As of the July, 2022, release via CMS

ALTRU HEALTH SYSTEM-ALTRU HOSPITAL

CMS id: 350019
1200 SOUTH COLUMBIA RD, GRAND FORKS ND 58201. County: GRAND FORKS
System: --
CBSA: Grand Forks, ND-MN

The 281-bed, acute-care hospital had $-23,428,861 in net service to patients*, with a total profit margin of 7.50009% in fiscal year 2021, the latest year available.
It spent 3.38% 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	250 118	245 118	225 119.5	225 118	232 119
Total beds Median	299 162	294 162	270 162	270 162	281 163.5
FTEs Median	3,258.36 788.06	3,216.50 793.42	3,165.12 806.03	2,862.26 787.61	2,773.84 804.34

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	522,293,144 150,932,746	528,261,097 158,950,878	542,608,827 168,696,998	520,544,566 163,454,693	557,134,252 186,589,412
Operating expenses Median	555,880,423 149,311,209	578,402,201 156,110,414	618,148,036 164,890,568	570,466,722 166,516,854	580,563,113 180,120,888
Net income from service 2 patients (NS2P) ? Median	-33,587,279 -964,173	-50,141,104 -643,601.5	-75,539,209 -116,254	-49,922,156 -5,025,862	-23,428,861 -1,284,564
NS2P margin ? Median	-6.43% -0.62	-9.49% -0.29	-13.92% 0.18	-9.59% -5.07	-4.21% -0.88

Range* of Net Service to Patient (NS2P) margins

= NS2P margin for ALTRU HEALTH SYSTEM-ALTRU HOSPITAL 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	45,182,123 5,089,215	49,581,082 4,572,541	70,812,087 5,268,134	97,187,833 13,092,619	71,883,270 12,369,236
⊳ Line 6: Contributions ? ⊳ Median	103,651 224,999	3,328,399 199,009	108,540 206,870.5	580,118 194,343	298,456 249,496
⊳ Line 7: Investments ? ⊳ Median	17,922,534 299,524	7,968,362 188,688.5	20,878,483 370,813	19,594,789 309,361.5	24,921,161 375,329
⊳ Line 8: Revenue from telephone service	NULL	NULL	NULL	NULL	NULL
⊳ Line 9: Revenue from tv and radio	--	--	--	--	--
⊳ Line 10: Purchase discounts	169,196	94,912	132,909	125,913	19,752
⊳ Line 11: Rebates and refunds of expenses	1,517,621	1,347,234	1,615,974	376,590	267,593
⊳ 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	70,446	88,630	83,693	66,278	62,471
⊳ 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	4,360	3,409	36,522	0	0
⊳ Line 18: Revenue from sale of medical records and abstracts	169,026	169,801	131,150	134,516	139,154
⊳ 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	87,368	93,823	94,647	44,501	79,064
⊳ Line 22: Rental of hospital space	88,483	198,737	726,511	653,696	639,455
⊳ 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	25,041,856	36,282,133	46,994,303	75,611,432	45,456,164
Total income ? Median	11,594,844 6,586,430	-560,022 6,767,106	-4,727,122 8,419,950	47,265,677 8,094,175	48,454,409 15,162,888
Non-operating expenses Median	0 146,289.5	11,786,638 164,857	0 89,880.5	1,474,292 106,761	1,277,527 31,473.5
Net income Median	11,594,844 6,043,842	-12,346,660 5,845,112	-4,727,122 7,606,259	45,791,385 7,283,041	47,176,882 14,957,241
Net margin Median	2.04323% 4.62%	-2.13668% 4.42%	-0.77062% 5.16%	7.41282% 5.2%	7.50009% 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 ALTRU HEALTH SYSTEM-ALTRU HOSPITAL 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	69,241,707 23,241,334	67,346,202 23,709,545	65,265,192 24,248,380	63,686,290 22,858,541	56,951,263 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	64,354,189 21,577,146	62,494,658 22,041,594	59,980,789 22,722,063	58,868,543 21,570,441	53,911,212 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	55,529 1,845,420	0 1,757,392	0 1,738,842	0 1,510,463	0 1,393,140
⊳ Inpatient rehabilitation facility (IRF) ⊳ Median	4,831,989 3,535,627	4,851,544 3,746,588	5,284,403 3,782,288	4,817,747 3,865,578	3,040,051 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	58,911,414 11,160,864	63,607,915 11,987,345	66,975,162 12,926,866	67,613,980 11,884,480	70,421,461 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	57,572,938 10,918,923	62,432,491 11,706,976	66,029,495 12,615,917	66,278,449 11,458,116	68,729,121 12,776,716
⊳ Home Health agencies (HHA) ⊳ Median	1,338,476 1,282,808	1,175,424 1,407,728	945,667 1,341,512	1,335,531 1,407,046	1,692,340 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	3,208,699 3,284,314	3,220,702 3,250,551	3,197,995 3,386,837	3,326,950 3,360,806	2,963,532 3,508,953
Disproportionate-share hospital (DSH) Median	1,142,400 594,888	1,144,203 595,761	1,280,591 577,894	1,217,158 542,168	1,163,794 549,667
Outlier Median	5,812,960 582,572	5,602,343 538,116	3,081,200 212,434	2,054,787 126,559	1,494,016 139,139

Uncompensated care

Item	2017	2018	2019	2020	2021
Medicaid shortfall Median	0 3,662,910	0 3,730,911	0 4,081,319	1,257,430 4,643,908	0 4,389,147
Charity care Median	1,177,534 2,654,636	3,226,933 2,940,659	3,249,389 3,380,215	2,290,030 3,488,738	3,139,881 3,233,405
Uncompensated care (UCC) Median	7,204,485 5,147,790	6,322,282 5,337,617	6,727,830 5,711,082	15,846,538 5,923,418	19,641,760 5,508,107
UCC as a % of operating expenses Median	1.30% 3.24	1.09% 3.12	1.09% 3.21	2.78% 3.3	3.38% 2.86
Total shortfall/UCC Median	7,204,485 9,489,989	6,322,282 9,424,297	6,727,830 10,120,158	17,103,968 11,171,337	19,641,760 10,133,851

Labor costs

	2017	2018	2019	2020	2021
Total salaries Median	278,431,865 52,142,039	283,873,258 54,485,252	293,257,692 57,395,589	268,956,144 58,830,919	286,990,457 61,722,907
Salaries as a % of operating expenses Median	50.09 36.68	49.08 36.56	47.44 36.37	47.15 35.93	49.43 35.24
Intern, resident salaries* Median	1,692,041 2,598,592	1,798,113 2,686,824	1,950,619 2,753,773	1,975,647 2,937,156	2,008,196 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	5,688,793 1,449,244	11,330,919 1,475,986	10,229,480 1,563,078	1,874,584 1,721,954	10,569,554 2,991,828
Contract hours, direct-care Median	67,748.75 22,725	152,178.25 23,018.5	124,306.75 24,503.48	27,783.00 25,026.5	81,308.00 33,786
Contract wages, direct-care Median	83.97 64.67	74.46 64.53	82.29 65.06	67.47 68.97	129.99 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.