EIN: 420680467
UEI: D5K2C5KB1NQ8
Audited by: Eide Bailly LLP
Oversight agency: 10 [Department of Agriculture]
Data as of August 27, 2026
Management decision deadline — for entities that funded this organization
The FAC accepted this audit on March 19, 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 September 19, 2024 (708 days ago).
What is a management decision? →The Medical Center does not have an internal control system designed to provide for the preparation of the schedule of expenditures of federal. As auditors, we were requested to draft the schedule of expenditures of federal awards. Cause: Auditor assistance with preparation of the schedule is not unusual as the schedule has unique and specialized requirements 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 of expenditures of federal awards without the assistance of the auditors. Questioned Costs: None reported. Context: Sampling was not used. Repeat Finding from Prior Years: No Recommendation: We recommend management continually be aware of the 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 ▴Department of Health and Human Services Federal 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#420680467 Preparation of Schedule of Expenditures of Federal Awards Material Weakness in Internal Control over Compliance - Other Criteria: Proper controls over financial reporting include a system designed to prepare the schedule of expenditures of federal awards and accompanying notes to the schedule of expenditures of federal awards. Condition: The Medical Center does not have an internal control system designed to provide for the preparation of the schedule of expenditures of federal. As auditors, we were requested to draft the schedule of expenditures of federal awards. Cause: Auditor assistance with preparation of the schedule is not unusual as the schedule has unique and specialized requirements 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 of expenditures of federal awards without the assistance of the auditors. Questioned Costs: None reported. Context: Sampling was not used. Repeat Finding from Prior Years: No Recommendation: We recommend management continually be aware of the 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.
Federal Agency Name: Department of Health and Human Services Program Name: COVID-19 Provider Relief Fund and American Rescue Plan Federal Financial Assistance Listing #93.498 Compliance Requirement: Other Finding Summary: The Medical Center does not have an internal control system designed to provide for the preparation of the schedule of expenditures of federal. We requested our auditors to assist with the draft of the schedule of expenditures for federal awards. Responsible Individuals: Ben Stevens, CFO Corrective Action Plan: Management Agrees with the Finding. This finding and recommendation is not a result of any change in the Medical Center’s procedures, rather it is due to an auditing standard implemented by the American Institute of Certified Public Accountants. Management feels that committing the resources necessary to remain current on the preparation of the schedule of expenditures of federal awards reporting requirements and corresponding footnote disclosures would lack benefit in relation to the cost but will continue evaluating on a going forward basis. Anticipated Completion Date: Ongoing
The Medical Center claimed expenses that had been reimbursed by another source. The Medical Center is a critical access hospital which means that a portion of their expenditures are covered by Medicare. The Medical Center did not decrease their expenses for the portion that was reimbursed by Medicare. The Medical Center’s special report submitted to the Department of Health and Human Services for Period 4 TIN #420680487 reported these expenses that were reimbursed by other sources which made the report inaccurate as well. Cause: The Medical Center did not have an internal control process in place to ensure the expenses reported were eligible expenditures under the federal program, and the report submitted to the Department of Health and Human Services for Period 4 was complete and accurate. The Medical Center did not consider Medicare reimbursement when claiming expenses under the federal program. Effect: Without reducing expenses by Medicare reimbursement, ineligible expenditures were claimed under the program, and the report was not accurately completed. Questioned Costs: The Medical Center had questioned costs of $580,669; however, the Medical Center had lost revenue carryforward on their submitted report of $234,595 and as noted in finding 2023-005, there was additional calculated lost revenue of $559,737 that could be used to cover these questioned costs. If the $580,669 of costs identified here are applied to the total remaining lost revenue, there is $213,633 of excess lost revenue remaining. Therefore, the Medical Center does not expect to have to return any funds. Context/Sampling: Sampling was not used Repeat Finding from Prior Years: No Recommendation: We recommend the Medical Center review the requirements of the federal program prior to compiling the expenditures claimed under the federal program. We also recommend the Medical Center implement a control process which includes a secondary review and approval of expenditures claimed under the federal program and a secondary review and approval of required reports to be submitted to the federal agency by and individual familiar with the requirements of the federal program. Views of Responsible Officials: Management agrees with the finding.
