Denver Health RFP# 1184 - Audit Services.docx

DHHA RFP# 1184 – Audit Services – Request for Proposals

Request for Proposal (RFP)# 1184 Audit Services

DENVER HEALTH AND HOSPITAL AUTHORITY

Purchasing – 777 Delaware St Denver, CO 80204

Date of Issuance: 5/19/2025

TABLE OF CONTENTS

1. INTRODUCTION - DENVER HEALTH

2. ENGAGEMENT SERVICES REQUIRED

3. TENTATIVE TIMELINE

4. MINIMUM QUALIFICATIONS

5. ATTACHMENTS

6. SUBMITTAL GUIDELINES

7. DIVERSITY, EQUITY, AND INCLUSION IN PROCUREMENT

8. SELECTION INFORMATION

9. GENERAL INFORMATION

10. PROPOSAL CONDITIONS

1. INTRODUCTION – DENVER HEALTH

Denver Health was established in 1860 and has been caring for the people of Denver and the Rocky Mountain Region ever since. Denver Health is a vast source of medical knowledge, technology and resources where every hour of every day our expert, caring staff delivers high-value care. Denver Health cares for all people. We are committed to providing the best care for every person, mind, body and spirit. We are committed to making our community a healthy place to live, work, and raise a family.

Founded on the banks of Cherry Creek in 1860, Denver Health reflects the historical mission of our nation’s public safety net hospitals. Additionally, Denver Health integrates acute hospital and emergency care with public and community health to deliver preventive, primary and acute care services. This integration promotes continuity of care for each patient. Integration also assures health care that is delivered in the most efficient, cost-effective setting. Denver Health cares for one -fourth of Denver’s population annually, and 50 percent of Denver’s children.

Denver Health cares for:

· The special health needs of the entire population with services ranging from trauma care to the Rocky Mountain Poison and Drug Center, and

· The needs of special populations such as the poor, uninsured, mentally ill, pregnant teens, persons addicted to alcohol and other substances, victims of violence, the homeless and those with AIDS.

Denver Health Medical Center Denver Health Medical Center (DHMC) is Denver Health’s acute care hospital. With 555-licensed beds, DHMC is one of the state’s busiest hospitals with more than 20,000 admissions annually.

Rocky Mountain Regional Trauma Center Denver Health Medical Center is home to the Rocky Mountain Regional Trauma Center (RMRTC), the region’s academic Level I Trauma Center, certified for both adults and children (Level II). Denver Health’s Level One Trauma Center is one of the world’s leading trauma centers and has one of the highest survival rates in the country.

911 Emergency Response Denver Health operates Denver’s 911 medical emergency response system. In 2024, Denver Health paramedics responded to more than 130,000 calls for emergency medical assistance and transported nearly 80,000 patients to 12 area hospitals.

Community Health Services Denver Health’s Community Health Services manages more than 740,000 outpatient visits annually.

Family Health Centers The Authority operates fourteen community health clinics located throughout the Denver metropolitan area and one community health clinic located in Winter Park. Included are three Urgent Care Centers, two of which are FQHC and one non-FQHC site.

School-based Health Centers Nineteen School-based Health Centers in Denver Public Schools offer on-site medical care to elementary, middle and high school students.

Public Health Public Health Institute at Denver Health (PHIDH) serves as the center for communicable disease reporting, surveillance, investigation and control for the City and County of Denver. An integral part of Denver Health, infectious disease physicians from DPH work with hospital physicians on disease prevention and treatment throughout the hospital and family health centers. Through numerous grant-funded programs, DPH conducts important research on infectious diseases including hepatitis surveillance; tuberculosis clinical trials; HIV/AIDS prevention, counseling, testing and treatment; and vaccine trials.

Rocky Mountain Poison and Drug Services Denver Health offers many alternatives to expensive emergency room visits and/or hospitalization. The Rocky Mountain Poison and Drug Services (RMPDS) handles many minor poisoning emergencies by telephone. In addition, the Center’s staff of toxicologists cares for seriously ill patients in the hospital.

Through Denver Health’s 24-hour Nurse Line, more than 85,000 patients get free and confidential answers to health-related questions, to avoid costly emergency room visits.

