EIN: 450227753
UEI: F3AWQ6E1VE55
Data as of August 19, 2026
Management decision deadline — for entities that funded this organization
The FAC accepted this audit on February 24, 2026. 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 August 24, 2026 (4 days from today).
What is a management decision? →Department of Agriculture Federal Financial Assistance Listing #10.766 Community Facilities Loans and Grants Cluster Department of Health and Human Services Federal Financial Assistance Listing #93.697 COVID-19 Testing and Mitigation for Rural Health Clinics Department of Health and Human Services Federal Financial Assistance Listing #93.301 COVID-19 Small Rural Hospital Improvement Grants Preparation of Schedule of Expenditures of Federal Awards Material Weakness in Internal Control Over Compliance - Other Criteria Proper controls over financial reporting include the ability to prepare the Consolidated Schedule of Expenditures of Federal Awards (Schedule) and accompanying notes to the Schedule. Condition The Medical 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 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 Schedule that is correct without assistance of the auditors. Questioned Costs None reported. Context Sampling was not used. Repeat Finding from Prior Years Yes 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 Medical Center’s Consolidated Schedule of Expenditures of Federal Awards and internal controls that impact financial reporting. Views of Responsible Officials Management agrees with the finding.
Federal Agency Name Department of Agriculture Federal Assistance Listing #10.766 Program Name Community Facilities Loan and Grants Cluster Federal Agency Name Department of Health and Human Services Federal Assistance Listing #93.697 Program Name COVID 19 Testing and Mitigations for Rural Health Clinics Federal Agency Name Department of Health and Human Services Federal Assistance Listing #93.301 Program Name COVID 19 Small Rural Hospital Improvement Grants Finding Summary Eide Bailly assisted in the preparation of our draft consolidated schedule of expenditures and federal awards and accompanying notes to the consolidated schedule of expenditures and federal awards. Corrective Action Plan It is not cost effective to have an internal control system designed to provide for a complete and accurate schedule of expenditures and federal awards. We requested that our auditors, Eide Bailly LLP, assist in the preparation of the schedule of expenditures. We have designated a member of management to review the drafted schedule of expenditures. Responsible Individuals Judy Monson, CFO; Nikki Lindsey, CEO Anticipated Completion Date Ongoing
2022-003
Department of Agriculture Federal Financial Assistance Listing #10.766 Community Facilities Loans and Grants Cluster Lack of Timely Reconciliations of the General Cash, Construction, and Required Reserve Accounts Material Weakness in Internal Control Over Compliance – Special Tests and Provisions Criteria The Medical Center is required to establish accounts into which borrower funds, loan proceeds, the revenue of the facility financed, and any other income shall be deposited in accordance with loan resolutions authorizing the incurrence of indebtedness related to the loan proceeds. These accounts shall be maintained in accordance with the loan resolutions as long as the authorized indebtedness is outstanding. These accounts include the general account (i.e., operating checking account), construction account, debt service account, and reserve account (USDA Accounts). Condition The Medical Center does not have an internal control system designed to ensure that the USDA Accounts noted above are reconciled on a timely basis. The lack of timely reconciliations required several adjustments to be made during the audit. Cause The Medical Center had turnover in the Chief Financial Officer position along with a construction project that utilized significant finance department time and resources. Effect There is a reasonable possibility that errors related to the USDA Accounts and other accounts impacted by the USDA Accounts, including construction in progress, are not properly stated in the consolidated financial statements. In addition, there could be amounts expended from the USDA Accounts that do not meet the requirements and those expenditures would not be identified in a timely manner. Questioned Costs None reported. Context Sampling was not used. There are four USDA Accounts currently in use and all USDA Accounts were reviewed. Repeat Finding from Prior Years No Recommendation We recommend that a formalized process be established to ensure timely reconciliation of the USDA Accounts as well as a review process of those reconciliations each month. Views of Responsible Officials Management agrees with the finding.
Federal Agency Name Department of Agriculture Federal Assistance Listing #10.766 Program Name Community Facilities Loan and Grants Cluster Finding Summary The Medical Center does not ensure that the required USDA Accounts (General Account, Construction Account, Debt Service Account, and Reserve Account) were reconciled on a timely basis. This increases the possibility that errors related to the USDA Accounts and other accounts impacted by the USDA Accounts, including construction in progress, are not properly stated in the financial statements. In addition, there could be amounts expended from the USDA Accounts that do not meet the requirements and those expenditures would not be identified in a timely manner. Corrective Action Plan Internal controls will be updated to have a formalized process established to ensure timely reconciliation of the USDA Accounts as well as a review process of those reconciliations each month Responsible Individuals Judy Monson, CFO; Nikki Lindsey, CEO; Jasen Walker, Controller Anticipated Completion Date Complete.
Management decision deadline — for entities that funded this organization
The FAC accepted this audit on May 14, 2025. 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 November 14, 2025, which was (279 days ago).
