BOULDER CITY HOSPITAL, INC.Non-Profit

U.S. Department of Agriculture Federal Financial Assistance Listing #10.766 FaCommunity cilities Loans and Grants Special Tests and Provisions 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 Loan Resolution Security Agreement requires a monthly amount to be set aside in a reserve fund until the specific account balance is reached. Condition – The Hospital did not sufficiently fund their reserve account. As of December 31, 2024, the Hospital should have USDA debt reserves at least equal to $459,327. The USDA debt reserves equaled $141,821 as of December 31, 2024. Cause – Management has not funded the USDA debt reserves adequately. Effect – The Hospital was not in compliance with their provisions of the USDA debt agreements. Questioned Costs – None reported. Context – Sampling was not used. Repeat Finding from Prior Years – Yes, repeated finding 2023-003. Recommendation – We recommend the Hospital fund the reserve account adequately at each measurement date. Views of Responsible Officials – Management agrees with the finding.

2023-003 U.S. Department of Agriculture Federal Financial Assistance Listing #10.766 Community Facilities Loans and Grants Cluster Special Tests and Provisions 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 Loan Resolution Security Agreement requires a monthly amount to be set aside in a reserve fund until the specific account balance is reached. Condition – The Hospital did not sufficiently fund their reserve account. As of December 31, 2023, the Hospital should have USDA debt reserves at least equal to $389,998. The USDA debt reserves equaled $141,821 as of December 31, 2023. Cause – Management has not funded the USDA debt reserves adequately. Effect – The Hospital was not in compliance with their provisions of the USDA debt agreements. Questioned Costs - None reported. Context – Sampling was not used. Repeat Finding from Prior Years - Yes Recommendation - We recommend the Hospital fund the reserve account adequately at each measurement date. Views of Responsible Officials - Management agrees with the 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 – Periods 3 & 4 TIN #88‐0065829 Reporting Material Weakness in Internal Control Over Compliance and Material Noncompliance Criteria ‐ The Hospital must establish and maintain effective internal control over federal awards that provides reasonable assurance that the Hospital is managing the federal awards in compliance with federal statutes, regulations and terms and conditions of the federal award. The Hospital selected option iii to calculate lost revenue which allows for an alternate reasonable methodology to be used. Condition – The Hospital opted for a budget to actual comparison for the calculation of lost revenue as an alternate reasonable methodology, however the actual amounts used did not consider adjustments during the fiscal year. Cause ‐ The Hospital did not have an internal control process in place to ensure the accuracy of the reporting key line items and excluded adjustments to revenue from the actual balances used in the lost revenue calculation. Effect – There was no effect on the amount of lost revenue applied against the funding received, however there were errors in the key line items reported that resulted in an underreporting of lost revenue. Questioned Costs ‐ None reported. Context ‐ Key line items were tested on the Period 3 & 4 Department of Health and Human Services special reports. Repeat Finding from Prior Years ‐ Yes Recommendation ‐ We recommend that management review the calculation methodology for lost revenues and ensure the amounts used for actual revenues agrees to the amounts presented in the financial statements. Views of Responsible Officials ‐ Management agrees with the 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 – Periods 3 & 4 TIN #88‐0065829 Allowable Costs and Activities Material Weakness in Internal Control Over Compliance Criteria ‐ The Hospital must establish and maintain effective internal control over federal awards that provides reasonable assurance that the Hospital is managing the federal awards in compliance with federal statutes, regulations and terms and conditions of the federal award. Condition – The Hospital opted for a budget to actual comparison for the calculation of lost revenue as an alternate reasonable methodology, however the actual amounts used did not consider adjustments during the fiscal year. Cause ‐ The Hospital did not have an internal control process in place to ensure the accuracy of the calculation and excluded adjustments to revenue. Effect – There was no effect on the amount of lost revenue applied against the funding received. Questioned Costs ‐ None reported. Context – The lost revenue calculation for all applicable quarters was tested and reviewed. Repeat Finding from Prior Years ‐ Yes Recommendation ‐ We recommend that management review the calculation methodology for lost revenues and ensure the amounts used for actual revenues agrees to the amounts presented in the financial statements. Views of Responsible Officials ‐ Management agrees with the finding.

Department of Agriculture Federal Financial Assistance Listing #10.766 Community Facilities Loans and Grants Cluster Special Tests and Provisions 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 Loan Resolution Security Agreement requires a monthly amount to be set aside in a reserve fund until the specific account balance is reached. Condition ‐ The Hospital did not sufficiently fund their reserve account. As of December 31, 2022, the Hospital should have USDA debt reserves at least equal to $320,669. Cause ‐ There was a lack of adequate policies governing the understanding and execution of loan agreement requirements. Effect ‐ The Hospital was not in compliance with their provisions of the USDA debt agreements. Questioned Costs ‐ None reported. Context ‐ Sampling was not used. Repeat Finding from Prior Years ‐ No Recommendation ‐ We recommend the Hospital enhance internal control policies to ensure that loan requirements are monitored and met. Views of Responsible Officials ‐ Management agrees with the finding.

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