or similar subawards; (2) The results of previous audits including whether or not the subrecipient receives a Single Audit in accordance with Subpart F of this part, and the extent to which the same or similar subaward has been audited as a major program; (3) Whether the subrecipient has new personnel or new or substantially changed systems; and (4) The extent and results of Federal awarding agency monitoring (e.g., if the subrecipient also receives Federal awards directly from a Federal awarding agency). Additionally, 45 CFR section 75 303(a) states the non Federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. Condition When subawards are made to subrecipients, the pass through entities are required to communicate the dollar amount made available under each Federal award and the Assistance Listings Number (ALN) at time of disbursement. BMC does not have system in place to provide the ALN at the time of disbursement of funds. During the year ended September 30, 2023, the BMC passed through $18,031,446 of federal funding to subrecipients. In order to assess the subrecipient’s risk of non compliance, BMC has subrecipient monitoring policies and procedures in place which include the use of a risk assessment questionnaire. The risk assessment questionnaire includes considerations consistent with 2 CFR 200.332(b), including the entity’s prior experience and results of Single Audits, in addition to other factors. As part of our testing related subrecipient monitoring, we identified the following: 1. For 4 of 16 subrecipients selected for testwork BMC did not perform a risk assessment of the entity for purposes of determining the appropriate subrecipient monitoring related to the subaward. However, for these subrecipients, BMC did perform monitoring procedures, including review of invoices for reimbursement, review of Research Performance Progress Reports and review of Single Audit reports. Cause The condition found was primarily due to the monitoring procedures implemented by BMC do not include a review to ensure that a risk assessment is performed for each active subrecipient and BMC does not have a mechanism in place to provide the ALN at the time of disbursement of funds to the subrecipient. Possible Asserted Effect Failure to perform an annual risk assessment to determine appropriate subrecipient monitoring procedures may result in insufficient monitoring procedures being performed to detect subrecipient noncompliance with Federal statutes, regulations, and the terms and conditions of the award. Failure to adequately communicate award identification information could result in the subrecipient not being able to adequately track and report the subawards received resulting in errors being reported on the schedule of expenditures of federal awards within a subrecipient’s annual single audit report and not being able to comply with required terms and conditions of the federal award. Questioned Costs None. Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Recommendation We recommend BMC implement policies, procedures, and internal controls to ensure subrecipient risk assessments are performed for each subrecipient to determine the appropriate subrecipient monitoring is performed in accordance with 45 CFR 75.352(d) and 45 CFR 75.352(e). We recommend that BMC enhance its processes and internal controls over its reporting to the subrecipients of the federal program to ensure all award identification information required under 45 CFR 75.352(a) is provided to the subrecipients.

FY End: 2023-09-30
Bmc Health System, Inc.
Compliance Requirement: M
Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaw...

Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaward modification. When some of this information is not available, the pass through entity must provide the best information available to describe the Federal award and subaward. Required information includes: (xii) Assistance Listings number and Title; the pass through entity must identify the dollar amount made available under each Federal award and the Assistance Listings Number at time of disbursement; (2 CFE section 200.332xxi) (b) Evaluate each subrecipient’s risk of noncompliance with Federal statutes, regulations, and the terms and conditions of the subaward for purposes of determining the appropriate subrecipient monitoring described in paragraphs (d) and (e) of this section, which may include consideration of such factors as: (1) The subrecipient’s prior experience with the same or similar subawards; (2) The results of previous audits including whether or not the subrecipient receives a Single Audit in accordance with Subpart F of this part, and the extent to which the same or similar subaward has been audited as a major program; (3) Whether the subrecipient has new personnel or new or substantially changed systems; and (4) The extent and results of Federal awarding agency monitoring (e.g., if the subrecipient also receives Federal awards directly from a Federal awarding agency). Additionally, 45 CFR section 75 303(a) states the non Federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. Condition When subawards are made to subrecipients, the pass through entities are required to communicate the dollar amount made available under each Federal award and the Assistance Listings Number (ALN) at time of disbursement. BMC does not have system in place to provide the ALN at the time of disbursement of funds. During the year ended September 30, 2023, the BMC passed through $18,031,446 of federal funding to subrecipients. In order to assess the subrecipient’s risk of non compliance, BMC has subrecipient monitoring policies and procedures in place which include the use of a risk assessment questionnaire. The risk assessment questionnaire includes considerations consistent with 2 CFR 200.332(b), including the entity’s prior experience and results of Single Audits, in addition to other factors. As part of our testing related subrecipient monitoring, we identified the following: 1. For 4 of 16 subrecipients selected for testwork BMC did not perform a risk assessment of the entity for purposes of determining the appropriate subrecipient monitoring related to the subaward. However, for these subrecipients, BMC did perform monitoring procedures, including review of invoices for reimbursement, review of Research Performance Progress Reports and review of Single Audit reports. Cause The condition found was primarily due to the monitoring procedures implemented by BMC do not include a review to ensure that a risk assessment is performed for each active subrecipient and BMC does not have a mechanism in place to provide the ALN at the time of disbursement of funds to the subrecipient. Possible Asserted Effect Failure to perform an annual risk assessment to determine appropriate subrecipient monitoring procedures may result in insufficient monitoring procedures being performed to detect subrecipient noncompliance with Federal statutes, regulations, and the terms and conditions of the award. Failure to adequately communicate award identification information could result in the subrecipient not being able to adequately track and report the subawards received resulting in errors being reported on the schedule of expenditures of federal awards within a subrecipient’s annual single audit report and not being able to comply with required terms and conditions of the federal award. Questioned Costs None. Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Recommendation We recommend BMC implement policies, procedures, and internal controls to ensure subrecipient risk assessments are performed for each subrecipient to determine the appropriate subrecipient monitoring is performed in accordance with 45 CFR 75.352(d) and 45 CFR 75.352(e). We recommend that BMC enhance its processes and internal controls over its reporting to the subrecipients of the federal program to ensure all award identification information required under 45 CFR 75.352(a) is provided to the subrecipients.

FY End: 2023-09-30
Bmc Health System, Inc.
Compliance Requirement: M
Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaw...

Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaward modification. When some of this information is not available, the pass through entity must provide the best information available to describe the Federal award and subaward. Required information includes: (xii) Assistance Listings number and Title; the pass through entity must identify the dollar amount made available under each Federal award and the Assistance Listings Number at time of disbursement; (2 CFE section 200.332xxi) (b) Evaluate each subrecipient’s risk of noncompliance with Federal statutes, regulations, and the terms and conditions of the subaward for purposes of determining the appropriate subrecipient monitoring described in paragraphs (d) and (e) of this section, which may include consideration of such factors as: (1) The subrecipient’s prior experience with the same or similar subawards; (2) The results of previous audits including whether or not the subrecipient receives a Single Audit in accordance with Subpart F of this part, and the extent to which the same or similar subaward has been audited as a major program; (3) Whether the subrecipient has new personnel or new or substantially changed systems; and (4) The extent and results of Federal awarding agency monitoring (e.g., if the subrecipient also receives Federal awards directly from a Federal awarding agency). Additionally, 45 CFR section 75 303(a) states the non Federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. Condition When subawards are made to subrecipients, the pass through entities are required to communicate the dollar amount made available under each Federal award and the Assistance Listings Number (ALN) at time of disbursement. BMC does not have system in place to provide the ALN at the time of disbursement of funds. During the year ended September 30, 2023, the BMC passed through $18,031,446 of federal funding to subrecipients. In order to assess the subrecipient’s risk of non compliance, BMC has subrecipient monitoring policies and procedures in place which include the use of a risk assessment questionnaire. The risk assessment questionnaire includes considerations consistent with 2 CFR 200.332(b), including the entity’s prior experience and results of Single Audits, in addition to other factors. As part of our testing related subrecipient monitoring, we identified the following: 1. For 4 of 16 subrecipients selected for testwork BMC did not perform a risk assessment of the entity for purposes of determining the appropriate subrecipient monitoring related to the subaward. However, for these subrecipients, BMC did perform monitoring procedures, including review of invoices for reimbursement, review of Research Performance Progress Reports and review of Single Audit reports. Cause The condition found was primarily due to the monitoring procedures implemented by BMC do not include a review to ensure that a risk assessment is performed for each active subrecipient and BMC does not have a mechanism in place to provide the ALN at the time of disbursement of funds to the subrecipient. Possible Asserted Effect Failure to perform an annual risk assessment to determine appropriate subrecipient monitoring procedures may result in insufficient monitoring procedures being performed to detect subrecipient noncompliance with Federal statutes, regulations, and the terms and conditions of the award. Failure to adequately communicate award identification information could result in the subrecipient not being able to adequately track and report the subawards received resulting in errors being reported on the schedule of expenditures of federal awards within a subrecipient’s annual single audit report and not being able to comply with required terms and conditions of the federal award. Questioned Costs None. Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Recommendation We recommend BMC implement policies, procedures, and internal controls to ensure subrecipient risk assessments are performed for each subrecipient to determine the appropriate subrecipient monitoring is performed in accordance with 45 CFR 75.352(d) and 45 CFR 75.352(e). We recommend that BMC enhance its processes and internal controls over its reporting to the subrecipients of the federal program to ensure all award identification information required under 45 CFR 75.352(a) is provided to the subrecipients.

FY End: 2023-09-30
Bmc Health System, Inc.
Compliance Requirement: M
Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaw...

Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaward modification. When some of this information is not available, the pass through entity must provide the best information available to describe the Federal award and subaward. Required information includes: (xii) Assistance Listings number and Title; the pass through entity must identify the dollar amount made available under each Federal award and the Assistance Listings Number at time of disbursement; (2 CFE section 200.332xxi) (b) Evaluate each subrecipient’s risk of noncompliance with Federal statutes, regulations, and the terms and conditions of the subaward for purposes of determining the appropriate subrecipient monitoring described in paragraphs (d) and (e) of this section, which may include consideration of such factors as: (1) The subrecipient’s prior experience with the same or similar subawards; (2) The results of previous audits including whether or not the subrecipient receives a Single Audit in accordance with Subpart F of this part, and the extent to which the same or similar subaward has been audited as a major program; (3) Whether the subrecipient has new personnel or new or substantially changed systems; and (4) The extent and results of Federal awarding agency monitoring (e.g., if the subrecipient also receives Federal awards directly from a Federal awarding agency). Additionally, 45 CFR section 75 303(a) states the non Federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. Condition When subawards are made to subrecipients, the pass through entities are required to communicate the dollar amount made available under each Federal award and the Assistance Listings Number (ALN) at time of disbursement. BMC does not have system in place to provide the ALN at the time of disbursement of funds. During the year ended September 30, 2023, the BMC passed through $18,031,446 of federal funding to subrecipients. In order to assess the subrecipient’s risk of non compliance, BMC has subrecipient monitoring policies and procedures in place which include the use of a risk assessment questionnaire. The risk assessment questionnaire includes considerations consistent with 2 CFR 200.332(b), including the entity’s prior experience and results of Single Audits, in addition to other factors. As part of our testing related subrecipient monitoring, we identified the following: 1. For 4 of 16 subrecipients selected for testwork BMC did not perform a risk assessment of the entity for purposes of determining the appropriate subrecipient monitoring related to the subaward. However, for these subrecipients, BMC did perform monitoring procedures, including review of invoices for reimbursement, review of Research Performance Progress Reports and review of Single Audit reports. Cause The condition found was primarily due to the monitoring procedures implemented by BMC do not include a review to ensure that a risk assessment is performed for each active subrecipient and BMC does not have a mechanism in place to provide the ALN at the time of disbursement of funds to the subrecipient. Possible Asserted Effect Failure to perform an annual risk assessment to determine appropriate subrecipient monitoring procedures may result in insufficient monitoring procedures being performed to detect subrecipient noncompliance with Federal statutes, regulations, and the terms and conditions of the award. Failure to adequately communicate award identification information could result in the subrecipient not being able to adequately track and report the subawards received resulting in errors being reported on the schedule of expenditures of federal awards within a subrecipient’s annual single audit report and not being able to comply with required terms and conditions of the federal award. Questioned Costs None. Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Recommendation We recommend BMC implement policies, procedures, and internal controls to ensure subrecipient risk assessments are performed for each subrecipient to determine the appropriate subrecipient monitoring is performed in accordance with 45 CFR 75.352(d) and 45 CFR 75.352(e). We recommend that BMC enhance its processes and internal controls over its reporting to the subrecipients of the federal program to ensure all award identification information required under 45 CFR 75.352(a) is provided to the subrecipients.

FY End: 2023-09-30
Bmc Health System, Inc.
Compliance Requirement: M
Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaw...

Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaward modification. When some of this information is not available, the pass through entity must provide the best information available to describe the Federal award and subaward. Required information includes: (xii) Assistance Listings number and Title; the pass through entity must identify the dollar amount made available under each Federal award and the Assistance Listings Number at time of disbursement; (2 CFE section 200.332xxi) (b) Evaluate each subrecipient’s risk of noncompliance with Federal statutes, regulations, and the terms and conditions of the subaward for purposes of determining the appropriate subrecipient monitoring described in paragraphs (d) and (e) of this section, which may include consideration of such factors as: (1) The subrecipient’s prior experience with the same or similar subawards; (2) The results of previous audits including whether or not the subrecipient receives a Single Audit in accordance with Subpart F of this part, and the extent to which the same or similar subaward has been audited as a major program; (3) Whether the subrecipient has new personnel or new or substantially changed systems; and (4) The extent and results of Federal awarding agency monitoring (e.g., if the subrecipient also receives Federal awards directly from a Federal awarding agency). Additionally, 45 CFR section 75 303(a) states the non Federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. Condition When subawards are made to subrecipients, the pass through entities are required to communicate the dollar amount made available under each Federal award and the Assistance Listings Number (ALN) at time of disbursement. BMC does not have system in place to provide the ALN at the time of disbursement of funds. During the year ended September 30, 2023, the BMC passed through $18,031,446 of federal funding to subrecipients. In order to assess the subrecipient’s risk of non compliance, BMC has subrecipient monitoring policies and procedures in place which include the use of a risk assessment questionnaire. The risk assessment questionnaire includes considerations consistent with 2 CFR 200.332(b), including the entity’s prior experience and results of Single Audits, in addition to other factors. As part of our testing related subrecipient monitoring, we identified the following: 1. For 4 of 16 subrecipients selected for testwork BMC did not perform a risk assessment of the entity for purposes of determining the appropriate subrecipient monitoring related to the subaward. However, for these subrecipients, BMC did perform monitoring procedures, including review of invoices for reimbursement, review of Research Performance Progress Reports and review of Single Audit reports. Cause The condition found was primarily due to the monitoring procedures implemented by BMC do not include a review to ensure that a risk assessment is performed for each active subrecipient and BMC does not have a mechanism in place to provide the ALN at the time of disbursement of funds to the subrecipient. Possible Asserted Effect Failure to perform an annual risk assessment to determine appropriate subrecipient monitoring procedures may result in insufficient monitoring procedures being performed to detect subrecipient noncompliance with Federal statutes, regulations, and the terms and conditions of the award. Failure to adequately communicate award identification information could result in the subrecipient not being able to adequately track and report the subawards received resulting in errors being reported on the schedule of expenditures of federal awards within a subrecipient’s annual single audit report and not being able to comply with required terms and conditions of the federal award. Questioned Costs None. Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Recommendation We recommend BMC implement policies, procedures, and internal controls to ensure subrecipient risk assessments are performed for each subrecipient to determine the appropriate subrecipient monitoring is performed in accordance with 45 CFR 75.352(d) and 45 CFR 75.352(e). We recommend that BMC enhance its processes and internal controls over its reporting to the subrecipients of the federal program to ensure all award identification information required under 45 CFR 75.352(a) is provided to the subrecipients.

FY End: 2023-09-30
Bmc Health System, Inc.
Compliance Requirement: M
Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaw...

Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaward modification. When some of this information is not available, the pass through entity must provide the best information available to describe the Federal award and subaward. Required information includes: (xii) Assistance Listings number and Title; the pass through entity must identify the dollar amount made available under each Federal award and the Assistance Listings Number at time of disbursement; (2 CFE section 200.332xxi) (b) Evaluate each subrecipient’s risk of noncompliance with Federal statutes, regulations, and the terms and conditions of the subaward for purposes of determining the appropriate subrecipient monitoring described in paragraphs (d) and (e) of this section, which may include consideration of such factors as: (1) The subrecipient’s prior experience with the same or similar subawards; (2) The results of previous audits including whether or not the subrecipient receives a Single Audit in accordance with Subpart F of this part, and the extent to which the same or similar subaward has been audited as a major program; (3) Whether the subrecipient has new personnel or new or substantially changed systems; and (4) The extent and results of Federal awarding agency monitoring (e.g., if the subrecipient also receives Federal awards directly from a Federal awarding agency). Additionally, 45 CFR section 75 303(a) states the non Federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. Condition When subawards are made to subrecipients, the pass through entities are required to communicate the dollar amount made available under each Federal award and the Assistance Listings Number (ALN) at time of disbursement. BMC does not have system in place to provide the ALN at the time of disbursement of funds. During the year ended September 30, 2023, the BMC passed through $18,031,446 of federal funding to subrecipients. In order to assess the subrecipient’s risk of non compliance, BMC has subrecipient monitoring policies and procedures in place which include the use of a risk assessment questionnaire. The risk assessment questionnaire includes considerations consistent with 2 CFR 200.332(b), including the entity’s prior experience and results of Single Audits, in addition to other factors. As part of our testing related subrecipient monitoring, we identified the following: 1. For 4 of 16 subrecipients selected for testwork BMC did not perform a risk assessment of the entity for purposes of determining the appropriate subrecipient monitoring related to the subaward. However, for these subrecipients, BMC did perform monitoring procedures, including review of invoices for reimbursement, review of Research Performance Progress Reports and review of Single Audit reports. Cause The condition found was primarily due to the monitoring procedures implemented by BMC do not include a review to ensure that a risk assessment is performed for each active subrecipient and BMC does not have a mechanism in place to provide the ALN at the time of disbursement of funds to the subrecipient. Possible Asserted Effect Failure to perform an annual risk assessment to determine appropriate subrecipient monitoring procedures may result in insufficient monitoring procedures being performed to detect subrecipient noncompliance with Federal statutes, regulations, and the terms and conditions of the award. Failure to adequately communicate award identification information could result in the subrecipient not being able to adequately track and report the subawards received resulting in errors being reported on the schedule of expenditures of federal awards within a subrecipient’s annual single audit report and not being able to comply with required terms and conditions of the federal award. Questioned Costs None. Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Recommendation We recommend BMC implement policies, procedures, and internal controls to ensure subrecipient risk assessments are performed for each subrecipient to determine the appropriate subrecipient monitoring is performed in accordance with 45 CFR 75.352(d) and 45 CFR 75.352(e). We recommend that BMC enhance its processes and internal controls over its reporting to the subrecipients of the federal program to ensure all award identification information required under 45 CFR 75.352(a) is provided to the subrecipients.

FY End: 2023-09-30
Bmc Health System, Inc.
Compliance Requirement: M
Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaw...

Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaward modification. When some of this information is not available, the pass through entity must provide the best information available to describe the Federal award and subaward. Required information includes: (xii) Assistance Listings number and Title; the pass through entity must identify the dollar amount made available under each Federal award and the Assistance Listings Number at time of disbursement; (2 CFE section 200.332xxi) (b) Evaluate each subrecipient’s risk of noncompliance with Federal statutes, regulations, and the terms and conditions of the subaward for purposes of determining the appropriate subrecipient monitoring described in paragraphs (d) and (e) of this section, which may include consideration of such factors as: (1) The subrecipient’s prior experience with the same or similar subawards; (2) The results of previous audits including whether or not the subrecipient receives a Single Audit in accordance with Subpart F of this part, and the extent to which the same or similar subaward has been audited as a major program; (3) Whether the subrecipient has new personnel or new or substantially changed systems; and (4) The extent and results of Federal awarding agency monitoring (e.g., if the subrecipient also receives Federal awards directly from a Federal awarding agency). Additionally, 45 CFR section 75 303(a) states the non Federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. Condition When subawards are made to subrecipients, the pass through entities are required to communicate the dollar amount made available under each Federal award and the Assistance Listings Number (ALN) at time of disbursement. BMC does not have system in place to provide the ALN at the time of disbursement of funds. During the year ended September 30, 2023, the BMC passed through $18,031,446 of federal funding to subrecipients. In order to assess the subrecipient’s risk of non compliance, BMC has subrecipient monitoring policies and procedures in place which include the use of a risk assessment questionnaire. The risk assessment questionnaire includes considerations consistent with 2 CFR 200.332(b), including the entity’s prior experience and results of Single Audits, in addition to other factors. As part of our testing related subrecipient monitoring, we identified the following: 1. For 4 of 16 subrecipients selected for testwork BMC did not perform a risk assessment of the entity for purposes of determining the appropriate subrecipient monitoring related to the subaward. However, for these subrecipients, BMC did perform monitoring procedures, including review of invoices for reimbursement, review of Research Performance Progress Reports and review of Single Audit reports. Cause The condition found was primarily due to the monitoring procedures implemented by BMC do not include a review to ensure that a risk assessment is performed for each active subrecipient and BMC does not have a mechanism in place to provide the ALN at the time of disbursement of funds to the subrecipient. Possible Asserted Effect Failure to perform an annual risk assessment to determine appropriate subrecipient monitoring procedures may result in insufficient monitoring procedures being performed to detect subrecipient noncompliance with Federal statutes, regulations, and the terms and conditions of the award. Failure to adequately communicate award identification information could result in the subrecipient not being able to adequately track and report the subawards received resulting in errors being reported on the schedule of expenditures of federal awards within a subrecipient’s annual single audit report and not being able to comply with required terms and conditions of the federal award. Questioned Costs None. Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Recommendation We recommend BMC implement policies, procedures, and internal controls to ensure subrecipient risk assessments are performed for each subrecipient to determine the appropriate subrecipient monitoring is performed in accordance with 45 CFR 75.352(d) and 45 CFR 75.352(e). We recommend that BMC enhance its processes and internal controls over its reporting to the subrecipients of the federal program to ensure all award identification information required under 45 CFR 75.352(a) is provided to the subrecipients.

FY End: 2023-09-30
Bmc Health System, Inc.
Compliance Requirement: M
Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaw...

Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaward modification. When some of this information is not available, the pass through entity must provide the best information available to describe the Federal award and subaward. Required information includes: (xii) Assistance Listings number and Title; the pass through entity must identify the dollar amount made available under each Federal award and the Assistance Listings Number at time of disbursement; (2 CFE section 200.332xxi) (b) Evaluate each subrecipient’s risk of noncompliance with Federal statutes, regulations, and the terms and conditions of the subaward for purposes of determining the appropriate subrecipient monitoring described in paragraphs (d) and (e) of this section, which may include consideration of such factors as: (1) The subrecipient’s prior experience with the same or similar subawards; (2) The results of previous audits including whether or not the subrecipient receives a Single Audit in accordance with Subpart F of this part, and the extent to which the same or similar subaward has been audited as a major program; (3) Whether the subrecipient has new personnel or new or substantially changed systems; and (4) The extent and results of Federal awarding agency monitoring (e.g., if the subrecipient also receives Federal awards directly from a Federal awarding agency). Additionally, 45 CFR section 75 303(a) states the non Federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. Condition When subawards are made to subrecipients, the pass through entities are required to communicate the dollar amount made available under each Federal award and the Assistance Listings Number (ALN) at time of disbursement. BMC does not have system in place to provide the ALN at the time of disbursement of funds. During the year ended September 30, 2023, the BMC passed through $18,031,446 of federal funding to subrecipients. In order to assess the subrecipient’s risk of non compliance, BMC has subrecipient monitoring policies and procedures in place which include the use of a risk assessment questionnaire. The risk assessment questionnaire includes considerations consistent with 2 CFR 200.332(b), including the entity’s prior experience and results of Single Audits, in addition to other factors. As part of our testing related subrecipient monitoring, we identified the following: 1. For 4 of 16 subrecipients selected for testwork BMC did not perform a risk assessment of the entity for purposes of determining the appropriate subrecipient monitoring related to the subaward. However, for these subrecipients, BMC did perform monitoring procedures, including review of invoices for reimbursement, review of Research Performance Progress Reports and review of Single Audit reports. Cause The condition found was primarily due to the monitoring procedures implemented by BMC do not include a review to ensure that a risk assessment is performed for each active subrecipient and BMC does not have a mechanism in place to provide the ALN at the time of disbursement of funds to the subrecipient. Possible Asserted Effect Failure to perform an annual risk assessment to determine appropriate subrecipient monitoring procedures may result in insufficient monitoring procedures being performed to detect subrecipient noncompliance with Federal statutes, regulations, and the terms and conditions of the award. Failure to adequately communicate award identification information could result in the subrecipient not being able to adequately track and report the subawards received resulting in errors being reported on the schedule of expenditures of federal awards within a subrecipient’s annual single audit report and not being able to comply with required terms and conditions of the federal award. Questioned Costs None. Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Recommendation We recommend BMC implement policies, procedures, and internal controls to ensure subrecipient risk assessments are performed for each subrecipient to determine the appropriate subrecipient monitoring is performed in accordance with 45 CFR 75.352(d) and 45 CFR 75.352(e). We recommend that BMC enhance its processes and internal controls over its reporting to the subrecipients of the federal program to ensure all award identification information required under 45 CFR 75.352(a) is provided to the subrecipients.

FY End: 2023-09-30
Bmc Health System, Inc.
Compliance Requirement: M
Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaw...

Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaward modification. When some of this information is not available, the pass through entity must provide the best information available to describe the Federal award and subaward. Required information includes: (xii) Assistance Listings number and Title; the pass through entity must identify the dollar amount made available under each Federal award and the Assistance Listings Number at time of disbursement; (2 CFE section 200.332xxi) (b) Evaluate each subrecipient’s risk of noncompliance with Federal statutes, regulations, and the terms and conditions of the subaward for purposes of determining the appropriate subrecipient monitoring described in paragraphs (d) and (e) of this section, which may include consideration of such factors as: (1) The subrecipient’s prior experience with the same or similar subawards; (2) The results of previous audits including whether or not the subrecipient receives a Single Audit in accordance with Subpart F of this part, and the extent to which the same or similar subaward has been audited as a major program; (3) Whether the subrecipient has new personnel or new or substantially changed systems; and (4) The extent and results of Federal awarding agency monitoring (e.g., if the subrecipient also receives Federal awards directly from a Federal awarding agency). Additionally, 45 CFR section 75 303(a) states the non Federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. Condition When subawards are made to subrecipients, the pass through entities are required to communicate the dollar amount made available under each Federal award and the Assistance Listings Number (ALN) at time of disbursement. BMC does not have system in place to provide the ALN at the time of disbursement of funds. During the year ended September 30, 2023, the BMC passed through $18,031,446 of federal funding to subrecipients. In order to assess the subrecipient’s risk of non compliance, BMC has subrecipient monitoring policies and procedures in place which include the use of a risk assessment questionnaire. The risk assessment questionnaire includes considerations consistent with 2 CFR 200.332(b), including the entity’s prior experience and results of Single Audits, in addition to other factors. As part of our testing related subrecipient monitoring, we identified the following: 1. For 4 of 16 subrecipients selected for testwork BMC did not perform a risk assessment of the entity for purposes of determining the appropriate subrecipient monitoring related to the subaward. However, for these subrecipients, BMC did perform monitoring procedures, including review of invoices for reimbursement, review of Research Performance Progress Reports and review of Single Audit reports. Cause The condition found was primarily due to the monitoring procedures implemented by BMC do not include a review to ensure that a risk assessment is performed for each active subrecipient and BMC does not have a mechanism in place to provide the ALN at the time of disbursement of funds to the subrecipient. Possible Asserted Effect Failure to perform an annual risk assessment to determine appropriate subrecipient monitoring procedures may result in insufficient monitoring procedures being performed to detect subrecipient noncompliance with Federal statutes, regulations, and the terms and conditions of the award. Failure to adequately communicate award identification information could result in the subrecipient not being able to adequately track and report the subawards received resulting in errors being reported on the schedule of expenditures of federal awards within a subrecipient’s annual single audit report and not being able to comply with required terms and conditions of the federal award. Questioned Costs None. Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Recommendation We recommend BMC implement policies, procedures, and internal controls to ensure subrecipient risk assessments are performed for each subrecipient to determine the appropriate subrecipient monitoring is performed in accordance with 45 CFR 75.352(d) and 45 CFR 75.352(e). We recommend that BMC enhance its processes and internal controls over its reporting to the subrecipients of the federal program to ensure all award identification information required under 45 CFR 75.352(a) is provided to the subrecipients.

FY End: 2023-09-30
Bmc Health System, Inc.
Compliance Requirement: M
Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaw...

Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaward modification. When some of this information is not available, the pass through entity must provide the best information available to describe the Federal award and subaward. Required information includes: (xii) Assistance Listings number and Title; the pass through entity must identify the dollar amount made available under each Federal award and the Assistance Listings Number at time of disbursement; (2 CFE section 200.332xxi) (b) Evaluate each subrecipient’s risk of noncompliance with Federal statutes, regulations, and the terms and conditions of the subaward for purposes of determining the appropriate subrecipient monitoring described in paragraphs (d) and (e) of this section, which may include consideration of such factors as: (1) The subrecipient’s prior experience with the same or similar subawards; (2) The results of previous audits including whether or not the subrecipient receives a Single Audit in accordance with Subpart F of this part, and the extent to which the same or similar subaward has been audited as a major program; (3) Whether the subrecipient has new personnel or new or substantially changed systems; and (4) The extent and results of Federal awarding agency monitoring (e.g., if the subrecipient also receives Federal awards directly from a Federal awarding agency). Additionally, 45 CFR section 75 303(a) states the non Federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. Condition When subawards are made to subrecipients, the pass through entities are required to communicate the dollar amount made available under each Federal award and the Assistance Listings Number (ALN) at time of disbursement. BMC does not have system in place to provide the ALN at the time of disbursement of funds. During the year ended September 30, 2023, the BMC passed through $18,031,446 of federal funding to subrecipients. In order to assess the subrecipient’s risk of non compliance, BMC has subrecipient monitoring policies and procedures in place which include the use of a risk assessment questionnaire. The risk assessment questionnaire includes considerations consistent with 2 CFR 200.332(b), including the entity’s prior experience and results of Single Audits, in addition to other factors. As part of our testing related subrecipient monitoring, we identified the following: 1. For 4 of 16 subrecipients selected for testwork BMC did not perform a risk assessment of the entity for purposes of determining the appropriate subrecipient monitoring related to the subaward. However, for these subrecipients, BMC did perform monitoring procedures, including review of invoices for reimbursement, review of Research Performance Progress Reports and review of Single Audit reports. Cause The condition found was primarily due to the monitoring procedures implemented by BMC do not include a review to ensure that a risk assessment is performed for each active subrecipient and BMC does not have a mechanism in place to provide the ALN at the time of disbursement of funds to the subrecipient. Possible Asserted Effect Failure to perform an annual risk assessment to determine appropriate subrecipient monitoring procedures may result in insufficient monitoring procedures being performed to detect subrecipient noncompliance with Federal statutes, regulations, and the terms and conditions of the award. Failure to adequately communicate award identification information could result in the subrecipient not being able to adequately track and report the subawards received resulting in errors being reported on the schedule of expenditures of federal awards within a subrecipient’s annual single audit report and not being able to comply with required terms and conditions of the federal award. Questioned Costs None. Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Recommendation We recommend BMC implement policies, procedures, and internal controls to ensure subrecipient risk assessments are performed for each subrecipient to determine the appropriate subrecipient monitoring is performed in accordance with 45 CFR 75.352(d) and 45 CFR 75.352(e). We recommend that BMC enhance its processes and internal controls over its reporting to the subrecipients of the federal program to ensure all award identification information required under 45 CFR 75.352(a) is provided to the subrecipients.

FY End: 2023-09-30
Bmc Health System, Inc.
Compliance Requirement: M
Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaw...

Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaward modification. When some of this information is not available, the pass through entity must provide the best information available to describe the Federal award and subaward. Required information includes: (xii) Assistance Listings number and Title; the pass through entity must identify the dollar amount made available under each Federal award and the Assistance Listings Number at time of disbursement; (2 CFE section 200.332xxi) (b) Evaluate each subrecipient’s risk of noncompliance with Federal statutes, regulations, and the terms and conditions of the subaward for purposes of determining the appropriate subrecipient monitoring described in paragraphs (d) and (e) of this section, which may include consideration of such factors as: (1) The subrecipient’s prior experience with the same or similar subawards; (2) The results of previous audits including whether or not the subrecipient receives a Single Audit in accordance with Subpart F of this part, and the extent to which the same or similar subaward has been audited as a major program; (3) Whether the subrecipient has new personnel or new or substantially changed systems; and (4) The extent and results of Federal awarding agency monitoring (e.g., if the subrecipient also receives Federal awards directly from a Federal awarding agency). Additionally, 45 CFR section 75 303(a) states the non Federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. Condition When subawards are made to subrecipients, the pass through entities are required to communicate the dollar amount made available under each Federal award and the Assistance Listings Number (ALN) at time of disbursement. BMC does not have system in place to provide the ALN at the time of disbursement of funds. During the year ended September 30, 2023, the BMC passed through $18,031,446 of federal funding to subrecipients. In order to assess the subrecipient’s risk of non compliance, BMC has subrecipient monitoring policies and procedures in place which include the use of a risk assessment questionnaire. The risk assessment questionnaire includes considerations consistent with 2 CFR 200.332(b), including the entity’s prior experience and results of Single Audits, in addition to other factors. As part of our testing related subrecipient monitoring, we identified the following: 1. For 4 of 16 subrecipients selected for testwork BMC did not perform a risk assessment of the entity for purposes of determining the appropriate subrecipient monitoring related to the subaward. However, for these subrecipients, BMC did perform monitoring procedures, including review of invoices for reimbursement, review of Research Performance Progress Reports and review of Single Audit reports. Cause The condition found was primarily due to the monitoring procedures implemented by BMC do not include a review to ensure that a risk assessment is performed for each active subrecipient and BMC does not have a mechanism in place to provide the ALN at the time of disbursement of funds to the subrecipient. Possible Asserted Effect Failure to perform an annual risk assessment to determine appropriate subrecipient monitoring procedures may result in insufficient monitoring procedures being performed to detect subrecipient noncompliance with Federal statutes, regulations, and the terms and conditions of the award. Failure to adequately communicate award identification information could result in the subrecipient not being able to adequately track and report the subawards received resulting in errors being reported on the schedule of expenditures of federal awards within a subrecipient’s annual single audit report and not being able to comply with required terms and conditions of the federal award. Questioned Costs None. Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Recommendation We recommend BMC implement policies, procedures, and internal controls to ensure subrecipient risk assessments are performed for each subrecipient to determine the appropriate subrecipient monitoring is performed in accordance with 45 CFR 75.352(d) and 45 CFR 75.352(e). We recommend that BMC enhance its processes and internal controls over its reporting to the subrecipients of the federal program to ensure all award identification information required under 45 CFR 75.352(a) is provided to the subrecipients.

FY End: 2023-09-30
Bmc Health System, Inc.
Compliance Requirement: M
Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaw...

Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaward modification. When some of this information is not available, the pass through entity must provide the best information available to describe the Federal award and subaward. Required information includes: (xii) Assistance Listings number and Title; the pass through entity must identify the dollar amount made available under each Federal award and the Assistance Listings Number at time of disbursement; (2 CFE section 200.332xxi) (b) Evaluate each subrecipient’s risk of noncompliance with Federal statutes, regulations, and the terms and conditions of the subaward for purposes of determining the appropriate subrecipient monitoring described in paragraphs (d) and (e) of this section, which may include consideration of such factors as: (1) The subrecipient’s prior experience with the same or similar subawards; (2) The results of previous audits including whether or not the subrecipient receives a Single Audit in accordance with Subpart F of this part, and the extent to which the same or similar subaward has been audited as a major program; (3) Whether the subrecipient has new personnel or new or substantially changed systems; and (4) The extent and results of Federal awarding agency monitoring (e.g., if the subrecipient also receives Federal awards directly from a Federal awarding agency). Additionally, 45 CFR section 75 303(a) states the non Federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. Condition When subawards are made to subrecipients, the pass through entities are required to communicate the dollar amount made available under each Federal award and the Assistance Listings Number (ALN) at time of disbursement. BMC does not have system in place to provide the ALN at the time of disbursement of funds. During the year ended September 30, 2023, the BMC passed through $18,031,446 of federal funding to subrecipients. In order to assess the subrecipient’s risk of non compliance, BMC has subrecipient monitoring policies and procedures in place which include the use of a risk assessment questionnaire. The risk assessment questionnaire includes considerations consistent with 2 CFR 200.332(b), including the entity’s prior experience and results of Single Audits, in addition to other factors. As part of our testing related subrecipient monitoring, we identified the following: 1. For 4 of 16 subrecipients selected for testwork BMC did not perform a risk assessment of the entity for purposes of determining the appropriate subrecipient monitoring related to the subaward. However, for these subrecipients, BMC did perform monitoring procedures, including review of invoices for reimbursement, review of Research Performance Progress Reports and review of Single Audit reports. Cause The condition found was primarily due to the monitoring procedures implemented by BMC do not include a review to ensure that a risk assessment is performed for each active subrecipient and BMC does not have a mechanism in place to provide the ALN at the time of disbursement of funds to the subrecipient. Possible Asserted Effect Failure to perform an annual risk assessment to determine appropriate subrecipient monitoring procedures may result in insufficient monitoring procedures being performed to detect subrecipient noncompliance with Federal statutes, regulations, and the terms and conditions of the award. Failure to adequately communicate award identification information could result in the subrecipient not being able to adequately track and report the subawards received resulting in errors being reported on the schedule of expenditures of federal awards within a subrecipient’s annual single audit report and not being able to comply with required terms and conditions of the federal award. Questioned Costs None. Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Recommendation We recommend BMC implement policies, procedures, and internal controls to ensure subrecipient risk assessments are performed for each subrecipient to determine the appropriate subrecipient monitoring is performed in accordance with 45 CFR 75.352(d) and 45 CFR 75.352(e). We recommend that BMC enhance its processes and internal controls over its reporting to the subrecipients of the federal program to ensure all award identification information required under 45 CFR 75.352(a) is provided to the subrecipients.

FY End: 2023-09-30
Bmc Health System, Inc.
Compliance Requirement: M
Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaw...

Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaward modification. When some of this information is not available, the pass through entity must provide the best information available to describe the Federal award and subaward. Required information includes: (xii) Assistance Listings number and Title; the pass through entity must identify the dollar amount made available under each Federal award and the Assistance Listings Number at time of disbursement; (2 CFE section 200.332xxi) (b) Evaluate each subrecipient’s risk of noncompliance with Federal statutes, regulations, and the terms and conditions of the subaward for purposes of determining the appropriate subrecipient monitoring described in paragraphs (d) and (e) of this section, which may include consideration of such factors as: (1) The subrecipient’s prior experience with the same or similar subawards; (2) The results of previous audits including whether or not the subrecipient receives a Single Audit in accordance with Subpart F of this part, and the extent to which the same or similar subaward has been audited as a major program; (3) Whether the subrecipient has new personnel or new or substantially changed systems; and (4) The extent and results of Federal awarding agency monitoring (e.g., if the subrecipient also receives Federal awards directly from a Federal awarding agency). Additionally, 45 CFR section 75 303(a) states the non Federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. Condition When subawards are made to subrecipients, the pass through entities are required to communicate the dollar amount made available under each Federal award and the Assistance Listings Number (ALN) at time of disbursement. BMC does not have system in place to provide the ALN at the time of disbursement of funds. During the year ended September 30, 2023, the BMC passed through $18,031,446 of federal funding to subrecipients. In order to assess the subrecipient’s risk of non compliance, BMC has subrecipient monitoring policies and procedures in place which include the use of a risk assessment questionnaire. The risk assessment questionnaire includes considerations consistent with 2 CFR 200.332(b), including the entity’s prior experience and results of Single Audits, in addition to other factors. As part of our testing related subrecipient monitoring, we identified the following: 1. For 4 of 16 subrecipients selected for testwork BMC did not perform a risk assessment of the entity for purposes of determining the appropriate subrecipient monitoring related to the subaward. However, for these subrecipients, BMC did perform monitoring procedures, including review of invoices for reimbursement, review of Research Performance Progress Reports and review of Single Audit reports. Cause The condition found was primarily due to the monitoring procedures implemented by BMC do not include a review to ensure that a risk assessment is performed for each active subrecipient and BMC does not have a mechanism in place to provide the ALN at the time of disbursement of funds to the subrecipient. Possible Asserted Effect Failure to perform an annual risk assessment to determine appropriate subrecipient monitoring procedures may result in insufficient monitoring procedures being performed to detect subrecipient noncompliance with Federal statutes, regulations, and the terms and conditions of the award. Failure to adequately communicate award identification information could result in the subrecipient not being able to adequately track and report the subawards received resulting in errors being reported on the schedule of expenditures of federal awards within a subrecipient’s annual single audit report and not being able to comply with required terms and conditions of the federal award. Questioned Costs None. Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Recommendation We recommend BMC implement policies, procedures, and internal controls to ensure subrecipient risk assessments are performed for each subrecipient to determine the appropriate subrecipient monitoring is performed in accordance with 45 CFR 75.352(d) and 45 CFR 75.352(e). We recommend that BMC enhance its processes and internal controls over its reporting to the subrecipients of the federal program to ensure all award identification information required under 45 CFR 75.352(a) is provided to the subrecipients.

FY End: 2023-09-30
Bmc Health System, Inc.
Compliance Requirement: M
Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaw...

Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaward modification. When some of this information is not available, the pass through entity must provide the best information available to describe the Federal award and subaward. Required information includes: (xii) Assistance Listings number and Title; the pass through entity must identify the dollar amount made available under each Federal award and the Assistance Listings Number at time of disbursement; (2 CFE section 200.332xxi) (b) Evaluate each subrecipient’s risk of noncompliance with Federal statutes, regulations, and the terms and conditions of the subaward for purposes of determining the appropriate subrecipient monitoring described in paragraphs (d) and (e) of this section, which may include consideration of such factors as: (1) The subrecipient’s prior experience with the same or similar subawards; (2) The results of previous audits including whether or not the subrecipient receives a Single Audit in accordance with Subpart F of this part, and the extent to which the same or similar subaward has been audited as a major program; (3) Whether the subrecipient has new personnel or new or substantially changed systems; and (4) The extent and results of Federal awarding agency monitoring (e.g., if the subrecipient also receives Federal awards directly from a Federal awarding agency). Additionally, 45 CFR section 75 303(a) states the non Federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. Condition When subawards are made to subrecipients, the pass through entities are required to communicate the dollar amount made available under each Federal award and the Assistance Listings Number (ALN) at time of disbursement. BMC does not have system in place to provide the ALN at the time of disbursement of funds. During the year ended September 30, 2023, the BMC passed through $18,031,446 of federal funding to subrecipients. In order to assess the subrecipient’s risk of non compliance, BMC has subrecipient monitoring policies and procedures in place which include the use of a risk assessment questionnaire. The risk assessment questionnaire includes considerations consistent with 2 CFR 200.332(b), including the entity’s prior experience and results of Single Audits, in addition to other factors. As part of our testing related subrecipient monitoring, we identified the following: 1. For 4 of 16 subrecipients selected for testwork BMC did not perform a risk assessment of the entity for purposes of determining the appropriate subrecipient monitoring related to the subaward. However, for these subrecipients, BMC did perform monitoring procedures, including review of invoices for reimbursement, review of Research Performance Progress Reports and review of Single Audit reports. Cause The condition found was primarily due to the monitoring procedures implemented by BMC do not include a review to ensure that a risk assessment is performed for each active subrecipient and BMC does not have a mechanism in place to provide the ALN at the time of disbursement of funds to the subrecipient. Possible Asserted Effect Failure to perform an annual risk assessment to determine appropriate subrecipient monitoring procedures may result in insufficient monitoring procedures being performed to detect subrecipient noncompliance with Federal statutes, regulations, and the terms and conditions of the award. Failure to adequately communicate award identification information could result in the subrecipient not being able to adequately track and report the subawards received resulting in errors being reported on the schedule of expenditures of federal awards within a subrecipient’s annual single audit report and not being able to comply with required terms and conditions of the federal award. Questioned Costs None. Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Recommendation We recommend BMC implement policies, procedures, and internal controls to ensure subrecipient risk assessments are performed for each subrecipient to determine the appropriate subrecipient monitoring is performed in accordance with 45 CFR 75.352(d) and 45 CFR 75.352(e). We recommend that BMC enhance its processes and internal controls over its reporting to the subrecipients of the federal program to ensure all award identification information required under 45 CFR 75.352(a) is provided to the subrecipients.

FY End: 2023-09-30
Bmc Health System, Inc.
Compliance Requirement: M
Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaw...

Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaward modification. When some of this information is not available, the pass through entity must provide the best information available to describe the Federal award and subaward. Required information includes: (xii) Assistance Listings number and Title; the pass through entity must identify the dollar amount made available under each Federal award and the Assistance Listings Number at time of disbursement; (2 CFE section 200.332xxi) (b) Evaluate each subrecipient’s risk of noncompliance with Federal statutes, regulations, and the terms and conditions of the subaward for purposes of determining the appropriate subrecipient monitoring described in paragraphs (d) and (e) of this section, which may include consideration of such factors as: (1) The subrecipient’s prior experience with the same or similar subawards; (2) The results of previous audits including whether or not the subrecipient receives a Single Audit in accordance with Subpart F of this part, and the extent to which the same or similar subaward has been audited as a major program; (3) Whether the subrecipient has new personnel or new or substantially changed systems; and (4) The extent and results of Federal awarding agency monitoring (e.g., if the subrecipient also receives Federal awards directly from a Federal awarding agency). Additionally, 45 CFR section 75 303(a) states the non Federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. Condition When subawards are made to subrecipients, the pass through entities are required to communicate the dollar amount made available under each Federal award and the Assistance Listings Number (ALN) at time of disbursement. BMC does not have system in place to provide the ALN at the time of disbursement of funds. During the year ended September 30, 2023, the BMC passed through $18,031,446 of federal funding to subrecipients. In order to assess the subrecipient’s risk of non compliance, BMC has subrecipient monitoring policies and procedures in place which include the use of a risk assessment questionnaire. The risk assessment questionnaire includes considerations consistent with 2 CFR 200.332(b), including the entity’s prior experience and results of Single Audits, in addition to other factors. As part of our testing related subrecipient monitoring, we identified the following: 1. For 4 of 16 subrecipients selected for testwork BMC did not perform a risk assessment of the entity for purposes of determining the appropriate subrecipient monitoring related to the subaward. However, for these subrecipients, BMC did perform monitoring procedures, including review of invoices for reimbursement, review of Research Performance Progress Reports and review of Single Audit reports. Cause The condition found was primarily due to the monitoring procedures implemented by BMC do not include a review to ensure that a risk assessment is performed for each active subrecipient and BMC does not have a mechanism in place to provide the ALN at the time of disbursement of funds to the subrecipient. Possible Asserted Effect Failure to perform an annual risk assessment to determine appropriate subrecipient monitoring procedures may result in insufficient monitoring procedures being performed to detect subrecipient noncompliance with Federal statutes, regulations, and the terms and conditions of the award. Failure to adequately communicate award identification information could result in the subrecipient not being able to adequately track and report the subawards received resulting in errors being reported on the schedule of expenditures of federal awards within a subrecipient’s annual single audit report and not being able to comply with required terms and conditions of the federal award. Questioned Costs None. Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Recommendation We recommend BMC implement policies, procedures, and internal controls to ensure subrecipient risk assessments are performed for each subrecipient to determine the appropriate subrecipient monitoring is performed in accordance with 45 CFR 75.352(d) and 45 CFR 75.352(e). We recommend that BMC enhance its processes and internal controls over its reporting to the subrecipients of the federal program to ensure all award identification information required under 45 CFR 75.352(a) is provided to the subrecipients.

FY End: 2023-09-30
Bmc Health System, Inc.
Compliance Requirement: M
Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaw...

Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaward modification. When some of this information is not available, the pass through entity must provide the best information available to describe the Federal award and subaward. Required information includes: (xii) Assistance Listings number and Title; the pass through entity must identify the dollar amount made available under each Federal award and the Assistance Listings Number at time of disbursement; (2 CFE section 200.332xxi) (b) Evaluate each subrecipient’s risk of noncompliance with Federal statutes, regulations, and the terms and conditions of the subaward for purposes of determining the appropriate subrecipient monitoring described in paragraphs (d) and (e) of this section, which may include consideration of such factors as: (1) The subrecipient’s prior experience with the same or similar subawards; (2) The results of previous audits including whether or not the subrecipient receives a Single Audit in accordance with Subpart F of this part, and the extent to which the same or similar subaward has been audited as a major program; (3) Whether the subrecipient has new personnel or new or substantially changed systems; and (4) The extent and results of Federal awarding agency monitoring (e.g., if the subrecipient also receives Federal awards directly from a Federal awarding agency). Additionally, 45 CFR section 75 303(a) states the non Federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. Condition When subawards are made to subrecipients, the pass through entities are required to communicate the dollar amount made available under each Federal award and the Assistance Listings Number (ALN) at time of disbursement. BMC does not have system in place to provide the ALN at the time of disbursement of funds. During the year ended September 30, 2023, the BMC passed through $18,031,446 of federal funding to subrecipients. In order to assess the subrecipient’s risk of non compliance, BMC has subrecipient monitoring policies and procedures in place which include the use of a risk assessment questionnaire. The risk assessment questionnaire includes considerations consistent with 2 CFR 200.332(b), including the entity’s prior experience and results of Single Audits, in addition to other factors. As part of our testing related subrecipient monitoring, we identified the following: 1. For 4 of 16 subrecipients selected for testwork BMC did not perform a risk assessment of the entity for purposes of determining the appropriate subrecipient monitoring related to the subaward. However, for these subrecipients, BMC did perform monitoring procedures, including review of invoices for reimbursement, review of Research Performance Progress Reports and review of Single Audit reports. Cause The condition found was primarily due to the monitoring procedures implemented by BMC do not include a review to ensure that a risk assessment is performed for each active subrecipient and BMC does not have a mechanism in place to provide the ALN at the time of disbursement of funds to the subrecipient. Possible Asserted Effect Failure to perform an annual risk assessment to determine appropriate subrecipient monitoring procedures may result in insufficient monitoring procedures being performed to detect subrecipient noncompliance with Federal statutes, regulations, and the terms and conditions of the award. Failure to adequately communicate award identification information could result in the subrecipient not being able to adequately track and report the subawards received resulting in errors being reported on the schedule of expenditures of federal awards within a subrecipient’s annual single audit report and not being able to comply with required terms and conditions of the federal award. Questioned Costs None. Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Recommendation We recommend BMC implement policies, procedures, and internal controls to ensure subrecipient risk assessments are performed for each subrecipient to determine the appropriate subrecipient monitoring is performed in accordance with 45 CFR 75.352(d) and 45 CFR 75.352(e). We recommend that BMC enhance its processes and internal controls over its reporting to the subrecipients of the federal program to ensure all award identification information required under 45 CFR 75.352(a) is provided to the subrecipients.

FY End: 2023-09-30
Bmc Health System, Inc.
Compliance Requirement: M
Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaw...

Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaward modification. When some of this information is not available, the pass through entity must provide the best information available to describe the Federal award and subaward. Required information includes: (xii) Assistance Listings number and Title; the pass through entity must identify the dollar amount made available under each Federal award and the Assistance Listings Number at time of disbursement; (2 CFE section 200.332xxi) (b) Evaluate each subrecipient’s risk of noncompliance with Federal statutes, regulations, and the terms and conditions of the subaward for purposes of determining the appropriate subrecipient monitoring described in paragraphs (d) and (e) of this section, which may include consideration of such factors as: (1) The subrecipient’s prior experience with the same or similar subawards; (2) The results of previous audits including whether or not the subrecipient receives a Single Audit in accordance with Subpart F of this part, and the extent to which the same or similar subaward has been audited as a major program; (3) Whether the subrecipient has new personnel or new or substantially changed systems; and (4) The extent and results of Federal awarding agency monitoring (e.g., if the subrecipient also receives Federal awards directly from a Federal awarding agency). Additionally, 45 CFR section 75 303(a) states the non Federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. Condition When subawards are made to subrecipients, the pass through entities are required to communicate the dollar amount made available under each Federal award and the Assistance Listings Number (ALN) at time of disbursement. BMC does not have system in place to provide the ALN at the time of disbursement of funds. During the year ended September 30, 2023, the BMC passed through $18,031,446 of federal funding to subrecipients. In order to assess the subrecipient’s risk of non compliance, BMC has subrecipient monitoring policies and procedures in place which include the use of a risk assessment questionnaire. The risk assessment questionnaire includes considerations consistent with 2 CFR 200.332(b), including the entity’s prior experience and results of Single Audits, in addition to other factors. As part of our testing related subrecipient monitoring, we identified the following: 1. For 4 of 16 subrecipients selected for testwork BMC did not perform a risk assessment of the entity for purposes of determining the appropriate subrecipient monitoring related to the subaward. However, for these subrecipients, BMC did perform monitoring procedures, including review of invoices for reimbursement, review of Research Performance Progress Reports and review of Single Audit reports. Cause The condition found was primarily due to the monitoring procedures implemented by BMC do not include a review to ensure that a risk assessment is performed for each active subrecipient and BMC does not have a mechanism in place to provide the ALN at the time of disbursement of funds to the subrecipient. Possible Asserted Effect Failure to perform an annual risk assessment to determine appropriate subrecipient monitoring procedures may result in insufficient monitoring procedures being performed to detect subrecipient noncompliance with Federal statutes, regulations, and the terms and conditions of the award. Failure to adequately communicate award identification information could result in the subrecipient not being able to adequately track and report the subawards received resulting in errors being reported on the schedule of expenditures of federal awards within a subrecipient’s annual single audit report and not being able to comply with required terms and conditions of the federal award. Questioned Costs None. Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Recommendation We recommend BMC implement policies, procedures, and internal controls to ensure subrecipient risk assessments are performed for each subrecipient to determine the appropriate subrecipient monitoring is performed in accordance with 45 CFR 75.352(d) and 45 CFR 75.352(e). We recommend that BMC enhance its processes and internal controls over its reporting to the subrecipients of the federal program to ensure all award identification information required under 45 CFR 75.352(a) is provided to the subrecipients.

FY End: 2023-09-30
Bmc Health System, Inc.
Compliance Requirement: M
Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaw...

Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaward modification. When some of this information is not available, the pass through entity must provide the best information available to describe the Federal award and subaward. Required information includes: (xii) Assistance Listings number and Title; the pass through entity must identify the dollar amount made available under each Federal award and the Assistance Listings Number at time of disbursement; (2 CFE section 200.332xxi) (b) Evaluate each subrecipient’s risk of noncompliance with Federal statutes, regulations, and the terms and conditions of the subaward for purposes of determining the appropriate subrecipient monitoring described in paragraphs (d) and (e) of this section, which may include consideration of such factors as: (1) The subrecipient’s prior experience with the same or similar subawards; (2) The results of previous audits including whether or not the subrecipient receives a Single Audit in accordance with Subpart F of this part, and the extent to which the same or similar subaward has been audited as a major program; (3) Whether the subrecipient has new personnel or new or substantially changed systems; and (4) The extent and results of Federal awarding agency monitoring (e.g., if the subrecipient also receives Federal awards directly from a Federal awarding agency). Additionally, 45 CFR section 75 303(a) states the non Federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. Condition When subawards are made to subrecipients, the pass through entities are required to communicate the dollar amount made available under each Federal award and the Assistance Listings Number (ALN) at time of disbursement. BMC does not have system in place to provide the ALN at the time of disbursement of funds. During the year ended September 30, 2023, the BMC passed through $18,031,446 of federal funding to subrecipients. In order to assess the subrecipient’s risk of non compliance, BMC has subrecipient monitoring policies and procedures in place which include the use of a risk assessment questionnaire. The risk assessment questionnaire includes considerations consistent with 2 CFR 200.332(b), including the entity’s prior experience and results of Single Audits, in addition to other factors. As part of our testing related subrecipient monitoring, we identified the following: 1. For 4 of 16 subrecipients selected for testwork BMC did not perform a risk assessment of the entity for purposes of determining the appropriate subrecipient monitoring related to the subaward. However, for these subrecipients, BMC did perform monitoring procedures, including review of invoices for reimbursement, review of Research Performance Progress Reports and review of Single Audit reports. Cause The condition found was primarily due to the monitoring procedures implemented by BMC do not include a review to ensure that a risk assessment is performed for each active subrecipient and BMC does not have a mechanism in place to provide the ALN at the time of disbursement of funds to the subrecipient. Possible Asserted Effect Failure to perform an annual risk assessment to determine appropriate subrecipient monitoring procedures may result in insufficient monitoring procedures being performed to detect subrecipient noncompliance with Federal statutes, regulations, and the terms and conditions of the award. Failure to adequately communicate award identification information could result in the subrecipient not being able to adequately track and report the subawards received resulting in errors being reported on the schedule of expenditures of federal awards within a subrecipient’s annual single audit report and not being able to comply with required terms and conditions of the federal award. Questioned Costs None. Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Recommendation We recommend BMC implement policies, procedures, and internal controls to ensure subrecipient risk assessments are performed for each subrecipient to determine the appropriate subrecipient monitoring is performed in accordance with 45 CFR 75.352(d) and 45 CFR 75.352(e). We recommend that BMC enhance its processes and internal controls over its reporting to the subrecipients of the federal program to ensure all award identification information required under 45 CFR 75.352(a) is provided to the subrecipients.

FY End: 2023-09-30
Bmc Health System, Inc.
Compliance Requirement: M
Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaw...

Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaward modification. When some of this information is not available, the pass through entity must provide the best information available to describe the Federal award and subaward. Required information includes: (xii) Assistance Listings number and Title; the pass through entity must identify the dollar amount made available under each Federal award and the Assistance Listings Number at time of disbursement; (2 CFE section 200.332xxi) (b) Evaluate each subrecipient’s risk of noncompliance with Federal statutes, regulations, and the terms and conditions of the subaward for purposes of determining the appropriate subrecipient monitoring described in paragraphs (d) and (e) of this section, which may include consideration of such factors as: (1) The subrecipient’s prior experience with the same or similar subawards; (2) The results of previous audits including whether or not the subrecipient receives a Single Audit in accordance with Subpart F of this part, and the extent to which the same or similar subaward has been audited as a major program; (3) Whether the subrecipient has new personnel or new or substantially changed systems; and (4) The extent and results of Federal awarding agency monitoring (e.g., if the subrecipient also receives Federal awards directly from a Federal awarding agency). Additionally, 45 CFR section 75 303(a) states the non Federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. Condition When subawards are made to subrecipients, the pass through entities are required to communicate the dollar amount made available under each Federal award and the Assistance Listings Number (ALN) at time of disbursement. BMC does not have system in place to provide the ALN at the time of disbursement of funds. During the year ended September 30, 2023, the BMC passed through $18,031,446 of federal funding to subrecipients. In order to assess the subrecipient’s risk of non compliance, BMC has subrecipient monitoring policies and procedures in place which include the use of a risk assessment questionnaire. The risk assessment questionnaire includes considerations consistent with 2 CFR 200.332(b), including the entity’s prior experience and results of Single Audits, in addition to other factors. As part of our testing related subrecipient monitoring, we identified the following: 1. For 4 of 16 subrecipients selected for testwork BMC did not perform a risk assessment of the entity for purposes of determining the appropriate subrecipient monitoring related to the subaward. However, for these subrecipients, BMC did perform monitoring procedures, including review of invoices for reimbursement, review of Research Performance Progress Reports and review of Single Audit reports. Cause The condition found was primarily due to the monitoring procedures implemented by BMC do not include a review to ensure that a risk assessment is performed for each active subrecipient and BMC does not have a mechanism in place to provide the ALN at the time of disbursement of funds to the subrecipient. Possible Asserted Effect Failure to perform an annual risk assessment to determine appropriate subrecipient monitoring procedures may result in insufficient monitoring procedures being performed to detect subrecipient noncompliance with Federal statutes, regulations, and the terms and conditions of the award. Failure to adequately communicate award identification information could result in the subrecipient not being able to adequately track and report the subawards received resulting in errors being reported on the schedule of expenditures of federal awards within a subrecipient’s annual single audit report and not being able to comply with required terms and conditions of the federal award. Questioned Costs None. Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Recommendation We recommend BMC implement policies, procedures, and internal controls to ensure subrecipient risk assessments are performed for each subrecipient to determine the appropriate subrecipient monitoring is performed in accordance with 45 CFR 75.352(d) and 45 CFR 75.352(e). We recommend that BMC enhance its processes and internal controls over its reporting to the subrecipients of the federal program to ensure all award identification information required under 45 CFR 75.352(a) is provided to the subrecipients.

