EIN: 576000003
UEI: GUARMBV7JW79
Data as of August 25, 2026
Management decision deadline — for entities that funded this organization
The FAC accepted this audit on March 21, 2023. 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 September 21, 2023 (1070 days ago).
What is a management decision? →The Center does not have an internal control system designed to provide for review and approval of the quarterly form RD 442-2, Statement of Budget, Income, and Equity (OMB No. 0575-0015) reports submitted. Cause: The Center?s internal controls were not established to cover quarterly reporting to the federal agency. Effect: There is a potential that the Center?s form RD 442-2 could contain errors in financial information. Questioned Costs: None reported Repeat Finding from Prior Years: No Context: No sampling was performed. 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 Center?s quarterly filings and implement controls to ensure the accuracy of the filed reports, which should include an independent review and approval. Views of Responsible Officials: Management agrees with the finding.
Show full finding ▾Hide full finding ▴U.S. Department of Agriculture Federal Financial Assistance Listing #10.766 Community Facilities Loans and Grants 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 the conditions of the award. Condition: The Center does not have an internal control system designed to provide for review and approval of the quarterly form RD 442-2, Statement of Budget, Income, and Equity (OMB No. 0575-0015) reports submitted. Cause: The Center?s internal controls were not established to cover quarterly reporting to the federal agency. Effect: There is a potential that the Center?s form RD 442-2 could contain errors in financial information. Questioned Costs: None reported Repeat Finding from Prior Years: No Context: No sampling was performed. 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 Center?s quarterly filings and implement controls to ensure the accuracy of the filed reports, which should include an independent review and approval. Views of Responsible Officials: Management agrees with the finding.
Finding 2022-002 Federal Agency Name: U.S. Department of Agriculture Program Name: Community Facilities Loans and Grants CFDA #10.766 Finding Summary: The Center does not have an internal control system designed to provide for review and approval of the quarterly form RD 442-2, Statement of Budget, Income, and Equity (OMB No. 0575-0015) reports submitted. Responsible Individuals: Will Grant, Interim Chief Financial Officer Corrective Action Plan: The center is in the process of revising internal controls to ensure the Center?s quarterly reporting is reviewed and approved prior to submission. Anticipated Completion Date: Ongoing
FAC accepted this audit on June 29, 2022 — management decision was due December 29, 2022.
The 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 Center meets a specified threshold of federal expenditures. Effect: There is a reasonable possibility that the Center would not be able to draft the Schedule that is correct without the 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 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.
Show full finding ▾Hide full finding ▴2021-003 Department of Health and Human Services Federal Assistance Listing/CFDA #93.461 HRSA COVID-19 Claims Reimbursement for the Uninsured Program and the COVID-19 Coverage Assistance Fund Department of Health and Human Services Federal Assistance Listing/CFDA #93.697 COVID-19 Testing and Mitigation for Rural Health Clinics Department of Health and Human Services Federal Assistance Listing/CFDA #93.912 Rural Health Care Services Outreach, Rural Health Network Development and Small Health Care Provider Quality Improvement Department of Health and Human Services Federal Assistance Listing/CFDA #93.323 Epidemiology and Laboratory Capacity for Infectious Diseases (ELC) Department of Health and Human Services Federal Assistance Listing/CFDA #93.069 Public Health Emergency Preparedness 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 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 Center meets a specified threshold of federal expenditures. Effect: There is a reasonable possibility that the Center would not be able to draft the Schedule that is correct without the 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 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.
