EIN: 450231181
UEI: J2LKAGMKLNQ7
Data as of August 25, 2026
Management decision deadline — for entities that funded this organization
The FAC accepted this audit on April 16, 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 October 16, 2024 (678 days ago).
What is a management decision? →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 and Period 5 TIN #450231181 Reporting Significant Deficiency in Internal Control Over Compliance and 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. Condition The Medical Center improperly reported expenses in the Period 5 report submission due to an amount improperly carried forward from a previous report. Cause The Medical Center did not have an adequate internal control policy in place to ensure that expenses were properly reported in future submissions in accordance with the terms and conditions of the grant. Effect While the error provided a difference between reported expenses and supportable expenses, the Medical Center had excess lost revenues available to be applied to future periods. This error also indicated there is a lack of policies governing the review and approval of the expense reporting to the HHS special report. Questioned Costs None reported. Reported expenses were overstated by $66,659 on the Period 5 report, however, the Medical Center had $94,302 of excess lost revenue to offset this error. Context/Sampling: All key line items from the Period 4 and Period 5 reports were tested. Repeat Finding from Prior Years: No Recommendation We recommend that the Medical Center enhance internal control policies to ensure all reports are reviewed and approved to ensure the proper reporting and meet 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 and Period 5 TIN #450231181 Reporting Significant Deficiency in Internal Control Over Compliance and 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. Condition The Medical Center improperly reported expenses in the Period 5 report submission due to an amount improperly carried forward from a previous report. Cause The Medical Center did not have an adequate internal control policy in place to ensure that expenses were properly reported in future submissions in accordance with the terms and conditions of the grant. Effect While the error provided a difference between reported expenses and supportable expenses, the Medical Center had excess lost revenues available to be applied to future periods. This error also indicated there is a lack of policies governing the review and approval of the expense reporting to the HHS special report. Questioned Costs None reported. Reported expenses were overstated by $66,659 on the Period 5 report, however, the Medical Center had $94,302 of excess lost revenue to offset this error. Context/Sampling: All key line items from the Period 4 and Period 5 reports were tested. Repeat Finding from Prior Years: No Recommendation We recommend that the Medical Center enhance internal control policies to ensure all reports are reviewed and approved to ensure the proper reporting and meet the requirements of the federal program. Views of Responsible Officials Management agrees with the finding.
Federal Agency Name: Department of Health and Human Services Federal Assistance Listing: #93.498 Program Name: COVID-19 Provider Relief Fund and American Rescue Plan Rural Distribution Finding Summary: Expense carryforward was improperly submitted as unused lost revenue in Period 1, which caused the amount to be improperly carried forward to Period 5 from the previous report. Corrective Action Plan: All tracking and reports will be reviewed by someone other than the preparer. The reviewer will sign off by email or by physical signature that they have reviewed and agree with the support. Responsible Individuals: Beverly Fiferlick, CFO Anticipated Completion Date: June 30, 2024
FAC accepted this audit on November 7, 2022 — management decision was due May 7, 2023.
2021-002 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 #450231181 Preparation of Consolidated Schedule of Expenditures of Federal Awards Significant Deficiency in Internal Control Over Compliance 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 complete and accurate consolidated 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 with 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 - 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 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.
