As of the July, 2022, release via CMS

ADVENTIST HEALTH ST. HELENA

CMS id: 050013
10 WOODLAND ROAD, ST. HELENA CA 94574. County: NAPA
System: ADVENTIST HEALTH
CBSA: Napa, CA

The 127-bed, acute-care hospital had $-62,254,306 in net service to patients*, with a total profit margin of -3.06934% in fiscal year 2021, the latest year available.
It spent 0.56% 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	nfp	nfp	nfp	nfp	nfp
Acute beds Median	127 118	105 118	126 119.5	126 118	115 119
Total beds Median	152 162	130 162	151 162	151 162	127 163.5
FTEs Median	812.90 788.06	689.42 793.42	687.96 806.03	630.26 787.61	647.64 804.34

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	226,655,652 150,932,746	214,517,979 158,950,878	212,372,599 168,696,998	153,190,119 163,454,693	225,296,057 186,589,412
Operating expenses Median	263,977,662 149,311,209	265,167,989 156,110,414	278,172,413 164,890,568	233,215,566 166,516,854	287,550,363 180,120,888
Net income from service 2 patients (NS2P) ? Median	-37,322,010 -964,173	-50,650,010 -643,601.5	-65,799,814 -116,254	-80,025,447 -5,025,862	-62,254,306 -1,284,564
NS2P margin ? Median	-16.47% -0.62	-23.61% -0.29	-30.98% 0.18	-52.24% -5.07	-27.63% -0.88

Range* of Net Service to Patient (NS2P) margins

= NS2P margin for ADVENTIST HEALTH ST. HELENA 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	36,271,750 5,089,215	39,938,801 4,572,541	38,591,105 5,268,134	58,777,594 13,092,619	53,691,245 12,369,236
⊳ Line 6: Contributions ? ⊳ Median	1,035,751 224,999	2,335,290 199,009	4,368,135 206,870.5	46,634 194,343	3,094,940 249,496
⊳ Line 7: Investments ? ⊳ Median	223,702 299,524	635,570 188,688.5	1,199,930 370,813	637,481 309,361.5	56,393 375,329
⊳ 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	862,744	887,738	932,777	489,529	536,992
⊳ Line 15: Revenue from rental of living quarters	790,687	1,073,179	995,440	613,549	820,897
⊳ 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	3,012	4,864	19,891	1,146	184
⊳ Line 19: Tuition (fees, sale of textbooks, uniforms, etc.)	0	0	0	0	0
⊳ Line 20: Revenue from gifts, flowers, coffee shops, canteen	150,048	137,883	67,359	23,178	27,606
⊳ Line 21: Rental of vending machines	6,670	1,468	-220	0	-4,217
⊳ Line 22: Rental of hospital space	87,438	87,888	346,691	578,957	572,973
⊳ Line 23: Gov appropriations ? ⊳ Median	0 1,017,693	0 983,261.5	0 1,173,286	0 1,987,202	0 1,597,664
⊳ Sum Line 24	33,111,698	34,774,921	30,661,102	56,387,120	48,585,477
Total income ? Median	-1,050,260 6,586,430	-10,711,209 6,767,106	-27,208,709 8,419,950	-21,247,853 8,094,175	-8,563,061 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	-1,050,260 6,043,842	-10,711,209 5,845,112	-27,208,709 7,606,259	-21,247,853 7,283,041	-8,563,061 14,957,241
Net margin Median	-0.39945% 4.62%	-4.20944% 4.42%	-10.84169% 5.16%	-10.02410% 5.2%	-3.06934% 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 ADVENTIST HEALTH ST. HELENA 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	56,407,886 23,241,334	47,703,637 23,709,545	50,791,485 24,248,380	28,906,618 22,858,541	43,076,639 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	53,023,732 21,577,146	43,910,140 22,041,594	47,240,555 22,722,063	28,138,155 21,570,441	43,076,639 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	3,384,154 1,845,420	3,793,497 1,757,392	3,550,930 1,738,842	768,463 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	23,135,017 11,160,864	32,760,045 11,987,345	31,244,545 12,926,866	28,016,639 11,884,480	42,213,562 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	23,135,017 10,918,923	32,760,045 11,706,976	31,244,545 12,615,917	28,016,639 11,458,116	42,213,562 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	2,852,801 594,888	2,432,985 595,761	2,571,478 577,894	1,568,925 542,168	2,328,280 549,667
Outlier Median	2,686,662 582,572	5,235,589 538,116	1,786,124 212,434	747,258 126,559	1,391,051 139,139

Uncompensated care

Item	2017	2018	2019	2020	2021
Medicaid shortfall Median	6,501,319 3,662,910	7,750,562 3,730,911	5,622,785 4,081,319	2,755,695 4,643,908	0 4,389,147
Charity care Median	5,399,578 2,654,636	1,168,461 2,940,659	2,333,761 3,380,215	3,638,255 3,488,738	1,173,939 3,233,405
Uncompensated care (UCC) Median	6,058,349 5,147,790	1,569,609 5,337,617	2,908,508 5,711,082	4,343,347 5,923,418	1,604,537 5,508,107
UCC as a % of operating expenses Median	2.30% 3.24	0.59% 3.12	1.05% 3.21	1.86% 3.3	0.56% 2.86
Total shortfall/UCC Median	12,559,668 9,489,989	9,320,171 9,424,297	8,531,293 10,120,158	7,099,042 11,171,337	1,604,537 10,133,851

Labor costs

	2017	2018	2019	2020	2021
Total salaries Median	73,293,597 52,142,039	71,914,223 54,485,252	71,651,115 57,395,589	56,465,221 58,830,919	68,610,498 61,722,907
Salaries as a % of operating expenses Median	27.77 36.68	27.12 36.56	25.76 36.37	24.21 35.93	23.86 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	3,132,800 1,449,244	4,214,402 1,475,986	2,722,469 1,563,078	2,029,116 1,721,954	6,573,964 2,991,828
Contract hours, direct-care Median	27,491.00 22,725	45,091.85 23,018.5	30,602.04 24,503.48	17,758.18 25,026.5	41,827.17 33,786
Contract wages, direct-care Median	113.96 64.67	93.46 64.53	88.96 65.06	114.26 68.97	157.17 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.