What is a management decision? →Department of Agriculture Federal Financial Assistance Listing #10.766 Community Facilities Loans and Grants Cluster Department of Treasury Federal Financial Assistance Listing #21.027 COVID-19 Coronavirus State and Local Fiscal Recovery Funds Preparation of Schedule of Expenditures of Federal Awards Material Weakness in Internal Control Over Compliance - Other Criteria: Proper controls over financial reporting include the ability to prepare the Consolidated Schedule of Expenditures of Federal Awards (Schedule) and accompanying notes to the Schedule. Condition: The Medical 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 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 Schedule that is correct without assistance of the auditors. Questioned Costs: None reported. Context: Sampling was not used. Repeat Finding from Prior Years: Yes 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 Medical Center’s Consolidated Schedule of Expenditures of Federal Awards and internal controls that impact financial reporting. Views of Responsible Officials: Management agrees with the finding.
Finding 2022-003 Federal Agency Name Department of Agriculture Federal Assistance Listing #10.766 Program Name: Community Facilities Loan and Grants Cluster Federal Agency Name: Department of Treasury Federal Assistance Listing #21.027 Program Name: COVID 19 Coronavirus State and Local Fiscal Recovery Funds Finding Summary: Eide Bailly assisted in the preparation of our draft consolidated schedule of expenditures and federal awards and accompanying notes to the consolidated schedule of expenditures and federal awards. Corrective Action Plan: It is not cost effective to have an internal control system designed to provide for a complete and accurate schedule of expenditures and federal awards. We requested that our auditors, Eide Bailly LLP, assist in the preparation of the schedule of expenditures. We have designated a member of management to review the drafted schedule of expenditures. Responsible Individuals: Judy Monson, CFO; Nikki Lindsey, CEO Anticipated Completion Date: Ongoing
Department of Agriculture Federal Financial Assistance Listing #10.766 Community Facilities Loans and Grants Cluster Department of Treasury Federal Financial Assistance Listing #21.027 COVID-19 Coronavirus State and Local Fiscal Recovery Funds Preparation of Schedule of Expenditures of Federal Awards Material Weakness in Internal Control Over Compliance - Other Criteria: Proper controls over financial reporting include the ability to prepare the Consolidated Schedule of Expenditures of Federal Awards (Schedule) and accompanying notes to the Schedule. Condition: The Medical 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 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 Schedule that is correct without assistance of the auditors. Questioned Costs: None reported. Context: Sampling was not used. Repeat Finding from Prior Years: Yes 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 Medical Center’s Consolidated Schedule of Expenditures of Federal Awards and internal controls that impact financial reporting. Views of Responsible Officials: Management agrees with the finding.
Federal Agency Name: Department of Agriculture Federal Assistance Listing #10.766 Program Name: Community Facilities Loan and Grants Cluster Finding Summary: The Medical Center does not have an internal control system designed to identify the reports that need to be filed with the USDA. In addition, there is not a mechanism to ensure various reports are filed timely. Corrective Action Plan: Internal controls will be updated to have a formalized process established that identifies the three reports that need to be filed and the required due dates. We will have these reports reviewed and approved by the Board of Directors prior to submission. Responsible Individuals: Judy Monson, CFO; Nikki Lindsey, CEO Anticipated Completion Date: June 30, 2025
Management decision deadline — for entities that funded this organization
The FAC accepted this audit on September 29, 2022. 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 March 29, 2023, which was (1240 days ago).
What is a management decision? →2021-003 Department of Health and Human Services Federal Assistance Listing/CFDA #93.498 COVID-19 Provider Relief Fund and American Rescue Plan Rural (ARP) Distribution Applicable Federal Award Number and Year ? Period 1 TIN #450227753 Department of Health and Human Services Federal Assistance Listing/CFDA #93.301 COVID-19 Coronavirus State Hospital Improvement Program and Small Rural Hospital Improvement Grant Program Department of Agriculture Federal Assistance Listing/CFDA #10.766 Community Facilities Loans and Grants Cluster Preparation of Schedule of Expenditures of Federal Awards Material Weakness in Internal Control Over Compliance ? Other Criteria: Proper controls over financial reporting include the ability to prepare the Consolidated Schedule of Expenditures of Federal Awards (Schedule) and accompanying notes to the Schedule. Condition: The Organization 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 Organization meets a specified threshold of federal expenditures. Effect: There is a reasonable possibility that the Organization would not be able to draft a Schedule that is correct without assistance of the auditors. Questioned Costs: None reported. Context: 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 Organization?s Consolidated Schedule of Expenditures of Federal Awards and internal controls that impact financial reporting. Views of Responsible Officials: Management agrees with the finding.
