North Big Horn Hospital DistrictNon-Profit

2023-001 Provider Relief Fund Reporting of Lost Revenue Federal Agency Department of Health and Human Services Federal Assistance Listing Number 93.498 – Provider Relief Fund and American Rescue Plan Rural Distribution Award Numbers Not applicable Criteria [ X ] Compliance Finding [ ] Significant Deficiency [ X ] Material Weakness Under the terms and conditions of the award, the recipient certifies it will report actual net patient service revenues for the periods reported on in its reporting of actual net patient service revenues for its calculation of lost revenues due to coronavirus. Condition Patient service revenues for were not reported net of contractual adjustments and bad debt. Context This finding appears to be an isolated problem. Cause The District prepared its lost revenue calculations using gross patient service revenues without including contractual adjustments and bad debt. Effect The actual patient service revenues for 2023 did not reflect the correct amounts to be used in its lost revenue calculations. If net patient service revenues had been reported, the District would still have sufficient healthcare-related expenses attributable to coronavirus and lost revenues to use all of the Provider Relief Fund amounts received. Therefore, there is no effect on the District’s retention of the Provider Relief Funds. Recommendation We recommend the District’s management correct its lost revenue calculation for any future reporting for the Provider Relief Fund. Views of responsible officials and planned corrective actions Net Patient Revenues by Financial Class are not available in the CPSI system and can only be estimated. In the event there is another PHE that results in more than $750,000 received by facility, Net Patient Revenue will be easily obtainable in the CERNER system for future reporting.

Finding 2021-001 Program Name: Provider Relief Fund Federal Assistance Listing Number: 93.498 Federal Agency: U.S. Department of Health and Human Services Type of Finding: Noncompliance, Significant Deficiency Compliance Requirement: Reporting Questioned Costs: None Criteria: 2 CFR Part 200.512 requires that, for non-federal entities, ?The audit must be completed, and the data collection form described in paragraph (b) of this section and reporting package described in paragraph (c) of this section must be submitted within the earlier of 30 calendar days after receipt of the auditor's report(s), or nine months after the end of the audit period.? Condition: The reporting deadline for the 2021 single audit reporting package was September 30, 2022; however, North Big Horn Hospital District did not submit its single audit reporting package by that date. Cause: North Big Horn Hospital District was unable to complete the single audit by the deadline. This resulted in the late submission of the single audit reporting package. Effect: Without accurate and timely reporting, agencies are unable to properly oversee the expenditure of federal awards. Recommendation: We recommend that management implement processes and procedures to identify the requirements and related controls to ensure compliance. View of Responsible Officials: Management agrees with the finding above. Management will review the existing accounting policies and procedures and implement additional controls to ensure timely submission of reports.