FY End: 2023-09-30
Bmc Health System, Inc.
Compliance Requirement: M
Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaw...

Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaward modification. When some of this information is not available, the pass through entity must provide the best information available to describe the Federal award and subaward. Required information includes: (xii) Assistance Listings number and Title; the pass through entity must identify the dollar amount made available under each Federal award and the Assistance Listings Number at time of disbursement; (2 CFE section 200.332xxi) (b) Evaluate each subrecipient’s risk of noncompliance with Federal statutes, regulations, and the terms and conditions of the subaward for purposes of determining the appropriate subrecipient monitoring described in paragraphs (d) and (e) of this section, which may include consideration of such factors as: (1) The subrecipient’s prior experience with the same or similar subawards; (2) The results of previous audits including whether or not the subrecipient receives a Single Audit in accordance with Subpart F of this part, and the extent to which the same or similar subaward has been audited as a major program; (3) Whether the subrecipient has new personnel or new or substantially changed systems; and (4) The extent and results of Federal awarding agency monitoring (e.g., if the subrecipient also receives Federal awards directly from a Federal awarding agency). Additionally, 45 CFR section 75 303(a) states the non Federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. Condition When subawards are made to subrecipients, the pass through entities are required to communicate the dollar amount made available under each Federal award and the Assistance Listings Number (ALN) at time of disbursement. BMC does not have system in place to provide the ALN at the time of disbursement of funds. During the year ended September 30, 2023, the BMC passed through $18,031,446 of federal funding to subrecipients. In order to assess the subrecipient’s risk of non compliance, BMC has subrecipient monitoring policies and procedures in place which include the use of a risk assessment questionnaire. The risk assessment questionnaire includes considerations consistent with 2 CFR 200.332(b), including the entity’s prior experience and results of Single Audits, in addition to other factors. As part of our testing related subrecipient monitoring, we identified the following: 1. For 4 of 16 subrecipients selected for testwork BMC did not perform a risk assessment of the entity for purposes of determining the appropriate subrecipient monitoring related to the subaward. However, for these subrecipients, BMC did perform monitoring procedures, including review of invoices for reimbursement, review of Research Performance Progress Reports and review of Single Audit reports. Cause The condition found was primarily due to the monitoring procedures implemented by BMC do not include a review to ensure that a risk assessment is performed for each active subrecipient and BMC does not have a mechanism in place to provide the ALN at the time of disbursement of funds to the subrecipient. Possible Asserted Effect Failure to perform an annual risk assessment to determine appropriate subrecipient monitoring procedures may result in insufficient monitoring procedures being performed to detect subrecipient noncompliance with Federal statutes, regulations, and the terms and conditions of the award. Failure to adequately communicate award identification information could result in the subrecipient not being able to adequately track and report the subawards received resulting in errors being reported on the schedule of expenditures of federal awards within a subrecipient’s annual single audit report and not being able to comply with required terms and conditions of the federal award. Questioned Costs None. Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Recommendation We recommend BMC implement policies, procedures, and internal controls to ensure subrecipient risk assessments are performed for each subrecipient to determine the appropriate subrecipient monitoring is performed in accordance with 45 CFR 75.352(d) and 45 CFR 75.352(e). We recommend that BMC enhance its processes and internal controls over its reporting to the subrecipients of the federal program to ensure all award identification information required under 45 CFR 75.352(a) is provided to the subrecipients.

FY End: 2023-09-30
Bmc Health System, Inc.
Compliance Requirement: M
Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaw...

Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaward modification. When some of this information is not available, the pass through entity must provide the best information available to describe the Federal award and subaward. Required information includes: (xii) Assistance Listings number and Title; the pass through entity must identify the dollar amount made available under each Federal award and the Assistance Listings Number at time of disbursement; (2 CFE section 200.332xxi) (b) Evaluate each subrecipient’s risk of noncompliance with Federal statutes, regulations, and the terms and conditions of the subaward for purposes of determining the appropriate subrecipient monitoring described in paragraphs (d) and (e) of this section, which may include consideration of such factors as: (1) The subrecipient’s prior experience with the same or similar subawards; (2) The results of previous audits including whether or not the subrecipient receives a Single Audit in accordance with Subpart F of this part, and the extent to which the same or similar subaward has been audited as a major program; (3) Whether the subrecipient has new personnel or new or substantially changed systems; and (4) The extent and results of Federal awarding agency monitoring (e.g., if the subrecipient also receives Federal awards directly from a Federal awarding agency). Additionally, 45 CFR section 75 303(a) states the non Federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. Condition When subawards are made to subrecipients, the pass through entities are required to communicate the dollar amount made available under each Federal award and the Assistance Listings Number (ALN) at time of disbursement. BMC does not have system in place to provide the ALN at the time of disbursement of funds. During the year ended September 30, 2023, the BMC passed through $18,031,446 of federal funding to subrecipients. In order to assess the subrecipient’s risk of non compliance, BMC has subrecipient monitoring policies and procedures in place which include the use of a risk assessment questionnaire. The risk assessment questionnaire includes considerations consistent with 2 CFR 200.332(b), including the entity’s prior experience and results of Single Audits, in addition to other factors. As part of our testing related subrecipient monitoring, we identified the following: 1. For 4 of 16 subrecipients selected for testwork BMC did not perform a risk assessment of the entity for purposes of determining the appropriate subrecipient monitoring related to the subaward. However, for these subrecipients, BMC did perform monitoring procedures, including review of invoices for reimbursement, review of Research Performance Progress Reports and review of Single Audit reports. Cause The condition found was primarily due to the monitoring procedures implemented by BMC do not include a review to ensure that a risk assessment is performed for each active subrecipient and BMC does not have a mechanism in place to provide the ALN at the time of disbursement of funds to the subrecipient. Possible Asserted Effect Failure to perform an annual risk assessment to determine appropriate subrecipient monitoring procedures may result in insufficient monitoring procedures being performed to detect subrecipient noncompliance with Federal statutes, regulations, and the terms and conditions of the award. Failure to adequately communicate award identification information could result in the subrecipient not being able to adequately track and report the subawards received resulting in errors being reported on the schedule of expenditures of federal awards within a subrecipient’s annual single audit report and not being able to comply with required terms and conditions of the federal award. Questioned Costs None. Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Recommendation We recommend BMC implement policies, procedures, and internal controls to ensure subrecipient risk assessments are performed for each subrecipient to determine the appropriate subrecipient monitoring is performed in accordance with 45 CFR 75.352(d) and 45 CFR 75.352(e). We recommend that BMC enhance its processes and internal controls over its reporting to the subrecipients of the federal program to ensure all award identification information required under 45 CFR 75.352(a) is provided to the subrecipients.

FY End: 2023-09-30
Bmc Health System, Inc.
Compliance Requirement: M
Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaw...

Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaward modification. When some of this information is not available, the pass through entity must provide the best information available to describe the Federal award and subaward. Required information includes: (xii) Assistance Listings number and Title; the pass through entity must identify the dollar amount made available under each Federal award and the Assistance Listings Number at time of disbursement; (2 CFE section 200.332xxi) (b) Evaluate each subrecipient’s risk of noncompliance with Federal statutes, regulations, and the terms and conditions of the subaward for purposes of determining the appropriate subrecipient monitoring described in paragraphs (d) and (e) of this section, which may include consideration of such factors as: (1) The subrecipient’s prior experience with the same or similar subawards; (2) The results of previous audits including whether or not the subrecipient receives a Single Audit in accordance with Subpart F of this part, and the extent to which the same or similar subaward has been audited as a major program; (3) Whether the subrecipient has new personnel or new or substantially changed systems; and (4) The extent and results of Federal awarding agency monitoring (e.g., if the subrecipient also receives Federal awards directly from a Federal awarding agency). Additionally, 45 CFR section 75 303(a) states the non Federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. Condition When subawards are made to subrecipients, the pass through entities are required to communicate the dollar amount made available under each Federal award and the Assistance Listings Number (ALN) at time of disbursement. BMC does not have system in place to provide the ALN at the time of disbursement of funds. During the year ended September 30, 2023, the BMC passed through $18,031,446 of federal funding to subrecipients. In order to assess the subrecipient’s risk of non compliance, BMC has subrecipient monitoring policies and procedures in place which include the use of a risk assessment questionnaire. The risk assessment questionnaire includes considerations consistent with 2 CFR 200.332(b), including the entity’s prior experience and results of Single Audits, in addition to other factors. As part of our testing related subrecipient monitoring, we identified the following: 1. For 4 of 16 subrecipients selected for testwork BMC did not perform a risk assessment of the entity for purposes of determining the appropriate subrecipient monitoring related to the subaward. However, for these subrecipients, BMC did perform monitoring procedures, including review of invoices for reimbursement, review of Research Performance Progress Reports and review of Single Audit reports. Cause The condition found was primarily due to the monitoring procedures implemented by BMC do not include a review to ensure that a risk assessment is performed for each active subrecipient and BMC does not have a mechanism in place to provide the ALN at the time of disbursement of funds to the subrecipient. Possible Asserted Effect Failure to perform an annual risk assessment to determine appropriate subrecipient monitoring procedures may result in insufficient monitoring procedures being performed to detect subrecipient noncompliance with Federal statutes, regulations, and the terms and conditions of the award. Failure to adequately communicate award identification information could result in the subrecipient not being able to adequately track and report the subawards received resulting in errors being reported on the schedule of expenditures of federal awards within a subrecipient’s annual single audit report and not being able to comply with required terms and conditions of the federal award. Questioned Costs None. Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Recommendation We recommend BMC implement policies, procedures, and internal controls to ensure subrecipient risk assessments are performed for each subrecipient to determine the appropriate subrecipient monitoring is performed in accordance with 45 CFR 75.352(d) and 45 CFR 75.352(e). We recommend that BMC enhance its processes and internal controls over its reporting to the subrecipients of the federal program to ensure all award identification information required under 45 CFR 75.352(a) is provided to the subrecipients.

FY End: 2023-09-30
Bmc Health System, Inc.
Compliance Requirement: M
Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaw...

Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaward modification. When some of this information is not available, the pass through entity must provide the best information available to describe the Federal award and subaward. Required information includes: (xii) Assistance Listings number and Title; the pass through entity must identify the dollar amount made available under each Federal award and the Assistance Listings Number at time of disbursement; (2 CFE section 200.332xxi) (b) Evaluate each subrecipient’s risk of noncompliance with Federal statutes, regulations, and the terms and conditions of the subaward for purposes of determining the appropriate subrecipient monitoring described in paragraphs (d) and (e) of this section, which may include consideration of such factors as: (1) The subrecipient’s prior experience with the same or similar subawards; (2) The results of previous audits including whether or not the subrecipient receives a Single Audit in accordance with Subpart F of this part, and the extent to which the same or similar subaward has been audited as a major program; (3) Whether the subrecipient has new personnel or new or substantially changed systems; and (4) The extent and results of Federal awarding agency monitoring (e.g., if the subrecipient also receives Federal awards directly from a Federal awarding agency). Additionally, 45 CFR section 75 303(a) states the non Federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. Condition When subawards are made to subrecipients, the pass through entities are required to communicate the dollar amount made available under each Federal award and the Assistance Listings Number (ALN) at time of disbursement. BMC does not have system in place to provide the ALN at the time of disbursement of funds. During the year ended September 30, 2023, the BMC passed through $18,031,446 of federal funding to subrecipients. In order to assess the subrecipient’s risk of non compliance, BMC has subrecipient monitoring policies and procedures in place which include the use of a risk assessment questionnaire. The risk assessment questionnaire includes considerations consistent with 2 CFR 200.332(b), including the entity’s prior experience and results of Single Audits, in addition to other factors. As part of our testing related subrecipient monitoring, we identified the following: 1. For 4 of 16 subrecipients selected for testwork BMC did not perform a risk assessment of the entity for purposes of determining the appropriate subrecipient monitoring related to the subaward. However, for these subrecipients, BMC did perform monitoring procedures, including review of invoices for reimbursement, review of Research Performance Progress Reports and review of Single Audit reports. Cause The condition found was primarily due to the monitoring procedures implemented by BMC do not include a review to ensure that a risk assessment is performed for each active subrecipient and BMC does not have a mechanism in place to provide the ALN at the time of disbursement of funds to the subrecipient. Possible Asserted Effect Failure to perform an annual risk assessment to determine appropriate subrecipient monitoring procedures may result in insufficient monitoring procedures being performed to detect subrecipient noncompliance with Federal statutes, regulations, and the terms and conditions of the award. Failure to adequately communicate award identification information could result in the subrecipient not being able to adequately track and report the subawards received resulting in errors being reported on the schedule of expenditures of federal awards within a subrecipient’s annual single audit report and not being able to comply with required terms and conditions of the federal award. Questioned Costs None. Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Recommendation We recommend BMC implement policies, procedures, and internal controls to ensure subrecipient risk assessments are performed for each subrecipient to determine the appropriate subrecipient monitoring is performed in accordance with 45 CFR 75.352(d) and 45 CFR 75.352(e). We recommend that BMC enhance its processes and internal controls over its reporting to the subrecipients of the federal program to ensure all award identification information required under 45 CFR 75.352(a) is provided to the subrecipients.

FY End: 2023-09-30
Bmc Health System, Inc.
Compliance Requirement: M
Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaw...

Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaward modification. When some of this information is not available, the pass through entity must provide the best information available to describe the Federal award and subaward. Required information includes: (xii) Assistance Listings number and Title; the pass through entity must identify the dollar amount made available under each Federal award and the Assistance Listings Number at time of disbursement; (2 CFE section 200.332xxi) (b) Evaluate each subrecipient’s risk of noncompliance with Federal statutes, regulations, and the terms and conditions of the subaward for purposes of determining the appropriate subrecipient monitoring described in paragraphs (d) and (e) of this section, which may include consideration of such factors as: (1) The subrecipient’s prior experience with the same or similar subawards; (2) The results of previous audits including whether or not the subrecipient receives a Single Audit in accordance with Subpart F of this part, and the extent to which the same or similar subaward has been audited as a major program; (3) Whether the subrecipient has new personnel or new or substantially changed systems; and (4) The extent and results of Federal awarding agency monitoring (e.g., if the subrecipient also receives Federal awards directly from a Federal awarding agency). Additionally, 45 CFR section 75 303(a) states the non Federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. Condition When subawards are made to subrecipients, the pass through entities are required to communicate the dollar amount made available under each Federal award and the Assistance Listings Number (ALN) at time of disbursement. BMC does not have system in place to provide the ALN at the time of disbursement of funds. During the year ended September 30, 2023, the BMC passed through $18,031,446 of federal funding to subrecipients. In order to assess the subrecipient’s risk of non compliance, BMC has subrecipient monitoring policies and procedures in place which include the use of a risk assessment questionnaire. The risk assessment questionnaire includes considerations consistent with 2 CFR 200.332(b), including the entity’s prior experience and results of Single Audits, in addition to other factors. As part of our testing related subrecipient monitoring, we identified the following: 1. For 4 of 16 subrecipients selected for testwork BMC did not perform a risk assessment of the entity for purposes of determining the appropriate subrecipient monitoring related to the subaward. However, for these subrecipients, BMC did perform monitoring procedures, including review of invoices for reimbursement, review of Research Performance Progress Reports and review of Single Audit reports. Cause The condition found was primarily due to the monitoring procedures implemented by BMC do not include a review to ensure that a risk assessment is performed for each active subrecipient and BMC does not have a mechanism in place to provide the ALN at the time of disbursement of funds to the subrecipient. Possible Asserted Effect Failure to perform an annual risk assessment to determine appropriate subrecipient monitoring procedures may result in insufficient monitoring procedures being performed to detect subrecipient noncompliance with Federal statutes, regulations, and the terms and conditions of the award. Failure to adequately communicate award identification information could result in the subrecipient not being able to adequately track and report the subawards received resulting in errors being reported on the schedule of expenditures of federal awards within a subrecipient’s annual single audit report and not being able to comply with required terms and conditions of the federal award. Questioned Costs None. Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Recommendation We recommend BMC implement policies, procedures, and internal controls to ensure subrecipient risk assessments are performed for each subrecipient to determine the appropriate subrecipient monitoring is performed in accordance with 45 CFR 75.352(d) and 45 CFR 75.352(e). We recommend that BMC enhance its processes and internal controls over its reporting to the subrecipients of the federal program to ensure all award identification information required under 45 CFR 75.352(a) is provided to the subrecipients.

FY End: 2023-09-30
Bmc Health System, Inc.
Compliance Requirement: M
Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaw...

Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaward modification. When some of this information is not available, the pass through entity must provide the best information available to describe the Federal award and subaward. Required information includes: (xii) Assistance Listings number and Title; the pass through entity must identify the dollar amount made available under each Federal award and the Assistance Listings Number at time of disbursement; (2 CFE section 200.332xxi) (b) Evaluate each subrecipient’s risk of noncompliance with Federal statutes, regulations, and the terms and conditions of the subaward for purposes of determining the appropriate subrecipient monitoring described in paragraphs (d) and (e) of this section, which may include consideration of such factors as: (1) The subrecipient’s prior experience with the same or similar subawards; (2) The results of previous audits including whether or not the subrecipient receives a Single Audit in accordance with Subpart F of this part, and the extent to which the same or similar subaward has been audited as a major program; (3) Whether the subrecipient has new personnel or new or substantially changed systems; and (4) The extent and results of Federal awarding agency monitoring (e.g., if the subrecipient also receives Federal awards directly from a Federal awarding agency). Additionally, 45 CFR section 75 303(a) states the non Federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. Condition When subawards are made to subrecipients, the pass through entities are required to communicate the dollar amount made available under each Federal award and the Assistance Listings Number (ALN) at time of disbursement. BMC does not have system in place to provide the ALN at the time of disbursement of funds. During the year ended September 30, 2023, the BMC passed through $18,031,446 of federal funding to subrecipients. In order to assess the subrecipient’s risk of non compliance, BMC has subrecipient monitoring policies and procedures in place which include the use of a risk assessment questionnaire. The risk assessment questionnaire includes considerations consistent with 2 CFR 200.332(b), including the entity’s prior experience and results of Single Audits, in addition to other factors. As part of our testing related subrecipient monitoring, we identified the following: 1. For 4 of 16 subrecipients selected for testwork BMC did not perform a risk assessment of the entity for purposes of determining the appropriate subrecipient monitoring related to the subaward. However, for these subrecipients, BMC did perform monitoring procedures, including review of invoices for reimbursement, review of Research Performance Progress Reports and review of Single Audit reports. Cause The condition found was primarily due to the monitoring procedures implemented by BMC do not include a review to ensure that a risk assessment is performed for each active subrecipient and BMC does not have a mechanism in place to provide the ALN at the time of disbursement of funds to the subrecipient. Possible Asserted Effect Failure to perform an annual risk assessment to determine appropriate subrecipient monitoring procedures may result in insufficient monitoring procedures being performed to detect subrecipient noncompliance with Federal statutes, regulations, and the terms and conditions of the award. Failure to adequately communicate award identification information could result in the subrecipient not being able to adequately track and report the subawards received resulting in errors being reported on the schedule of expenditures of federal awards within a subrecipient’s annual single audit report and not being able to comply with required terms and conditions of the federal award. Questioned Costs None. Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Recommendation We recommend BMC implement policies, procedures, and internal controls to ensure subrecipient risk assessments are performed for each subrecipient to determine the appropriate subrecipient monitoring is performed in accordance with 45 CFR 75.352(d) and 45 CFR 75.352(e). We recommend that BMC enhance its processes and internal controls over its reporting to the subrecipients of the federal program to ensure all award identification information required under 45 CFR 75.352(a) is provided to the subrecipients.

