SMP HEALTH - ST. ANDREW'S

2021-003 Department of Health and Human Services Federal Assistance Listing/CFDA #93.498 COVID-19 Provider Relief Fund and American Rescue Plan Applicable Federal Award Number and Year ? Period 1 TIN #45-0226426 and TIN #45-0451306 Preparation of Schedule of Expenditures of Federal Awards Material Weakness in Internal Control Over Compliance Criteria: Proper controls over financial reporting include the ability to prepare the schedule of expenditures of federal awards (Schedule) and accompanying notes to the Schedule. Condition: The Health Center does not have an internal control system designed to provide for a complete and accurate schedule of expenditures of federal awards being audited. We were requested to draft the Schedule. 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 Health Center meets a specified threshold of federal expenditures. Effect: There is a reasonable possibility that the Health Center would not be able to draft the Schedule that is correct without the assistance of the auditors. Questioned Costs: None reported. Context/Sampling: Sampling was not used. Repeat Finding from Prior Years: No Recommendation: While we recognize that this condition is not unusual for an organization with limited staffing, we recommend management be aware of the financial reporting requirements relating to the Health 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.

2021-004 Department of Health and Human Services Federal Assistance Listing/CFDA #93.498 COVID-19 Provider Relief Fund and American Rescue Plan Applicable Federal Award Number and Year ? Period 1 TIN #45-0226426 and TIN #45-0451306 Activities Allowed or Unallowed and Allowable Costs/Cost Principles 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: The Health Center?s final expenditure listing summarizing the allowable costs claimed under the Provider Relief Fund program was not reviewed and approved by a separate individual outside of the preparer. There was no documentation relating to routine contract labor from January 2020 that supported the costs were necessary to prevent, prepare for, or respond to coronavirus. Cause: The Health Center did not have an internal control process in place to ensure a secondary review and approval of eligible expenditures that were summarized from the underlying supporting spreadsheets to the final expenditure listing was documented. The summary spreadsheet was used to claim allowable costs under the federal program. The guidance relating to allowable costs was not specific and the Health Center did not document their consideration of allowability of the January 2020 contract labor costs. Effect: Without a secondary review and approval, there is a possibility that ineligible expenditures may be claimed under the program and the report may not be accurately completed. Questioned Costs: None reported. Routine January 2020 contract labor was less than $25,000. Context/Sampling: Nonstatistical sampling was used. Sample size was 60 of 530 expenditures, however the final expenditure listing summarizing the allowable costs was not formally reviewed. Repeat Finding from Prior Years: No Recommendation: We recommend the Health Center implement a control process which includes a secondary review and approval of the summarized final expenditure listing used to claim the allowable costs under the federal program. Views of Responsible Officials: Management agrees with the finding.

2021-005 Department of Health and Human Services Federal Assistance Listing/CFDA #93.498 COVID-19 Provider Relief Fund and American Rescue Plan Applicable Federal Award Number and Year ? Period 1 TIN #45-0226426 and TIN #45-0451306 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 Health Center?s lost revenue calculation claimed under the Provider Relief Fund program did not consider the impact of year-end audit entries on net patient revenue to the applicable quarters? lost revenue calculation. Cause: The Health Center did not have an internal control process in place to ensure the lost revenue calculation reflected year-end audit entries to all applicable quarters. The guidance relating to lost revenue calculation was not specific and the Health Center did not document their consideration of adjustments due to audit entries. Effect: Year-end audit entries were posted in the last month of each fiscal year. There is a possibility that ineligible lost revenues may be claimed under the program and the report may not be accurately completed without consideration of adjusting quarterly net patient revenue for year-end audit entries. Questioned Costs: $57,418, if year-end audit entries were allocated pro-rata in proportion to net patient revenue by quarter. Context/Sampling: Sampling was not used. Repeat Finding from Prior Years: No Recommendation: We recommend the Health Center implement a control process which includes consideration of the impact of year-end audit entries on net patient revenue by quarter for lost revenue calculations. Views of Responsible Officials: Management agrees with the finding.