As of the July, 2022, release via CMS

ATHENS LIMESTONE

CMS id: 010079
700 MARKET ST W, ATHENS AL 35611. County: LIMESTONE
System: HEALTHGROUP OF ALABAMA
CBSA: Huntsville, AL

The 66-bed, acute-care hospital had $-7,201,861 in net service to patients*, with a total profit margin of 13.13708% in fiscal year 2021, the latest year available.
It spent 5.42% of its operating expenses on uncompensated care and reported $0 in Medicaid shortfall.

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

Note: Medians are from acute-care 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	gov	gov	gov	gov	gov
Acute beds Median	61 118	56 118	56 119.5	56 118	56 119
Total beds Median	71 162	66 162	66 162	66 162	66 163.5
FTEs Median	495.73 788.06	501.48 793.42	546.12 806.03	543.25 787.61	573.36 804.34

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	61,235,078 150,932,746	67,331,744 158,950,878	66,215,007 168,696,998	85,070,367 163,454,693	82,264,779 186,589,412
Operating expenses Median	61,348,455 149,311,209	67,117,230 156,110,414	77,736,165 164,890,568	97,909,546 166,516,854	89,466,640 180,120,888
Net income from service 2 patients (NS2P) ? Median	-113,377 -964,173	214,514 -643,601.5	-11,521,158 -116,254	-12,839,179 -5,025,862	-7,201,861 -1,284,564
NS2P margin ? Median	-0.19% -0.62	0.32% -0.29	-17.40% 0.18	-15.09% -5.07	-8.75% -0.88

Range* of Net Service to Patient (NS2P) margins

= NS2P margin for ATHENS LIMESTONE compared to all** acute-care 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 acute-care hospitals available to calculate medians:

2017	2018	2019	2020	2021
3,157	3,092	3,050	3,052	2,566

	2017	2018	2019	2020	2021
Other income* Median Click here to show/hide details	2,713,007 5,089,215	4,173,603 4,572,541	8,673,408 5,268,134	18,092,877 13,092,619	20,732,729 12,369,236
⊳ Line 6: Contributions ? ⊳ Median	133,899 224,999	123,551 199,009	118,118 206,870.5	57,000 194,343	276,152 249,496
⊳ Line 7: Investments ? ⊳ Median	290,606 299,524	15,663 188,688.5	19,100 370,813	40,891 309,361.5	33,978 375,329
⊳ Line 8: Revenue from telephone service	NULL	NULL	NULL	NULL	NULL
⊳ Line 9: Revenue from tv and radio	--	--	--	--	--
⊳ Line 10: Purchase discounts	28,862	628,901	0	0	0
⊳ Line 11: Rebates and refunds of expenses	87,871	82,113	25,113	12,038	41,385
⊳ 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	364,536	422,023	408,650	368,728	429,924
⊳ 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	3,063	0
⊳ Line 17: Revenue from sale of drugs to other than patients	1,026	0	0	5,213	0
⊳ Line 18: Revenue from sale of medical records and abstracts	2,032	4,443	3,974	3,709	-33,977
⊳ Line 19: Tuition (fees, sale of textbooks, uniforms, etc.)	1	63,965	9,330	11,426	10,711
⊳ Line 20: Revenue from gifts, flowers, coffee shops, canteen	34,616	56,687	130,635	97,981	0
⊳ Line 21: Rental of vending machines	31,722	28,735	23,103	19,048	11,220
⊳ Line 22: Rental of hospital space	597,325	357,476	656,331	940,678	563,482
⊳ Line 23: Gov appropriations ? ⊳ Median	492,167 1,017,693	2,390,046 983,261.5	0 1,173,286	500,000 1,987,202	8,756,838 1,597,664
⊳ Sum Line 24	648,344	--	7,279,054	16,033,102	10,643,016
Total income ? Median	2,599,630 6,586,430	4,388,117 6,767,106	-2,847,750 8,419,950	5,253,698 8,094,175	13,530,868 15,162,888
Non-operating expenses Median	0 146,289.5	0 164,857	0 89,880.5	0 106,761	0 31,473.5
Net income Median	2,599,630 6,043,842	4,388,117 5,845,112	-2,847,750 7,606,259	5,253,698 7,283,041	13,530,868 14,957,241
Net margin Median	4.06522% 4.62%	6.13677% 4.42%	-3.80266% 5.16%	5.09261% 5.2%	13.13708% 9.25%

* 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 ATHENS LIMESTONE compared to all** acute-care hospitals, from CMS cost reports.
The chart below is interactive: click or touch to see more.