Show full finding ▾Hide full finding ▴Department of Health and Human Services Federal 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#420680467 Activities Allowed or Unallowed and Allowable Costs/Costs Principles and Reporting Material Weakness in Internal Control Over Compliance and Material Noncompliance Criteria: 2 CFR 200.303 (a) establishes that the auditee must establish and maintain effective internal control over federal awards that provides reasonable assurance that the entity is managing the federal award in compliance with federal statutes, regulations and conditions of the federal award. Condition: The Medical Center claimed expenses that had been reimbursed by another source. The Medical Center is a critical access hospital which means that a portion of their expenditures are covered by Medicare. The Medical Center did not decrease their expenses for the portion that was reimbursed by Medicare. The Medical Center’s special report submitted to the Department of Health and Human Services for Period 4 TIN #420680487 reported these expenses that were reimbursed by other sources which made the report inaccurate as well. Cause: The Medical Center did not have an internal control process in place to ensure the expenses reported were eligible expenditures under the federal program, and the report submitted to the Department of Health and Human Services for Period 4 was complete and accurate. The Medical Center did not consider Medicare reimbursement when claiming expenses under the federal program. Effect: Without reducing expenses by Medicare reimbursement, ineligible expenditures were claimed under the program, and the report was not accurately completed. Questioned Costs: The Medical Center had questioned costs of $580,669; however, the Medical Center had lost revenue carryforward on their submitted report of $234,595 and as noted in finding 2023-005, there was additional calculated lost revenue of $559,737 that could be used to cover these questioned costs. If the $580,669 of costs identified here are applied to the total remaining lost revenue, there is $213,633 of excess lost revenue remaining. Therefore, the Medical Center does not expect to have to return any funds. Context/Sampling: Sampling was not used Repeat Finding from Prior Years: No Recommendation: We recommend the Medical Center review the requirements of the federal program prior to compiling the expenditures claimed under the federal program. We also recommend the Medical Center implement a control process which includes a secondary review and approval of expenditures claimed under the federal program and a secondary review and approval of required reports to be submitted to the federal agency by and individual familiar with the requirements of the federal program. Views of Responsible Officials: Management agrees with the finding.
Federal Agency Name: Department of Health and Human Services Program Name: COVID-19 Provider Relief Fund and American Rescue Plan Federal Financial Assistance Listing #93.498 Compliance Requirement: Activities Allowed or Unallowed and Allowable Costs/Costs Principles and Reporting Finding Summary: Winneshiek Medical Center claimed expenses that had been reimbursed by another source. The Medical Center is a critical access hospital which means that a portion of their expenditures are covered by Medicare. The Medical Center did not decrease their expenses for the portion that was reimbursed by Medicare. The Medical Center’s special report submitted to the Department of Health and Human Services for Period 4 TIN #420680487 reported these expenses that were reimbursed by other sources which made the report inaccurate as well. Responsible Individuals: Ben Stevens, CFO Corrective Action Plan: Management agrees with the finding. The Medical Center created a “Federal Reporting Review Policy” dated March 9, 2023 as a result of working with HRSA and the 2021FY audit. This policy was approved and is now in process. Anticipated Completion Date: No future reports are anticipated to be filed under this program.
The Medical Center’s lost revenue calculation did not take into consideration budgeted 340B revenue, but included actual 340B revenue, and did not take into consideration Period 1 questioned costs that were replaced with excess lost revenue. In addition, the calculation was not reviewed and approved by a separate individual outside of the preparer. The Medical Center’s special report submitted to the Department of Health and Human Services for Period 4 TIN #420680487 was not reviewed and approved by a separate individual outside of the preparer. Cause: The Medical Center did not have an internal control process in place to ensure effective review and approval of the lost revenue calculation, and the report submitted to the Department of Health and Human Services for Period 4 was completed and documented. Effect: Without an effective secondary review and approval, the lost revenue calculation and amounts claimed under the program were not calculated properly, and the report was not accurately completed. Questioned Costs: None as the Medical Center’s lost revenue calculation would have increased by $559,737 due to the calculation errors. Context/Sampling: The lost revenue calculation for all applicable quarters was tested and reviewed. 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 the Medical Center implement a control process which includes a secondary review and approval of required reports to be submitted to the federal agency. We also recommend the Medical Center implement a control process which includes a secondary review and approval of the lost revenue calculation to ensure all required revenue streams are included for both actual and budget within the lost revenue calculation. Views of Responsible Officials: Management agrees with the finding.
