As of the July, 2022, release via CMS

CITIZENS MEMORIAL HOSPITAL DISTRICT

CMS id: 260195
1500 NORTH OAKLAND, BOLIVAR MO 65613. County: POLK
System: CITIZENS MEMORIAL HOSPITAL DISTRICT
CBSA: Springfield, MO

The 72-bed, acute-care hospital had $-29,274,299 in net service to patients*, with a total profit margin of 2.69936% in fiscal year 2021, the latest year available.
It spent 3.55% of its operating expenses on uncompensated care and reported $1,951,306 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	44 118	44 118	44 119.5	44 118	44 119
Total beds Median	72 162	72 162	72 162	72 162	72 163.5
FTEs Median	1,051.22 788.06	1,112.09 793.42	1,183.45 806.03	1,173.50 787.61	1,172.06 804.34

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	137,249,949 150,932,746	136,633,642 158,950,878	141,881,686 168,696,998	136,129,231 163,454,693	154,063,251 186,589,412
Operating expenses Median	149,893,034 149,311,209	159,334,125 156,110,414	170,730,204 164,890,568	172,185,899 166,516,854	183,337,550 180,120,888
Net income from service 2 patients (NS2P) ? Median	-12,643,085 -964,173	-22,700,483 -643,601.5	-28,848,518 -116,254	-36,056,668 -5,025,862	-29,274,299 -1,284,564
NS2P margin ? Median	-9.21% -0.62	-16.61% -0.29	-20.33% 0.18	-26.49% -5.07	-19.00% -0.88

Range* of Net Service to Patient (NS2P) margins

= NS2P margin for CITIZENS MEMORIAL HOSPITAL DISTRICT 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	21,064,775 5,089,215	23,389,497 4,572,541	26,983,428 5,268,134	34,934,905 13,092,619	34,360,532 12,369,236
⊳ Line 6: Contributions ? ⊳ Median	6,573 224,999	6,152 199,009	52,596 206,870.5	13,656 194,343	13,288 249,496
⊳ Line 7: Investments ? ⊳ Median	431,219 299,524	538,615 188,688.5	559,150 370,813	543,383 309,361.5	497,560 375,329
⊳ Line 8: Revenue from telephone service	NULL	NULL	NULL	NULL	NULL
⊳ Line 9: Revenue from tv and radio	--	--	--	--	--
⊳ Line 10: Purchase discounts	-13,681	-15,597	-3,045	326	313
⊳ 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	313,696	351,161	377,688	370,652	368,979
⊳ Line 14: Revenue from meals sold to emplyees and guests	1,147,398	1,187,785	1,343,590	1,229,035	875,838
⊳ 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	12,060,676	14,858,293	18,352,906	21,097,805	22,493,694
⊳ 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	8,049	7,353	6,917	16,446	8,362
⊳ Line 22: Rental of hospital space	24,900	25,200	24,450	23,400	23,400
⊳ 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	7,085,945	6,430,535	6,269,176	11,640,202	10,079,098
Total income ? Median	8,421,690 6,586,430	689,014 6,767,106	-1,865,090 8,419,950	-1,121,763 8,094,175	5,086,233 15,162,888
Non-operating expenses Median	9 146,289.5	7 164,857	0 89,880.5	10,362 106,761	0 31,473.5
Net income Median	8,421,681 6,043,842	689,007 5,845,112	-1,865,090 7,606,259	-1,132,125 7,283,041	5,086,233 14,957,241
Net margin Median	5.31958% 4.62%	0.43057% 4.42%	-1.10449% 5.16%	-0.66181% 5.2%	2.69936% 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 CITIZENS MEMORIAL HOSPITAL DISTRICT 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	14,156,376 23,241,334	13,858,708 23,709,545	13,109,312 24,248,380	12,502,777 22,858,541	11,633,420 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	12,675,780 21,577,146	11,884,854 22,041,594	11,427,426 22,722,063	10,688,326 21,570,441	10,384,823 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	1,480,596 1,845,420	1,973,854 1,757,392	1,681,886 1,738,842	1,814,451 1,510,463	1,248,597 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	15,161,810 11,160,864	15,539,308 11,987,345	15,905,113 12,926,866	15,735,157 11,884,480	16,004,335 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	10,083,236 10,918,923	10,393,609 11,706,976	10,609,578 12,615,917	10,686,239 11,458,116	10,745,443 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	5,078,574 618,038	5,145,699 697,279	5,295,535 690,232	5,048,918 684,010	5,258,892 670,558
⊳ 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	257,314 594,888	236,243 595,761	226,346 577,894	211,368 542,168	172,959 549,667
Outlier Median	37,658 582,572	14,983 538,116	24,141 212,434	8,646 126,559	13,011 139,139

Uncompensated care

Item	2017	2018	2019	2020	2021
Medicaid shortfall Median	4,566,257 3,662,910	5,275,696 3,730,911	5,899,715 4,081,319	6,653,202 4,643,908	1,951,306 4,389,147
Charity care Median	363,399 2,654,636	793,288 2,940,659	451,267 3,380,215	912,022 3,488,738	1,107,958 3,233,405
Uncompensated care (UCC) Median	4,965,352 5,147,790	5,831,917 5,337,617	4,541,144 5,711,082	5,633,876 5,923,418	6,512,590 5,508,107
UCC as a % of operating expenses Median	3.31% 3.24	3.66% 3.12	2.66% 3.21	3.27% 3.3	3.55% 2.86
Total shortfall/UCC Median	9,531,609 9,489,989	11,107,613 9,424,297	10,440,859 10,120,158	12,287,078 11,171,337	8,463,896 10,133,851

Labor costs

	2017	2018	2019	2020	2021
Total salaries Median	67,655,358 52,142,039	71,633,244 54,485,252	78,666,155 57,395,589	80,164,483 58,830,919	85,227,227 61,722,907
Salaries as a % of operating expenses Median	45.14 36.68	44.96 36.56	46.08 36.37	46.56 35.93	46.49 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	1,140,170 1,449,244	1,440,650 1,475,986	514,591 1,563,078	523,072 1,721,954	412,903 2,991,828
Contract hours, direct-care Median	17,990.48 22,725	23,935.45 23,018.5	7,157.00 24,503.48	7,675.76 25,026.5	4,794.02 33,786
Contract wages, direct-care Median	63.38 64.67	60.19 64.53	71.90 65.06	68.15 68.97	86.13 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.