Farmers Union Hospital Association d/b/a Great Plains Reg Med CenterNon-Profit

Department of Health and Human Services Federal Assistance Listing /CFDA #93.461 HRSA COVID -19 Claims Reimbursement for Uninsured Program and COVID 19 Coverage Assistance Fund Department of Health and Human Services Federal Assistance Listing /CFDA #93.889 Public Health Emergency Preparedness Department of Health and Human Services Federal Assistance Listing /CFDA #93.301 COVID -19 Public Health Emergency Preparedness Preparation of 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 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 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 and the internal controls that impact financial reporting. Views of Responsible Officials: Management agrees with the finding.

Department of Health and Human Services Federal Financial Assistance Listing /CFDA #93.498 Provider Relief Fund (PRF) and America Rescue Plan (ARP) Rural Distribution Applicable Federal Award Number and Year ? Period 1 TIN #730579295 Activities Allowable or Unallowed, Allowable Cost / Cost Principles and Reporting 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 quarterly cutoff of lost revenues included on the Period 1 HRSA report did not include adjustments for changes in estimated amounts due to and from third party payors. The Center?s internal controls did not identify these errors. Cause: The Center?s internal controls over the major federal program included a separate review and approval, however, this control did not identify the errors. Effect: There were errors in the reporting of patient care revenues and lost revenues claimed on the Health Resources and Services Administration (HRSA) Period 1 report. This deficiency creates the potential that lost revenues reported on the major federal program may not be in compliance with program terms and conditions. Questioned Costs: None. While there were errors in the reporting of patient care revenues on the period 1 HRSA report, the result was the underreporting of lost revenues. Context: The lost revenues were reviewed in total and all key line items were tested on the Period 1 HRSA special report. Repeat Finding from Prior Years: No Views of Responsible Officials: Management agrees with the finding.