EIN: 411392082
UEI: NL3YAWLVSGK1
Data as of August 23, 2026
Management decision deadline — for entities that funded this organization
The FAC accepted this audit on January 4, 2024. Under 2 CFR 200.521(d), a pass-through entity that provided federal funds to this organization for this audit period must issue a management decision on these findings by July 4, 2024 (781 days ago).
What is a management decision? →There were the expenses claimed under general and administrative category that were in excess of the amounts actually incurred under the program. Also, there was a duplication of utility expenses already claimed for the month of November 2021. Cause: The Medical Center claimed general and administrative costs that did not agree to supporting documentation due to clerical errors within the final expenditure listing. Effect: Expenditures included within the special report submitted to the Department of Health and Human Services for Period 4 TIN# 411392082 relating to general and administrative expenses were overstated by $53,954. Questioned Costs: The Medical Center has additional lost revenue in Period 4 that exceeds the general and administrative expenses. As a result, there are no questioned costs for activities allowed or unallowed and allowable costs/cost principles. Expenses included within the special report were overstated by $53,954. Context/Sampling: Summary level testing was performed over mortgage, utilities, and insurance. Key line items were tested on the Period 4 Department of Health and Human Services special report. Repeat Finding from Prior Years: No Recommendation: We recommend implementing a control process that reviews the clerical accuracy to the supporting detail being used to claim the allowable costs under the program. Views of Responsible Officials: Management agrees with the finding.
Show full finding ▾Hide full finding ▴2023-003 Department of Health and Human Services Federal Financial Assistance Listing #93.498 COVID-19 Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Applicable Federal Award Number and Year – Period 4 TIN# 411392082 Activities Allowed or Unallowed and Allowable Costs/Cost Principles Material Weakness in Internal Control over Compliance and Noncompliance Reporting Material Weakness in Internal Control over Compliance and Material Noncompliance Criteria: 2 CFR 200.303(a) establishes that the auditee must establish and maintain effective internal control over the federal award that provides assurance that the entity is managing the federal award in compliance with federal statutes, regulations, and conditions of the federal award. Condition: There were the expenses claimed under general and administrative category that were in excess of the amounts actually incurred under the program. Also, there was a duplication of utility expenses already claimed for the month of November 2021. Cause: The Medical Center claimed general and administrative costs that did not agree to supporting documentation due to clerical errors within the final expenditure listing. Effect: Expenditures included within the special report submitted to the Department of Health and Human Services for Period 4 TIN# 411392082 relating to general and administrative expenses were overstated by $53,954. Questioned Costs: The Medical Center has additional lost revenue in Period 4 that exceeds the general and administrative expenses. As a result, there are no questioned costs for activities allowed or unallowed and allowable costs/cost principles. Expenses included within the special report were overstated by $53,954. Context/Sampling: Summary level testing was performed over mortgage, utilities, and insurance. Key line items were tested on the Period 4 Department of Health and Human Services special report. Repeat Finding from Prior Years: No Recommendation: We recommend implementing a control process that reviews the clerical accuracy to the supporting detail being used to claim the allowable costs under the program. Views of Responsible Officials: Management agrees with the finding.
Finding 2023-003 Federal Agency Name: Department of Health and Human Services Program Name: COVID-19 Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Applicable Federal Award Number and Year- Period 4 TIN# 411392082 Federal Financial Assistance Listing #93.498 Finding Summary: There were expenses claimed under the general and administrative category that were in excess of the amounts actually incurred under the program. Also, there was a duplication of utility expenses already claimed for the month of November 2021. Responsible Individuals: Sandra Schlechter, Chief Financial Officer, and Bradly Burris, Chief Executive Officer Corrective Action Plan: We had Sandra Schlechter, Chief Financial Officer, and Ryan Hill, Controller, review all the forms and expenses to make sure there are no duplications. There were additional unreimbursed expenses and excess lost revenue on the Period 4 report to cover this oversight. Anticipated Completion Date: December 31, 2023, as no further reporting requirements are anticipated for this program.
FAC accepted this audit on February 27, 2023 — management decision was due August 27, 2023.
The fiscal year 2021 audit report was either not submitted to USDA or submitted to USDA with no retained documentation to support when the report was submitted. In addition, the FY2023 operating budget was not submitted to USDA in the period under audit. Cause: The Medical Center did not have an internal control process in place to ensure timely submission of the required reports to USDA and the Medical Center did not retain documentation to support when the fiscal year 2021 audit report was submitted to USDA. Effect: The required reports may not have been submitted to USDA. Questioned Costs: None reported. Context/Sampling: Sampling was not used. Repeat Finding from Prior Years: No Recommendation: We recommend implementing a process to ensure timely submission of the annual audit report and operating budget and retain documentation to support when the report and budget are submitted to USDA. Views of Responsible Officials: Management agrees with the finding.
