As of the July, 2022, release via CMS

CROOK COUNTY MEDICAL SERVICES

CMS id: 531311
713 OAK STREET, SUNDANCE WY 82729. County: CROOK
System: --
CBSA: Gillette, WY

The 48-bed, CAH hospital had $-1,168,714 in net service to patients*, with a total profit margin of 12.80298% in fiscal year 2021, the latest year available.
It spent 2.69% of its operating expenses on uncompensated care and reported $209,914 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	16 23	16 23	16 23	16 23	16 23
Total beds Median	48 25	48 25	48 25	48 25	48 25
FTEs Median	96.84 149.18	109.31 151.6	112.10 151.58	105.88 152.78	136.11 151.99

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	7,269,836 19,395,819	8,089,835 19,790,685	8,342,531 20,891,573	9,814,621 20,752,910	10,755,080 22,925,976
Operating expenses Median	8,748,211 21,082,256	9,731,412 21,740,728	10,198,155 22,449,917	10,959,479 23,028,561	11,923,794 24,906,213
Net income from service 2 patients (NS2P) ? Median	-1,478,375 -1,166,928	-1,641,577 -1,178,891	-1,855,624 -1,189,234	-1,144,858 -1,989,193	-1,168,714 -1,175,562
NS2P margin ? Median	-20.34% -6.37	-20.29% -6.47	-22.24% -6.58	-11.66% -10.52	-10.87% -5.81

Range* of Net Service to Patient (NS2P) margins

= NS2P margin for CROOK COUNTY MEDICAL SERVICES 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	1,923,424 1,517,926	1,065,688 1,554,100	1,551,093 1,708,825	1,448,630 3,606,354	2,919,463 4,946,640
⊳ Line 6: Contributions ? ⊳ Median	99,359 68,435	33,450 61,711.5	39,219 71,344	37,473 80,654	61,247 103,902
⊳ Line 7: Investments ? ⊳ Median	2,358 25,389	4,420 35,427	5,881 59,240	5,400 47,652	18,461 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	67,946	57,350	56,626	65,897	54,081
⊳ 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	1,082,432 525,619.5	706,608 568,101.5	744,221 581,486	734,966 657,916	649,866 640,942
⊳ Sum Line 24	671,329	263,860	705,146	604,894	2,135,808
Total income ? Median	445,049 445,049	-575,889 379,292	-304,531 655,032	303,772 1,453,054	1,750,749 3,734,026
Non-operating expenses Median	0 56,329	0 45,230	0 61,507	0 80,747	0 39,130
Net income Median	445,049 309,249	-575,889 305,537	-304,531 515,321.5	303,772 1,282,423	1,750,749 3,678,491
Net margin Median	4.84104% 1.7%	-6.29007% 1.61%	-3.07805% 2.36%	2.69702% 5.41%	12.80298% 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 CROOK COUNTY MEDICAL SERVICES 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	523,097 1,512,374	342,460 1,478,094	354,462 1,365,460	607,390 1,289,169	838,377 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	523,097 1,441,589	342,460 1,403,245	354,462 1,290,206	607,390 1,229,191	838,377 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	1,288,036 4,108,627	1,653,996 4,367,646	2,171,008 4,566,928	2,255,612 4,517,324	2,649,497 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	927,162 3,508,078	1,247,900 3,742,383	1,717,623 3,932,686	1,645,950 3,847,302	1,973,502 3,879,271
⊳ Home Health agencies (HHA) ⊳ Median	0 299,331.5	0 299,936	0 316,639	0 288,635	0 297,926
⊳ Community mental health clinics (CMHC) ⊳ Median	0 --	0 --	0 --	0 --	0 --
⊳ Rural health clinics ⊳ Median	360,874 702,405	406,096 746,179	453,385 800,433	609,662 774,040	675,995 742,054
⊳ 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	0 4,679	0 5,256	0 5,165.5	0 6,341	0 5,998

Uncompensated care

Item	2017	2018	2019	2020	2021
Medicaid shortfall Median	552,449 553,475.5	275,171 567,149	439,182 599,174.5	311,733 641,417	209,914 631,057
Charity care Median	56,389 190,496	3,124 225,101	7,228 238,624	25,537 260,478.5	25,137 225,887
Uncompensated care (UCC) Median	178,571 860,218.5	390,696 933,428	464,939 986,290	221,670 998,939	320,232 871,713
UCC as a % of operating expenses Median	2.04% 3.77	4.01% 3.82	4.56% 3.7	2.02% 3.74	2.69% 3.04
Total shortfall/UCC Median	731,020 1,405,482	665,867 1,525,979	904,121 1,576,055	533,403 1,691,815	530,146 1,476,802

Labor costs

	2017	2018	2019	2020	2021
Total salaries Median	5,198,343 8,521,101	5,825,105 8,786,419	5,994,099 9,086,354	6,411,309 9,512,636	7,040,001 9,933,360
Salaries as a % of operating expenses Median	59.42 42.53	59.86 42.58	58.78 42.62	58.50 42.72	59.04 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.