As of the July, 2022, release via CMS

SANFORD BISMARCK

CMS id: 350015
300 N 7TH ST, BISMARCK ND 58501. County: BURLEIGH
System: SANFORD
CBSA: Bismarck, ND

The 242-bed, acute-care hospital had $-8,181,019 in net service to patients*, with a total profit margin of 11.16086% in fiscal year 2021, the latest year available.
It spent 1.76% 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	172 118	172 118	177 119.5	179 118	188 119
Total beds Median	237 162	225 162	231 162	233 162	242 163.5
FTEs Median	434.16 788.06	2,432.24 793.42	2,596.00 806.03	2,652.44 787.61	2,726.00 804.34

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	494,342,588 150,932,746	506,160,811 158,950,878	588,779,207 168,696,998	603,346,334 163,454,693	699,446,397 186,589,412
Operating expenses Median	509,191,888 149,311,209	507,935,969 156,110,414	585,991,288 164,890,568	623,156,960 166,516,854	707,627,416 180,120,888
Net income from service 2 patients (NS2P) ? Median	-14,849,300 -964,173	-1,775,158 -643,601.5	2,787,919 -116,254	-19,810,626 -5,025,862	-8,181,019 -1,284,564
NS2P margin ? Median	-3.00% -0.62	-0.35% -0.29	0.47% 0.18	-3.28% -5.07	-1.17% -0.88

Range* of Net Service to Patient (NS2P) margins

= NS2P margin for SANFORD BISMARCK 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	40,778,205 5,089,215	38,938,931 4,572,541	64,320,671 5,268,134	102,089,408 13,092,619	97,080,241 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	0 188,688.5	0 370,813	0 309,361.5	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	22,055	22,055	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	1,111,905	1,111,905	1,226,332	1,045,744	1,155,920
⊳ 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	0	0	0	0
⊳ Line 18: Revenue from sale of medical records and abstracts	0	0	0	0	0
⊳ Line 19: Tuition (fees, sale of textbooks, uniforms, etc.)	229,124	229,124	389,506	305,529	378,500
⊳ Line 20: Revenue from gifts, flowers, coffee shops, canteen	0	0	0	0	0
⊳ Line 21: Rental of vending machines	0	0	0	0	0
⊳ Line 22: Rental of hospital space	0	0	0	0	0
⊳ 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	39,415,121	37,575,847	62,704,833	100,738,135	95,545,821
Total income ? Median	25,928,905 6,586,430	37,163,773 6,767,106	67,108,590 8,419,950	82,278,782 8,094,175	88,899,222 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	25,928,905 6,043,842	37,163,773 5,845,112	67,108,590 7,606,259	82,278,782 7,283,041	88,899,222 14,957,241
Net margin Median	4.84543% 4.62%	6.81779% 4.42%	10.27539% 5.16%	11.66354% 5.2%	11.16086% 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 SANFORD BISMARCK 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	52,332,330 23,241,334	56,986,329 23,709,545	62,767,956 24,248,380	64,435,669 22,858,541	69,040,516 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	50,221,937 21,577,146	56,006,490 22,041,594	61,881,161 22,722,063	63,873,857 21,570,441	68,343,647 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	612,737 1,845,420	636,920 1,757,392	886,795 1,738,842	561,812 1,510,463	696,869 1,393,140
⊳ Inpatient rehabilitation facility (IRF) ⊳ Median	1,497,656 3,535,627	342,919 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	46,288,834 11,160,864	50,046,217 11,987,345	57,075,372 12,926,866	61,542,520 11,884,480	76,464,948 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	45,367,881 10,918,923	49,144,520 11,706,976	56,042,489 12,615,917	60,283,901 11,458,116	75,133,717 12,776,716
⊳ Home Health agencies (HHA) ⊳ Median	920,953 1,282,808	901,697 1,407,728	1,032,883 1,341,512	1,258,619 1,407,046	1,331,231 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	1,432,514 3,284,314	1,540,412 3,250,551	1,599,278 3,386,837	1,598,340 3,360,806	1,722,258 3,508,953
Disproportionate-share hospital (DSH) Median	1,358,596 594,888	1,488,977 595,761	1,534,233 577,894	1,786,007 542,168	1,864,446 549,667
Outlier Median	1,952,427 582,572	2,905,215 538,116	541,997 212,434	758,896 126,559	779,216 139,139

Uncompensated care

Item	2017	2018	2019	2020	2021
Medicaid shortfall Median	0 3,662,910	0 3,730,911	0 4,081,319	0 4,643,908	0 4,389,147
Charity care Median	4,681,942 2,654,636	5,522,869 2,940,659	7,006,393 3,380,215	7,737,876 3,488,738	7,315,179 3,233,405
Uncompensated care (UCC) Median	12,353,006 5,147,790	9,243,086 5,337,617	12,251,010 5,711,082	12,241,343 5,923,418	12,424,693 5,508,107
UCC as a % of operating expenses Median	2.43% 3.24	1.82% 3.12	2.09% 3.21	1.96% 3.3	1.76% 2.86
Total shortfall/UCC Median	12,353,006 9,489,989	9,243,086 9,424,297	12,251,010 10,120,158	12,241,343 11,171,337	12,424,693 10,133,851

Labor costs

	2017	2018	2019	2020	2021
Total salaries Median	234,615,995 52,142,039	228,573,861 54,485,252	257,920,823 57,395,589	269,918,835 58,830,919	297,165,610 61,722,907
Salaries as a % of operating expenses Median	46.08 36.68	45.00 36.56	44.01 36.37	43.31 35.93	41.99 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	618,076 1,251,927	603,365 1,186,494	563,864 1,204,885	669,729 1,279,653	773,157 1,469,317
Contract adjusted salaries, direct-care Median	4,652,132 1,449,244	4,880,971 1,475,986	7,548,514 1,563,078	6,815,871 1,721,954	20,546,222 2,991,828
Contract hours, direct-care Median	73,704.00 22,725	76,851.00 23,018.5	115,804.06 24,503.48	98,032.00 25,026.5	150,838.00 33,786
Contract wages, direct-care Median	63.12 64.67	63.51 64.53	65.18 65.06	69.53 68.97	136.21 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.