FY End: 2023-09-30
Bmc Health System, Inc.
Compliance Requirement: M
Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaw...

Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaward modification. When some of this information is not available, the pass through entity must provide the best information available to describe the Federal award and subaward. Required information includes: (xii) Assistance Listings number and Title; the pass through entity must identify the dollar amount made available under each Federal award and the Assistance Listings Number at time of disbursement; (2 CFE section 200.332xxi) (b) Evaluate each subrecipient’s risk of noncompliance with Federal statutes, regulations, and the terms and conditions of the subaward for purposes of determining the appropriate subrecipient monitoring described in paragraphs (d) and (e) of this section, which may include consideration of such factors as: (1) The subrecipient’s prior experience with the same or similar subawards; (2) The results of previous audits including whether or not the subrecipient receives a Single Audit in accordance with Subpart F of this part, and the extent to which the same or similar subaward has been audited as a major program; (3) Whether the subrecipient has new personnel or new or substantially changed systems; and (4) The extent and results of Federal awarding agency monitoring (e.g., if the subrecipient also receives Federal awards directly from a Federal awarding agency). Additionally, 45 CFR section 75 303(a) states the non Federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. Condition When subawards are made to subrecipients, the pass through entities are required to communicate the dollar amount made available under each Federal award and the Assistance Listings Number (ALN) at time of disbursement. BMC does not have system in place to provide the ALN at the time of disbursement of funds. During the year ended September 30, 2023, the BMC passed through $18,031,446 of federal funding to subrecipients. In order to assess the subrecipient’s risk of non compliance, BMC has subrecipient monitoring policies and procedures in place which include the use of a risk assessment questionnaire. The risk assessment questionnaire includes considerations consistent with 2 CFR 200.332(b), including the entity’s prior experience and results of Single Audits, in addition to other factors. As part of our testing related subrecipient monitoring, we identified the following: 1. For 4 of 16 subrecipients selected for testwork BMC did not perform a risk assessment of the entity for purposes of determining the appropriate subrecipient monitoring related to the subaward. However, for these subrecipients, BMC did perform monitoring procedures, including review of invoices for reimbursement, review of Research Performance Progress Reports and review of Single Audit reports. Cause The condition found was primarily due to the monitoring procedures implemented by BMC do not include a review to ensure that a risk assessment is performed for each active subrecipient and BMC does not have a mechanism in place to provide the ALN at the time of disbursement of funds to the subrecipient. Possible Asserted Effect Failure to perform an annual risk assessment to determine appropriate subrecipient monitoring procedures may result in insufficient monitoring procedures being performed to detect subrecipient noncompliance with Federal statutes, regulations, and the terms and conditions of the award. Failure to adequately communicate award identification information could result in the subrecipient not being able to adequately track and report the subawards received resulting in errors being reported on the schedule of expenditures of federal awards within a subrecipient’s annual single audit report and not being able to comply with required terms and conditions of the federal award. Questioned Costs None. Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Recommendation We recommend BMC implement policies, procedures, and internal controls to ensure subrecipient risk assessments are performed for each subrecipient to determine the appropriate subrecipient monitoring is performed in accordance with 45 CFR 75.352(d) and 45 CFR 75.352(e). We recommend that BMC enhance its processes and internal controls over its reporting to the subrecipients of the federal program to ensure all award identification information required under 45 CFR 75.352(a) is provided to the subrecipients.

FY End: 2023-09-30
Bmc Health System, Inc.
Compliance Requirement: M
Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaw...

Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaward modification. When some of this information is not available, the pass through entity must provide the best information available to describe the Federal award and subaward. Required information includes: (xii) Assistance Listings number and Title; the pass through entity must identify the dollar amount made available under each Federal award and the Assistance Listings Number at time of disbursement; (2 CFE section 200.332xxi) (b) Evaluate each subrecipient’s risk of noncompliance with Federal statutes, regulations, and the terms and conditions of the subaward for purposes of determining the appropriate subrecipient monitoring described in paragraphs (d) and (e) of this section, which may include consideration of such factors as: (1) The subrecipient’s prior experience with the same or similar subawards; (2) The results of previous audits including whether or not the subrecipient receives a Single Audit in accordance with Subpart F of this part, and the extent to which the same or similar subaward has been audited as a major program; (3) Whether the subrecipient has new personnel or new or substantially changed systems; and (4) The extent and results of Federal awarding agency monitoring (e.g., if the subrecipient also receives Federal awards directly from a Federal awarding agency). Additionally, 45 CFR section 75 303(a) states the non Federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. Condition When subawards are made to subrecipients, the pass through entities are required to communicate the dollar amount made available under each Federal award and the Assistance Listings Number (ALN) at time of disbursement. BMC does not have system in place to provide the ALN at the time of disbursement of funds. During the year ended September 30, 2023, the BMC passed through $18,031,446 of federal funding to subrecipients. In order to assess the subrecipient’s risk of non compliance, BMC has subrecipient monitoring policies and procedures in place which include the use of a risk assessment questionnaire. The risk assessment questionnaire includes considerations consistent with 2 CFR 200.332(b), including the entity’s prior experience and results of Single Audits, in addition to other factors. As part of our testing related subrecipient monitoring, we identified the following: 1. For 4 of 16 subrecipients selected for testwork BMC did not perform a risk assessment of the entity for purposes of determining the appropriate subrecipient monitoring related to the subaward. However, for these subrecipients, BMC did perform monitoring procedures, including review of invoices for reimbursement, review of Research Performance Progress Reports and review of Single Audit reports. Cause The condition found was primarily due to the monitoring procedures implemented by BMC do not include a review to ensure that a risk assessment is performed for each active subrecipient and BMC does not have a mechanism in place to provide the ALN at the time of disbursement of funds to the subrecipient. Possible Asserted Effect Failure to perform an annual risk assessment to determine appropriate subrecipient monitoring procedures may result in insufficient monitoring procedures being performed to detect subrecipient noncompliance with Federal statutes, regulations, and the terms and conditions of the award. Failure to adequately communicate award identification information could result in the subrecipient not being able to adequately track and report the subawards received resulting in errors being reported on the schedule of expenditures of federal awards within a subrecipient’s annual single audit report and not being able to comply with required terms and conditions of the federal award. Questioned Costs None. Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Recommendation We recommend BMC implement policies, procedures, and internal controls to ensure subrecipient risk assessments are performed for each subrecipient to determine the appropriate subrecipient monitoring is performed in accordance with 45 CFR 75.352(d) and 45 CFR 75.352(e). We recommend that BMC enhance its processes and internal controls over its reporting to the subrecipients of the federal program to ensure all award identification information required under 45 CFR 75.352(a) is provided to the subrecipients.

FY End: 2023-09-30
Bmc Health System, Inc.
Compliance Requirement: M
Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaw...

Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaward modification. When some of this information is not available, the pass through entity must provide the best information available to describe the Federal award and subaward. Required information includes: (xii) Assistance Listings number and Title; the pass through entity must identify the dollar amount made available under each Federal award and the Assistance Listings Number at time of disbursement; (2 CFE section 200.332xxi) (b) Evaluate each subrecipient’s risk of noncompliance with Federal statutes, regulations, and the terms and conditions of the subaward for purposes of determining the appropriate subrecipient monitoring described in paragraphs (d) and (e) of this section, which may include consideration of such factors as: (1) The subrecipient’s prior experience with the same or similar subawards; (2) The results of previous audits including whether or not the subrecipient receives a Single Audit in accordance with Subpart F of this part, and the extent to which the same or similar subaward has been audited as a major program; (3) Whether the subrecipient has new personnel or new or substantially changed systems; and (4) The extent and results of Federal awarding agency monitoring (e.g., if the subrecipient also receives Federal awards directly from a Federal awarding agency). Additionally, 45 CFR section 75 303(a) states the non Federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. Condition When subawards are made to subrecipients, the pass through entities are required to communicate the dollar amount made available under each Federal award and the Assistance Listings Number (ALN) at time of disbursement. BMC does not have system in place to provide the ALN at the time of disbursement of funds. During the year ended September 30, 2023, the BMC passed through $18,031,446 of federal funding to subrecipients. In order to assess the subrecipient’s risk of non compliance, BMC has subrecipient monitoring policies and procedures in place which include the use of a risk assessment questionnaire. The risk assessment questionnaire includes considerations consistent with 2 CFR 200.332(b), including the entity’s prior experience and results of Single Audits, in addition to other factors. As part of our testing related subrecipient monitoring, we identified the following: 1. For 4 of 16 subrecipients selected for testwork BMC did not perform a risk assessment of the entity for purposes of determining the appropriate subrecipient monitoring related to the subaward. However, for these subrecipients, BMC did perform monitoring procedures, including review of invoices for reimbursement, review of Research Performance Progress Reports and review of Single Audit reports. Cause The condition found was primarily due to the monitoring procedures implemented by BMC do not include a review to ensure that a risk assessment is performed for each active subrecipient and BMC does not have a mechanism in place to provide the ALN at the time of disbursement of funds to the subrecipient. Possible Asserted Effect Failure to perform an annual risk assessment to determine appropriate subrecipient monitoring procedures may result in insufficient monitoring procedures being performed to detect subrecipient noncompliance with Federal statutes, regulations, and the terms and conditions of the award. Failure to adequately communicate award identification information could result in the subrecipient not being able to adequately track and report the subawards received resulting in errors being reported on the schedule of expenditures of federal awards within a subrecipient’s annual single audit report and not being able to comply with required terms and conditions of the federal award. Questioned Costs None. Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Recommendation We recommend BMC implement policies, procedures, and internal controls to ensure subrecipient risk assessments are performed for each subrecipient to determine the appropriate subrecipient monitoring is performed in accordance with 45 CFR 75.352(d) and 45 CFR 75.352(e). We recommend that BMC enhance its processes and internal controls over its reporting to the subrecipients of the federal program to ensure all award identification information required under 45 CFR 75.352(a) is provided to the subrecipients.

FY End: 2023-09-30
Bmc Health System, Inc.
Compliance Requirement: M
Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaw...

Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaward modification. When some of this information is not available, the pass through entity must provide the best information available to describe the Federal award and subaward. Required information includes: (xii) Assistance Listings number and Title; the pass through entity must identify the dollar amount made available under each Federal award and the Assistance Listings Number at time of disbursement; (2 CFE section 200.332xxi) (b) Evaluate each subrecipient’s risk of noncompliance with Federal statutes, regulations, and the terms and conditions of the subaward for purposes of determining the appropriate subrecipient monitoring described in paragraphs (d) and (e) of this section, which may include consideration of such factors as: (1) The subrecipient’s prior experience with the same or similar subawards; (2) The results of previous audits including whether or not the subrecipient receives a Single Audit in accordance with Subpart F of this part, and the extent to which the same or similar subaward has been audited as a major program; (3) Whether the subrecipient has new personnel or new or substantially changed systems; and (4) The extent and results of Federal awarding agency monitoring (e.g., if the subrecipient also receives Federal awards directly from a Federal awarding agency). Additionally, 45 CFR section 75 303(a) states the non Federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. Condition When subawards are made to subrecipients, the pass through entities are required to communicate the dollar amount made available under each Federal award and the Assistance Listings Number (ALN) at time of disbursement. BMC does not have system in place to provide the ALN at the time of disbursement of funds. During the year ended September 30, 2023, the BMC passed through $18,031,446 of federal funding to subrecipients. In order to assess the subrecipient’s risk of non compliance, BMC has subrecipient monitoring policies and procedures in place which include the use of a risk assessment questionnaire. The risk assessment questionnaire includes considerations consistent with 2 CFR 200.332(b), including the entity’s prior experience and results of Single Audits, in addition to other factors. As part of our testing related subrecipient monitoring, we identified the following: 1. For 4 of 16 subrecipients selected for testwork BMC did not perform a risk assessment of the entity for purposes of determining the appropriate subrecipient monitoring related to the subaward. However, for these subrecipients, BMC did perform monitoring procedures, including review of invoices for reimbursement, review of Research Performance Progress Reports and review of Single Audit reports. Cause The condition found was primarily due to the monitoring procedures implemented by BMC do not include a review to ensure that a risk assessment is performed for each active subrecipient and BMC does not have a mechanism in place to provide the ALN at the time of disbursement of funds to the subrecipient. Possible Asserted Effect Failure to perform an annual risk assessment to determine appropriate subrecipient monitoring procedures may result in insufficient monitoring procedures being performed to detect subrecipient noncompliance with Federal statutes, regulations, and the terms and conditions of the award. Failure to adequately communicate award identification information could result in the subrecipient not being able to adequately track and report the subawards received resulting in errors being reported on the schedule of expenditures of federal awards within a subrecipient’s annual single audit report and not being able to comply with required terms and conditions of the federal award. Questioned Costs None. Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Recommendation We recommend BMC implement policies, procedures, and internal controls to ensure subrecipient risk assessments are performed for each subrecipient to determine the appropriate subrecipient monitoring is performed in accordance with 45 CFR 75.352(d) and 45 CFR 75.352(e). We recommend that BMC enhance its processes and internal controls over its reporting to the subrecipients of the federal program to ensure all award identification information required under 45 CFR 75.352(a) is provided to the subrecipients.

FY End: 2023-09-30
Bmc Health System, Inc.
Compliance Requirement: M
Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaw...

Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaward modification. When some of this information is not available, the pass through entity must provide the best information available to describe the Federal award and subaward. Required information includes: (xii) Assistance Listings number and Title; the pass through entity must identify the dollar amount made available under each Federal award and the Assistance Listings Number at time of disbursement; (2 CFE section 200.332xxi) (b) Evaluate each subrecipient’s risk of noncompliance with Federal statutes, regulations, and the terms and conditions of the subaward for purposes of determining the appropriate subrecipient monitoring described in paragraphs (d) and (e) of this section, which may include consideration of such factors as: (1) The subrecipient’s prior experience with the same or similar subawards; (2) The results of previous audits including whether or not the subrecipient receives a Single Audit in accordance with Subpart F of this part, and the extent to which the same or similar subaward has been audited as a major program; (3) Whether the subrecipient has new personnel or new or substantially changed systems; and (4) The extent and results of Federal awarding agency monitoring (e.g., if the subrecipient also receives Federal awards directly from a Federal awarding agency). Additionally, 45 CFR section 75 303(a) states the non Federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. Condition When subawards are made to subrecipients, the pass through entities are required to communicate the dollar amount made available under each Federal award and the Assistance Listings Number (ALN) at time of disbursement. BMC does not have system in place to provide the ALN at the time of disbursement of funds. During the year ended September 30, 2023, the BMC passed through $18,031,446 of federal funding to subrecipients. In order to assess the subrecipient’s risk of non compliance, BMC has subrecipient monitoring policies and procedures in place which include the use of a risk assessment questionnaire. The risk assessment questionnaire includes considerations consistent with 2 CFR 200.332(b), including the entity’s prior experience and results of Single Audits, in addition to other factors. As part of our testing related subrecipient monitoring, we identified the following: 1. For 4 of 16 subrecipients selected for testwork BMC did not perform a risk assessment of the entity for purposes of determining the appropriate subrecipient monitoring related to the subaward. However, for these subrecipients, BMC did perform monitoring procedures, including review of invoices for reimbursement, review of Research Performance Progress Reports and review of Single Audit reports. Cause The condition found was primarily due to the monitoring procedures implemented by BMC do not include a review to ensure that a risk assessment is performed for each active subrecipient and BMC does not have a mechanism in place to provide the ALN at the time of disbursement of funds to the subrecipient. Possible Asserted Effect Failure to perform an annual risk assessment to determine appropriate subrecipient monitoring procedures may result in insufficient monitoring procedures being performed to detect subrecipient noncompliance with Federal statutes, regulations, and the terms and conditions of the award. Failure to adequately communicate award identification information could result in the subrecipient not being able to adequately track and report the subawards received resulting in errors being reported on the schedule of expenditures of federal awards within a subrecipient’s annual single audit report and not being able to comply with required terms and conditions of the federal award. Questioned Costs None. Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Recommendation We recommend BMC implement policies, procedures, and internal controls to ensure subrecipient risk assessments are performed for each subrecipient to determine the appropriate subrecipient monitoring is performed in accordance with 45 CFR 75.352(d) and 45 CFR 75.352(e). We recommend that BMC enhance its processes and internal controls over its reporting to the subrecipients of the federal program to ensure all award identification information required under 45 CFR 75.352(a) is provided to the subrecipients.

FY End: 2023-09-30
Bmc Health System, Inc.
Compliance Requirement: M
Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaw...

Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaward modification. When some of this information is not available, the pass through entity must provide the best information available to describe the Federal award and subaward. Required information includes: (xii) Assistance Listings number and Title; the pass through entity must identify the dollar amount made available under each Federal award and the Assistance Listings Number at time of disbursement; (2 CFE section 200.332xxi) (b) Evaluate each subrecipient’s risk of noncompliance with Federal statutes, regulations, and the terms and conditions of the subaward for purposes of determining the appropriate subrecipient monitoring described in paragraphs (d) and (e) of this section, which may include consideration of such factors as: (1) The subrecipient’s prior experience with the same or similar subawards; (2) The results of previous audits including whether or not the subrecipient receives a Single Audit in accordance with Subpart F of this part, and the extent to which the same or similar subaward has been audited as a major program; (3) Whether the subrecipient has new personnel or new or substantially changed systems; and (4) The extent and results of Federal awarding agency monitoring (e.g., if the subrecipient also receives Federal awards directly from a Federal awarding agency). Additionally, 45 CFR section 75 303(a) states the non Federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. Condition When subawards are made to subrecipients, the pass through entities are required to communicate the dollar amount made available under each Federal award and the Assistance Listings Number (ALN) at time of disbursement. BMC does not have system in place to provide the ALN at the time of disbursement of funds. During the year ended September 30, 2023, the BMC passed through $18,031,446 of federal funding to subrecipients. In order to assess the subrecipient’s risk of non compliance, BMC has subrecipient monitoring policies and procedures in place which include the use of a risk assessment questionnaire. The risk assessment questionnaire includes considerations consistent with 2 CFR 200.332(b), including the entity’s prior experience and results of Single Audits, in addition to other factors. As part of our testing related subrecipient monitoring, we identified the following: 1. For 4 of 16 subrecipients selected for testwork BMC did not perform a risk assessment of the entity for purposes of determining the appropriate subrecipient monitoring related to the subaward. However, for these subrecipients, BMC did perform monitoring procedures, including review of invoices for reimbursement, review of Research Performance Progress Reports and review of Single Audit reports. Cause The condition found was primarily due to the monitoring procedures implemented by BMC do not include a review to ensure that a risk assessment is performed for each active subrecipient and BMC does not have a mechanism in place to provide the ALN at the time of disbursement of funds to the subrecipient. Possible Asserted Effect Failure to perform an annual risk assessment to determine appropriate subrecipient monitoring procedures may result in insufficient monitoring procedures being performed to detect subrecipient noncompliance with Federal statutes, regulations, and the terms and conditions of the award. Failure to adequately communicate award identification information could result in the subrecipient not being able to adequately track and report the subawards received resulting in errors being reported on the schedule of expenditures of federal awards within a subrecipient’s annual single audit report and not being able to comply with required terms and conditions of the federal award. Questioned Costs None. Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Recommendation We recommend BMC implement policies, procedures, and internal controls to ensure subrecipient risk assessments are performed for each subrecipient to determine the appropriate subrecipient monitoring is performed in accordance with 45 CFR 75.352(d) and 45 CFR 75.352(e). We recommend that BMC enhance its processes and internal controls over its reporting to the subrecipients of the federal program to ensure all award identification information required under 45 CFR 75.352(a) is provided to the subrecipients.

