WASHINGTON COUNTY MEMORIAL HOSPITALLocal Government

2023 – 001 Federal agency: U.S. Department of Health and Human Services Other Programs Federal program title: COVID-19 Provider Relief Fund and American Rescue Plan Rural Distribution CFDA Number: 93.498 Pass-Through Agency: N/A Pass-Through Number(s): N/A Award Period: Period 4 Type of Finding: Significant Deficiency in Internal Control in and over Compliance Compliance Requirement: Reporting Criteria or specific requirement: Surrounding reporting activities, the Hospital’s internal controls should be designed to assure all reporting completed under program guidelines. Condition: During our testing, we identified the Hospital did not have internal controls in place to ensure reporting was completed in accordance with HHS guidelines. Questioned costs: None Context: During our testing, it was identified that the Hospital selected Option 2 for reporting of lost revenues, which compared actual net patient revenue for each quarter during the period of availability against budget for each quarter. In order to utilize this option, budgets must have been approved before March 27, 2020. However, the budget for periods beginning September 1, 2020, through the end of the period of availability were not approved prior to this date. As such, the Hospital utilized the budget amounts for the same month of the previous year, which is not in accordance with the guidelines under Option 2. Cause: The Hospital was amidst a pandemic and due to the reporting requirements constantly changing, the Hospital reported under their initial understanding of the lost revenue guidance. Effect: The auditor noted no instances of noncompliance with the provisions of lost revenues claimed, as the approved quarters lost revenues exceeded the amount claimed; however, the internal controls around compliance over reporting were not effective. Repeat Finding: N/A Recommendation: We recommend the Hospital design controls to ensure that reporting is completing in accordance with latest HHS guidelines. Views of responsible officials: There is no disagreement with the audit finding.

2022 – 001 Federal agency: U.S. Department of Health and Human Services Other Programs Federal program title: Rural Communities Opioid Response Program-Implementation Assistance Listing Number: 93.912 Pass-Through Agency: N/A Pass-Through Number(s): N/A Award Period: Fiscal Year 2022 Type of Finding: Significant Deficiency in Internal Control in and over Compliance Compliance Requirement: Subrecipient Monitoring Criteria or specific requirement: Surrounding monitoring activities, the Hospital’s internal controls should be designed to assure all subrecipients are monitored throughout the award period. Condition: During our testing, we identified the Hospital did not have internal controls in place to ensure subrecipients were monitored during the award period. Questioned costs: None Context: During our testing, it was identified that no contracts or agreements exist between the Hospital and the four subrecipient organizations who received Opioid Implementation Program funds passed through from the Hospital. Cause: Guidance for the Opioid Implementation Program funding is unclear beyond the objective within the program narrative. Effect: The lack of controls in place over the monitoring functions increases the risk of misstatements, fraud, or errors occurring and not being detected and corrected. Repeat Finding: N/A Recommendation: We recommend the Hospital implements agreements between the Hospital and any entities in which federal funding are awarded (passed through) to in order to make the respective program requirements understood. Views of responsible officials: There is no disagreement with the audit finding. Processes have been corrected over the course of the single audit and agreements with subrecipients have been executed.

Federal agency: U.S. Department of Health and Human Services Other Programs Federal program title: Provider Relief Funding CFDA Number: 93.498 Pass-Through Agency: N/A Pass-Through Number(s): N/A Award Period: Period 1 Type of Finding: Significant Deficiency in Internal Control in and over Compliance Compliance Requirement: Reporting Criteria or specific requirement: Surrounding reporting activities, the Hospital?s internal controls should be designed to assure all reporting completed under program guidelines. Condition: During our testing, we identified the Hospital did not have internal controls in place to ensure reporting was completed in accordance with HHS guidelines. Questioned costs: None Context: During our testing, it was identified that the Hospital selected Option 2 for reporting of lost revenues, which compared actual net patient revenue for each quarter during the period of availability against budget for each quarter. In order to utilize this option, budgets must have been approved before March 27, 2020. However, the budget for periods beginning September 1, 2020, through the end of the period of availability were not approved prior to this date. As such, the Hospital utilized the budget amounts for the same month of the previous year, which is not in accordance with the guidelines under Option 2. Cause: The Hospital was amidst a pandemic and due to the reporting requirements constantly changing, the Hospital reported under their initial understanding of the lost revenue guidance. Effect: The auditor noted no instances of noncompliance with the provisions of lost revenues claimed, as the approved quarters lost revenues exceeded the amount claimed; however, the internal controls around compliance over reporting were not effective. Repeat Finding: N/A Recommendation: We recommend the Hospital design controls to ensure that reporting is completing in accordance with latest HHS guidelines. Views of responsible officials: There is no disagreement with the audit finding.