As of the July, 2022, release via CMS

MONUMENT HEALTH SPEARFISH HOSPITAL

CMS id: 430048
1440 NORTH MAIN, SPEARFISH SD 57783. County: LAWRENCE
System: MONUMENT HEALTH
CBSA: Spearfish, SD

The 27-bed, acute-care hospital had $-1,842,033 in net service to patients*, with a total profit margin of 4.08555% in fiscal year 2021, the latest year available.
It spent 2.18% of its operating expenses on uncompensated care and reported $2,049,456 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	24 118	24 118	24 119.5	24 118	24 119
Total beds Median	27 162	27 162	27 162	27 162	27 163.5
FTEs Median	499.06 788.06	460.97 793.42	454.71 806.03	453.74 787.61	486.02 804.34

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	86,620,990 150,932,746	80,787,384 158,950,878	83,627,209 168,696,998	90,204,208 163,454,693	102,810,977 186,589,412
Operating expenses Median	87,585,536 149,311,209	88,748,804 156,110,414	89,582,978 164,890,568	96,212,113 166,516,854	104,653,010 180,120,888
Net income from service 2 patients (NS2P) ? Median	-964,546 -964,173	-7,961,420 -643,601.5	-5,955,769 -116,254	-6,007,905 -5,025,862	-1,842,033 -1,284,564
NS2P margin ? Median	-1.11% -0.62	-9.85% -0.29	-7.12% 0.18	-6.66% -5.07	-1.79% -0.88

Range* of Net Service to Patient (NS2P) margins

= NS2P margin for MONUMENT HEALTH SPEARFISH 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	4,019,722 5,089,215	4,913,481 4,572,541	4,383,531 5,268,134	10,412,650 13,092,619	6,299,804 12,369,236
⊳ Line 6: Contributions ? ⊳ Median	20,974 224,999	0 199,009	0 206,870.5	0 194,343	0 249,496
⊳ Line 7: Investments ? ⊳ Median	1,601 299,524	0 188,688.5	11 370,813	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	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	72,640	74,152	66,935	61,250	58,865
⊳ Line 15: Revenue from rental of living quarters	0	0	0	0	0
⊳ Line 16: Revenue from sale of medical and surgical supplies	0	5,708	6,153	6,636	8,535
⊳ 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	4,544	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	1,089	956	510	243	277
⊳ Line 22: Rental of hospital space	0	2,143	1,350	1,300	11,863
⊳ Line 23: Gov appropriations ? ⊳ Median	60,014 1,017,693	66,484 983,261.5	52,568 1,173,286	91,483 1,987,202	0 1,597,664
⊳ Sum Line 24	3,858,860	4,764,038	4,256,004	10,251,738	6,220,264
Total income ? Median	3,055,176 6,586,430	-3,047,939 6,767,106	-1,572,238 8,419,950	4,404,745 8,094,175	4,457,771 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	3,055,176 6,043,842	-3,047,939 5,845,112	-1,572,238 7,606,259	4,404,745 7,283,041	4,457,771 14,957,241
Net margin Median	3.37064% 4.62%	-3.55649% 4.42%	-1.78642% 5.16%	4.37774% 5.2%	4.08555% 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 MONUMENT HEALTH SPEARFISH 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	9,441,834 23,241,334	8,494,968 23,709,545	7,233,569 24,248,380	6,350,275 22,858,541	7,821,520 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	9,441,834 21,577,146	8,494,968 22,041,594	7,233,569 22,722,063	6,350,275 21,570,441	7,821,520 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	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	11,364,304 11,160,864	11,270,139 11,987,345	12,774,236 12,926,866	12,858,699 11,884,480	15,148,629 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	9,766,547 10,918,923	10,538,855 11,706,976	12,174,643 12,615,917	12,312,881 11,458,116	14,530,751 12,776,716
⊳ Home Health agencies (HHA) ⊳ Median	818,774 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	778,983 618,038	731,284 697,279	599,593 690,232	545,818 684,010	617,878 670,558
⊳ 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	166,317 594,888	123,320 595,761	100,001 577,894	85,200 542,168	59,204 549,667
Outlier Median	49,317 582,572	95,422 538,116	143,644 212,434	170,102 126,559	72,251 139,139

Uncompensated care

Item	2017	2018	2019	2020	2021
Medicaid shortfall Median	3,041,840 3,662,910	2,622,349 3,730,911	2,381,531 4,081,319	1,906,607 4,643,908	2,049,456 4,389,147
Charity care Median	579,953 2,654,636	147,343 2,940,659	1,222,122 3,380,215	1,365,279 3,488,738	984,805 3,233,405
Uncompensated care (UCC) Median	2,316,358 5,147,790	2,715,935 5,337,617	2,875,293 5,711,082	3,257,918 5,923,418	2,286,304 5,508,107
UCC as a % of operating expenses Median	2.64% 3.24	3.06% 3.12	3.21% 3.21	3.39% 3.3	2.18% 2.86
Total shortfall/UCC Median	5,358,198 9,489,989	5,338,284 9,424,297	5,256,824 10,120,158	5,164,525 11,171,337	4,335,760 10,133,851

Labor costs

	2017	2018	2019	2020	2021
Total salaries Median	39,059,430 52,142,039	40,215,321 54,485,252	42,169,970 57,395,589	44,197,151 58,830,919	48,141,224 61,722,907
Salaries as a % of operating expenses Median	44.60 36.68	45.31 36.56	47.07 36.37	45.94 35.93	46.00 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	33,920 1,449,244	0 1,475,986	276,464 1,563,078	78,148 1,721,954	292,824 2,991,828
Contract hours, direct-care Median	483.75 22,725	0.00 23,018.5	3,467.23 24,503.48	975.00 25,026.5	3,322.50 33,786
Contract wages, direct-care Median	70.12 64.67	0.00 64.53	79.74 65.06	80.15 68.97	88.13 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.