Show full finding ▾Hide full finding ▴2022-003 Department of Agriculture Federal Financial Assistance Listing #10.766 Communities Facilities Loans and Grants Cluster Reporting Material Weakness in Internal Control over Compliance and Material Noncompliance Criteria: 2 CFR 200.303(a) establishes that the auditee must establish and maintain effective internal control over the federal award that provides assurance that the entity is managing the federal award in compliance with federal statutes, regulations, and conditions of the federal award. Within the amended letter of conditions dated August 20, 2014, for the USDA financing, annual audited financial statements are required to be submitted to USDA. In addition, the fiscal year operating budget must be submitted and approved by USDA. Condition: The fiscal year 2021 audit report was either not submitted to USDA or submitted to USDA with no retained documentation to support when the report was submitted. In addition, the FY2023 operating budget was not submitted to USDA in the period under audit. Cause: The Medical Center did not have an internal control process in place to ensure timely submission of the required reports to USDA and the Medical Center did not retain documentation to support when the fiscal year 2021 audit report was submitted to USDA. Effect: The required reports may not have been submitted to USDA. Questioned Costs: None reported. Context/Sampling: Sampling was not used. Repeat Finding from Prior Years: No Recommendation: We recommend implementing a process to ensure timely submission of the annual audit report and operating budget and retain documentation to support when the report and budget are submitted to USDA. Views of Responsible Officials: Management agrees with the finding.
Finding 2022-003 Federal Agency Name: Department of Agriculture Program Name: Communities Facilities Loans and Grant Cluster Federal Financial Assistance Listing #10.766 Reporting: Material Weakness in Internal Control over Compliance and Material Noncompliance Finding Summary: The fiscal year 2021 audit report was either not submitted to USDA or submitted to USDA with no retained documentation to support when the report was submitted. The FY 2023 operating budget was not submitted to USDA during the period under audit. Responsible Individuals: Sandra Schlechter, Chief Financial Officer, and Bradley Burris, Chief Executive Officer Corrective Action Plan: There will be internal reminders set up in management?s yearly calendar for information to be sent to USDA for submission of the annual audited financial statements and operating budget for the next fiscal year. Anticipated Completion Date: February 2023
No secondary level of review is being performed over the reserve fund balance as compared to the reserve fund requirements, or the days cash on hand and debt service compared to the minimum requirements. Cause: The Medical Center did not have an internal control process in place to ensure a secondary level of review is being performed on the required minimums for the reserve account and financial covenants. Effect: The Medical Center could be in violation of the required minimums if management is not monitoring compliance. Questioned Costs: None reported Context/Sampling: Sampling was not used. Repeat Finding from Prior Year: No Recommendation: We recommend management implement a process and controls ensuring a secondary level of review is completed over the reserve account and the required financial covenant minimums. Views of Responsible Officials: Management agrees with the finding.
Show full finding ▾Hide full finding ▴2022-004 Department of Agriculture Federal Financial Assistance Listing #10.766 Communities Facilities Loans and Grants Cluster Special Tests and Provisions Material Weakness in Internal Control over Compliance Criteria: 2 CFR 200.303(a) establishes that the auditee must establish and maintain effective internal control over the federal award that provides assurance that the entity is managing the federal award in compliance with federal statutes, regulations, and conditions of the federal award. The May 13,2014 letter of conditions with USDA state the Medical Center must set aside a reserve fund at a rate of 10% of the annual payment until the reserve account reaches the amount of one full year?s annual payment. The intercreditor and parity agreement for Series 2021 Gross Revenue Medical Center Refunding Note subjects the USDA Series 2016 financing to the same financial covenant compliance requirements relating to days cash on hand and debt service. Condition: No secondary level of review is being performed over the reserve fund balance as compared to the reserve fund requirements, or the days cash on hand and debt service compared to the minimum requirements. Cause: The Medical Center did not have an internal control process in place to ensure a secondary level of review is being performed on the required minimums for the reserve account and financial covenants. Effect: The Medical Center could be in violation of the required minimums if management is not monitoring compliance. Questioned Costs: None reported Context/Sampling: Sampling was not used. Repeat Finding from Prior Year: No Recommendation: We recommend management implement a process and controls ensuring a secondary level of review is completed over the reserve account and the required financial covenant minimums. Views of Responsible Officials: Management agrees with the finding.
