Greene County Medical Center

Department of Agriculture Federal Financial Assistance Listing #10.766 Community Facilities Loans and Grants Activities Allowed or Unallowed and Allowable Costs/Cost Principles Significant Deficiency in Internal Control Over Compliance Criteria: 2 CFR 200.303(a) establishes that the auditee must establish and maintain effective internal control over the federal award that provides assurance that the entity is managing the federal award in compliance with federal statutes, regulations, and conditions of the federal award. Condition: The Medical Center excluded adjustments from the lost revenue calculation. Cause: The Medical Center did not have an internal control process in place to ensure the lost revenue calculation reported under the federal program was updated for all adjustments related to cost report settlements. Effect: Without adjusting for cost report settlements, the lost revenue calculation was inaccurate. Questioned Costs: There were no questioned costs related to the lost revenue calculation, as there was still enough lost revenue to support the grant and the matching portion of the grant. Context: The entire lost revenue calculation was tested. Repeat Finding from Prior Years: No Recommendation: We recommend the Medical Center enhance internal control policies to ensure that the lost revenue calculation properly includes and excludes all relevant information. Views of Responsible Officials: Management agrees with the finding.

Finding 2023-004: Activities Allowed or Unallowed and Allowable Costs/Cost Principles Federal Agency Name: Department of Agriculture Program Name: Community Facilities Loans and Grants Federal Financial Assistance Listing Number: 10.766 Finding Summary: The Medical Center excluded adjustments from the lost revenue calculation. Responsible Individuals: Mark Wall, CFO Response: The Medical Center agrees with the findings. We will utilize our outside accounting firm for guidance to ensure appropriateness of calculations going forward. Completion Date: Ongoing

2022-004

Department of Health and Human Services Federal Financial Assistance Listing #93.498 COVID‐19 Provider Relief Fund (PRF) and American Rescue Plan (ARP) Rural Distribution Applicable Federal Award Number and Year – Period 4 TIN #426037888 Activities Allowed or Unallowed and Allowable Costs/Cost Principles and Reporting Significant Deficiency in Internal Control Over Compliance Criteria: 2 CFR 200.303(a) establishes that the auditee must establish and maintain effective internal control over the federal award that provides assurance that the entity is managing the federal award in compliance with federal statutes, regulations, and conditions of the federal award. Condition: The Medical Center included expenses in the Department of Health and Human Services (HHS) special report for Period 4 that were transcribed incorrectly or were preliminary amounts instead of final expenses which caused the HHS special report to be inaccurate. In addition, there was no evidence of formal review and approval over tracking of expenditures that were claimed for the program. In addition, there was no evidence retained that the Medical Center’s special reports submitted to the Department of Health and Human Services for Period 4 TIN #426037888 were reviewed or approved by an individual separate from the preparer prior to submission. Cause: The Medical Center did not have an internal control process in place to ensure documentation of review and approval of the tracking of expenditures claimed under the federal program and the reports submitted to the Department of Health and Human Services. Effect: The lack of adequate policies governing review and approval increases the risk that employees participating in the federal awards administration may not be able to detect and correct noncompliance in a timely manner. Questioned Costs: None over the $25,000 limit. Context: A sample of 11 ($629,403) from a population of 24 items ($806,374) were tested for activities allowed or unallowed and allowable costs/cost principles. Key line items were tested on the Period 4 HHS special report. Repeat Finding from Prior Years: Yes Recommendation: We recommend the Medical Center enhance internal control policies to ensure that formal documentation of review and approval is obtained and retained, and review is thorough enough to catch mistakes. Views of Responsible Officials: Management agrees with the finding.

