As of the July, 2022, release via CMS

ADVENTIST HEALTH SONORA

CMS id: 050335
1000 GREENLEY ROAD, SONORA CA 95370. County: TUOLUMNE
System: ADVENTIST HEALTH
CBSA: Sonora, CA

The 152-bed, acute-care hospital had $15,879,811 in net service to patients*, with a total profit margin of 15.87072% in fiscal year 2021, the latest year available.
It spent 0.53% 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	78 118	78 118	78 119.5	78 118	78 119
Total beds Median	152 162	152 162	152 162	152 162	152 163.5
FTEs Median	1,068.00 788.06	1,050.97 793.42	1,026.48 806.03	929.39 787.61	881.07 804.34

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	249,100,472 150,932,746	256,562,814 158,950,878	264,127,215 168,696,998	248,663,132 163,454,693	286,418,449 186,589,412
Operating expenses Median	239,973,446 149,311,209	247,823,196 156,110,414	262,903,778 164,890,568	260,002,020 166,516,854	270,538,638 180,120,888
Net income from service 2 patients (NS2P) ? Median	9,127,026 -964,173	8,739,618 -643,601.5	1,223,437 -116,254	-11,338,888 -5,025,862	15,879,811 -1,284,564
NS2P margin ? Median	3.66% -0.62	3.41% -0.29	0.46% 0.18	-4.56% -5.07	5.54% -0.88

Range* of Net Service to Patient (NS2P) margins

= NS2P margin for ADVENTIST HEALTH SONORA 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	0 5,089,215	12,671,627 4,572,541	19,699,310 5,268,134	32,960,779 13,092,619	33,952,988 12,369,236
⊳ Line 6: Contributions ? ⊳ Median	0 224,999	0 199,009	0 206,870.5	0 194,343	0 249,496
⊳ Line 7: Investments ? ⊳ Median	0 299,524	2,875,863 188,688.5	6,307,811 370,813	5,547,127 309,361.5	7,950,804 375,329
⊳ 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	0	167,201	143,658	534,318	911,303
⊳ 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	6,499,776	11,457,512	11,311,710	10,253,880
⊳ Line 18: Revenue from sale of medical records and abstracts	0	16,865	13,564	15,607	9,840
⊳ Line 19: Tuition (fees, sale of textbooks, uniforms, etc.)	0	0	0	0	0
⊳ Line 20: Revenue from gifts, flowers, coffee shops, canteen	0	35,065	44,867	24,092	-13,331
⊳ Line 21: Rental of vending machines	0	0	0	1,435	448
⊳ Line 22: Rental of hospital space	0	0	0	2,600	2,400
⊳ 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	--	3,076,857	1,731,898	15,523,890	14,837,644
Total income ? Median	9,127,026 6,586,430	21,411,245 6,767,106	20,922,747 8,419,950	21,621,891 8,094,175	49,832,799 15,162,888
Non-operating expenses Median	-12,104,000 146,289.5	-440,888 164,857	-399,267 89,880.5	-1,101,275 106,761	-1,012,463 31,473.5
Net income Median	21,231,026 6,043,842	21,852,133 5,845,112	21,322,014 7,606,259	22,723,166 7,283,041	50,845,262 14,957,241
Net margin Median	8.52308% 4.62%	8.11640% 4.42%	7.51234% 5.16%	8.06862% 5.2%	15.87072% 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 SONORA 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	35,975,052 23,241,334	33,733,087 23,709,545	36,626,745 24,248,380	36,140,815 22,858,541	38,223,268 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	35,903,600 21,577,146	33,717,472 22,041,594	36,616,722 22,722,063	36,119,310 21,570,441	38,164,773 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	71,452 1,203,033	15,615 1,215,295	10,023 1,313,657	21,505 1,365,298	58,495 1,179,746
All outpatient revenue Median Click here to show/hide details	52,146,678 11,160,864	56,706,501 11,987,345	60,403,557 12,926,866	54,576,708 11,884,480	60,930,131 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	46,261,403 10,918,923	51,057,510 11,706,976	57,264,969 12,615,917	54,150,437 11,458,116	60,613,874 12,776,716
⊳ Home Health agencies (HHA) ⊳ Median	5,375,238 1,282,808	5,322,953 1,407,728	2,477,647 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	510,037 618,038	326,038 697,279	660,941 690,232	426,271 684,010	316,257 670,558
⊳ 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	944,118 594,888	838,693 595,761	903,136 577,894	940,951 542,168	939,920 549,667
Outlier Median	894,800 582,572	921,925 538,116	383,235 212,434	345,094 126,559	753,784 139,139

Uncompensated care

Item	2017	2018	2019	2020	2021
Medicaid shortfall Median	5,833,011 3,662,910	6,806,181 3,730,911	0 4,081,319	0 4,643,908	0 4,389,147
Charity care Median	5,709,434 2,654,636	675,538 2,940,659	935,834 3,380,215	563,054 3,488,738	1,098,780 3,233,405
Uncompensated care (UCC) Median	6,782,571 5,147,790	2,044,958 5,337,617	3,236,107 5,711,082	1,816,230 5,923,418	1,438,619 5,508,107
UCC as a % of operating expenses Median	2.83% 3.24	0.83% 3.12	1.23% 3.21	0.70% 3.3	0.53% 2.86
Total shortfall/UCC Median	12,615,582 9,489,989	8,851,139 9,424,297	3,236,107 10,120,158	1,816,230 11,171,337	1,438,619 10,133,851

Labor costs

	2017	2018	2019	2020	2021
Total salaries Median	82,405,042 52,142,039	83,056,123 54,485,252	82,482,812 57,395,589	75,546,752 58,830,919	80,375,415 61,722,907
Salaries as a % of operating expenses Median	34.34 36.68	33.51 36.56	31.37 36.37	29.06 35.93	29.71 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	1,524,743 1,449,244	1,642,161 1,475,986	0 1,563,078	1,066,431 1,721,954	1,977,350 2,991,828
Contract hours, direct-care Median	20,006.00 22,725	22,842.16 23,018.5	0.00 24,503.48	14,128.47 25,026.5	15,856.92 33,786
Contract wages, direct-care Median	76.21 64.67	71.89 64.53	0.00 65.06	75.48 68.97	124.70 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.