Show full finding ▾Hide full finding ▴Department of Health and Human Services Federal 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#420680467 Reporting Material Weakness in Internal Control Over Compliance and Material Noncompliance Criteria: 2 CFR 200.303 (a) establishes that the auditee must establish and maintain effective internal control over federal awards that provides reasonable assurance that the entity is managing the federal award in compliance with federal statutes, regulations and conditions of the federal award. Condition: The Medical Center’s lost revenue calculation did not take into consideration budgeted 340B revenue, but included actual 340B revenue, and did not take into consideration Period 1 questioned costs that were replaced with excess lost revenue. In addition, the calculation was not reviewed and approved by a separate individual outside of the preparer. The Medical Center’s special report submitted to the Department of Health and Human Services for Period 4 TIN #420680487 was not reviewed and approved by a separate individual outside of the preparer. Cause: The Medical Center did not have an internal control process in place to ensure effective review and approval of the lost revenue calculation, and the report submitted to the Department of Health and Human Services for Period 4 was completed and documented. Effect: Without an effective secondary review and approval, the lost revenue calculation and amounts claimed under the program were not calculated properly, and the report was not accurately completed. Questioned Costs: None as the Medical Center’s lost revenue calculation would have increased by $559,737 due to the calculation errors. Context/Sampling: The lost revenue calculation for all applicable quarters was tested and reviewed. 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 the Medical Center implement a control process which includes a secondary review and approval of required reports to be submitted to the federal agency. We also recommend the Medical Center implement a control process which includes a secondary review and approval of the lost revenue calculation to ensure all required revenue streams are included for both actual and budget within the lost revenue calculation. Views of Responsible Officials: Management agrees with the finding.
Federal Agency Name: Department of Health and Human Services Program Name: COVID-19 Provider Relief Fund and American Rescue Plan Federal Financial Assistance Listing #93.498 Compliance Requirement: Reporting Finding Summary: The Medical Center’s lost revenue calculation did not take into consideration budgeted 340B revenue, but included actual 340B revenue, and did not take into consideration Period 1 questioned costs that were replaced with excess lost revenue. In addition, the calculation was not reviewed and approved by a separate individual outside of the preparer. The Medical Center’s special report submitted to the Department of Health and Human Services for Period 4 TIN #420680487 was not reviewed and approved by a separate individual outside of the preparer. Responsible Individuals: Ben Stevens, CFO Corrective Action Plan: Management agrees with the finding. The Medical Center created a “Federal Reporting Review Policy” dated March 9, 2023 as a result of working with HRSA and the 2021FY audit. This policy was approved and is now in process. Anticipated Completion Date: No future reports are anticipated to be filed under this program.
FAC accepted this audit on September 25, 2022 — management decision was due March 25, 2023.
