A hospital in Emmetsburg, IA. It ran an operating surplus of 12.1% in FY25 on $40.3M of operating revenue. It held 31 days of cash on hand (28th percentile of 822 Critical Access Hospitals on liquidity, FY25 pool). Operating margin improved from 1.0% in FY21 to 12.1% in FY25.
Operating margin · FY25
+12.1%
Astrelis calculation · as-filed inputs
▲ 2.1 pts vs FY24
vs Critical Access Hospitals83rd pctl of 824 (FY25 pool)
pool: this metric's own fiscal year · excludes historical, non-panel, and out-of-range values
Days cash on hand · FY25
31d
all sources
Astrelis calculation · as-filed inputs
▲ 11 days vs FY24
vs Critical Access Hospitals28th pctl of 822 (FY25 pool)
pool: this metric's own fiscal year · excludes historical, non-panel, and out-of-range values
Total operating revenue · FY25
$40.3M
Astrelis calculation · as-filed inputs
▲ $2.7M vs FY24
vs Critical Access Hospitals62nd pctl of 833 (FY25 pool)
pool: this metric's own fiscal year · excludes historical, non-panel, and out-of-range values
Total margin · incl. nonoperating · FY25
+13.3%
Astrelis calculation · as-filed inputs
▲ 2.1 pts vs FY24
vs Critical Access Hospitals75th pctl of 824 (FY25 pool)
pool: this metric's own fiscal year · excludes historical, non-panel, and out-of-range values
One point of operating margin at PALO ALTO COUNTY HOSPITAL is about $403K per year (1% of FY25 total operating revenue).
Where PALO ALTO COUNTY sits among Critical Access Hospitals
Operating margin · FY25 pool · n = 824 of 1,399 filed
Each point is one Critical Access Hospital in the national FY25 distribution for this provider type, placed by operating margin. Facilities are not matched on size, case mix, or market; that is the matched-peer comparison in the paid benchmark. The Critical Access Hospital FY25 median is -0.2%. Descriptive context only, not a ranking.
One critical access hospitalPALO ALTOCritical Access Hospital median
The money
$ thousands · HCRIS cost-report basis · as filed, QA-gated
Ratios tell you how this hospital is doing. Statements tell you what kind of organization it is, and where the money comes from. Every figure below traces to a public cost-report filing, shown as filed. A ratio computes only when every input is reported in the filing (otherwise its cell states which input is Not reported in source); a year whose balance sheet does not reconcile is labeled, and its derived ratios read Astrelis calculation unavailable. Not audited by Astrelis.
Net patient receivables ÷ (net patient revenue ÷ 365), same fiscal year
Astrelis calculation · HCRIS WS G / G-3
Medicare inpatient contribution margin
+29.3% (FY24)
Full comparison in the CAH Performance Benchmark.
HCRIS cost report · CAH economics engine
Medicare outpatient contribution margin
+60.8% (FY24)
Full comparison in the CAH Performance Benchmark.
HCRIS cost report · CAH economics engine
$ in thousands
Line item
FY23
FY24
FY25
Patient revenue
28,926
34,245
37,261
Other operating revenue
4,483
3,364
3,048
Total operating revenue
33,409
37,609
40,309
Total operating expenses
33,138
33,848
35,452
Operating income
271
3,761
4,857
Operating margin %
+0.8%
+10.0%
+12.1%
Grants & contributions
1,630
14
55
Investment income
905
1,460
1,739
Other non-operating, net
(435)
(805)
(1,018)
Net income
2,371
4,430
5,633
Net income %
+6.6%
+11.3%
+13.3%
— = Not reported in source for that year.
HCRIS Worksheet G-3 / S-3 · $ thousands · FY21–FY25 · FY20–21 may include COVID-era relief funding in nonoperating income
How it operates
quality & operational context · CMS public reporting
A 24-bed hospital running at 8% occupancy, where swing beds are 43% of the inpatient business, and 86% of patient revenue is outpatient.