Denver CARES Behavioral Health Services manages Denver CARES, a 100-bed, non-medical facility, which provides a safe setting for more than 23,000 detoxifying public inebriates each year.

Denver Health Medical Plan Denver Health Medical Plan, Inc. (DHMP) is a local, nonprofit health insurance company established in 1997 to provide quality, accessible and affordable health insurance. We provide health insurance coverage to over 115,000 members in the Denver Metro Area. We offer employer group, Medicare, Child Health Plan Plus (CHP+), health care exchange and Medicaid products. Our largest member population is Medicaid totaling more than 80,000 members. Denver Health Medical Plan is a subsidiary of Denver Health and Hospital Authority.

Denver Health Foundation Denver Health Foundation is an independent 501(c)(3) nonprofit corporation that operates separately from Denver Health and Hospital Authority and has its own governing structure, board of directors and by-laws. Founded in 1988, Denver Health Foundation raises private funds that support Denver Health and Hospital Authority in its role to sustain and advance the health and well-being of Denver, Colorado and the Rocky Mountain Region.

2. ENGAGEMENT SERVICES REQUIRED

In addition, please refer to Attachment A – Statement of Work

The Authority

1. The annual audit of the Authority’s Basic Financial Statements covers a two-year comparative period and includes:

· Independent Auditor’s Report,

· Management’s Discussion and Analysis (unaudited),

· Financial Statements:

1. Statements of Net Position,

2. Balance Sheets,

3. Statements of Revenues, Expenses and Changes in Net Position,

4. Statements of Cash Flows,

5. Statements of Fiduciary Net Position,

6. Notes to Financial Statements,

· Required or Additional Supplementary Information:

1. Schedule of the Authority’s Proportionate Share of the Net Pension Liability – DERP

2. Schedule of the Authority’s Pension Contributions – DERP

3. Schedule of the Authority’s Proportionate Share of the Net OPEB Liability – DERP

4. Schedule of the Authority’s OPEB Contributions – DERP

5. Schedule of the Authority’s Qualified Replacement Benefit Plan – DERP RBA

6. Consolidating Schedules

7. Supplementary Budget to Actual Information

· Any other reports required by GASB.

The Authority’s Basic Financial Statements are to be issued by April 1st each year, following March FAC and Board approval. Interim fieldwork usually takes approximately two weeks, and final fieldwork typically takes approximately six weeks.

2. As a recipient of major federal program awards, the Authority is required to prepare and file a Report on Compliance with Requirements Applicable to Each Major Program and on Internal Control Over Compliance in Accordance with U.S. Office of Management and Budget 2 CFR 200, Subpart F, along with the Schedule of Expenditures of Federal Awards. The number of programs required to be tested varies from year to year and is based on the final schedule of expenditures of federal awards.

The Single Audit Report is normally complete in conjunction with the DHHA financial statement audit but must be submitted to the federal government no later than September 30th of the year following the audit year. Interim fieldwork usually takes approximately two weeks, and final fieldwork typically takes approximately six weeks.

3. Debt covenant compliance report as required under the Master Trust Indenture.

The Debt covenant compliance report is required to be issued by April 1st each year.

4. ACUTE Financial Report Agreed upon procedure report. The primary function of this report is to assist the Joint Management Committee with review of this line of business annual financials.

The report is due by the end of February every year. This work typically takes two weeks to complete.

5. Primary Care Fund Application agreed upon procedure report. The primary function of this report is solely to assist the Authority and the Colorado Department of Health Care Policy and Financing in evaluating whether the Unduplicated User/Patient Count provided in Steps 1, 2a, 2b, 2c, 2d, 3, 4 and 5 of Q1 Table 1 of the Primary Care Fund Application meets the criteria for the category as defined by the Department for the Primary Care Fund.

The Primary Care Fund Application agreed upon procedure report is required to be issued at least 1 week prior of the Colorado Health Care Policy and Financing deadline each year (typically in May of each year).

6. Retirement plan audit. The function of this audit is to audit the Authority retirement plans [section 457(b) and 401(a) plans] currently administered by Fidelity and the compliance of the plans with the requirements of Colorado law for public pension plans and other generally applicable retirement plan standards.

The audit of the Retirement plans will be due by December 31st each year.

