As of the July, 2022, release via CMS

GRAPE COMMUNITY HOSPITAL - HAMBURG

CMS id: 161324
275 HWY NORTH, HAMBURG IA 51640. County: FREMONT
System: --
CBSA: Rural Iowa

The 25-bed, CAH hospital had $-732,609 in net service to patients*, with a total profit margin of 29.40728% in fiscal year 2021, the latest year available.
It spent 1.89% of its operating expenses on uncompensated care and reported $514,370 in Medicaid shortfall.

* For more about Net Service to Patients and operating revenue, please the finance section below.

Note: Medians are from CAH hospitals with "complete" fiscal years. For more about how we calculated medians and cost reports in general, please click here.

Details

	2017	2018	2019	2020	2021
# of days in fyear	365	365	365	366	365
Ownership	nfp	nfp	nfp	nfp	nfp
Acute beds Median	25 23	25 23	25 23	25 23	25 23
Total beds Median	25 25	25 25	25 25	25 25	25 25
FTEs Median	86.65 149.18	88.48 151.6	88.26 151.58	87.43 152.78	90.60 151.99

Finances As they appear in worksheet G3 of the cost reports.

Note: Net Patient Revenue is considered operating revenue, which means Net Service to Patients is considered operating profit. Click here for more about cost report financials

Hospital cost reports are an enormously complicated dataset. There are whole organizations and an offical CMS vendor dedicated to helping researchers work with the data.
It's important to understand that hospital financials in cost reports are not organized in the same as other sources such as annual financial reports to bond holders.

The biggest difference is the concept of operating revenue and profit. Net Service to patients (NS2P), which is the sum of net patient revenue minus operating expenses, is considered the equivalent of operating profit according to the Medicaid and CHIP Payment and Access Commission (MACPAC). See the last paragraph of "Primary Data Sources" on page 55 of Annual Analysis of Disproportionate Share Hospital Allotments to States (PDF).

That would make Net Patient Revenue = operating revenue.

All this makes things challenging when comparing what's reported in cost reports to other sources. It becomes clearer when you consider that, beyond the purpose of reimbursement, cost reports are a tool for policymakers trying to understand the financial situation of a hospital doing the tasks specific to hospitals.

In other words, while a facility with a division that formulates drugs might include earnings from that as operating revenue in their corporate annual result, this is not central to the operations of a hospital caring for patients and so it is counted as "other income." (See below the financials section for more on "other income")

The healthcare consulting firm HMP, in a former partnership with Modern Healthcare, did develop a formula for estimating operating revenue closer to what one might find in other sources. We no longer use this for the following reasons:

The measure was not widely used beyond HMP and Modern Healthcare. Many hospitals had their own internal estimates of operating revenue and profit.
Because of this, there was confusion when reporting operating results for individual hospitals. There was often pushback when a facility's internal numbers did not match what Modern Healthcare was reporting.
The formula includes revenue from portions of the "other income" section, which may also include non-operating revenue. HMP themselves point out in a caveat on their site that they cannot exclude all non-operating revenue from their measure.

HMP's operating measure has proven problematic in the past for our reporting and the partnership with them ended years ago. It's best to not use a measure that we alone cannot defend.

	2017	2018	2019	2020	2021
Net patient revenue ? Median	10,693,400 19,395,819	10,717,181 19,790,685	10,718,755 20,891,573	10,870,465 20,752,910	10,934,555 22,925,976
Operating expenses Median	10,927,526 21,082,256	11,195,493 21,740,728	11,436,838 22,449,917	11,730,441 23,028,561	11,667,164 24,906,213
Net income from service 2 patients (NS2P) ? Median	-234,126 -1,166,928	-478,312 -1,178,891	-718,083 -1,189,234	-859,976 -1,989,193	-732,609 -1,175,562
NS2P margin ? Median	-2.19% -6.37	-4.46% -6.47	-6.70% -6.58	-7.91% -10.52	-6.70% -5.81

Range* of Net Service to Patient (NS2P) margins

= NS2P margin for GRAPE COMMUNITY HOSPITAL - HAMBURG compared to all** CAH hospitals, from CMS cost reports.
Note: NS2P is considered operating margin by MACPAC. The chart below is interactive: click or touch to see more.