The metrics this hospital type is judged on: care quality, patient experience, and scale. Each is labeled by provenance class and public source; descriptive context only, never a ranking or adequacy claim. Provenance labels: Reported value is copied from the named public source; Astrelis calculation is a formula applied to unchanged reported inputs, with the formula shown; Illustrative estimate is a benchmark gap, multiplier, or scenario — never a measurement.
Scale and flow
Occupancy
7.9%
Reported value2025
HCRIS WS S-3
Average daily census
1.89
Reported value2025
HCRIS WS S-3
Staffed beds (acute)
24
Reported value2025
HCRIS WS S-3
Annual discharges
277
Reported value2025
HCRIS WS S-3
Average length of stay
2 days
Reported value2025
HCRIS WS S-3
Cost per patient day
$51,529
Astrelis calculation2025
Astrelis calculation — total operating expense ÷ total patient days (HCRIS WS G-3 / S-3)
Cost per discharge (unadjusted)
$127,984
Astrelis calculation2025
Astrelis calculation — total operating expense ÷ discharges, NOT case-mix adjusted (adjusted discharges are not on the public filing set)
Swing-bed average daily census
1.41
Reported value2025
HCRIS WS S-3 L5–6
Swing-bed share of inpatient days
42.7%
Reported value2025
HCRIS WS S-3 (acute + swing days)
Outpatient share of patient revenue
85.9%
Reported value2025
HCRIS WS G-2 L28
How the care measures up
C. difficile infection (SIR)
Not reported in source (note 1)
CMS-reported measure07/01/2024 to 06/30/2025
CMS Care Compare
Hospital-wide unplanned readmission
14.8%
No Different Than the National Rate
CMS-reported measure07/01/2023 to 06/30/2024
CMS Care Compare
Note 1: Results cannot be calculated for this reporting period.
Trajectory
Cost-report basis · 5 reporting years
Operating margin
Days cash on hand
The county this hospital serves
PALO ALTO County, IA
Median household income
$69.0K
vs $82.1K US · $59.7K rural median
Poverty rate
11.7%
vs 12.5% US · 14.3% rural median
Uninsured
5.0%
vs 8.6% US · 8.4% rural median
Age 65+
21.9%
vs 16.8% US · 20.6% rural median
Fair or poor health
16.7%
self-reported, adults · CDC PLACES
Primary-care shortage
Designated
HRSA HPSA
Economic context: 9.1% of county personal income is Medicare/Medicaid medical benefits; 19.5% arrives as government transfers (BEA, 2022).
Illustrative advocacy scenario: what this hospital means to Palo Alto County
Illustrative estimate · FY25 cost report
Direct annual spending
$35.5M
total operating expense · Reported value, not a local-capture estimate
Economic activity
$81.5M
direct spending × 2.30 · AHA national hospital economic activity report — a national hospital ratio, not a CAH or county figure · Illustrative estimate
Employment and labor income multipliers are from the National Center for Rural Health Works 2016 study of Critical Access Hospital economic impact (IMPLAN Type II, U.S. rural county populations); the economic-activity ratio is from the AHA national hospital economic activity report and describes U.S. hospitals as a whole; it is not a CAH-specific or county-specific figure. Applying any of these to an individual facility is an illustrative advocacy scenario, not a measurement: local capture depends on payroll residency, purchasing patterns, and county economic structure the sources do not observe. This facility is a critical access hospital, the NCRHW study population. Direct figures are reported values from the facility's HCRIS cost report. Want a defensible facility-specific figure? Request a Facility Economic Impact Study →
Medicare inpatient contribution marginFY24Astrelis calculation from reported HCRIS inputs
+29.3% (FY24).
The Board Briefing
Operating margin improved 2.1 points vs FY24 — the briefing traces why, line by line.
CAH Performance Benchmark: FY25 peer pool · n = 824 · conservative low band; acuity limits stated in the report.
Report coverage: Limited Facility Benchmark. 14 of 17 facility measures available from public sources. The report covers the available measures against their peer benchmarks; measures the public record does not carry become findings. Coverage is disclosed here before you reserve, and thin data is never a decline reason. The refund guarantee stands: if we cannot deliver the published scope, you pay nothing.
The Board Briefing
Your facility and its world, board-ready. Measures the public record does not carry become findings, never a decline reason.
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