The Medical Center does not have an internal control system designed to provide for the preparation of the schedule of expenditures of federal. As auditors, we were requested to draft the schedule of expenditures of federal awards.Cause: Auditor assistance with preparation of the schedule is not unusual as the schedule has unique and specialized requirements 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 of expenditures of federal awards without the assistance of the auditors.Questioned Costs: None reported.Context: Sampling was not used.Repeat Finding from Prior Years: NoRecommendation: We recommend management continually be aware of the 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 Assistance Listing/CFDA #93.498COVID-19 Provider Relief Fund and American Rescue Plan (ARP) Rural DistributionApplicable federal Award Number and Year ? Period 1 TIN#420680467Preparation of Schedule of Expenditures of Federal AwardsMaterial Weakness in Internal Control over Compliance - OtherCriteria: Proper controls over financial reporting include a system designed to prepare the schedule of expenditures of federal awards and accompanying notes to the schedule of expenditures of federal awards.Condition: The Medical Center does not have an internal control system designed to provide for the preparation of the schedule of expenditures of federal. As auditors, we were requested to draft the schedule of expenditures of federal awards.Cause: Auditor assistance with preparation of the schedule is not unusual as the schedule has unique and specialized requirements 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 of expenditures of federal awards without the assistance of the auditors.Questioned Costs: None reported.Context: Sampling was not used.Repeat Finding from Prior Years: NoRecommendation: We recommend management continually be aware of the 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 2021-003: Preparation of Schedule of Expenditures of Federal AwardsFederal Agency Name: Department of Health and Human ServicesProgram Name: COVID-19 Provider Relief Fund and American Rescue PlanFederal Financial Assistance Listing/CFDA Number: 93.498Finding Summary: The Medical Center does not have an internal control system designed to provide for the preparation of the schedule of expenditures of federal awards. As auditors, we were requested to draft the schedule of expenditures of federal awards.Responsible Individuals: Ben Stevens, CFOCorrective Action Plan: Management agrees with the finding. The Medical Center will work to identify a policy and procedure surrounding the review and approval of reporting for federal grants. This policy will provide a reconciliation of federal awards received and comparing them to federal award websites and compare them to the expenditures reported.Anticipated Completion Date: September 30, 2022
Winneshiek Medical Center claimed contracted physicians? salaries in excess of the Executive Level II salary level under the federal program. In addition, the expenditures identified as eligible and claimed under the federal program were not reviewed and approved by a separate individual outside of the preparer. The Medical Center?s lost revenue calculation did not take into consideration 340B revenue and the calculation was not reviewed and approved by a separate individual outside of the preparer. The Medical Center?s special report submitted to the Department of Health and Human Services for Period 1 TIN #420680487 was not reviewed and approved by a separate individual outside of the preparer.Cause: The Medical Center did not have an internal control process in place to ensure review and approval of eligible expenditures claimed under the federal program, the lost revenue calculation, and the report submitted to the Department of Health and Human Services for Period 1 was documented. The Medical Center did not consider the Executive Level II salary limit when claiming contracted physician salaries under the federal program. In addition, the Medical Center did not consider 340B as program revenue when calculating lost revenue.Effect: Without a secondary review and approval, there is a possibility that ineligible expenditures may be claimed under the program, the lost revenue calculation and amounts claimed under the program may not calculated properly, and the report may not be accurately completed.Questioned Costs: None reported for activities allowed or unallowed and allowable costs/costs principles as the Medical Center had eligible expenses and lost revenue that exceeded the Period 1 funds received. However, the Medical Center?s lost revenue carryforward would have been reduced by $378,546 had the 340b revenue been included and eligible expense would have been reduced by $65,303 relating to contracted physicians? salaries on the Period 1 report.Context/Sampling: A nonstatistical sample of 7 contracted salary and benefit disbursements out of a total of approximately 140 contracted salary and benefit disbursements were tested which accounted for $10,384 out of $143,597 of contracted salary and benefit disbursements. The lost revenue calculation for all applicable quarters was tested and reviewed. 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 Medical Center implement a control process which includes a secondary review and approval of expenditures claimed under the federal program and a secondary review and approval of required reports to be submitted to the federal agency. We recommend the Medical Center review the contracted physicians? salaries claimed under the federal program and implement procedures to ensure the physicians? salaries claimed are limited to the Executive Level II salary level. We also recommend the Medical Center implement a control process which includes a secondary review and approval of the lost revenue calculation to ensure all required revenue streams are included within the lost revenue calculation.Views of Responsible Officials: Management agrees with the finding.