FY End: 2023-09-30
Bmc Health System, Inc.
Compliance Requirement: M
Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaw...

Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaward modification. When some of this information is not available, the pass through entity must provide the best information available to describe the Federal award and subaward. Required information includes: (xii) Assistance Listings number and Title; the pass through entity must identify the dollar amount made available under each Federal award and the Assistance Listings Number at time of disbursement; (2 CFE section 200.332xxi) (b) Evaluate each subrecipient’s risk of noncompliance with Federal statutes, regulations, and the terms and conditions of the subaward for purposes of determining the appropriate subrecipient monitoring described in paragraphs (d) and (e) of this section, which may include consideration of such factors as: (1) The subrecipient’s prior experience with the same or similar subawards; (2) The results of previous audits including whether or not the subrecipient receives a Single Audit in accordance with Subpart F of this part, and the extent to which the same or similar subaward has been audited as a major program; (3) Whether the subrecipient has new personnel or new or substantially changed systems; and (4) The extent and results of Federal awarding agency monitoring (e.g., if the subrecipient also receives Federal awards directly from a Federal awarding agency). Additionally, 45 CFR section 75 303(a) states the non Federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. Condition When subawards are made to subrecipients, the pass through entities are required to communicate the dollar amount made available under each Federal award and the Assistance Listings Number (ALN) at time of disbursement. BMC does not have system in place to provide the ALN at the time of disbursement of funds. During the year ended September 30, 2023, the BMC passed through $18,031,446 of federal funding to subrecipients. In order to assess the subrecipient’s risk of non compliance, BMC has subrecipient monitoring policies and procedures in place which include the use of a risk assessment questionnaire. The risk assessment questionnaire includes considerations consistent with 2 CFR 200.332(b), including the entity’s prior experience and results of Single Audits, in addition to other factors. As part of our testing related subrecipient monitoring, we identified the following: 1. For 4 of 16 subrecipients selected for testwork BMC did not perform a risk assessment of the entity for purposes of determining the appropriate subrecipient monitoring related to the subaward. However, for these subrecipients, BMC did perform monitoring procedures, including review of invoices for reimbursement, review of Research Performance Progress Reports and review of Single Audit reports. Cause The condition found was primarily due to the monitoring procedures implemented by BMC do not include a review to ensure that a risk assessment is performed for each active subrecipient and BMC does not have a mechanism in place to provide the ALN at the time of disbursement of funds to the subrecipient. Possible Asserted Effect Failure to perform an annual risk assessment to determine appropriate subrecipient monitoring procedures may result in insufficient monitoring procedures being performed to detect subrecipient noncompliance with Federal statutes, regulations, and the terms and conditions of the award. Failure to adequately communicate award identification information could result in the subrecipient not being able to adequately track and report the subawards received resulting in errors being reported on the schedule of expenditures of federal awards within a subrecipient’s annual single audit report and not being able to comply with required terms and conditions of the federal award. Questioned Costs None. Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Recommendation We recommend BMC implement policies, procedures, and internal controls to ensure subrecipient risk assessments are performed for each subrecipient to determine the appropriate subrecipient monitoring is performed in accordance with 45 CFR 75.352(d) and 45 CFR 75.352(e). We recommend that BMC enhance its processes and internal controls over its reporting to the subrecipients of the federal program to ensure all award identification information required under 45 CFR 75.352(a) is provided to the subrecipients.

FY End: 2023-09-30
Bmc Health System, Inc.
Compliance Requirement: M
Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaw...

Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaward modification. When some of this information is not available, the pass through entity must provide the best information available to describe the Federal award and subaward. Required information includes: (xii) Assistance Listings number and Title; the pass through entity must identify the dollar amount made available under each Federal award and the Assistance Listings Number at time of disbursement; (2 CFE section 200.332xxi) (b) Evaluate each subrecipient’s risk of noncompliance with Federal statutes, regulations, and the terms and conditions of the subaward for purposes of determining the appropriate subrecipient monitoring described in paragraphs (d) and (e) of this section, which may include consideration of such factors as: (1) The subrecipient’s prior experience with the same or similar subawards; (2) The results of previous audits including whether or not the subrecipient receives a Single Audit in accordance with Subpart F of this part, and the extent to which the same or similar subaward has been audited as a major program; (3) Whether the subrecipient has new personnel or new or substantially changed systems; and (4) The extent and results of Federal awarding agency monitoring (e.g., if the subrecipient also receives Federal awards directly from a Federal awarding agency). Additionally, 45 CFR section 75 303(a) states the non Federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. Condition When subawards are made to subrecipients, the pass through entities are required to communicate the dollar amount made available under each Federal award and the Assistance Listings Number (ALN) at time of disbursement. BMC does not have system in place to provide the ALN at the time of disbursement of funds. During the year ended September 30, 2023, the BMC passed through $18,031,446 of federal funding to subrecipients. In order to assess the subrecipient’s risk of non compliance, BMC has subrecipient monitoring policies and procedures in place which include the use of a risk assessment questionnaire. The risk assessment questionnaire includes considerations consistent with 2 CFR 200.332(b), including the entity’s prior experience and results of Single Audits, in addition to other factors. As part of our testing related subrecipient monitoring, we identified the following: 1. For 4 of 16 subrecipients selected for testwork BMC did not perform a risk assessment of the entity for purposes of determining the appropriate subrecipient monitoring related to the subaward. However, for these subrecipients, BMC did perform monitoring procedures, including review of invoices for reimbursement, review of Research Performance Progress Reports and review of Single Audit reports. Cause The condition found was primarily due to the monitoring procedures implemented by BMC do not include a review to ensure that a risk assessment is performed for each active subrecipient and BMC does not have a mechanism in place to provide the ALN at the time of disbursement of funds to the subrecipient. Possible Asserted Effect Failure to perform an annual risk assessment to determine appropriate subrecipient monitoring procedures may result in insufficient monitoring procedures being performed to detect subrecipient noncompliance with Federal statutes, regulations, and the terms and conditions of the award. Failure to adequately communicate award identification information could result in the subrecipient not being able to adequately track and report the subawards received resulting in errors being reported on the schedule of expenditures of federal awards within a subrecipient’s annual single audit report and not being able to comply with required terms and conditions of the federal award. Questioned Costs None. Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Recommendation We recommend BMC implement policies, procedures, and internal controls to ensure subrecipient risk assessments are performed for each subrecipient to determine the appropriate subrecipient monitoring is performed in accordance with 45 CFR 75.352(d) and 45 CFR 75.352(e). We recommend that BMC enhance its processes and internal controls over its reporting to the subrecipients of the federal program to ensure all award identification information required under 45 CFR 75.352(a) is provided to the subrecipients.

FY End: 2023-09-30
Bmc Health System, Inc.
Compliance Requirement: M
Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaw...

Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaward modification. When some of this information is not available, the pass through entity must provide the best information available to describe the Federal award and subaward. Required information includes: (xii) Assistance Listings number and Title; the pass through entity must identify the dollar amount made available under each Federal award and the Assistance Listings Number at time of disbursement; (2 CFE section 200.332xxi) (b) Evaluate each subrecipient’s risk of noncompliance with Federal statutes, regulations, and the terms and conditions of the subaward for purposes of determining the appropriate subrecipient monitoring described in paragraphs (d) and (e) of this section, which may include consideration of such factors as: (1) The subrecipient’s prior experience with the same or similar subawards; (2) The results of previous audits including whether or not the subrecipient receives a Single Audit in accordance with Subpart F of this part, and the extent to which the same or similar subaward has been audited as a major program; (3) Whether the subrecipient has new personnel or new or substantially changed systems; and (4) The extent and results of Federal awarding agency monitoring (e.g., if the subrecipient also receives Federal awards directly from a Federal awarding agency). Additionally, 45 CFR section 75 303(a) states the non Federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. Condition When subawards are made to subrecipients, the pass through entities are required to communicate the dollar amount made available under each Federal award and the Assistance Listings Number (ALN) at time of disbursement. BMC does not have system in place to provide the ALN at the time of disbursement of funds. During the year ended September 30, 2023, the BMC passed through $18,031,446 of federal funding to subrecipients. In order to assess the subrecipient’s risk of non compliance, BMC has subrecipient monitoring policies and procedures in place which include the use of a risk assessment questionnaire. The risk assessment questionnaire includes considerations consistent with 2 CFR 200.332(b), including the entity’s prior experience and results of Single Audits, in addition to other factors. As part of our testing related subrecipient monitoring, we identified the following: 1. For 4 of 16 subrecipients selected for testwork BMC did not perform a risk assessment of the entity for purposes of determining the appropriate subrecipient monitoring related to the subaward. However, for these subrecipients, BMC did perform monitoring procedures, including review of invoices for reimbursement, review of Research Performance Progress Reports and review of Single Audit reports. Cause The condition found was primarily due to the monitoring procedures implemented by BMC do not include a review to ensure that a risk assessment is performed for each active subrecipient and BMC does not have a mechanism in place to provide the ALN at the time of disbursement of funds to the subrecipient. Possible Asserted Effect Failure to perform an annual risk assessment to determine appropriate subrecipient monitoring procedures may result in insufficient monitoring procedures being performed to detect subrecipient noncompliance with Federal statutes, regulations, and the terms and conditions of the award. Failure to adequately communicate award identification information could result in the subrecipient not being able to adequately track and report the subawards received resulting in errors being reported on the schedule of expenditures of federal awards within a subrecipient’s annual single audit report and not being able to comply with required terms and conditions of the federal award. Questioned Costs None. Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Recommendation We recommend BMC implement policies, procedures, and internal controls to ensure subrecipient risk assessments are performed for each subrecipient to determine the appropriate subrecipient monitoring is performed in accordance with 45 CFR 75.352(d) and 45 CFR 75.352(e). We recommend that BMC enhance its processes and internal controls over its reporting to the subrecipients of the federal program to ensure all award identification information required under 45 CFR 75.352(a) is provided to the subrecipients.

FY End: 2023-09-30
Bmc Health System, Inc.
Compliance Requirement: M
Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaw...

Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaward modification. When some of this information is not available, the pass through entity must provide the best information available to describe the Federal award and subaward. Required information includes: (xii) Assistance Listings number and Title; the pass through entity must identify the dollar amount made available under each Federal award and the Assistance Listings Number at time of disbursement; (2 CFE section 200.332xxi) (b) Evaluate each subrecipient’s risk of noncompliance with Federal statutes, regulations, and the terms and conditions of the subaward for purposes of determining the appropriate subrecipient monitoring described in paragraphs (d) and (e) of this section, which may include consideration of such factors as: (1) The subrecipient’s prior experience with the same or similar subawards; (2) The results of previous audits including whether or not the subrecipient receives a Single Audit in accordance with Subpart F of this part, and the extent to which the same or similar subaward has been audited as a major program; (3) Whether the subrecipient has new personnel or new or substantially changed systems; and (4) The extent and results of Federal awarding agency monitoring (e.g., if the subrecipient also receives Federal awards directly from a Federal awarding agency). Additionally, 45 CFR section 75 303(a) states the non Federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. Condition When subawards are made to subrecipients, the pass through entities are required to communicate the dollar amount made available under each Federal award and the Assistance Listings Number (ALN) at time of disbursement. BMC does not have system in place to provide the ALN at the time of disbursement of funds. During the year ended September 30, 2023, the BMC passed through $18,031,446 of federal funding to subrecipients. In order to assess the subrecipient’s risk of non compliance, BMC has subrecipient monitoring policies and procedures in place which include the use of a risk assessment questionnaire. The risk assessment questionnaire includes considerations consistent with 2 CFR 200.332(b), including the entity’s prior experience and results of Single Audits, in addition to other factors. As part of our testing related subrecipient monitoring, we identified the following: 1. For 4 of 16 subrecipients selected for testwork BMC did not perform a risk assessment of the entity for purposes of determining the appropriate subrecipient monitoring related to the subaward. However, for these subrecipients, BMC did perform monitoring procedures, including review of invoices for reimbursement, review of Research Performance Progress Reports and review of Single Audit reports. Cause The condition found was primarily due to the monitoring procedures implemented by BMC do not include a review to ensure that a risk assessment is performed for each active subrecipient and BMC does not have a mechanism in place to provide the ALN at the time of disbursement of funds to the subrecipient. Possible Asserted Effect Failure to perform an annual risk assessment to determine appropriate subrecipient monitoring procedures may result in insufficient monitoring procedures being performed to detect subrecipient noncompliance with Federal statutes, regulations, and the terms and conditions of the award. Failure to adequately communicate award identification information could result in the subrecipient not being able to adequately track and report the subawards received resulting in errors being reported on the schedule of expenditures of federal awards within a subrecipient’s annual single audit report and not being able to comply with required terms and conditions of the federal award. Questioned Costs None. Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Recommendation We recommend BMC implement policies, procedures, and internal controls to ensure subrecipient risk assessments are performed for each subrecipient to determine the appropriate subrecipient monitoring is performed in accordance with 45 CFR 75.352(d) and 45 CFR 75.352(e). We recommend that BMC enhance its processes and internal controls over its reporting to the subrecipients of the federal program to ensure all award identification information required under 45 CFR 75.352(a) is provided to the subrecipients.

FY End: 2023-09-30
Bmc Health System, Inc.
Compliance Requirement: M
Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaw...

Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaward modification. When some of this information is not available, the pass through entity must provide the best information available to describe the Federal award and subaward. Required information includes: (xii) Assistance Listings number and Title; the pass through entity must identify the dollar amount made available under each Federal award and the Assistance Listings Number at time of disbursement; (2 CFE section 200.332xxi) (b) Evaluate each subrecipient’s risk of noncompliance with Federal statutes, regulations, and the terms and conditions of the subaward for purposes of determining the appropriate subrecipient monitoring described in paragraphs (d) and (e) of this section, which may include consideration of such factors as: (1) The subrecipient’s prior experience with the same or similar subawards; (2) The results of previous audits including whether or not the subrecipient receives a Single Audit in accordance with Subpart F of this part, and the extent to which the same or similar subaward has been audited as a major program; (3) Whether the subrecipient has new personnel or new or substantially changed systems; and (4) The extent and results of Federal awarding agency monitoring (e.g., if the subrecipient also receives Federal awards directly from a Federal awarding agency). Additionally, 45 CFR section 75 303(a) states the non Federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. Condition When subawards are made to subrecipients, the pass through entities are required to communicate the dollar amount made available under each Federal award and the Assistance Listings Number (ALN) at time of disbursement. BMC does not have system in place to provide the ALN at the time of disbursement of funds. During the year ended September 30, 2023, the BMC passed through $18,031,446 of federal funding to subrecipients. In order to assess the subrecipient’s risk of non compliance, BMC has subrecipient monitoring policies and procedures in place which include the use of a risk assessment questionnaire. The risk assessment questionnaire includes considerations consistent with 2 CFR 200.332(b), including the entity’s prior experience and results of Single Audits, in addition to other factors. As part of our testing related subrecipient monitoring, we identified the following: 1. For 4 of 16 subrecipients selected for testwork BMC did not perform a risk assessment of the entity for purposes of determining the appropriate subrecipient monitoring related to the subaward. However, for these subrecipients, BMC did perform monitoring procedures, including review of invoices for reimbursement, review of Research Performance Progress Reports and review of Single Audit reports. Cause The condition found was primarily due to the monitoring procedures implemented by BMC do not include a review to ensure that a risk assessment is performed for each active subrecipient and BMC does not have a mechanism in place to provide the ALN at the time of disbursement of funds to the subrecipient. Possible Asserted Effect Failure to perform an annual risk assessment to determine appropriate subrecipient monitoring procedures may result in insufficient monitoring procedures being performed to detect subrecipient noncompliance with Federal statutes, regulations, and the terms and conditions of the award. Failure to adequately communicate award identification information could result in the subrecipient not being able to adequately track and report the subawards received resulting in errors being reported on the schedule of expenditures of federal awards within a subrecipient’s annual single audit report and not being able to comply with required terms and conditions of the federal award. Questioned Costs None. Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Recommendation We recommend BMC implement policies, procedures, and internal controls to ensure subrecipient risk assessments are performed for each subrecipient to determine the appropriate subrecipient monitoring is performed in accordance with 45 CFR 75.352(d) and 45 CFR 75.352(e). We recommend that BMC enhance its processes and internal controls over its reporting to the subrecipients of the federal program to ensure all award identification information required under 45 CFR 75.352(a) is provided to the subrecipients.

FY End: 2023-09-30
Bmc Health System, Inc.
Compliance Requirement: M
Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaw...

Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaward modification. When some of this information is not available, the pass through entity must provide the best information available to describe the Federal award and subaward. Required information includes: (xii) Assistance Listings number and Title; the pass through entity must identify the dollar amount made available under each Federal award and the Assistance Listings Number at time of disbursement; (2 CFE section 200.332xxi) (b) Evaluate each subrecipient’s risk of noncompliance with Federal statutes, regulations, and the terms and conditions of the subaward for purposes of determining the appropriate subrecipient monitoring described in paragraphs (d) and (e) of this section, which may include consideration of such factors as: (1) The subrecipient’s prior experience with the same or similar subawards; (2) The results of previous audits including whether or not the subrecipient receives a Single Audit in accordance with Subpart F of this part, and the extent to which the same or similar subaward has been audited as a major program; (3) Whether the subrecipient has new personnel or new or substantially changed systems; and (4) The extent and results of Federal awarding agency monitoring (e.g., if the subrecipient also receives Federal awards directly from a Federal awarding agency). Additionally, 45 CFR section 75 303(a) states the non Federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. Condition When subawards are made to subrecipients, the pass through entities are required to communicate the dollar amount made available under each Federal award and the Assistance Listings Number (ALN) at time of disbursement. BMC does not have system in place to provide the ALN at the time of disbursement of funds. During the year ended September 30, 2023, the BMC passed through $18,031,446 of federal funding to subrecipients. In order to assess the subrecipient’s risk of non compliance, BMC has subrecipient monitoring policies and procedures in place which include the use of a risk assessment questionnaire. The risk assessment questionnaire includes considerations consistent with 2 CFR 200.332(b), including the entity’s prior experience and results of Single Audits, in addition to other factors. As part of our testing related subrecipient monitoring, we identified the following: 1. For 4 of 16 subrecipients selected for testwork BMC did not perform a risk assessment of the entity for purposes of determining the appropriate subrecipient monitoring related to the subaward. However, for these subrecipients, BMC did perform monitoring procedures, including review of invoices for reimbursement, review of Research Performance Progress Reports and review of Single Audit reports. Cause The condition found was primarily due to the monitoring procedures implemented by BMC do not include a review to ensure that a risk assessment is performed for each active subrecipient and BMC does not have a mechanism in place to provide the ALN at the time of disbursement of funds to the subrecipient. Possible Asserted Effect Failure to perform an annual risk assessment to determine appropriate subrecipient monitoring procedures may result in insufficient monitoring procedures being performed to detect subrecipient noncompliance with Federal statutes, regulations, and the terms and conditions of the award. Failure to adequately communicate award identification information could result in the subrecipient not being able to adequately track and report the subawards received resulting in errors being reported on the schedule of expenditures of federal awards within a subrecipient’s annual single audit report and not being able to comply with required terms and conditions of the federal award. Questioned Costs None. Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Recommendation We recommend BMC implement policies, procedures, and internal controls to ensure subrecipient risk assessments are performed for each subrecipient to determine the appropriate subrecipient monitoring is performed in accordance with 45 CFR 75.352(d) and 45 CFR 75.352(e). We recommend that BMC enhance its processes and internal controls over its reporting to the subrecipients of the federal program to ensure all award identification information required under 45 CFR 75.352(a) is provided to the subrecipients.