Finding 2022-004 Federal Agency Name: Department of Agriculture Program Name: Communities Facilities Loans and Grant Cluster Federal Financial Assistance Listing #10.766 Special Tests and Provisions: Material Weakness in Internal Control over Compliance Finding Summary: The Medical Center did not have an internal control process in place to ensure a secondary level of review is being performed on the required minimum for the reserve account and financial covenants. Responsible Individuals: Sandra Schlechter, Chief Financial Officer, and Bradley Burris, Chief Executive Officer Corrective Action Plan: Within the monthly board packet, we will include the calculation of days on hand, the debt service covenant ratio, the balance of the reserve along with the required minimum requirements for each of these items. This packet is presented monthly to the board of directors for approval. Anticipated Completion Date: February 2023
FAC accepted this audit on September 15, 2022 — management decision was due March 15, 2023.
The Medical Center does not have an internal control system designed for the preparation of the schedule. As auditors, we were requested to assist with the preparation of the schedule.Cause: Auditor assistance with preparation of the schedule is not unusual as the schedule has unique and specialized requirement and preparation is only required when the Medical Center meets a specified threshold of federal expenditures.Effect: There is a reasonable possibility that the Medical Center would not be able to draft a complete and accurate schedule without the assistance of the auditors.Questioned Costs: None reported.Context: Sampling was not used.Repeat Finding from Prior Years: NoRecommendation: While we recognize that this condition is not unusual for an organization with limited staffing, it is important that the Medical Center is aware of this condition for financial reporting requirements relating to the Medical Center?s schedule of expenditures of federal awards and the internal controls that impact financial reporting.Views of Responsible Officials: Management agrees with the finding.
Show full finding ▾Hide full finding ▴2021-003 Department of Health and Human ServicesFederal Financial Assistance Listing/CFDA #93.498COVID-19 Provider Relief Fund and American Rescue Plan (ARP) Rural DistributionApplicable Federal Award Number and Year ? Period 1 TIN #411392082Preparation of the Schedule of Expenditures of Federal AwardsMaterial Weakness in Internal Control over Compliance - OtherCriteria: Proper controls over financial reporting includes a system designed to prepare the schedule of expenditures of federal awards (the schedule) and the accompanying notes to the schedule.Condition: The Medical Center does not have an internal control system designed for the preparation of the schedule. As auditors, we were requested to assist with the preparation of the schedule.Cause: Auditor assistance with preparation of the schedule is not unusual as the schedule has unique and specialized requirement and preparation is only required when the Medical Center meets a specified threshold of federal expenditures.Effect: There is a reasonable possibility that the Medical Center would not be able to draft a complete and accurate schedule without the assistance of the auditors.Questioned Costs: None reported.Context: Sampling was not used.Repeat Finding from Prior Years: NoRecommendation: While we recognize that this condition is not unusual for an organization with limited staffing, it is important that the Medical Center is aware of this condition for financial reporting requirements relating to the Medical Center?s schedule of expenditures of federal awards and the internal controls that impact financial reporting.Views of Responsible Officials: Management agrees with the finding.
Finding 2021-003Federal Agency Name: Department of Health and Human ServicesProgram Name: COVID-19 Provider Relief Fund and American Rescue Plan (ARP) Rural DistributionFederal Financial Assistance Listing #93.498Finding Summary: The Medical Center does not have an internal control system designed for the preparation of the schedule of expenditures offederal awards (the Schedule). Eide Bailly LLP assisted with the preparation of the schedule.Responsible Individuals: Sandra Schlechter, Chief Financial Officer, Bradley Burris, Chief Executive OfficerCorrective Action Plan: It is not cost effective to have an internal control system designed to provide for the preparation of the schedule of expenditures of federal awards. We will continue to provide the information to and have our auditors, Eide Bailly LLP, prepare the schedule. We will review the expenditures that meet the classification to help prepare, prevent and respond for COVID-19. These expenditures will be copied and put in a binder with the corresponding grant that it qualifies for, as well as put in a spreadsheet with tab categories labeled.Anticipated Completion Date: Ongoing
During testing we identified the following:- The Medical Center?s final expenditure listing identified as eligible and claimed under the Provider Relief Fund and American Rescue Plan Rural Distribution program (the program) was not reviewed and approved by a separate individual outside of the preparer.- There was no documentation relating to mortgage principal and interest payments and insurance from January 2020 that supported the costs were necessary to prevent, prepare for, or respond to the coronavirus. In addition, two expenses were claimed under the program where the amounts claimed did not agree to supporting documentation which led to $50 being over claimed under the program.- The Medical Center claimed COVID wages and benefits in excess of the amounts actually incurred under the program and claimed the September 2020 mortgage payment twice.