Show full finding ▾Hide full finding ▴2021-002 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 #450231181 Preparation of Consolidated Schedule of Expenditures of Federal Awards Significant Deficiency in Internal Control Over Compliance 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 complete and accurate consolidated 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 with 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 - 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 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 2021-002 Federal Agency Name: Department of Health and Human Services Program Name: COVID-19 Provider Relief Fund and American Rescue Plan Rural Distribution Federal Assistance Listing/CFDA #93.498 Finding Summary: Eide Bailly LLP prepared our consolidated schedule of expenditures of federal awards (Schedule) and accompanying notes to the Schedule. Responsible Individuals: Beverly Fiferlick, CFO Corrective Action Plan: Having auditors assist with preparing the consolidated schedule of expenditures of federal awards (SEFA) is not unusual. Due to the delays in obtaining the guidance to conduct the compliance audit for the Provider Relief Funds, this finding would generally be included as part of the consolidated financial statement audit under Government Auditing Standards, yellowbook. As the consolidated financial statement audit had been issued prior to the compliance audit being completed, this finding needed to be identified separately. Anticipated Completion Date: Ongoing
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 #450231181 Activities Allowed or Unallowed and Allowable Costs/Cost Principles, 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 - The Medical Center had several invoices identified as eligible under the Provider Relief Funds that were not reviewed and approved. In addition, the Medical Center did not have a control policy in place to obtain formal documentation for the secondary review and approval for the final expenditure listing, lost revenue calculation identified as eligible and claimed under the Provider Relief Fund program, and special report submitted to the Department of Health and Human Services for Period 1. Cause - The Medical Center did not have an adequate internal control policy in place to ensure review and approval over specifically identified invoices, the final expenditure listing, the lost revenue calculation, or preparation of HHS Period 1 reporting were documented. Effect - The lack of adequate policies governing the review and approval of invoices, expenditure listing, lost revenue calculation, and the HHS Period 1 report increases the risk that employees participating in the federal award administration may not be able to detect and correct noncompliance in a timely manner. Without a secondary review and approval, there is a possibility that ineligible expenditures may be claimed under the program. Questioned Costs - None reported. Context - A nonstatistical sample of 65 expenditures were selected for testing, which accounted for $450,448 of $2,208,176 direct program expenditures along with the calculation for lost revenue for activities allowed and unallowable cost/cost principles. Of these 65, 34 did not have evidence of being reviewed and approved as eligible under the Provider Relief Funds. The overall expense worksheet and lost revenue worksheet did not have evidence of a review by someone other than the preparer (i.e. population of two). The Report submitted to HHS also did not have a documented secondary review and approval (i.e., population of one). Repeat Finding from Prior Years ? No. Recommendation - We recommend that the Medical Center enhance internal control policies to ensure All invoices are reviewed and approved to ensure all expenses claimed under the federal program are necessary, reasonable, and meet the requirements of the federal program. We also recommend the Medical Center implement a control process which includes a secondary review and approval of the final expenditure listing and lost revenue calculation used to claim the allowable costs under the federal program and that there is evidence of the review and approval. In addition, the Report submitted to HHS should have a secondary review and approval that is documented. Views of Responsible Officials - Management agrees with the finding.
Show full finding ▾Hide full finding ▴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 #450231181 Activities Allowed or Unallowed and Allowable Costs/Cost Principles, 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 - The Medical Center had several invoices identified as eligible under the Provider Relief Funds that were not reviewed and approved. In addition, the Medical Center did not have a control policy in place to obtain formal documentation for the secondary review and approval for the final expenditure listing, lost revenue calculation identified as eligible and claimed under the Provider Relief Fund program, and special report submitted to the Department of Health and Human Services for Period 1. Cause - The Medical Center did not have an adequate internal control policy in place to ensure review and approval over specifically identified invoices, the final expenditure listing, the lost revenue calculation, or preparation of HHS Period 1 reporting were documented. Effect - The lack of adequate policies governing the review and approval of invoices, expenditure listing, lost revenue calculation, and the HHS Period 1 report increases the risk that employees participating in the federal award administration may not be able to detect and correct noncompliance in a timely manner. Without a secondary review and approval, there is a possibility that ineligible expenditures may be claimed under the program. Questioned Costs - None reported. Context - A nonstatistical sample of 65 expenditures were selected for testing, which accounted for $450,448 of $2,208,176 direct program expenditures along with the calculation for lost revenue for activities allowed and unallowable cost/cost principles. Of these 65, 34 did not have evidence of being reviewed and approved as eligible under the Provider Relief Funds. The overall expense worksheet and lost revenue worksheet did not have evidence of a review by someone other than the preparer (i.e. population of two). The Report submitted to HHS also did not have a documented secondary review and approval (i.e., population of one). Repeat Finding from Prior Years ? No. Recommendation - We recommend that the Medical Center enhance internal control policies to ensure All invoices are reviewed and approved to ensure all expenses claimed under the federal program are necessary, reasonable, and meet the requirements of the federal program. We also recommend the Medical Center implement a control process which includes a secondary review and approval of the final expenditure listing and lost revenue calculation used to claim the allowable costs under the federal program and that there is evidence of the review and approval. In addition, the Report submitted to HHS should have a secondary review and approval that is documented. 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 Federal Assistance Listing/CFDA #93.498 Finding Summary: The Medical Center had several invoices identified as eligible under the Provider Relief Funds that were not reviewed and approved. In Addition, the Medical Center did not have a control policy in place to obtain formal documentation for the secondary review and approval for the final expenditure listing, lost revenue calculation identified as eligible and claimed under the Provider Relief Fund program, and special report submitted to the Department of Health and Human Services for Period 1. Responsible Individuals: Beverly Fiferlick, CFO Corrective Action Plan: We have implemented a control process which electronically and manually saves the secondary review and approval related to the use of Federal assistance. Anticipated Completion Date: Policy was updated June 30, 2022
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