7. Tax Return. The audit firm selected will also be engaged to prepare and electronically submit multiple Form 990s and, UBIT where applicable. The timing is typically in June for 990s to be completed.

The Authority staff prepares all work-papers, financial statements, footnotes, schedules and management discussion and analysis. The Authority is not subject to Sarbanes-Oxley requirements. All audit reports will be presented to the Finance Committee and Board of Directors. All audit reports are required in printed, bound form, as well as a pdf and Word format for electronic submission.

In addition, please discuss your requirements for the use of the Authority financial statements and audit report(s) in an offering document.

As with any industry, there are certain critical areas that require significant management judgment. For the Authority, the critical areas are the value of the patient accounts receivable, third-party settlements. Actuarial reports are used to assist the Authority in establishing values for medical malpractice, workers’ compensation and its employee plan IBNR. Additionally, the Authority has a proportionate share of a multi-employer pension plan that is recorded using an actuarial report. These reports will be made available.

DHHA OMC Inc.

OMC requires an annual audit of two-year comparative financial statements, issued separately from the Authority. The financial statements include:

· Independent Auditor’s Report

· Financial Statements:

1. Balance Sheets,

2. Statements of Operations and Changes in Net Assets (Deficit),

3. Statements of Cash Flows,

4. Notes to Financial Statements,

· Any other reports required by FASB.

Tax Return. The audit firm selected will also be engaged to prepare and electronically submit Form 990s and, UBIT where applicable. The timing is typically in June for 990s to be completed.

The Plan The Plan requires an annual audit of two-year comparative statutory financial statements, issued separately from the Authority. The financial statements include:

· the Independent Auditors’ Report,

· Statutory Financial Statements

· Statement of Admitted Assets, Liabilities and Surplus,

· Statutory Statements of Revenue and Expenses,

· Statutory Statements of Changes in Surplus,

· Statutory Statements of Cash Flows,

· Notes to Statutory Financial Statements

· Supplemental Investment Information and Disclosures

· Summary Investment Schedule

· Statutory to GAAP financials – presented discretely in the Authority financials and subject to that audit’s timeline.

· Any other reports required by SAP

In addition, the Plan requires an Auditors Letter of Qualifications, and a Letter of Significant Deficiencies in Internal Control. All these items are filed with the Division of Insurance by the Plan. The audited financial statements are filed as well with the National Association of Insurance Commissioners and with CMS. The CMS filing is due on or before April 30 of each year. Audits must be submitted to the Division and the NAIC by June 1 annually. Audits are required in printed, bound form, as well as a pdf format for electronic submission. In addition, the Plan would request a letter to management on all internal control weaknesses noted, even those considered non-material. The audit firm should expect to present the results of its audit to the Board of Directors of the Plan, as well as the Denver Health and Hospital Authority’s Finance Committee, which serves as the Audit Committee for the Plan.

The firm selected must be willing and able to comply with Division of Insurance Amended Regulation 3-1-4 “Concerning Annual Audited Financial Reports”. The firm must agree to rotate audit partners as required by this regulation, and to maintain audit work-papers for Division of Insurance or CMS review upon request. The Plan is subject to a Financial Exam by the Division every five years; as part of that, the Division normally requests external audit work-papers.

The Plan’s Audit Report must be received in time to meet the April 30th CMS deadline. However, since the statutory statement is under preparation in January and February (due March 1), final audit adjustments must be provided in February. This makes the timing of final field work difficult, as final financial statements and report are prepared after the annual statement is filed. Interim field work can be performed in the final quarter of the calendar year and is imperative in order to meet these tight year-end filing timelines. The Plan’s staff prepare all workpapers. Transaction test-work normally includes tests of claims payment transactions as well as other types of disbursements. The Plan engages the Authority’s Office of Compliance to perform claims test work throughout the year. The auditor chosen should be willing to work with the Authority’s Office of Compliance throughout the year to ensure that the test-work performed by them can be used to minimize additional claims test-work by the auditor.