* Data range does not show outliers, which fall beyond the minimum and maximum of the range.
** From cost reports with complete fiscal years. Number of CAH hospitals available to calculate medians:

2017	2018	2019	2020	2021
1,314	1,322	1,316	1,319	1,132

	2017	2018	2019	2020	2021
Other income* Median Click here to show/hide details	693,450 1,517,926	394,799 1,554,100	533,531 1,708,825	280,203 3,606,354	5,592,877 4,946,640
⊳ Line 6: Contributions ? ⊳ Median	531,620 68,435	214,146 61,711.5	172,641 71,344	24,898 80,654	1,679,170 103,902
⊳ Line 7: Investments ? ⊳ Median	1,428 25,389	13,342 35,427	29,918 59,240	22,232 47,652	11,678 52,317
⊳ Line 8: Revenue from telephone service	NULL	NULL	NULL	NULL	NULL
⊳ Line 9: Revenue from tv and radio	--	--	--	--	--
⊳ Line 10: Purchase discounts	0	0	0	0	0
⊳ Line 11: Rebates and refunds of expenses	0	0	0	0	0
⊳ Line 12: Parking lot receipts	0	0	0	0	0
⊳ Line 13: Revenue from laundry and linen service	0	0	0	0	0
⊳ Line 14: Revenue from meals sold to emplyees and guests	0	0	0	0	0
⊳ Line 15: Revenue from rental of living quarters	0	0	0	0	0
⊳ Line 16: Revenue from sale of medical and surgical supplies	0	0	0	0	0
⊳ Line 17: Revenue from sale of drugs to other than patients	0	0	0	0	0
⊳ Line 18: Revenue from sale of medical records and abstracts	0	0	0	0	0
⊳ Line 19: Tuition (fees, sale of textbooks, uniforms, etc.)	0	0	0	0	0
⊳ Line 20: Revenue from gifts, flowers, coffee shops, canteen	0	0	0	0	0
⊳ Line 21: Rental of vending machines	0	0	0	0	0
⊳ Line 22: Rental of hospital space	0	0	0	0	0
⊳ Line 23: Gov appropriations ? ⊳ Median	0 525,619.5	0 568,101.5	0 581,486	0 657,916	0 640,942
⊳ Sum Line 24	160,402	167,311	330,972	233,073	3,902,029
Total income ? Median	459,324 445,049	-83,513 379,292	-184,552 655,032	-579,773 1,453,054	4,860,268 3,734,026
Non-operating expenses Median	6,420 56,329	0 45,230	0 61,507	0 80,747	0 39,130
Net income Median	452,904 309,249	-83,513 305,537	-184,552 515,321.5	-579,773 1,282,423	4,860,268 3,678,491
Net margin Median	3.97743% 1.7%	-0.75156% 1.61%	-1.64013% 2.36%	-5.19945% 5.41%	29.40728% 13.38%

* About "Other income": Other income, or line 25 in worksheet G3, is the sum of lines 6 through 24. It includes three lines that are considered non-operating revenue - contributions, investments and government appropriations. Medians are included for these three lines. It also contains items that are not central to providing healthcare, such as revenue from parking or gift shops.
"Sum Line 24" is a special case. Called "Other (specify)" in the cost reports, CMS allows for this line to be "subscripted," or divided into sublines like 002400, 002401, 002402. And hospitals do that, up to 100 lines, to detail income (and sometimes negative returns) that are otherwise not covered in the previous "other" lines. Therefore, "Sum Line 24" is the sum of all the lines 24.

Range* of total profit (loss) margins

= Total margin for GRAPE COMMUNITY HOSPITAL - HAMBURG compared to all** CAH hospitals, from CMS cost reports.
The chart below is interactive: click or touch to see more.

* Data range does not show outliers, which fall beyond the minimum and maximum of the range.
** From cost reports with complete fiscal years. Number of CAH hospitals available to calculate medians:

2017	2018	2019	2020	2021
1,314	1,322	1,316	1,319	1,132

Medicare revenue

Inpatient and outpatient revenue

	2017	2018	2019	2020	2021
All inpatient revenue Median Click here to show/hide details	892,692 1,512,374	1,090,958 1,478,094	878,938 1,365,460	1,104,357 1,289,169	1,040,830 1,354,214
"All inpatient revenue" is made up of any Medicare payments for routine inpatient, swingbed SNFs, TEFRA, IPF, IRF, inpatient long-term care, CAH and inpatient SNF facilities. Medians are only calculated when there are sufficient facilities reporting revenue.
⊳ Routine inpatient revenue ⊳ Median	0 --	0 --	0 --	0 --	0 --
⊳ Swingbeds ⊳ Median	0 --	0 --	0 --	0 --	0 --
⊳ Tax Equity and Fiscal Responsibility Act payments (TEFRA) ⊳ Median	0 --	0 --	0 --	0 --	0 --
⊳ Inpatient psychiatric facility (IPF) ⊳ Median	0 1,435,730	0 1,483,001	0 1,283,328	0 992,950.5	0 --
⊳ Inpatient rehabilitation facility (IRF) ⊳ Median	0 --	0 --	0 --	0 --	0 --
⊳ Long-term care hospital (LTCH) ⊳ Median	0 --	0 --	0 --	0 --	0 --
⊳ Critical-access hospitals ⊳ Median	892,692 1,441,589	1,090,958 1,403,245	878,938 1,290,206	1,104,357 1,229,191	1,040,830 1,287,699
⊳ Skilled-nursing facilities (SNF) ⊳ Median	0 206,041.5	0 214,490	0 174,030.5	0 236,717.5	0 192,758.5
All outpatient revenue Median Click here to show/hide details	3,657,459 4,108,627	3,282,275 4,367,646	3,291,124 4,566,928	3,002,525 4,517,324	2,935,161 4,554,272
"All outpatient revenue" is made up of any payments for routine outpatient, HHA, CMHC, rural health and other federally-qualified health clinics. Medians are only calculated when there are sufficient facilities reporting revenue.
⊳ Routine outpatient revenue ⊳ Median	3,319,795 3,508,078	2,931,293 3,742,383	3,016,142 3,932,686	2,757,803 3,847,302	2,815,363 3,879,271
⊳ Home Health agencies (HHA) ⊳ Median	337,664 299,331.5	350,982 299,936	274,982 316,639	244,722 288,635	119,798 297,926
⊳ Community mental health clinics (CMHC) ⊳ Median	0 --	0 --	0 --	0 --	0 --
⊳ Rural health clinics ⊳ Median	0 702,405	0 746,179	0 800,433	0 774,040	0 742,054
⊳ Other federally qualified health clinics ⊳ Median	0 --	0 --	0 --	0 --	0 --

Other payments

Item	2017	2018	2019	2020	2021
Graduate Medical Education (GME) Median	0 --	0 --	0 --	0 --	0 --
Disproportionate-share hospital (DSH) Median	0 --	0 --	0 --	0 --	0 --
Outlier Median	5,393 4,679	3,908 5,256	4,496 5,165.5	0 6,341	0 5,998

Uncompensated care

Item	2017	2018	2019	2020	2021
Medicaid shortfall Median	237,550 553,475.5	281,506 567,149	333,033 599,174.5	677,131 641,417	514,370 631,057
Charity care Median	111,274 190,496	111,877 225,101	417,601 238,624	99,439 260,478.5	84,044 225,887
Uncompensated care (UCC) Median	236,629 860,218.5	277,265 933,428	604,216 986,290	229,785 998,939	220,363 871,713
UCC as a % of operating expenses Median	2.17% 3.77	2.48% 3.82	5.28% 3.7	1.96% 3.74	1.89% 3.04
Total shortfall/UCC Median	474,179 1,405,482	558,771 1,525,979	937,249 1,576,055	906,916 1,691,815	734,733 1,476,802

Labor costs

	2017	2018	2019	2020	2021
Total salaries Median	4,252,305 8,521,101	4,430,883 8,786,419	4,498,630 9,086,354	4,595,114 9,512,636	4,906,184 9,933,360
Salaries as a % of operating expenses Median	39.69 42.53	40.57 42.58	40.34 42.62	39.88 42.72	42.82 42.27
Intern, resident salaries* Median	0 --	0 --	0 --	0 --	0 --
Contract intern, resident salaries* Median	0 --	0 --	0 --	0 --	0 --
Contract adjusted salaries, direct-care Median	0 --	0 --	0 --	0 --	0 --
Contract hours, direct-care Median	0.00 --	0.00 --	0.00 --	0.00 --	0.00 --
Contract wages, direct-care Median	0.00 --	0.00 --	0.00 --	0.00 --	0.00 --

* in an approved program

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Cost reports are self-reported by the facility, are subject to revision and should be considered preliminary.

* Net Service to patients (NS2P) equals net patient revenue minus operating expenses. NS2P is considered the equivalent of operating profit according to the Medicaid and CHIP Payment and Access Commission (MACPAC). See the last paragraph of "Primary Data Sources" on page 55 of Annual Analysis of Disproportionate Share Hospital Allotments to States (PDF).

About medians

Medians are calculated from reports with "complete" fiscal years, or reports with fiscal years of at least 300 days and no more than 420 days.

In cases where there are fewer than 50 values reported, medians are not calculated. For childrens' hospitals, it's when fewer than 20 are reported.

Web app by Tim Broderick | email.