As of the July, 2022, release via CMS

ST ALEXIUS MEDICAL CENTER

CMS id: 350002
900 EAST BROADWAY AVENUE, BISMARCK ND 58506. County: BURLEIGH
System: COMMONSPIRIT HEALTH (FKA CHI)
CBSA: Bismarck, ND

The 202-bed, acute-care hospital had $-113,122,751 in net service to patients*, with a total profit margin of -34.15579% in fiscal year 2021, the latest year available.
It spent 1.40% of its operating expenses on uncompensated care and reported $807,771 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	142 118	142 118	142 119.5	142 118	142 119
Total beds Median	225 162	225 162	225 162	225 162	202 163.5
FTEs Median	1,577.98 788.06	1,319.15 793.42	1,253.00 806.03	1,208.42 787.61	1,158.56 804.34

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	272,005,168 150,932,746	275,314,064 158,950,878	257,622,570 168,696,998	240,783,753 163,454,693	231,696,716 186,589,412
Operating expenses Median	321,189,668 149,311,209	305,179,444 156,110,414	344,848,282 164,890,568	296,855,156 166,516,854	344,819,467 180,120,888
Net income from service 2 patients (NS2P) ? Median	-49,184,500 -964,173	-29,865,380 -643,601.5	-87,225,712 -116,254	-56,071,403 -5,025,862	-113,122,751 -1,284,564
NS2P margin ? Median	-18.08% -0.62	-10.85% -0.29	-33.86% 0.18	-23.29% -5.07	-48.82% -0.88

Range* of Net Service to Patient (NS2P) margins

= NS2P margin for ST ALEXIUS MEDICAL CENTER 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	19,706,454 5,089,215	15,821,385 4,572,541	13,167,717 5,268,134	22,609,836 13,092,619	25,332,413 12,369,236
⊳ Line 6: Contributions ? ⊳ Median	694,698 224,999	843,202 199,009	554,038 206,870.5	314,797 194,343	0 249,496
⊳ Line 7: Investments ? ⊳ Median	909,750 299,524	0 188,688.5	0 370,813	43,721 309,361.5	0 375,329
⊳ Line 8: Revenue from telephone service	NULL	NULL	NULL	NULL	NULL
⊳ Line 9: Revenue from tv and radio	--	--	--	--	--
⊳ Line 10: Purchase discounts	14,123	14,326	9,268	2,314	0
⊳ Line 11: Rebates and refunds of expenses	1,247,480	1,914,427	65,552	47,222	0
⊳ Line 12: Parking lot receipts	675	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	852,147	46,902	44,681	54,741	74,537
⊳ 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	5,827,306	4,808,992	4,664,025	4,803,384	4,770,857
⊳ Line 18: Revenue from sale of medical records and abstracts	29,271	21,498	7,523	4,920	0
⊳ Line 19: Tuition (fees, sale of textbooks, uniforms, etc.)	1,289,932	419,247	636,397	575,672	0
⊳ Line 20: Revenue from gifts, flowers, coffee shops, canteen	0	0	0	0	0
⊳ Line 21: Rental of vending machines	67,071	37,301	33,476	32,785	0
⊳ Line 22: Rental of hospital space	610,906	548,746	560,520	891,015	768,517
⊳ 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	7,854,619	6,878,596	6,310,690	15,714,687	19,718,502
Total income ? Median	-29,478,046 6,586,430	-14,043,995 6,767,106	-74,057,995 8,419,950	-33,461,567 8,094,175	-87,790,338 15,162,888
Non-operating expenses Median	492,210 146,289.5	309,149 164,857	98,658 89,880.5	0 106,761	0 31,473.5
Net income Median	-29,970,256 6,043,842	-14,353,144 5,845,112	-74,156,653 7,606,259	-33,461,567 7,283,041	-87,790,338 14,957,241
Net margin Median	-10.27393% 4.62%	-4.93006% 4.42%	-27.38527% 5.16%	-12.70402% 5.2%	-34.15579% 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 ST ALEXIUS MEDICAL CENTER 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	51,351,384 23,241,334	49,131,389 23,709,545	41,821,184 24,248,380	41,854,423 22,858,541	40,367,915 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	49,355,586 21,577,146	47,522,628 22,041,594	39,992,221 22,722,063	39,629,047 21,570,441	38,144,419 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	591,535 1,845,420	391,800 1,757,392	710,978 1,738,842	529,445 1,510,463	462,274 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	1,404,263 1,203,033	1,216,961 1,215,295	1,117,985 1,313,657	1,695,931 1,365,298	1,761,222 1,179,746
All outpatient revenue Median Click here to show/hide details	30,639,797 11,160,864	33,516,143 11,987,345	37,031,130 12,926,866	32,555,313 11,884,480	35,234,179 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	30,156,087 10,918,923	33,516,143 11,706,976	37,031,130 12,615,917	32,555,313 11,458,116	35,234,179 12,776,716
⊳ Home Health agencies (HHA) ⊳ Median	483,710 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	938,429 3,284,314	921,751 3,250,551	834,768 3,386,837	799,000 3,360,806	867,998 3,508,953
Disproportionate-share hospital (DSH) Median	750,900 594,888	459,357 595,761	323,267 577,894	281,953 542,168	398,894 549,667
Outlier Median	1,371,172 582,572	2,284,648 538,116	2,733,775 212,434	948,170 126,559	323,248 139,139

Uncompensated care

Item	2017	2018	2019	2020	2021
Medicaid shortfall Median	0 3,662,910	0 3,730,911	0 4,081,319	1,775,222 4,643,908	807,771 4,389,147
Charity care Median	3,112,003 2,654,636	1,916,209 2,940,659	2,268,727 3,380,215	2,854,132 3,488,738	3,637,280 3,233,405
Uncompensated care (UCC) Median	5,108,507 5,147,790	8,805,303 5,337,617	5,756,202 5,711,082	5,999,804 5,923,418	4,830,882 5,508,107
UCC as a % of operating expenses Median	1.59% 3.24	2.89% 3.12	1.67% 3.21	2.02% 3.3	1.40% 2.86
Total shortfall/UCC Median	5,108,507 9,489,989	8,805,303 9,424,297	5,756,202 10,120,158	7,775,026 11,171,337	5,638,653 10,133,851

Labor costs

	2017	2018	2019	2020	2021
Total salaries Median	141,005,105 52,142,039	126,303,188 54,485,252	142,710,931 57,395,589	143,234,800 58,830,919	104,405,302 61,722,907
Salaries as a % of operating expenses Median	41.91 36.68	39.43 36.56	44.26 36.37	45.84 35.93	34.96 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	388,834 1,251,927	424,007 1,186,494	416,745 1,204,885	405,774 1,279,653	479,749 1,469,317
Contract adjusted salaries, direct-care Median	7,463,638 1,449,244	10,807,644 1,475,986	16,575,037 1,563,078	7,552,177 1,721,954	17,280,349 2,991,828
Contract hours, direct-care Median	94,910.13 22,725	159,522.00 23,018.5	247,156.00 24,503.48	130,182.00 25,026.5	213,965.00 33,786
Contract wages, direct-care Median	78.64 64.67	67.75 64.53	67.06 65.06	58.01 68.97	80.76 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.