The Plan’s assets consist primarily of cash, short, and long-term investments and Centers for Medicare and Medicaid Services (CMS) Affordable Care Act Exchange Risk Adjustment receivables. There are also a small number of fixed assets. Prepaid assets include claims pricing software costs, which if present at year end, are considered non-admitted. Premiums receivables are usually of a very small immaterial balance. The Plan’s primary payers are the Denver Health and Hospital Authority, the City and County of Denver’s Career Service Authority, the Denver Employee Retirement Plan, the State of Colorado Health Care Policy and Finance (CHP and Medicaid, and CMS, Medicare and Exchange). These payments come in primarily by ACH deposit monthly. There are premiums billed to Medicare and Exchange enrollees.

Areas on the Plan considered critical would be the evaluation of Incurred but Not Reported liability and ACA Exchange Risk Adjustment receivables. In certain cases, the determination of a premium deficiency reserve could be required. The Plan uses an external consulting actuary to develop and opine on the necessary claim liabilities for the statutory statements. The Plan will provide the external auditor with all work-papers related to the development of the IBNR and all other liabilities. The plan has a significant ACA Exchange Risk Adjustment receivable and Medicare Risk Adjustment receivables which require the use of an external consulting actuary to develop and opine on those estimates.

The Plan’s investments are all Federally issued SVO-exempt securities, with the exception of small balances in Class One/Exempt money market funds. The Plan has a statutory deposit held jointly with the Division of Insurance. The Plan also files a Risk Based Capital report annually by March 1 of each year. This is not required to be audited.

One of the Plan’s major sources of revenue is its relationship with its parent, the Authority. The Plan reviews all financial statements and accompanying footnotes, as well as prepares management’s discussion and analysis

The Plan’s internal controls mirror those of the Authority for purchasing and disbursement, except to the extent where insurance regulations require stricter compliance. At this time, the Plan is not subject to Sarbanes-Oxley requirements. The Plan has no employees, and pays no payroll taxes, and has no retirement or benefit obligations. All staff are leased from the Authority by way of a management services agreement. The Plan has a FAC Committee that includes the Authority Board members on the Authority’s FAC committee, plus the CEO and CFO of the Authority.

Tax Return. The audit firm selected will also be engaged to prepare and electronically submit multiple Form 990s and, UBIT where applicable. The timing is typically in June for 990s to be completed.

Denver Health Foundation

The Foundation requires an annual audit of two-year comparative financial statements, issued separately from the Authority. The financial statements include:

· Independent Auditor’s Report

1. Financial Statements:

2. Statements of Financial Position

3. Statements of Activities

4. Statements of Functional Expenses

5. Statements of Cash Flows

6. Notes to the Financial Statements

· Any other reports required by FASB.

· Drafting of the financial statements with assistance of Denver Health Foundation staff.

Tax Return. The audit firm selected will also be engaged to prepare and electronically submit Form 990s and, UBIT where applicable. The timing is typically in June for 990s to be completed.

Other services

We would like to request the following be considered or are required:

1. Authority staff requiring continuing professional education (CPE) credits be allowed to attend, at no cost, CPE courses offered by candidate.

2. Copies of industry specific manuals.

3. FASB, GASB and SAP updates.

4. The engagement partner and manager, along with audit staff, will attend Finance and Audit Committee and Board meetings, dedicated to a discussion of DHHA’s Financial Statements and Management Letters. Additional requests might be made by the FAC committee that would require the Auditors to attend.

5. In connection with future bond issuances or financing arrangements interim quarterly financial statements will be included in an Official Statement (OS). The successful audit firm will be required to perform a stub-period review of these interim statements and issue a comfort letter to the underwriter regarding the statements and other financial and statistical data included in the OS. Further, the auditors would be expected to issue a consent letter permitting the use of their audit report for inclusion with DHHAs latest audited financial statements in the OS.

Please provide pricing for bundled services as well as for individual services.

3. TENTATIVE REQUEST FOR PROPOSAL SCHEDULE

4. MINIMUM QUALIFICATIONS:

To be considered as qualified, the Contractor will provide evidence regarding the following:

· Must have a minimum of 5 years’ experience auditing healthcare clients with revenues $500M and greater.

· Must be a registered CPA firm in Colorado.

· Must have 2 CFR 200 (Single) accounting and auditing experience.

· Must have Health Maintenance Organization Insurance experience, and related Statutory-basis accounting and auditing experience.