Finding 2021 -003 Federal Agency Name: Department of Health and Human Services Program Name: COVID-19 Provider Relief Fund and American Rescue Plan Rural Distribution CFDA #93.498 Finding Summary: Eide Bailly assisted in the preparation of our draft consolidated schedule of expenditures and federal awards and accompanying notes to the consolidated schedule of expenditures and federal awards. Responsible Individuals: Barbara Anderson, CFO; Nikki Lindsey, CEO Corrective Action Plan: It is not cost effective to have an internal control system designed to provide for a complete and accurate schedule of expenditures and federal awards. We requested that our auditors, Eide Bailly LLP, assist in the preparation of the schedule of expenditures. We have designated a member of management to I , review the drafted schedule of expenditures. Anticipated Completion Date: Ongoing
2021-004 Department of Health and Human Services Federal Assistance Listing/CFDA #93.498 COVID-19 Provider Relief Fund and American Rescue Plan Rural (ARP) Distribution Applicable Federal Award Number and Year ? Period 1 TIN #450227753 Activities Allowed or Unallowed, 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 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 Organization claimed expenses based on specifically identified COVID related expenses. Condition: The Organization claimed expenses that were reimbursed by other funding sources. These expenses were improperly included within the HHS Special Report ? Period 1 (Report) which caused the Report to be inaccurate. Cause: The Organization submitted expenses that were to be reimbursed by other funding sources (i.e., Medicare). The Organization did not have an adequate internal control policy in place to ensure proper review over the terms and conditions of the program. Expenses reported were not reduced by other funding sources. Effect: The lack of adequate policies governing review of the terms and conditions of the program, and lack of review over Report preparation and submission increases the risk that employees participating in the federal award administration may not be able to detect and correct noncompliance in a timely manner. The Organization submitted expenses over their actual allowable expenses. Questioned Costs: There are questioned costs of $677,021 (actual) that were reimbursed or will be reimbursed by other funding sources. Context: A nonstatistical sample of 65 expenditures were selected for testing, which accounted for $229,641 of $2,490,221 direct program expenditures. Within the $229,649 sample, $86,883 of costs were reimbursed by a different funding source (i.e., Medicare cost reimbursed percentages estimated using the filed cost report for fiscal year 2020 and fiscal year 2021). There was also summary level testing completed over $549,137 of claimed expenses. Of the expenditures that were summary level tested, $165,727 of costs were reimbursed by a different funding source. The Report section, Other PRF Expenses, included expenses that were reimbursed or would be reimbursed by other funding sources. Repeat Finding from Prior Years: No Recommendation: We recommend that the Organization enhance internal control policies to ensure all amounts reimbursed by other funding sources are adequately documented and reduced from the eligible expenditure listing and are properly recorded in the reports required to be submitted to the federal agency. We also recommend that the Organization enhance internal control policies to ensure that the required reports are properly reviewed prior to submission to ensure all key line items are necessary, correct, meet the requirements of the federal program, and are properly recorded in the reports required to be submitted to the federal agency. Views of Responsible Officials: Management agrees with the finding
Finding 2021-004 Federal Agency Name: Department of Health and Human Service~ Program Name: COVID-19 Provider Relief Fund and American Rescue Plan Rural Distribution CFDA #93.498 Finding Summary: The Organization claimed expenses in the HHS Special Report Period 1 (Report) that were reimbursed by other funding sources, which caused the Report to be inaccurate. The Organization did not have an adequate internal control policy in place to ensure that expenses were only reimbursed by one funding source. Responsible Individuals: Barbara Anderson, CFO; Nikki Lindsey, CEO Corrective Action Plan: We will implement an internal control process to ensure expenses reimbursed by other payers are properly excluded when calculating amounts eligible under federal programs. Anticipated Completion Date: June 30, 2022
2021-005 Department of Health and Human Services Federal Assistance Listing/CFDA #93.498 COVID-19 Provider Relief Fund and American Rescue Plan Rural (ARP) Distribution Applicable Federal Award Number and Year ? Period 1 TIN #450227753 Activities Allowed or Unallowed, Allowable Costs/Costs 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 Organization?s special report submitted to the Department of Health and Human Services for Period 1 was reviewed and approved by an individual outside of the preparer prior to submission. Cause: The Organization did not have an adequate internal control policy in place to ensure documented review and approval of the tracking of expenditures claimed or the special 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 manner. Questioned Costs: None reported. Repeat Finding from Prior Years: No Recommendation: We recommend that the Organization 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 2021-005 Federal Agency Name: Department of Health and Human Services Program Name: COVID-19 Provider Relief Fund and American Rescue Plan Rural Distribution CFDA #93.498 Finding Summary: There was no formal documentation of review and approval for overall expenses of the Period 1 - HHS Special Report by a separate individual outside of the preparer. Responsible Individuals: Barbara Anderson, CFO; Nikki Lindsey, CEO Corrective Action Plan: All tracking documents that have calculations and submissions to federal agencies will be reviewed by the CEO if the CFO compiles for accuracy and vice versa. The reviewed will sign off by email or by physical signature that they have reviewed and agree with the calculations. Anticipated Completion Date: June 30, 2022
Data source: This information comes from the Federal Audit Clearinghouse, the official repository of Single Audit data. All data is public domain. Verify this organization's audit history at fac.gov.
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