Show full finding ▾Hide full finding ▴2021-004 Department of Health and Human ServicesFederal Assistance Listing/CFDA #93.498COVID-19 Provider Relief Fund and American Rescue Plan (ARP) Rural DistributionApplicable federal Award Number and Year ? Period 1 TIN#420680467Activities Allowed or Unallowed and Allowable Costs/Costs PrinciplesMaterial Weakness in Internal Control Over Compliance and NoncomplianceReportingMaterial Weakness in Internal Control Over Compliance and Material NoncomplianceCriteria: 2 CFR 200.303 (a) establishes that the auditee must establish and maintain effective internal control over federal awards that provides reasonable assurance that the entity is managing the federal award in compliance with federal statutes, regulations and conditions of the federal award. The federal award?s Terms and Conditions Section 202 Executive Pay states none of the funds appropriated under this federal program shall be used to pay the salary of an individual, through a grant or other mechanism, at a rate in excess of Executive Level II of the Federal Executive PayScale determined to be $197,300 effective January 2020 and $199,300 effective January 2021.Condition: Winneshiek Medical Center claimed contracted physicians? salaries in excess of the Executive Level II salary level under the federal program. In addition, the expenditures identified as eligible and claimed under the federal program were not reviewed and approved by a separate individual outside of the preparer. The Medical Center?s lost revenue calculation did not take into consideration 340B revenue and the calculation was not reviewed and approved by a separate individual outside of the preparer. The Medical Center?s special report submitted to the Department of Health and Human Services for Period 1 TIN #420680487 was not reviewed and approved by a separate individual outside of the preparer.Cause: The Medical Center did not have an internal control process in place to ensure review and approval of eligible expenditures claimed under the federal program, the lost revenue calculation, and the report submitted to the Department of Health and Human Services for Period 1 was documented. The Medical Center did not consider the Executive Level II salary limit when claiming contracted physician salaries under the federal program. In addition, the Medical Center did not consider 340B as program revenue when calculating lost revenue.Effect: Without a secondary review and approval, there is a possibility that ineligible expenditures may be claimed under the program, the lost revenue calculation and amounts claimed under the program may not calculated properly, and the report may not be accurately completed.Questioned Costs: None reported for activities allowed or unallowed and allowable costs/costs principles as the Medical Center had eligible expenses and lost revenue that exceeded the Period 1 funds received. However, the Medical Center?s lost revenue carryforward would have been reduced by $378,546 had the 340b revenue been included and eligible expense would have been reduced by $65,303 relating to contracted physicians? salaries on the Period 1 report.Context/Sampling: A nonstatistical sample of 7 contracted salary and benefit disbursements out of a total of approximately 140 contracted salary and benefit disbursements were tested which accounted for $10,384 out of $143,597 of contracted salary and benefit disbursements. The lost revenue calculation for all applicable quarters was tested and reviewed. 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 Medical Center implement a control process which includes a secondary review and approval of expenditures claimed under the federal program and a secondary review and approval of required reports to be submitted to the federal agency. We recommend the Medical Center review the contracted physicians? salaries claimed under the federal program and implement procedures to ensure the physicians? salaries claimed are limited to the Executive Level II salary level. We also recommend the Medical Center implement a control process which includes a secondary review and approval of the lost revenue calculation to ensure all required revenue streams are included within the lost revenue calculation.Views of Responsible Officials: Management agrees with the finding.
Finding 2021-004: Activities Allowed or Unallowed and Allowable Costs/Cost Principles and ReportingFederal Agency Name: Department of Health and Human ServicesProgram Name: COVID-19 Provider Relief Fund and American Rescue PlanFederal Financial Assistance Listing/CFDA Number: 93.498Finding Summary: Winneshiek Medical Center claimed contracted physicians? salaries in excess of the Executive Level II salary level under the federal program. In addition, the expenditures identified as eligible and claimed under the federal program were not reviewed and approved by a separate individual outside of the preparer. The Medical Center?s lost revenue calculation did not take into consideration 340B revenue and the calculation was not reviewed and approved by a separate individual outside of the preparer. The Medical Center?s special report submitted to the Department of Health and Human Services for Period 1 TIN #420680487 was not reviewed and approved by a separate individual outside of the preparer.Responsible Individuals: Ben Stevens, CFOCorrective Action Plan: Management agrees with the finding. The Medical Center will work to identify a policy and procedure to ensure the review and approval of documents by someone other than the preparer. In respects to the revenues and expenditures that were incorrectly not added as revenue or expenses that should have been excluded, the Medical Center will work to create a checklist of unique circumstances pertaining to federal grants to ensure items such as the two mentioned deficiencies will be caught prior to submission to agency. Future reports will be revised to correct the items indicated above relating to lost revenue and eligible expenditures.Anticipated Completion Date: September 30, 2022
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