Preparation of Schedule of Expenditures of Federal Awards Finding 2021-003 Federal Agency Name: Department of Health and Human Services Program Name: HRSA COVID-19 Claims Reimbursement for the Uninsured Program and the COVID-19 Coverage Assistance Fund CFDA # 93.461 Federal Agency Name: Department of Health and Human Services Program Name: COVID-19 Testing and Mitigation for Rural Health Clinics CFDA # 93.697 Federal Agency Name: Department of Health and Human Services Program Name: Rural Health Care Services Outreach, Rural Health Network Development and Small Health Care Provider Quality Improvement CFDA # 93.912 Federal Agency Name: Department of Health and Human Services Program Name: Epidemiology and Laboratory Capacity for Infectious Diseases (ELC) CFDA # 93.323 Federal Agency Name: Department of Health and Human Services Program Name: Public Health Emergency Preparedness CFDA # 93.069 Finding Summary: Eide Bailly LLP prepared the schedule of expenditures of federal awards and accompanying notes. Responsible Individuals: Will Grant, Interim Chief Financial Officer Corrective Action Plan: It is not cost effective to have an internal control system designed to provide for the preparation of the schedule of expenditures of federal awards and accompanying notes. We requested that our auditors prepared the schedule of expenditures of federal awards and accompanying notes as a part of the single audit. We have designated a member of management to review the drafted schedule of expenditures of federal awards and accompanying notes. Anticipated Completion Date: Ongoing
The Center?s eligible expenses and lost revenue claimed and reported under the Provider Relief Fund program was not reviewed and approved by a separate individual outside of the preparer. Cause: The Center had multiple individuals identifying and compiling eligible costs. In addition, the Center utilized outside consultants to assist with this process and with the calculation of lost revenues. The Center did not have an internal control process in place to ensure a review and approval of the report submitted to the Department of Health and Human Services for Period 1 by someone other than the preparer of the report. Effect: Without a secondary review and approval, there is a possibility that ineligible expenditures or lost revenues may be claimed under the program and the report may not be accurately completed. As discussed in Finding 2021-005, certain expenses were reported without being reduced by amounts reimbursed or obligated to be reimbursed by others. Additionally, lost revenue reported for the first quarter of 2021 was $0. There was an error in the calculation, which would have resulted in an additional $676,847 of lost revenues. This error did not result in any disallowed lost revenues. Questioned Costs: None. While there was an error to the first quarter of 2021, the Center did not report any lost revenues during that quarter. Context: 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 Center implement a control process which includes a documented secondary review and approval of required reports to be submitted to the federal agency. Views of Responsible Officials: Management agrees with the finding.
Show full finding ▾Hide full finding ▴2021-004 Department of Health and Human Services Federal Assistance Listing/CFDA #93.498 Provider Relief Fund (PRF) and American Rescue Plan (ARP) Rural Distribution Applicable Federal Award Number and Year ? Period 1 TIN #576000003 Activities Allowed or Unallowed, 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: The Center?s eligible expenses and lost revenue claimed and reported under the Provider Relief Fund program was not reviewed and approved by a separate individual outside of the preparer. Cause: The Center had multiple individuals identifying and compiling eligible costs. In addition, the Center utilized outside consultants to assist with this process and with the calculation of lost revenues. The Center did not have an internal control process in place to ensure a review and approval of the report submitted to the Department of Health and Human Services for Period 1 by someone other than the preparer of the report. Effect: Without a secondary review and approval, there is a possibility that ineligible expenditures or lost revenues may be claimed under the program and the report may not be accurately completed. As discussed in Finding 2021-005, certain expenses were reported without being reduced by amounts reimbursed or obligated to be reimbursed by others. Additionally, lost revenue reported for the first quarter of 2021 was $0. There was an error in the calculation, which would have resulted in an additional $676,847 of lost revenues. This error did not result in any disallowed lost revenues. Questioned Costs: None. While there was an error to the first quarter of 2021, the Center did not report any lost revenues during that quarter. Context: 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 Center implement a control process which includes a documented secondary review and approval of required reports to be submitted to the federal agency. Views of Responsible Officials: Management agrees with the finding.