Finding 2023-005: Activities Allowed or Unallowed and Allowable Costs/Cost Principles and Reporting Federal Agency Name: Department of Health and Human Services Program Name: COVID-19 Provider Relief Fund (PRF) and American Rescue Plan (ARP) Rural Distribution Federal Financial Assistance Listing Number: 93.498 Finding Summary: The Medical Center included expenses in the Department of Health and Human Services (HHS) special report for Period 4 that were transcribed incorrectly or were preliminary amounts instead of final expenses which caused the HHS special report to be inaccurate. In addition, there was no evidence of formal review and approval over tracking of expenditures that were claimed for the program. In addition, there was no evidence retained that the Medical Center's special reports submitted to the Department of Health and Human Services for Period 4 TIN #426037888 were reviewed or approved by an individual separate from the preparer prior to submission. Responsible Individuals: Mark Wall, CFO Response: Management agrees with the finding and has reviewed the operating procedures of Greene County Medical Center. Management will continue to monitor the Medical Center's operations and procedures. Furthermore, we will continually review the assignment of duties to obtain the maximum internal control possible under the circumstances. Completion Date: Ongoing

2022-005

Department of Health and Human Services Federal Financial Assistance Listing/CFDA #93.498 COVID-19 Provider Relief Fund (PRF) and American Rescue Plan (ARP) Rural Distribution Applicable Federal Award Number and Year ? Periods 2&3 TIN #426037888 Activities Allowed or Unallowed and Allowable Costs/Cost Principles and Reporting 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. Condition: There was no evidence of formal review and approval over tracking of expenditures that were claimed for the program. In addition, there was no evidence retained that the Medical Center?s special reports submitted to the Department of Health and Human Services for Periods 2 and 3 TIN #426037888 were reviewed or approved by an individual separate from the preparer prior to submission. Cause: The Medical Center did not have an internal control process in place to ensure documentation of review and approval of the tracking of expenditures claimed under the federal program and the reports submitted to the Department of Health and Human Services. Effect: The lack of adequate policies governing review and approval increases the risk that employees participating in the federal awards administration may not be able to detect and correct noncompliance in a timely. Questioned Costs: None reported. Repeat Finding from Prior Years: Yes Recommendation: We recommend the Medical Center enhance internal control policies to ensure that formal documentation of review and approval is obtained and retained. 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 Number: 93.498 Finding Summary: There was no evidence of formal review and approval over tracking of expenditures that were claimed for the program. In addition, there was no evidence retained that the Medical Center?s special reports submitted to the Department of Health and Human Services for Periods 2 and 3 TIN #426037888 were reviewed or approved by an individual separate from the preparer prior to submission. Responsible Individuals: Mark Wall, CFO Response: The Medical Center has made changes in the Finance Staff and now communicate regularly with an outside accounting firm. This firm will be used for guidance going forward to meet the terms and conditions of federal grants. Documents will be compiled by staff Accountant and Controller and verified for appropriateness by the accounting firm. Anticipated Completion Date: September 30, 2022

2021-006

2021-005 Department of Health and Human Services Federal Financial Assistance Listing/CFDA #93.498 COVID-19 Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Applicable Federal Award Number and Year ? Period 1 TIN #426037888 Activities Allowed or Unallowed and Allowable Costs/Cost Principles and Reporting Material Weakness in Internal Control Over Compliance and Material Noncompliance for Reporting Criteria: 2 CFR 200.303(a) establishes that the auditee must establish and maintain effective internal control over the federal award that provides assurance that the entity is managing the federal award in compliance with federal statutes, regulations, and conditions of the federal award. Condition: The Medical Center included expenses in the HHS special report for Period 1 that were outside of the grant period, were reimbursed by other sources, or otherwise unallowed which caused the HHS special report to be inaccurate. The Medical Center claimed expenses that were incurred prior to when the Medical Center began to prepare for, prevent and respond to the coronavirus. The Medical Center also claimed expenses that were funded by other sources. In addition, the Medical Center claimed the cost of a full 5-year lease rather than the payments that were made during the reporting period. Cause: The lack of adequate policies governing the determination of which costs meet the terms and conditions of the federal grant caused the report to be filled incorrectly. Effect: There were $475,372 of expenses that were reported incorrectly in the HHS special report Period 1 submitted. Questioned Costs: None reported for activities allowed or unallowed and allowable costs/cost principles as expenses that were originally reported in the Unreimbursed Expenses Attributable to Coronavirus section of the Department of Health and Human Services for Period 1 TIN #426037888 report were tested to cover the amount of unallowed expenses. Context: A nonstatistical sample of 60 items ($2,314,331) from a total population exceeding 250 items ($4,544,548) were tested for activities allowed or unallowed and allowable costs/cost principles. Key line items were tested on the Period 1 Department of Health and Human Services special report. Repeat Finding from Prior Years: No Recommendation: We recommend the Medical Center enhance internal control policies to ensure that the support of the HHS special report meet the terms and conditions of the grant and are properly included in the reports required to be submitted to the federal agency. Views of Responsible Officials: Management agrees with the finding.