· Must have foundation experience, and related fund accounting and auditing experience.

· Must have captive insurance accounting and auditing experience.

DHHA considers communication to be crucial in order to resolve any issues that may arise during the audit period. Accordingly, the auditor and management must meet periodically to discuss audit progress and related issues. Meetings may be held on an “as needed” basis depending upon the urgency of the issues. The auditors must immediately apprise senior management regarding any accounting or auditing concern that has come to their attention that might have an impact on their ability to issue an unqualified opinion on the financial statements.

5. ATTACHMENTS:

Attachment A – Statement of Work

· This includes detailed information about the project we’re anticipating, questions each vendor should answer in their proposal, and other expectations re: this project. Please review and send any questions or clarifications in Attachment B.

Attachment B – Questions & Clarifications Form

· Please complete this form and return a copy to Ben.McNeill@dhha.org by the Proposal Due Date in the Tentative Schedule above, if you have any questions about this RFP.

Attachment C – Service Agreement Template

· This document contains DHHA’s standard legal terms, which will be the terms and conditions used for the eventual awarded contract. Please review and let us know if you have any redlines. Please note that all proposals must include any standard legal terms or addenda necessary to complete the work outlined in Attachment A.

Attachment D – Blank W-9 Form

· Please complete this form and include it in your proposal submission.

Attachment E – Voluntary Self-Certification Form

· Please complete this form and include it in your proposal submission.

Attachment F – IT Risk Stratification

· Please complete this form and include it in your proposal submission. Note that more detailed technical information will be required during contract negotiation.

Attachment F – Simplified Cost Breakdown

· Please complete this form and include it in your proposal submission. You are encouraged to provide a more detailed cost breakdown in your preferred format as well, but please also submit it in this format.

Attachment G – RFP Bid Evaluation Matrix

· This will be used to rate the proposals received for this RFP and is included for reference.

6. SUBMITTAL GUIDELINES

Each respondent must provide a response that follows the outline below. Limit your response to the number of pages defined below within each section. Limits have been identified and brevity with clarity will be appreciated. The response to this request for proposal must include the following information:

SECTION 1 – TABLE OF CONTENTS: (2 Page Limit)

a. Complete proposal Cover Sheet (see pg. 6). One copy of the proposal cover sheet must be signed by an individual with authority to legally bind the company and included with the proposal.

b. Proposal Table of Contents.

SECTION 2 – EXECUTIVE SUMMARY: (3 Page Limit) This section should be viewed as a synopsis and should present a capsule overview of the proposal. In addition, it will be the vehicle whereby exceptional and outstanding characteristics of your proposal may be highlighted. This section should include, at a minimum,

a. the number of employees,

b. relevant organization chart,

c. recently completed similar size audits, and

d. duration the firm has been performing the same or similar services as those sought in this RFP.

SECTION 3 – TECHNICAL CAPABILITIES: (no Page Limit) Vendors must respond to the Statement of Work (section A) and complete all required responses/attachments as related to the products, equipment, performance, installation, training, maintenance, and cost.

a. This section will include the size of the professional staff experienced in auditing healthcare providers, and the size of the professional staff experienced in auditing governmental entities. Additionally, a copy of the firm’s most recent Peer Review Report should be included.

b. Experience in assessing the effectiveness of information technology controls and technical knowledge of Infor, Workday and EPIC and environments should be outlined in addition to the other aspects outlined in the Scope of Work above.

SECTION 4 – PROPOSED TEAM: (2 Page Limit, Excluding Resumes)

a. Provide an Organization Chart that clearly represents the reporting structure of the leadership and proposed assigned representatives.

a. Resumes are strongly encouraged for key client engagement partners but are not required.

SECTION 5 – PAST PERFORMANCE: (No Page Limit) Vendors shall furnish the names, addresses and telephone numbers of a minimum of three organizations most closely resembling the Authority, for which the Vendor has provided similar services within the last five (5) years. Members of the External Audit search committee may contact and interview any references provided.

SECTION 6 – AUDITED FINANCIAL STATEMENTS: (No Page Limit)

a. Audited financial statement for the firm for the last three years

SECTION 7 – CONTRACTUAL AGREEMENT: (No Page Limit)

a. The proposal must be based on Attachment C – Service Agreement as modified by DHHA in conjunction with this RFP. DHHA may entertain a limited number of proposed changes.