- The Medical Center?s lost revenue calculation and the Medical Center?s special report submitted to the Department of Health and Human Services for Period 1 TIN#41139082 were not reviewed and approved by a separate individual outside of the preparer or individual who inputted and submitted the report.- The Medical Center?s January 2020 mortgage principal and interest payments and insurance, excess COVID wages and benefits, along with the duplicative September 2020 mortgage payment were included within the report submitted to the Department of Health and Human Services for Period 1.Cause: Below are individual causes as it relates to the items identified during testing:- The Medical Center did not have an internal control process in place to ensure a secondary review and approval of the final expenditure listing, the lost revenue calculation, or the special report submitted to the Department of Health and Human Services for Period 1 TIN#41139082.- The guidance relating to allowable costs was unclear relating to general and administrative expenses incurred in quarter 1 of 2020 prior to the start of when the Medical Center first started preparing for coronavirus. In addition, the Medical Center did not document their consideration of allowability of the January 2020 expenses claimed.- The COVID wages and benefits claimed under the program did not agree to supporting documentation and the Medical Center claimed the September 2020 mortgage payment twice due to a formula error within the final expenditure listing.Effect: Without a secondary review and approval and documentation in place to support the Medical Center?s decisions, there is a possibility that ineligible expenditures are claimed under the program and included within the special report. Expenses included within the special report submitted to the Department of Health and Human Services for Period 1 TIN#411392082 relating to the January 2020 expenses, COVID wages and benefits and September 2020 mortgage payment were overstated by $103,895.Questioned Costs: As reported in Period 1, the Medical Center and has additional lost revenue that exceeds the January 2020 expenses, COVID wages and benefits and September 2020 mortgage payment. As a result, there are no questioned costs for activities allowed or unallowed and allowable costs/cost principles. Expenses included within the special report were overstated by $103,895.Context/Sampling: The below types of testing were performed:- Summary level testing was performed over mortgage, utilities, insurance and COVID appreciation bonus.- A nonstatistical sample of 60 ($274,945) out of a population greater than 250 transactions ($428,212) relating to general and administrative and healthcare related expenses, including personnel, supplies, equipment, and facilities were tested.- A nonstatistical sample of COVID wages and benefits for 5 months ($310,280) out of 12 months ($521,901) were tested.- Key line items were tested on the Period 1 Department of Health and Human Services special report.Repeat Finding from Prior Years: NoRecommendation: We recommend the following:- The Medical Center implement a control process which includes a secondary review and approval of the final expenditure listing used to claim the allowable costs under the program.- We recommend management document their consideration of allowability of January 2020 expenses claimed under the program.- The Medical Center implement a control process which includes a secondary review and approval of the lost revenue calculation.- The Medical Center implement a control process to ensure the special report is reviewed and approved prior to submission by a separate individual outside of the preparer.Views of Responsible Officials: Management agrees with the finding.
Show full finding ▾Hide full finding ▴2021-004 Department of Health and Human ServicesFederal Financial Assistance Listing/CFDA #93.498COVID-19 Provider Relief Fund and American Rescue Plan (ARP) Rural DistributionApplicable Federal Award Number and Year ? Period 1 TIN #411392082Activities Allowed or Unallowed and Allowable Costs/Cost PrinciplesMaterial Weakness in Internal Control over Compliance and NoncomplianceReportingMaterial Weakness in Internal Control over Compliance and NoncomplianceCriteria: 2 CFR 200.303(a) establishes that the auditee must establish and maintain effective internal control over the federal award that provides assurance that the entity is managing the federal award in compliance with federal statutes, regulations, and conditions of the federal award.Condition: During testing we identified the following:- The Medical Center?s final expenditure listing identified as eligible and claimed under the Provider Relief Fund and American Rescue Plan Rural Distribution program (the program) was not reviewed and approved by a separate individual outside of the preparer.- There was no documentation relating to mortgage principal and interest payments and insurance from January 2020 that supported the costs were necessary to prevent, prepare for, or respond to the coronavirus. In addition, two expenses were claimed under the program where the amounts claimed did not agree to supporting documentation which led to $50 being over claimed under the program.- The Medical Center claimed COVID wages and benefits in excess of the amounts actually incurred under the program and claimed the September 2020 mortgage payment twice.- The Medical Center?s lost revenue calculation and the Medical Center?s special report submitted to the Department of Health and Human Services for Period 1 TIN#41139082 were not reviewed and approved by a separate individual outside of the preparer or individual who inputted and submitted the report.