FY End: 2023-09-30
Bmc Health System, Inc.
Compliance Requirement: M
Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaw...

Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaward modification. When some of this information is not available, the pass through entity must provide the best information available to describe the Federal award and subaward. Required information includes: (xii) Assistance Listings number and Title; the pass through entity must identify the dollar amount made available under each Federal award and the Assistance Listings Number at time of disbursement; (2 CFE section 200.332xxi) (b) Evaluate each subrecipient’s risk of noncompliance with Federal statutes, regulations, and the terms and conditions of the subaward for purposes of determining the appropriate subrecipient monitoring described in paragraphs (d) and (e) of this section, which may include consideration of such factors as: (1) The subrecipient’s prior experience with the same or similar subawards; (2) The results of previous audits including whether or not the subrecipient receives a Single Audit in accordance with Subpart F of this part, and the extent to which the same or similar subaward has been audited as a major program; (3) Whether the subrecipient has new personnel or new or substantially changed systems; and (4) The extent and results of Federal awarding agency monitoring (e.g., if the subrecipient also receives Federal awards directly from a Federal awarding agency). Additionally, 45 CFR section 75 303(a) states the non Federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. Condition When subawards are made to subrecipients, the pass through entities are required to communicate the dollar amount made available under each Federal award and the Assistance Listings Number (ALN) at time of disbursement. BMC does not have system in place to provide the ALN at the time of disbursement of funds. During the year ended September 30, 2023, the BMC passed through $18,031,446 of federal funding to subrecipients. In order to assess the subrecipient’s risk of non compliance, BMC has subrecipient monitoring policies and procedures in place which include the use of a risk assessment questionnaire. The risk assessment questionnaire includes considerations consistent with 2 CFR 200.332(b), including the entity’s prior experience and results of Single Audits, in addition to other factors. As part of our testing related subrecipient monitoring, we identified the following: 1. For 4 of 16 subrecipients selected for testwork BMC did not perform a risk assessment of the entity for purposes of determining the appropriate subrecipient monitoring related to the subaward. However, for these subrecipients, BMC did perform monitoring procedures, including review of invoices for reimbursement, review of Research Performance Progress Reports and review of Single Audit reports. Cause The condition found was primarily due to the monitoring procedures implemented by BMC do not include a review to ensure that a risk assessment is performed for each active subrecipient and BMC does not have a mechanism in place to provide the ALN at the time of disbursement of funds to the subrecipient. Possible Asserted Effect Failure to perform an annual risk assessment to determine appropriate subrecipient monitoring procedures may result in insufficient monitoring procedures being performed to detect subrecipient noncompliance with Federal statutes, regulations, and the terms and conditions of the award. Failure to adequately communicate award identification information could result in the subrecipient not being able to adequately track and report the subawards received resulting in errors being reported on the schedule of expenditures of federal awards within a subrecipient’s annual single audit report and not being able to comply with required terms and conditions of the federal award. Questioned Costs None. Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Recommendation We recommend BMC implement policies, procedures, and internal controls to ensure subrecipient risk assessments are performed for each subrecipient to determine the appropriate subrecipient monitoring is performed in accordance with 45 CFR 75.352(d) and 45 CFR 75.352(e). We recommend that BMC enhance its processes and internal controls over its reporting to the subrecipients of the federal program to ensure all award identification information required under 45 CFR 75.352(a) is provided to the subrecipients.

FY End: 2023-09-30
Bmc Health System, Inc.
Compliance Requirement: M
Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaw...

Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaward modification. When some of this information is not available, the pass through entity must provide the best information available to describe the Federal award and subaward. Required information includes: (xii) Assistance Listings number and Title; the pass through entity must identify the dollar amount made available under each Federal award and the Assistance Listings Number at time of disbursement; (2 CFE section 200.332xxi) (b) Evaluate each subrecipient’s risk of noncompliance with Federal statutes, regulations, and the terms and conditions of the subaward for purposes of determining the appropriate subrecipient monitoring described in paragraphs (d) and (e) of this section, which may include consideration of such factors as: (1) The subrecipient’s prior experience with the same or similar subawards; (2) The results of previous audits including whether or not the subrecipient receives a Single Audit in accordance with Subpart F of this part, and the extent to which the same or similar subaward has been audited as a major program; (3) Whether the subrecipient has new personnel or new or substantially changed systems; and (4) The extent and results of Federal awarding agency monitoring (e.g., if the subrecipient also receives Federal awards directly from a Federal awarding agency). Additionally, 45 CFR section 75 303(a) states the non Federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. Condition When subawards are made to subrecipients, the pass through entities are required to communicate the dollar amount made available under each Federal award and the Assistance Listings Number (ALN) at time of disbursement. BMC does not have system in place to provide the ALN at the time of disbursement of funds. During the year ended September 30, 2023, the BMC passed through $18,031,446 of federal funding to subrecipients. In order to assess the subrecipient’s risk of non compliance, BMC has subrecipient monitoring policies and procedures in place which include the use of a risk assessment questionnaire. The risk assessment questionnaire includes considerations consistent with 2 CFR 200.332(b), including the entity’s prior experience and results of Single Audits, in addition to other factors. As part of our testing related subrecipient monitoring, we identified the following: 1. For 4 of 16 subrecipients selected for testwork BMC did not perform a risk assessment of the entity for purposes of determining the appropriate subrecipient monitoring related to the subaward. However, for these subrecipients, BMC did perform monitoring procedures, including review of invoices for reimbursement, review of Research Performance Progress Reports and review of Single Audit reports. Cause The condition found was primarily due to the monitoring procedures implemented by BMC do not include a review to ensure that a risk assessment is performed for each active subrecipient and BMC does not have a mechanism in place to provide the ALN at the time of disbursement of funds to the subrecipient. Possible Asserted Effect Failure to perform an annual risk assessment to determine appropriate subrecipient monitoring procedures may result in insufficient monitoring procedures being performed to detect subrecipient noncompliance with Federal statutes, regulations, and the terms and conditions of the award. Failure to adequately communicate award identification information could result in the subrecipient not being able to adequately track and report the subawards received resulting in errors being reported on the schedule of expenditures of federal awards within a subrecipient’s annual single audit report and not being able to comply with required terms and conditions of the federal award. Questioned Costs None. Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Recommendation We recommend BMC implement policies, procedures, and internal controls to ensure subrecipient risk assessments are performed for each subrecipient to determine the appropriate subrecipient monitoring is performed in accordance with 45 CFR 75.352(d) and 45 CFR 75.352(e). We recommend that BMC enhance its processes and internal controls over its reporting to the subrecipients of the federal program to ensure all award identification information required under 45 CFR 75.352(a) is provided to the subrecipients.

FY End: 2023-09-30
Bmc Health System, Inc.
Compliance Requirement: M
Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaw...

Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaward modification. When some of this information is not available, the pass through entity must provide the best information available to describe the Federal award and subaward. Required information includes: (xii) Assistance Listings number and Title; the pass through entity must identify the dollar amount made available under each Federal award and the Assistance Listings Number at time of disbursement; (2 CFE section 200.332xxi) (b) Evaluate each subrecipient’s risk of noncompliance with Federal statutes, regulations, and the terms and conditions of the subaward for purposes of determining the appropriate subrecipient monitoring described in paragraphs (d) and (e) of this section, which may include consideration of such factors as: (1) The subrecipient’s prior experience with the same or similar subawards; (2) The results of previous audits including whether or not the subrecipient receives a Single Audit in accordance with Subpart F of this part, and the extent to which the same or similar subaward has been audited as a major program; (3) Whether the subrecipient has new personnel or new or substantially changed systems; and (4) The extent and results of Federal awarding agency monitoring (e.g., if the subrecipient also receives Federal awards directly from a Federal awarding agency). Additionally, 45 CFR section 75 303(a) states the non Federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. Condition When subawards are made to subrecipients, the pass through entities are required to communicate the dollar amount made available under each Federal award and the Assistance Listings Number (ALN) at time of disbursement. BMC does not have system in place to provide the ALN at the time of disbursement of funds. During the year ended September 30, 2023, the BMC passed through $18,031,446 of federal funding to subrecipients. In order to assess the subrecipient’s risk of non compliance, BMC has subrecipient monitoring policies and procedures in place which include the use of a risk assessment questionnaire. The risk assessment questionnaire includes considerations consistent with 2 CFR 200.332(b), including the entity’s prior experience and results of Single Audits, in addition to other factors. As part of our testing related subrecipient monitoring, we identified the following: 1. For 4 of 16 subrecipients selected for testwork BMC did not perform a risk assessment of the entity for purposes of determining the appropriate subrecipient monitoring related to the subaward. However, for these subrecipients, BMC did perform monitoring procedures, including review of invoices for reimbursement, review of Research Performance Progress Reports and review of Single Audit reports. Cause The condition found was primarily due to the monitoring procedures implemented by BMC do not include a review to ensure that a risk assessment is performed for each active subrecipient and BMC does not have a mechanism in place to provide the ALN at the time of disbursement of funds to the subrecipient. Possible Asserted Effect Failure to perform an annual risk assessment to determine appropriate subrecipient monitoring procedures may result in insufficient monitoring procedures being performed to detect subrecipient noncompliance with Federal statutes, regulations, and the terms and conditions of the award. Failure to adequately communicate award identification information could result in the subrecipient not being able to adequately track and report the subawards received resulting in errors being reported on the schedule of expenditures of federal awards within a subrecipient’s annual single audit report and not being able to comply with required terms and conditions of the federal award. Questioned Costs None. Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Recommendation We recommend BMC implement policies, procedures, and internal controls to ensure subrecipient risk assessments are performed for each subrecipient to determine the appropriate subrecipient monitoring is performed in accordance with 45 CFR 75.352(d) and 45 CFR 75.352(e). We recommend that BMC enhance its processes and internal controls over its reporting to the subrecipients of the federal program to ensure all award identification information required under 45 CFR 75.352(a) is provided to the subrecipients.

FY End: 2023-09-30
Bmc Health System, Inc.
Compliance Requirement: M
Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaw...

Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaward modification. When some of this information is not available, the pass through entity must provide the best information available to describe the Federal award and subaward. Required information includes: (xii) Assistance Listings number and Title; the pass through entity must identify the dollar amount made available under each Federal award and the Assistance Listings Number at time of disbursement; (2 CFE section 200.332xxi) (b) Evaluate each subrecipient’s risk of noncompliance with Federal statutes, regulations, and the terms and conditions of the subaward for purposes of determining the appropriate subrecipient monitoring described in paragraphs (d) and (e) of this section, which may include consideration of such factors as: (1) The subrecipient’s prior experience with the same or similar subawards; (2) The results of previous audits including whether or not the subrecipient receives a Single Audit in accordance with Subpart F of this part, and the extent to which the same or similar subaward has been audited as a major program; (3) Whether the subrecipient has new personnel or new or substantially changed systems; and (4) The extent and results of Federal awarding agency monitoring (e.g., if the subrecipient also receives Federal awards directly from a Federal awarding agency). Additionally, 45 CFR section 75 303(a) states the non Federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. Condition When subawards are made to subrecipients, the pass through entities are required to communicate the dollar amount made available under each Federal award and the Assistance Listings Number (ALN) at time of disbursement. BMC does not have system in place to provide the ALN at the time of disbursement of funds. During the year ended September 30, 2023, the BMC passed through $18,031,446 of federal funding to subrecipients. In order to assess the subrecipient’s risk of non compliance, BMC has subrecipient monitoring policies and procedures in place which include the use of a risk assessment questionnaire. The risk assessment questionnaire includes considerations consistent with 2 CFR 200.332(b), including the entity’s prior experience and results of Single Audits, in addition to other factors. As part of our testing related subrecipient monitoring, we identified the following: 1. For 4 of 16 subrecipients selected for testwork BMC did not perform a risk assessment of the entity for purposes of determining the appropriate subrecipient monitoring related to the subaward. However, for these subrecipients, BMC did perform monitoring procedures, including review of invoices for reimbursement, review of Research Performance Progress Reports and review of Single Audit reports. Cause The condition found was primarily due to the monitoring procedures implemented by BMC do not include a review to ensure that a risk assessment is performed for each active subrecipient and BMC does not have a mechanism in place to provide the ALN at the time of disbursement of funds to the subrecipient. Possible Asserted Effect Failure to perform an annual risk assessment to determine appropriate subrecipient monitoring procedures may result in insufficient monitoring procedures being performed to detect subrecipient noncompliance with Federal statutes, regulations, and the terms and conditions of the award. Failure to adequately communicate award identification information could result in the subrecipient not being able to adequately track and report the subawards received resulting in errors being reported on the schedule of expenditures of federal awards within a subrecipient’s annual single audit report and not being able to comply with required terms and conditions of the federal award. Questioned Costs None. Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Recommendation We recommend BMC implement policies, procedures, and internal controls to ensure subrecipient risk assessments are performed for each subrecipient to determine the appropriate subrecipient monitoring is performed in accordance with 45 CFR 75.352(d) and 45 CFR 75.352(e). We recommend that BMC enhance its processes and internal controls over its reporting to the subrecipients of the federal program to ensure all award identification information required under 45 CFR 75.352(a) is provided to the subrecipients.

FY End: 2023-09-30
Bmc Health System, Inc.
Compliance Requirement: M
Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaw...

Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaward modification. When some of this information is not available, the pass through entity must provide the best information available to describe the Federal award and subaward. Required information includes: (xii) Assistance Listings number and Title; the pass through entity must identify the dollar amount made available under each Federal award and the Assistance Listings Number at time of disbursement; (2 CFE section 200.332xxi) (b) Evaluate each subrecipient’s risk of noncompliance with Federal statutes, regulations, and the terms and conditions of the subaward for purposes of determining the appropriate subrecipient monitoring described in paragraphs (d) and (e) of this section, which may include consideration of such factors as: (1) The subrecipient’s prior experience with the same or similar subawards; (2) The results of previous audits including whether or not the subrecipient receives a Single Audit in accordance with Subpart F of this part, and the extent to which the same or similar subaward has been audited as a major program; (3) Whether the subrecipient has new personnel or new or substantially changed systems; and (4) The extent and results of Federal awarding agency monitoring (e.g., if the subrecipient also receives Federal awards directly from a Federal awarding agency). Additionally, 45 CFR section 75 303(a) states the non Federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. Condition When subawards are made to subrecipients, the pass through entities are required to communicate the dollar amount made available under each Federal award and the Assistance Listings Number (ALN) at time of disbursement. BMC does not have system in place to provide the ALN at the time of disbursement of funds. During the year ended September 30, 2023, the BMC passed through $18,031,446 of federal funding to subrecipients. In order to assess the subrecipient’s risk of non compliance, BMC has subrecipient monitoring policies and procedures in place which include the use of a risk assessment questionnaire. The risk assessment questionnaire includes considerations consistent with 2 CFR 200.332(b), including the entity’s prior experience and results of Single Audits, in addition to other factors. As part of our testing related subrecipient monitoring, we identified the following: 1. For 4 of 16 subrecipients selected for testwork BMC did not perform a risk assessment of the entity for purposes of determining the appropriate subrecipient monitoring related to the subaward. However, for these subrecipients, BMC did perform monitoring procedures, including review of invoices for reimbursement, review of Research Performance Progress Reports and review of Single Audit reports. Cause The condition found was primarily due to the monitoring procedures implemented by BMC do not include a review to ensure that a risk assessment is performed for each active subrecipient and BMC does not have a mechanism in place to provide the ALN at the time of disbursement of funds to the subrecipient. Possible Asserted Effect Failure to perform an annual risk assessment to determine appropriate subrecipient monitoring procedures may result in insufficient monitoring procedures being performed to detect subrecipient noncompliance with Federal statutes, regulations, and the terms and conditions of the award. Failure to adequately communicate award identification information could result in the subrecipient not being able to adequately track and report the subawards received resulting in errors being reported on the schedule of expenditures of federal awards within a subrecipient’s annual single audit report and not being able to comply with required terms and conditions of the federal award. Questioned Costs None. Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Recommendation We recommend BMC implement policies, procedures, and internal controls to ensure subrecipient risk assessments are performed for each subrecipient to determine the appropriate subrecipient monitoring is performed in accordance with 45 CFR 75.352(d) and 45 CFR 75.352(e). We recommend that BMC enhance its processes and internal controls over its reporting to the subrecipients of the federal program to ensure all award identification information required under 45 CFR 75.352(a) is provided to the subrecipients.

FY End: 2023-09-30
Bmc Health System, Inc.
Compliance Requirement: M
Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaw...

Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaward modification. When some of this information is not available, the pass through entity must provide the best information available to describe the Federal award and subaward. Required information includes: (xii) Assistance Listings number and Title; the pass through entity must identify the dollar amount made available under each Federal award and the Assistance Listings Number at time of disbursement; (2 CFE section 200.332xxi) (b) Evaluate each subrecipient’s risk of noncompliance with Federal statutes, regulations, and the terms and conditions of the subaward for purposes of determining the appropriate subrecipient monitoring described in paragraphs (d) and (e) of this section, which may include consideration of such factors as: (1) The subrecipient’s prior experience with the same or similar subawards; (2) The results of previous audits including whether or not the subrecipient receives a Single Audit in accordance with Subpart F of this part, and the extent to which the same or similar subaward has been audited as a major program; (3) Whether the subrecipient has new personnel or new or substantially changed systems; and (4) The extent and results of Federal awarding agency monitoring (e.g., if the subrecipient also receives Federal awards directly from a Federal awarding agency). Additionally, 45 CFR section 75 303(a) states the non Federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. Condition When subawards are made to subrecipients, the pass through entities are required to communicate the dollar amount made available under each Federal award and the Assistance Listings Number (ALN) at time of disbursement. BMC does not have system in place to provide the ALN at the time of disbursement of funds. During the year ended September 30, 2023, the BMC passed through $18,031,446 of federal funding to subrecipients. In order to assess the subrecipient’s risk of non compliance, BMC has subrecipient monitoring policies and procedures in place which include the use of a risk assessment questionnaire. The risk assessment questionnaire includes considerations consistent with 2 CFR 200.332(b), including the entity’s prior experience and results of Single Audits, in addition to other factors. As part of our testing related subrecipient monitoring, we identified the following: 1. For 4 of 16 subrecipients selected for testwork BMC did not perform a risk assessment of the entity for purposes of determining the appropriate subrecipient monitoring related to the subaward. However, for these subrecipients, BMC did perform monitoring procedures, including review of invoices for reimbursement, review of Research Performance Progress Reports and review of Single Audit reports. Cause The condition found was primarily due to the monitoring procedures implemented by BMC do not include a review to ensure that a risk assessment is performed for each active subrecipient and BMC does not have a mechanism in place to provide the ALN at the time of disbursement of funds to the subrecipient. Possible Asserted Effect Failure to perform an annual risk assessment to determine appropriate subrecipient monitoring procedures may result in insufficient monitoring procedures being performed to detect subrecipient noncompliance with Federal statutes, regulations, and the terms and conditions of the award. Failure to adequately communicate award identification information could result in the subrecipient not being able to adequately track and report the subawards received resulting in errors being reported on the schedule of expenditures of federal awards within a subrecipient’s annual single audit report and not being able to comply with required terms and conditions of the federal award. Questioned Costs None. Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Recommendation We recommend BMC implement policies, procedures, and internal controls to ensure subrecipient risk assessments are performed for each subrecipient to determine the appropriate subrecipient monitoring is performed in accordance with 45 CFR 75.352(d) and 45 CFR 75.352(e). We recommend that BMC enhance its processes and internal controls over its reporting to the subrecipients of the federal program to ensure all award identification information required under 45 CFR 75.352(a) is provided to the subrecipients.

FY End: 2023-09-30
Bmc Health System, Inc.
Compliance Requirement: M
Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaw...

Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaward modification. When some of this information is not available, the pass through entity must provide the best information available to describe the Federal award and subaward. Required information includes: (xii) Assistance Listings number and Title; the pass through entity must identify the dollar amount made available under each Federal award and the Assistance Listings Number at time of disbursement; (2 CFE section 200.332xxi) (b) Evaluate each subrecipient’s risk of noncompliance with Federal statutes, regulations, and the terms and conditions of the subaward for purposes of determining the appropriate subrecipient monitoring described in paragraphs (d) and (e) of this section, which may include consideration of such factors as: (1) The subrecipient’s prior experience with the same or similar subawards; (2) The results of previous audits including whether or not the subrecipient receives a Single Audit in accordance with Subpart F of this part, and the extent to which the same or similar subaward has been audited as a major program; (3) Whether the subrecipient has new personnel or new or substantially changed systems; and (4) The extent and results of Federal awarding agency monitoring (e.g., if the subrecipient also receives Federal awards directly from a Federal awarding agency). Additionally, 45 CFR section 75 303(a) states the non Federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. Condition When subawards are made to subrecipients, the pass through entities are required to communicate the dollar amount made available under each Federal award and the Assistance Listings Number (ALN) at time of disbursement. BMC does not have system in place to provide the ALN at the time of disbursement of funds. During the year ended September 30, 2023, the BMC passed through $18,031,446 of federal funding to subrecipients. In order to assess the subrecipient’s risk of non compliance, BMC has subrecipient monitoring policies and procedures in place which include the use of a risk assessment questionnaire. The risk assessment questionnaire includes considerations consistent with 2 CFR 200.332(b), including the entity’s prior experience and results of Single Audits, in addition to other factors. As part of our testing related subrecipient monitoring, we identified the following: 1. For 4 of 16 subrecipients selected for testwork BMC did not perform a risk assessment of the entity for purposes of determining the appropriate subrecipient monitoring related to the subaward. However, for these subrecipients, BMC did perform monitoring procedures, including review of invoices for reimbursement, review of Research Performance Progress Reports and review of Single Audit reports. Cause The condition found was primarily due to the monitoring procedures implemented by BMC do not include a review to ensure that a risk assessment is performed for each active subrecipient and BMC does not have a mechanism in place to provide the ALN at the time of disbursement of funds to the subrecipient. Possible Asserted Effect Failure to perform an annual risk assessment to determine appropriate subrecipient monitoring procedures may result in insufficient monitoring procedures being performed to detect subrecipient noncompliance with Federal statutes, regulations, and the terms and conditions of the award. Failure to adequately communicate award identification information could result in the subrecipient not being able to adequately track and report the subawards received resulting in errors being reported on the schedule of expenditures of federal awards within a subrecipient’s annual single audit report and not being able to comply with required terms and conditions of the federal award. Questioned Costs None. Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Recommendation We recommend BMC implement policies, procedures, and internal controls to ensure subrecipient risk assessments are performed for each subrecipient to determine the appropriate subrecipient monitoring is performed in accordance with 45 CFR 75.352(d) and 45 CFR 75.352(e). We recommend that BMC enhance its processes and internal controls over its reporting to the subrecipients of the federal program to ensure all award identification information required under 45 CFR 75.352(a) is provided to the subrecipients.

FY End: 2023-09-30
Bmc Health System, Inc.
Compliance Requirement: M
Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaw...

Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaward modification. When some of this information is not available, the pass through entity must provide the best information available to describe the Federal award and subaward. Required information includes: (xii) Assistance Listings number and Title; the pass through entity must identify the dollar amount made available under each Federal award and the Assistance Listings Number at time of disbursement; (2 CFE section 200.332xxi) (b) Evaluate each subrecipient’s risk of noncompliance with Federal statutes, regulations, and the terms and conditions of the subaward for purposes of determining the appropriate subrecipient monitoring described in paragraphs (d) and (e) of this section, which may include consideration of such factors as: (1) The subrecipient’s prior experience with the same or similar subawards; (2) The results of previous audits including whether or not the subrecipient receives a Single Audit in accordance with Subpart F of this part, and the extent to which the same or similar subaward has been audited as a major program; (3) Whether the subrecipient has new personnel or new or substantially changed systems; and (4) The extent and results of Federal awarding agency monitoring (e.g., if the subrecipient also receives Federal awards directly from a Federal awarding agency). Additionally, 45 CFR section 75 303(a) states the non Federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. Condition When subawards are made to subrecipients, the pass through entities are required to communicate the dollar amount made available under each Federal award and the Assistance Listings Number (ALN) at time of disbursement. BMC does not have system in place to provide the ALN at the time of disbursement of funds. During the year ended September 30, 2023, the BMC passed through $18,031,446 of federal funding to subrecipients. In order to assess the subrecipient’s risk of non compliance, BMC has subrecipient monitoring policies and procedures in place which include the use of a risk assessment questionnaire. The risk assessment questionnaire includes considerations consistent with 2 CFR 200.332(b), including the entity’s prior experience and results of Single Audits, in addition to other factors. As part of our testing related subrecipient monitoring, we identified the following: 1. For 4 of 16 subrecipients selected for testwork BMC did not perform a risk assessment of the entity for purposes of determining the appropriate subrecipient monitoring related to the subaward. However, for these subrecipients, BMC did perform monitoring procedures, including review of invoices for reimbursement, review of Research Performance Progress Reports and review of Single Audit reports. Cause The condition found was primarily due to the monitoring procedures implemented by BMC do not include a review to ensure that a risk assessment is performed for each active subrecipient and BMC does not have a mechanism in place to provide the ALN at the time of disbursement of funds to the subrecipient. Possible Asserted Effect Failure to perform an annual risk assessment to determine appropriate subrecipient monitoring procedures may result in insufficient monitoring procedures being performed to detect subrecipient noncompliance with Federal statutes, regulations, and the terms and conditions of the award. Failure to adequately communicate award identification information could result in the subrecipient not being able to adequately track and report the subawards received resulting in errors being reported on the schedule of expenditures of federal awards within a subrecipient’s annual single audit report and not being able to comply with required terms and conditions of the federal award. Questioned Costs None. Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Recommendation We recommend BMC implement policies, procedures, and internal controls to ensure subrecipient risk assessments are performed for each subrecipient to determine the appropriate subrecipient monitoring is performed in accordance with 45 CFR 75.352(d) and 45 CFR 75.352(e). We recommend that BMC enhance its processes and internal controls over its reporting to the subrecipients of the federal program to ensure all award identification information required under 45 CFR 75.352(a) is provided to the subrecipients.

FY End: 2023-09-30
Bmc Health System, Inc.
Compliance Requirement: M
Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaw...

Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaward modification. When some of this information is not available, the pass through entity must provide the best information available to describe the Federal award and subaward. Required information includes: (xii) Assistance Listings number and Title; the pass through entity must identify the dollar amount made available under each Federal award and the Assistance Listings Number at time of disbursement; (2 CFE section 200.332xxi) (b) Evaluate each subrecipient’s risk of noncompliance with Federal statutes, regulations, and the terms and conditions of the subaward for purposes of determining the appropriate subrecipient monitoring described in paragraphs (d) and (e) of this section, which may include consideration of such factors as: (1) The subrecipient’s prior experience with the same or similar subawards; (2) The results of previous audits including whether or not the subrecipient receives a Single Audit in accordance with Subpart F of this part, and the extent to which the same or similar subaward has been audited as a major program; (3) Whether the subrecipient has new personnel or new or substantially changed systems; and (4) The extent and results of Federal awarding agency monitoring (e.g., if the subrecipient also receives Federal awards directly from a Federal awarding agency). Additionally, 45 CFR section 75 303(a) states the non Federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. Condition When subawards are made to subrecipients, the pass through entities are required to communicate the dollar amount made available under each Federal award and the Assistance Listings Number (ALN) at time of disbursement. BMC does not have system in place to provide the ALN at the time of disbursement of funds. During the year ended September 30, 2023, the BMC passed through $18,031,446 of federal funding to subrecipients. In order to assess the subrecipient’s risk of non compliance, BMC has subrecipient monitoring policies and procedures in place which include the use of a risk assessment questionnaire. The risk assessment questionnaire includes considerations consistent with 2 CFR 200.332(b), including the entity’s prior experience and results of Single Audits, in addition to other factors. As part of our testing related subrecipient monitoring, we identified the following: 1. For 4 of 16 subrecipients selected for testwork BMC did not perform a risk assessment of the entity for purposes of determining the appropriate subrecipient monitoring related to the subaward. However, for these subrecipients, BMC did perform monitoring procedures, including review of invoices for reimbursement, review of Research Performance Progress Reports and review of Single Audit reports. Cause The condition found was primarily due to the monitoring procedures implemented by BMC do not include a review to ensure that a risk assessment is performed for each active subrecipient and BMC does not have a mechanism in place to provide the ALN at the time of disbursement of funds to the subrecipient. Possible Asserted Effect Failure to perform an annual risk assessment to determine appropriate subrecipient monitoring procedures may result in insufficient monitoring procedures being performed to detect subrecipient noncompliance with Federal statutes, regulations, and the terms and conditions of the award. Failure to adequately communicate award identification information could result in the subrecipient not being able to adequately track and report the subawards received resulting in errors being reported on the schedule of expenditures of federal awards within a subrecipient’s annual single audit report and not being able to comply with required terms and conditions of the federal award. Questioned Costs None. Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Recommendation We recommend BMC implement policies, procedures, and internal controls to ensure subrecipient risk assessments are performed for each subrecipient to determine the appropriate subrecipient monitoring is performed in accordance with 45 CFR 75.352(d) and 45 CFR 75.352(e). We recommend that BMC enhance its processes and internal controls over its reporting to the subrecipients of the federal program to ensure all award identification information required under 45 CFR 75.352(a) is provided to the subrecipients.

FY End: 2023-09-30
Bmc Health System, Inc.
Compliance Requirement: M
Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaw...

Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaward modification. When some of this information is not available, the pass through entity must provide the best information available to describe the Federal award and subaward. Required information includes: (xii) Assistance Listings number and Title; the pass through entity must identify the dollar amount made available under each Federal award and the Assistance Listings Number at time of disbursement; (2 CFE section 200.332xxi) (b) Evaluate each subrecipient’s risk of noncompliance with Federal statutes, regulations, and the terms and conditions of the subaward for purposes of determining the appropriate subrecipient monitoring described in paragraphs (d) and (e) of this section, which may include consideration of such factors as: (1) The subrecipient’s prior experience with the same or similar subawards; (2) The results of previous audits including whether or not the subrecipient receives a Single Audit in accordance with Subpart F of this part, and the extent to which the same or similar subaward has been audited as a major program; (3) Whether the subrecipient has new personnel or new or substantially changed systems; and (4) The extent and results of Federal awarding agency monitoring (e.g., if the subrecipient also receives Federal awards directly from a Federal awarding agency). Additionally, 45 CFR section 75 303(a) states the non Federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. Condition When subawards are made to subrecipients, the pass through entities are required to communicate the dollar amount made available under each Federal award and the Assistance Listings Number (ALN) at time of disbursement. BMC does not have system in place to provide the ALN at the time of disbursement of funds. During the year ended September 30, 2023, the BMC passed through $18,031,446 of federal funding to subrecipients. In order to assess the subrecipient’s risk of non compliance, BMC has subrecipient monitoring policies and procedures in place which include the use of a risk assessment questionnaire. The risk assessment questionnaire includes considerations consistent with 2 CFR 200.332(b), including the entity’s prior experience and results of Single Audits, in addition to other factors. As part of our testing related subrecipient monitoring, we identified the following: 1. For 4 of 16 subrecipients selected for testwork BMC did not perform a risk assessment of the entity for purposes of determining the appropriate subrecipient monitoring related to the subaward. However, for these subrecipients, BMC did perform monitoring procedures, including review of invoices for reimbursement, review of Research Performance Progress Reports and review of Single Audit reports. Cause The condition found was primarily due to the monitoring procedures implemented by BMC do not include a review to ensure that a risk assessment is performed for each active subrecipient and BMC does not have a mechanism in place to provide the ALN at the time of disbursement of funds to the subrecipient. Possible Asserted Effect Failure to perform an annual risk assessment to determine appropriate subrecipient monitoring procedures may result in insufficient monitoring procedures being performed to detect subrecipient noncompliance with Federal statutes, regulations, and the terms and conditions of the award. Failure to adequately communicate award identification information could result in the subrecipient not being able to adequately track and report the subawards received resulting in errors being reported on the schedule of expenditures of federal awards within a subrecipient’s annual single audit report and not being able to comply with required terms and conditions of the federal award. Questioned Costs None. Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Recommendation We recommend BMC implement policies, procedures, and internal controls to ensure subrecipient risk assessments are performed for each subrecipient to determine the appropriate subrecipient monitoring is performed in accordance with 45 CFR 75.352(d) and 45 CFR 75.352(e). We recommend that BMC enhance its processes and internal controls over its reporting to the subrecipients of the federal program to ensure all award identification information required under 45 CFR 75.352(a) is provided to the subrecipients.

FY End: 2023-09-30
Bmc Health System, Inc.
Compliance Requirement: M
Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaw...

Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaward modification. When some of this information is not available, the pass through entity must provide the best information available to describe the Federal award and subaward. Required information includes: (xii) Assistance Listings number and Title; the pass through entity must identify the dollar amount made available under each Federal award and the Assistance Listings Number at time of disbursement; (2 CFE section 200.332xxi) (b) Evaluate each subrecipient’s risk of noncompliance with Federal statutes, regulations, and the terms and conditions of the subaward for purposes of determining the appropriate subrecipient monitoring described in paragraphs (d) and (e) of this section, which may include consideration of such factors as: (1) The subrecipient’s prior experience with the same or similar subawards; (2) The results of previous audits including whether or not the subrecipient receives a Single Audit in accordance with Subpart F of this part, and the extent to which the same or similar subaward has been audited as a major program; (3) Whether the subrecipient has new personnel or new or substantially changed systems; and (4) The extent and results of Federal awarding agency monitoring (e.g., if the subrecipient also receives Federal awards directly from a Federal awarding agency). Additionally, 45 CFR section 75 303(a) states the non Federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. Condition When subawards are made to subrecipients, the pass through entities are required to communicate the dollar amount made available under each Federal award and the Assistance Listings Number (ALN) at time of disbursement. BMC does not have system in place to provide the ALN at the time of disbursement of funds. During the year ended September 30, 2023, the BMC passed through $18,031,446 of federal funding to subrecipients. In order to assess the subrecipient’s risk of non compliance, BMC has subrecipient monitoring policies and procedures in place which include the use of a risk assessment questionnaire. The risk assessment questionnaire includes considerations consistent with 2 CFR 200.332(b), including the entity’s prior experience and results of Single Audits, in addition to other factors. As part of our testing related subrecipient monitoring, we identified the following: 1. For 4 of 16 subrecipients selected for testwork BMC did not perform a risk assessment of the entity for purposes of determining the appropriate subrecipient monitoring related to the subaward. However, for these subrecipients, BMC did perform monitoring procedures, including review of invoices for reimbursement, review of Research Performance Progress Reports and review of Single Audit reports. Cause The condition found was primarily due to the monitoring procedures implemented by BMC do not include a review to ensure that a risk assessment is performed for each active subrecipient and BMC does not have a mechanism in place to provide the ALN at the time of disbursement of funds to the subrecipient. Possible Asserted Effect Failure to perform an annual risk assessment to determine appropriate subrecipient monitoring procedures may result in insufficient monitoring procedures being performed to detect subrecipient noncompliance with Federal statutes, regulations, and the terms and conditions of the award. Failure to adequately communicate award identification information could result in the subrecipient not being able to adequately track and report the subawards received resulting in errors being reported on the schedule of expenditures of federal awards within a subrecipient’s annual single audit report and not being able to comply with required terms and conditions of the federal award. Questioned Costs None. Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Recommendation We recommend BMC implement policies, procedures, and internal controls to ensure subrecipient risk assessments are performed for each subrecipient to determine the appropriate subrecipient monitoring is performed in accordance with 45 CFR 75.352(d) and 45 CFR 75.352(e). We recommend that BMC enhance its processes and internal controls over its reporting to the subrecipients of the federal program to ensure all award identification information required under 45 CFR 75.352(a) is provided to the subrecipients.

FY End: 2023-09-30
Bmc Health System, Inc.
Compliance Requirement: M
Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaw...

Federal Agency: United States Department of Health and Human Services (HHS) Federal Program: R&D Cluster Federal Award Numbers: Various Federal Award Years: Various Reference: 2023 003 Criteria In accordance with 2 CFR 200.332, a pass through entity (PTE) must: (a) Ensure that every subaward is clearly identified to the subrecipient as a subaward and includes the following information at the time of the subaward and if any of these data elements change, include the changes in subsequent subaward modification. When some of this information is not available, the pass through entity must provide the best information available to describe the Federal award and subaward. Required information includes: (xii) Assistance Listings number and Title; the pass through entity must identify the dollar amount made available under each Federal award and the Assistance Listings Number at time of disbursement; (2 CFE section 200.332xxi) (b) Evaluate each subrecipient’s risk of noncompliance with Federal statutes, regulations, and the terms and conditions of the subaward for purposes of determining the appropriate subrecipient monitoring described in paragraphs (d) and (e) of this section, which may include consideration of such factors as: (1) The subrecipient’s prior experience with the same or similar subawards; (2) The results of previous audits including whether or not the subrecipient receives a Single Audit in accordance with Subpart F of this part, and the extent to which the same or similar subaward has been audited as a major program; (3) Whether the subrecipient has new personnel or new or substantially changed systems; and (4) The extent and results of Federal awarding agency monitoring (e.g., if the subrecipient also receives Federal awards directly from a Federal awarding agency). Additionally, 45 CFR section 75 303(a) states the non Federal entity must establish and maintain effective internal control over the Federal award that provides reasonable assurance that the non Federal entity is managing the Federal award in compliance with Federal statutes, regulations, and the terms and conditions of the Federal award. Condition When subawards are made to subrecipients, the pass through entities are required to communicate the dollar amount made available under each Federal award and the Assistance Listings Number (ALN) at time of disbursement. BMC does not have system in place to provide the ALN at the time of disbursement of funds. During the year ended September 30, 2023, the BMC passed through $18,031,446 of federal funding to subrecipients. In order to assess the subrecipient’s risk of non compliance, BMC has subrecipient monitoring policies and procedures in place which include the use of a risk assessment questionnaire. The risk assessment questionnaire includes considerations consistent with 2 CFR 200.332(b), including the entity’s prior experience and results of Single Audits, in addition to other factors. As part of our testing related subrecipient monitoring, we identified the following: 1. For 4 of 16 subrecipients selected for testwork BMC did not perform a risk assessment of the entity for purposes of determining the appropriate subrecipient monitoring related to the subaward. However, for these subrecipients, BMC did perform monitoring procedures, including review of invoices for reimbursement, review of Research Performance Progress Reports and review of Single Audit reports. Cause The condition found was primarily due to the monitoring procedures implemented by BMC do not include a review to ensure that a risk assessment is performed for each active subrecipient and BMC does not have a mechanism in place to provide the ALN at the time of disbursement of funds to the subrecipient. Possible Asserted Effect Failure to perform an annual risk assessment to determine appropriate subrecipient monitoring procedures may result in insufficient monitoring procedures being performed to detect subrecipient noncompliance with Federal statutes, regulations, and the terms and conditions of the award. Failure to adequately communicate award identification information could result in the subrecipient not being able to adequately track and report the subawards received resulting in errors being reported on the schedule of expenditures of federal awards within a subrecipient’s annual single audit report and not being able to comply with required terms and conditions of the federal award. Questioned Costs None. Statistical Sampling The sample was not intended to be, and was not, a statistically valid sample. Recommendation We recommend BMC implement policies, procedures, and internal controls to ensure subrecipient risk assessments are performed for each subrecipient to determine the appropriate subrecipient monitoring is performed in accordance with 45 CFR 75.352(d) and 45 CFR 75.352(e). We recommend that BMC enhance its processes and internal controls over its reporting to the subrecipients of the federal program to ensure all award identification information required under 45 CFR 75.352(a) is provided to the subrecipients.

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