SECTION 8 – COSTS: (No Page Limit)

a. Provide proposed pricing in the format provided in Attachment F – Simplified Cost Breakdown. More detailed pricing information may be required as well.

b. The proposed pricing will be valid until an award decision is made, and it must be valid for the term of the contract.

c. Denver Health does an RFP on audit services every 5 years

SECTION 9 – OTHER INFORMATION: (No Page Limit) Vendors may furnish any supplemental information that may contribute to this process.

7. DIVERSITY, EQUITY, AND INCLUSION (DEI) IN PROCUREMENT

At Denver Health it is our mission to provide high-quality medical care for everyone, regardless of their ability to pay. But we know that clinical care alone only accounts for 20 percent of a person’s health status. There are many other factors that impact a person’s overall wellbeing including their access to healthy food, housing, employment and education as well as the physical environment in which they live. To truly care for the whole person, we as an institution must address all of those other determinants of health. And that is why we have committed to serving our Denver community as an Anchor Institution.

Anchor institutions are place-based, mission-driven entities such as hospitals, universities, and government agencies that leverage their economic power alongside their human and intellectual resources to improve the long-term health and social welfare of their communities. For more information about Denver Health’s role as an Anchor Institution, please visit the following webpage: https://www.denverhealth.org/about-denver-health/anchor-institution.

As part of Denver Health’s commitment to its Anchor Institution goals, it is a priority for us to buy and invest locally and with businesses whose owners may have faced disadvantages and/or whose missions align with Denver Health’s, based on a set of factors as outlined in Attachment D, our Voluntary Business Category Self-Certification form. As part of your proposal, please complete Attachment D to the best of your ability.

8. SELECTION INFORMATION

Denver Health intends to select the proposal that represents the best value to the organization, as determined by a weighted evaluation of the below criteria. Evaluation criteria have been selected based on Denver Health’s needs for this service as detailed in the Statement of Work, and Denver Health’s DEI Goals as outlined in Section 7 will be taken into consideration. The evaluation criteria below will be used to first select the short list of vendors, and then to make an award:

· Costs

· Technical competence

· Experience with similar organizations/references

· Demonstrated ability to focus on the needs and specialized accounting issues specific to the Authority, rather than a “one size fits all” approach; and

· Track record and demonstrated focus on timeliness of meeting / exceeding deadlines, responding, and assisting with new issues that arise each year.

9. GENERAL INFORMATION

DHHA Purchasing Dept.--Mail Code 1415 Attn: Ben McNeill Ref. # RFP 1168 777 Delaware Street Denver, CO 80204 Late proposals will not be accepted. All Proposers are responsible for reviewing the requirements within this RFP and complying with the requirements established.

All questions or requests for clarification shall be directed only to Ben McNeill, utilizing Attachment B - Question & Clarifications Form. The completed form should be submitted by the date and time stated in Section 3. Contractors shall not contact any other individual at DHHA directly. Violations of this provision may result in the disqualification of a Contractor's Proposal. DHHA will collect and combine all forms. Responses to the submitted questions will be published by the date and time stated in Section 3.

10. PROPOSAL CONDITIONS

WE OFFER TO FURNISH TO DENVER HEALTH AND HOSPITAL AUTHORITY THE MATERIALS, SUPPLIES, PRODUCTS OR SERVICES REQUESTED IN ACCORDANCE WITH AND SUBJECT TO THE RULES, REGULATIONS AND CONDITIONS OF PURCHASE(S) DESCRIBED HEREIN.

Proposal #1184

Proposer:

Name: _______________________________________

Address: ______________________________________

City: ____________________ State ____ Zip ________

Telephone No. _________________________________

Facsimile No. __________________________________

Email address _________________________________

By:

(Printed or Typed Name)

(Written Signature)

Title: _____________________________________________

Date: _____________________________________________

Tax ID No. _____________________________________________

DHHA Purchasing:

By: _____________ _______________________ (Printed or Typed Name)

(Written Signature)

Title: __________ _________________________

Date: ____________________________________

Vendor agrees that bid price is valid until final award decision has been made by DHHA image1.jpeg