- The Medical Center?s January 2020 mortgage principal and interest payments and insurance, excess COVID wages and benefits, along with the duplicative September 2020 mortgage payment were included within the report submitted to the Department of Health and Human Services for Period 1.Cause: Below are individual causes as it relates to the items identified during testing:- The Medical Center did not have an internal control process in place to ensure a secondary review and approval of the final expenditure listing, the lost revenue calculation, or the special report submitted to the Department of Health and Human Services for Period 1 TIN#41139082.- The guidance relating to allowable costs was unclear relating to general and administrative expenses incurred in quarter 1 of 2020 prior to the start of when the Medical Center first started preparing for coronavirus. In addition, the Medical Center did not document their consideration of allowability of the January 2020 expenses claimed.- The COVID wages and benefits claimed under the program did not agree to supporting documentation and the Medical Center claimed the September 2020 mortgage payment twice due to a formula error within the final expenditure listing.Effect: Without a secondary review and approval and documentation in place to support the Medical Center?s decisions, there is a possibility that ineligible expenditures are claimed under the program and included within the special report. Expenses included within the special report submitted to the Department of Health and Human Services for Period 1 TIN#411392082 relating to the January 2020 expenses, COVID wages and benefits and September 2020 mortgage payment were overstated by $103,895.Questioned Costs: As reported in Period 1, the Medical Center and has additional lost revenue that exceeds the January 2020 expenses, COVID wages and benefits and September 2020 mortgage payment. As a result, there are no questioned costs for activities allowed or unallowed and allowable costs/cost principles. Expenses included within the special report were overstated by $103,895.Context/Sampling: The below types of testing were performed:- Summary level testing was performed over mortgage, utilities, insurance and COVID appreciation bonus.- A nonstatistical sample of 60 ($274,945) out of a population greater than 250 transactions ($428,212) relating to general and administrative and healthcare related expenses, including personnel, supplies, equipment, and facilities were tested.- A nonstatistical sample of COVID wages and benefits for 5 months ($310,280) out of 12 months ($521,901) were tested.- Key line items were tested on the Period 1 Department of Health and Human Services special report.Repeat Finding from Prior Years: NoRecommendation: We recommend the following:- The Medical Center implement a control process which includes a secondary review and approval of the final expenditure listing used to claim the allowable costs under the program.- We recommend management document their consideration of allowability of January 2020 expenses claimed under the program.- The Medical Center implement a control process which includes a secondary review and approval of the lost revenue calculation.- The Medical Center implement a control process to ensure the special report is reviewed and approved prior to submission by a separate individual outside of the preparer.Views of Responsible Officials: Management agrees with the finding.
Finding 2021-004Federal Agency Name: Department of Health and Human ServicesProgram Name: COVID-19 Provider Relief Fund and American Rescue Plan (ARP) Rural DistributionFederal Financial Assistance Listing #93.498Activities Allowed or Unallowed and Allowable Costs/Cost Principles and ReportingFinding Summary: During testing, our accountant's, Eide Bailly LLP, identified the following:-The Medical Center's final expenditure listing identified as eligible and claimed under the Provider Relief Fund and American Rescue Plan Rural Distribution program (the program) was not reviewed and approved by a separate individual outside of the preparer.-There was no documentation relating to mortgage principal and interest payments and insurance from January 2020 that supported the costs were necessary to prevent, prepare for, or respond to the coronavirus. In addition, two expenses were claimed under the program where the amounts claimed did not agree to supporting documentation which led to $50 being over claimed under the program.-The Medical Center claimed COVID wages and benefits in excess of the amounts actually incurred under the program and claimed the September 2020 mortgage payment twice.-The Medical Center's lost revenue calculation and the Medical Center's special report submitted to the Department of Health and Human Services for Period 1 TIN#41139082 were not reviewed and approved by a separate individual outside of the preparer or individual who inputted and submitted the report.-The Medical Center's January 2020 mortgage principal and interest payments and insurance, excess COVID wages and benefits, along with the duplicative September 2020 mortgage payment were included within the report submitted to the Department of Health and Human Services for Period 1.Responsible Individuals: Sandra Schlechter, Chief Financial Officer; Ryan Hill, Controller; and Peggy Boese, Accounts PayableCorrective Action Plan: Sandra Schlechter will be creating the expenditure worksheet for eligible expenses to be claimed under the federal program, as well as the lost revenue calculations. The worksheet will include vendor invoice information for onlyexpenses that meet the federal programs terms and conditions. Sandra will then provide the expenditure and lost revenue worksheets and calculations and any backup documentation to Ryan Hill, Controller for his review and approval of expenses and lost revenue claimed (formal documentation will be obtained and retained in house).Anticipated Completion Date: September 2022
FAC accepted this audit on November 19, 2017 — management decision was due May 19, 2018.
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