Finding 2021-005: Activities Allowed or Unallowed and Allowable Costs/Cost Principles and Reporting Federal Agency Name: Department of Health and Human Services Program Name: COVID-19 Provider Relief Fund and American Rescue Plan Federal Financial Assistance Listing/CFDA Number: 93.498 Finding Summary: The Medical Center included expenses in the HHS special report for Period 1 that were outside of the grant period, were reimbursed by other sources, or otherwise unallowed which caused the HHS special report to be inaccurate. Responsible Individuals: Mark Wall, CFO The Medical Center has made changes in the Finance Staff and now communicate regularly with an outside accounting firm. This firm will be used for guidance going forward to meet the terms and conditions of federal grants. Documents will be compiled by staff Accountant and Controller and verified for appropriateness by the accounting firm. Anticipated Completion Date: September 30, 2022

2021-006 Department of Health and Human Services Federal Financial Assistance Listing/CFDA #93.498 COVID-19 Provider Relief Fund and American Rescue Plan (ARP) Rural Distribution Applicable Federal Award Number and Year ? Period 1 TIN #426037888 Activities Allowed or Unallowed and Allowable Costs/Cost Principles and Reporting 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. Condition: There was no evidence of formal review and approval over tracking of expenditures that were claimed for the program. In addition, there was no evidence retained that the Medical Center?s special report submitted to the Department of Health and Human Services for Period 1 TIN #426037888 was reviewed or approved by an individual separate from the preparer prior to submission. Cause: The Medical Center did not have an internal control process in place to ensure documentation of review and approval of the tracking of expenditures claimed under the federal program and the report submitted to the Department of Health and Human Services for Period 1. Effect: The lack of adequate policies governing review and approval increases the risk that employees participating in the federal awards administration may not be able to detect and correct noncompliance in a timely. Questioned Costs: None reported. Repeat Finding from Prior Years: No Recommendation: We recommend the Medical Center enhance internal control policies to ensure that formal documentation of review and approval is obtained and retained. Views of Responsible Officials: Management agrees with the finding.

Finding 2021-006: Activities Allowed or Unallowed and Allowable Costs/Cost Principles and Reporting Federal Agency Name: Department of Health and Human Services Program Name: COVID-19 Provider Relief Fund and American Rescue Plan Federal Financial Assistance Listing/CFDA Number: 93.498 Finding Summary: There was no evidence of formal review and approval over tracking of expenditures were claimed for the program. In addition, there was no evidence retained that the Medical Center?s special report submitted to the Department of Health and Human Services for Period 1 TIN #426037888 was reviewed or approved by an individual separate from the preparer prior to submission. Responsible Individuals: Mark Wall, CFO The Medical Center has implemented a process where the Staff Accountant and Controller will compile the tracking of expenditures in an excel document. This will be reviewed by outside accounting firm for appropriateness. The sheet will be color coded to show when an expense has been claimed. The CFO will review, initial and retain a copy of the document for each submission. Anticipated Completion Date: September 30, 2022

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