We determined that The Hospital accounted for FEMA funds on a project-by-project basis as Federal regulations and FEMA guidelines require.  However, as of February 2017, the Hospital had not arranged for an audit of its Federal award, which it must complete and submit to the Federal Audit Clearinghouse by June 30, 2017.  We recommended that the Regional Administrator, FEMA Region IV, direct the South Carolina Emergency Division to actively monitor the Hospital’s compliance with the annual audit requirements.  If the Hospital does not meets it audit requirement by the June 30, 2017, due date, FEMA should direct South Carolina to impose appropriate additional award conditions to ensure the integrity of the FEMA award.