Review and Approval of the Report Submitted to the Department of Health and Human Services for Period 1 Finding 2021-004 Federal Agency Name: Department of Health and Human Services Program Name: Provider Relief Fund (PRF) and American Rescue Plan (ARP) Rural Distribution Applicable Federal Award Number and Year ? Period 1 TIN #576000003 CFDA # 93.498 Finding Summary: The Center?s eligible expenses and lost revenue claimed and reported under the Provider Relief Fund program was not reviewed and approved by a separate individual outside of the preparer. Responsible Individuals: Will Grant, Interim Chief Financial Officer Corrective Action Plan: The Center has enhanced the internal controls to ensure documented secondary review and approval of required reports to be submitted to the federal agency. Anticipated Completion Date: June 2022
The Center is a critical access hospital and reimbursed from Medicare based on the expenses incurred to treat Medicare beneficiaries for the majority of operating activities. The Center claimed expenses attributable to coronavirus, but did not reduce such expense by the amounts Medicare reimburses or is obligated to reimburse the Center. Cause: There was turnover of key financial personnel during 2021. The Center did not have an adequate internal control policy in place to ensure expenses claimed were being reduced by Medicare's reimbursement. The Center also did not have a control to ensure the reporting was reviewed and approved by someone other than the preparer (see finding 2021-004). Effect: The Center claimed and reported expenses that were reimbursed or obligated to be reimbursed by Medicare. Questioned Costs: None. While there were $92,838 of expenses considered to be reimbursed by another source reported, the Center had excess lost revenues of $2,076,354, which more than covers the error. Context: It was identified that amounts claimed were not reduced by Medicare reimbursement. Of the expenses claimed totaling $913,951, $860,807 of expenses were considered to be subject to cost-based reimbursement from Medicare. The Center estimated that Medicare reimburses approximately 11% of expenses reported on annual cost reports based on its 2021 filed cost report. Accordingly, $92,838 of expenses claimed were considered to be reimbursed by another source. Repeat Finding from Prior Years: No Recommendation: We recommend the Center modify internal control policies to ensure amounts claimed for this program are reduced by amounts reimbursed or obligated to be reimbursed by another source, including Medicare cost-based reimbursement. Views of Responsible Officials: Management agrees with the finding.
Show full finding ▾Hide full finding ▴2021-005 Department of Health and Human Services Federal Assistance Listing/CFDA #93.498 Provider Relief Fund (PRF) and American Rescue Plan (ARP) Rural Distribution Applicable Federal Award Number and Year ? Period 1 TIN #576000003 Activities Allowed or Unallowed and Allowable Costs/Cost Principles Significant Deficiency in Internal Control Over Compliance and Noncompliance Not Considered Material 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 Center is a critical access hospital and reimbursed from Medicare based on the expenses incurred to treat Medicare beneficiaries for the majority of operating activities. The Center claimed expenses attributable to coronavirus, but did not reduce such expense by the amounts Medicare reimburses or is obligated to reimburse the Center. Cause: There was turnover of key financial personnel during 2021. The Center did not have an adequate internal control policy in place to ensure expenses claimed were being reduced by Medicare's reimbursement. The Center also did not have a control to ensure the reporting was reviewed and approved by someone other than the preparer (see finding 2021-004). Effect: The Center claimed and reported expenses that were reimbursed or obligated to be reimbursed by Medicare. Questioned Costs: None. While there were $92,838 of expenses considered to be reimbursed by another source reported, the Center had excess lost revenues of $2,076,354, which more than covers the error. Context: It was identified that amounts claimed were not reduced by Medicare reimbursement. Of the expenses claimed totaling $913,951, $860,807 of expenses were considered to be subject to cost-based reimbursement from Medicare. The Center estimated that Medicare reimburses approximately 11% of expenses reported on annual cost reports based on its 2021 filed cost report. Accordingly, $92,838 of expenses claimed were considered to be reimbursed by another source. Repeat Finding from Prior Years: No Recommendation: We recommend the Center modify internal control policies to ensure amounts claimed for this program are reduced by amounts reimbursed or obligated to be reimbursed by another source, including Medicare cost-based reimbursement. Views of Responsible Officials: Management agrees with the finding.