2017	2018	2019	2020	2021
3,157	3,092	3,050	3,052	2,566

Medicare revenue

Inpatient and outpatient revenue

	2017	2018	2019	2020	2021
All inpatient revenue Median Click here to show/hide details	13,230,588 23,241,334	13,221,227 23,709,545	12,243,082 24,248,380	11,825,944 22,858,541	13,730,150 23,620,613
"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	13,230,588 21,577,146	13,221,227 22,041,594	12,243,082 22,722,063	11,825,944 21,570,441	13,730,150 22,140,684
⊳ 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 1,845,420	0 1,757,392	0 1,738,842	0 1,510,463	0 1,393,140
⊳ Inpatient rehabilitation facility (IRF) ⊳ Median	0 3,535,627	0 3,746,588	0 3,782,288	0 3,865,578	0 3,983,889
⊳ Long-term care hospital (LTCH) ⊳ Median	0 --	0 --	0 --	0 --	0 --
⊳ Critical-access hospitals ⊳ Median	0 --	0 --	0 --	0 --	0 --
⊳ Skilled-nursing facilities (SNF) ⊳ Median	0 1,203,033	0 1,215,295	0 1,313,657	0 1,365,298	0 1,179,746
All outpatient revenue Median Click here to show/hide details	7,788,139 11,160,864	7,198,169 11,987,345	7,231,935 12,926,866	6,452,001 11,884,480	6,352,057 13,145,163
"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	7,788,139 10,918,923	7,198,169 11,706,976	7,231,935 12,615,917	6,452,001 11,458,116	6,352,057 12,776,716
⊳ Home Health agencies (HHA) ⊳ Median	0 1,282,808	0 1,407,728	0 1,341,512	0 1,407,046	0 1,476,867
⊳ Community mental health clinics (CMHC) ⊳ Median	0 --	0 --	0 --	0 --	0 --
⊳ Rural health clinics ⊳ Median	0 618,038	0 697,279	0 690,232	0 684,010	0 670,558
⊳ 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 3,284,314	0 3,250,551	0 3,386,837	0 3,360,806	0 3,508,953
Disproportionate-share hospital (DSH) Median	320,412 594,888	348,313 595,761	306,878 577,894	290,384 542,168	262,893 549,667
Outlier Median	105,480 582,572	129,986 538,116	177,320 212,434	3,614 126,559	21,546 139,139

Uncompensated care

Item	2017	2018	2019	2020	2021
Medicaid shortfall Median	92,254 3,662,910	30,014 3,730,911	2,279,907 4,081,319	0 4,643,908	0 4,389,147
Charity care Median	524,217 2,654,636	891,932 2,940,659	1,172,352 3,380,215	995,620 3,488,738	1,203,162 3,233,405
Uncompensated care (UCC) Median	4,815,671 5,147,790	5,062,542 5,337,617	5,158,371 5,711,082	5,196,175 5,923,418	4,845,365 5,508,107
UCC as a % of operating expenses Median	7.85% 3.24	7.54% 3.12	6.64% 3.21	5.31% 3.3	5.42% 2.86
Total shortfall/UCC Median	4,907,925 9,489,989	5,092,556 9,424,297	7,438,278 10,120,158	5,196,175 11,171,337	4,845,365 10,133,851

Labor costs

	2017	2018	2019	2020	2021
Total salaries Median	22,944,611 52,142,039	23,960,854 54,485,252	28,093,638 57,395,589	29,334,777 58,830,919	33,634,774 61,722,907
Salaries as a % of operating expenses Median	37.40 36.68	35.70 36.56	36.14 36.37	29.96 35.93	37.59 35.24
Intern, resident salaries* Median	0 2,598,592	0 2,686,824	0 2,753,773	0 2,937,156	0 2,909,848
Contract intern, resident salaries* Median	0 1,251,927	0 1,186,494	0 1,204,885	0 1,279,653	0 1,469,317
Contract adjusted salaries, direct-care Median	1,290,086 1,449,244	1,525,082 1,475,986	1,354,275 1,563,078	540,094 1,721,954	36,096 2,991,828
Contract hours, direct-care Median	27,497.15 22,725	26,127.64 23,018.5	24,749.52 24,503.48	13,308.85 25,026.5	590.00 33,786
Contract wages, direct-care Median	46.92 64.67	58.37 64.53	54.72 65.06	40.58 68.97	61.18 88.94

* 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.