Consideration of Amounts Reimbursed by Medicare Finding 2021-005 Federal Agency Name: Department of Health and Human Services Program Name: Provider Relief Fund (PRF) and American Rescue Plan (ARP) Rural Distribution Applicable Federal Award Number and Year ? Period 1 TIN #576000003 CFDA # 93.498 Finding Summary: The Center is a critical access hospital and reimbursed from Medicare based on the expenses incurred to treat Medicare beneficiaries for the majority of operating activities. The Center claimed expenses attributable to coronavirus, but did not reduce such expense by the amounts Medicare reimburses or is obligated to reimburse the Center. Responsible Individuals: Will Grant, Interim Chief Financial Officer Corrective Action Plan: The Center has enhanced the internal controls to ensure underlying supporting records agree to the final reports submitted to HHS, including a review and approval by someone different than the individual inputting the report data. Anticipated Completion Date: June 2022
The Center claimed expenses that were claimed and reimbursed by the Center?s Paycheck Protection Program loan forgiveness. These expenses were identified as unallowed on the Center?s schedule of expenditures, but inadvertently included in the amounts ultimately reported on the Period 1 report to HHS. Cause: There was turnover of key financial personnel during 2021. The Center did not have an adequate internal control policy in place to ensure expenses claimed were being reduced by amounts reimbursed or obligated to be reimbursed by another source. The Center also did not have a control to ensure the reporting was reviewed and approved by someone other than the preparer (see finding 2021-004). Effect: The Center claimed and reported expenses that were reimbursed or obligated to be reimbursed by other sources. Questioned Costs: None. While there were $53,144 of expenses considered to be reimbursed by another source reported, the Center had excess lost revenues of $2,076,354, which more than covers the error. Context: Of the expenses claimed totaling $913,951, $41,879 of wages and salaries and $11,265 of employee benefits were identified as being reimbursed by the Center?s Paycheck Protection Program loan forgiveness, but included in the Period 1 report to HHS as allowable expenditures. Repeat Finding from Prior Years: No Recommendation: We recommend the Center create and internal control policy to ensure underlying supporting records agree to the final reports submitted to HHS, including a review and approval by someone different than the individual inputting the report data. Views of Responsible Officials: Management agrees with the finding.
Show full finding ▾Hide full finding ▴2021-006 Department of Health and Human Services Federal Assistance Listing/CFDA #93.498 Provider Relief Fund (PRF) and American Rescue Plan (ARP) Rural Distribution Applicable Federal Award Number and Year ? Period 1 TIN #576000003 Activities Allowed or Unallowed and Allowable Costs/Cost Principles Significant Deficiency in Internal Control Over Compliance and Noncompliance Not Considered Material 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 Center claimed expenses that were claimed and reimbursed by the Center?s Paycheck Protection Program loan forgiveness. These expenses were identified as unallowed on the Center?s schedule of expenditures, but inadvertently included in the amounts ultimately reported on the Period 1 report to HHS. Cause: There was turnover of key financial personnel during 2021. The Center did not have an adequate internal control policy in place to ensure expenses claimed were being reduced by amounts reimbursed or obligated to be reimbursed by another source. The Center also did not have a control to ensure the reporting was reviewed and approved by someone other than the preparer (see finding 2021-004). Effect: The Center claimed and reported expenses that were reimbursed or obligated to be reimbursed by other sources. Questioned Costs: None. While there were $53,144 of expenses considered to be reimbursed by another source reported, the Center had excess lost revenues of $2,076,354, which more than covers the error. Context: Of the expenses claimed totaling $913,951, $41,879 of wages and salaries and $11,265 of employee benefits were identified as being reimbursed by the Center?s Paycheck Protection Program loan forgiveness, but included in the Period 1 report to HHS as allowable expenditures. Repeat Finding from Prior Years: No Recommendation: We recommend the Center create and internal control policy to ensure underlying supporting records agree to the final reports submitted to HHS, including a review and approval by someone different than the individual inputting the report data. Views of Responsible Officials: Management agrees with the finding.
Review of Detail and Consideration of Expenses Reimbursed by Other Sources Finding 2021-006 Federal Agency Name: Department of Health and Human Services Program Name: Provider Relief Fund (PRF) and American Rescue Plan (ARP) Rural Distribution Applicable Federal Award Number and Year ? Period 1 TIN #576000003 CFDA # 93.498 Finding Summary: The Center claimed expenses that were claimed and reimbursed by the Center?s Paycheck Protection Program loan forgiveness. Responsible Individuals: Will Grant, Interim Chief Financial Officer Corrective Action Plan: The Center has enhanced the internal controls to ensure underlying supporting records agree to the final reports submitted to HHS, including a review and approval by someone different than the individual inputting the report data. Anticipated Completion Date: June 2022
FAC accepted this audit on November 5, 2018 — management decision was due May 5, 2019.
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