CCN 271319MADISON CountyGovernment - Hospital District or AuthorityRural (USDA RUCC)5 bedsLatest FY 2025
Cost-report basis
HCRIS · as filed
Not audited by Astrelis
Operating margin: -20.4% in FY2024, the 13th percentile of 1,307 critical access hospitals in the FY2024 pool. Days cash on hand: 72 days in FY2024, the 43rd percentile of 1,289 critical access hospitals in the FY2024 pool. Total operating revenue: $13.0M in FY2024, the 14th percentile of 1,320 critical access hospitals in the FY2024 pool. Total margin (including nonoperating): -9.9% in FY2024, the 7th percentile of 1,307 critical access hospitals in the FY2024 pool. Figures as filed; not audited by Astrelis.
Financial anchor year: FY24. Margin and revenue are as filed for FY24. Balance-sheet measures (current ratio, equity financing, days in A/R) use FY25, the latest filing whose balance sheet reconciled as filed. Every tile below states its own fiscal year; nothing is carried forward or estimated.
The read
A hospital in Sheridan, MT. It ran an operating loss of 20.4% in FY24 on $13.0M of operating revenue. It held 72 days of cash on hand (43rd percentile of 1,289 Critical Access Hospitals on liquidity, FY24 pool). Operating margin improved from -27.9% in FY20 to -9.7% in FY25.
Operating margin · FY24
-20.4%
Astrelis calculation · as-filed inputs
▼ 9.0 pts vs FY23
vs Critical Access Hospitals13th pctl of 1,307 (FY24 pool)
pool: this metric's own fiscal year · excludes historical, non-panel, and out-of-range values
Days cash on hand · FY24
72d
all sources
Astrelis calculation · as-filed inputs
▼ 21 days vs FY23
vs Critical Access Hospitals43rd pctl of 1,289 (FY24 pool)
pool: this metric's own fiscal year · excludes historical, non-panel, and out-of-range values
Total operating revenue · FY24
$13.0M
Astrelis calculation · as-filed inputs
▲ $0.4M vs FY23
vs Critical Access Hospitals14th pctl of 1,320 (FY24 pool)
pool: this metric's own fiscal year · excludes historical, non-panel, and out-of-range values
Total margin · incl. nonoperating · FY24
-9.9%
Astrelis calculation · as-filed inputs
▼ 6.6 pts vs FY23
vs Critical Access Hospitals7th pctl of 1,307 (FY24 pool)
pool: this metric's own fiscal year · excludes historical, non-panel, and out-of-range values
One point of operating margin at RUBY VALLEY MEDICAL CENTER is about $130K per year (1% of FY24 total operating revenue).
Where RUBY VALLEY MEDICAL sits among Critical Access Hospitals
Operating margin · FY24 pool · n = 1,307 of 1,404 filed
Each point is one Critical Access Hospital in the national FY24 distribution for Critical Access Hospitals, this hospital's comparison cohort, 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 FY24 median is -1.8%. Descriptive context only, not a ranking.
One critical access hospitalRUBY VALLEYCritical 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 × days in the report's own period ÷ net patient revenue, same fiscal year
Astrelis calculation · HCRIS WS G / G-3
$ in thousands
Line item
FY23
FY24
FY25 · 242 days
Patient revenue
12,494
13,257
9,328
Other operating revenue
57
(274)
465
Total operating revenue
12,551
12,983
9,792
Total operating expenses
13,982
15,637
10,741
Operating income
(1,432)
(2,655)
(949)
Operating margin %
-11.4%
-20.4%
-9.7%
Grants & contributions
840
851
1,120
Investment income
29
60
43
Other non-operating, net
116
341
129
Net income
(446)
(1,403)
342
Net income %
-3.3%
-9.9%
+3.1%
— = Not reported in source for that year.
HCRIS Worksheet G-3 / S-3 · $ thousands · FY20–FY25 · FY20–21 may include COVID-era relief funding in nonoperating income
How it operates
quality & operational context · CMS public reporting
A 5-bed hospital running at 6% occupancy, where swing beds are 92% of the inpatient business, and 83% 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
6.0%
Reported value2025
HCRIS WS S-3
Average daily census
0.30
Reported value2025
HCRIS WS S-3
Staffed beds (acute)
5
Reported value2025
HCRIS WS S-3
Annual discharges
24
Reported value2025
HCRIS WS S-3
Average length of stay
3 days
Reported value2025
HCRIS WS S-3
Cost per patient day
$149,178
Astrelis calculation2025
Astrelis calculation — total operating expense ÷ total patient days (HCRIS WS G-3 / S-3)
Cost per discharge (unadjusted)
$447,535
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
3.61
Reported value2025
HCRIS WS S-3 L5–6
Swing-bed share of inpatient days
92.4%
Reported value2025
HCRIS WS S-3 (acute + swing days)
Outpatient share of patient revenue
82.7%
Reported value2025
HCRIS WS G-2 L28
Who it serves
Total unreimbursed & uncompensated care
$2.2M
Reported value2023
HCRIS WS S-10 line 31
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
Not reported in source (note 2)
CMS-reported measure07/01/2023 to 06/30/2024
CMS Care Compare
Note 1: Results are not available for this reporting period.Note 2: The number of cases/patients is too few to report.
Trajectory
Cost-report basis · 6 reporting years
Operating margin
Days cash on hand
The county this hospital serves
MADISON County, MT · nonmetro, rural, metro-adjacent
Median household income
$67.4K
vs $82.1K US · $59.7K rural median
Poverty rate
6.8%
vs 12.5% US · 14.3% rural median
Uninsured
7.4%
vs 8.6% US · 8.4% rural median
Age 65+
30.6%
vs 16.8% US · 20.6% rural median
Fair or poor health
15.4%
self-reported, adults · CDC PLACES
Primary-care shortage
Designated
HRSA HPSA
Economic context: 6.1% of county personal income is Medicare/Medicaid medical benefits; 16.9% arrives as government transfers (BEA, 2022).
Illustrative advocacy scenario: what this hospital means to Madison County
Illustrative estimate · FY25 cost report
Direct annual spending
$10.7M
total operating expense · Reported value, not a local-capture estimate
Economic activity
$24.7M
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 →
Operating margin vs its peer poolFY24Astrelis calculation
Operating margin vs its peer pool: FY24 pool · n = 1,307.
CAH Performance Benchmark: FY24 peer pool · n = 1,307 · conservative low band; acuity limits stated in the report.
Report coverage: Limited Facility Benchmark. 15 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.
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Astrelis Atlas, "Ruby Valley Medical Center", https://astrelis.co/hospitals/271319, release 2321a4fc37a7 (2026-10-22). Figures as filed in the named public sources; not audited by Astrelis.
Machine-readable twin of this page: astrelis.co/hospitals/271319.md (Markdown, the same figures with their fiscal years, pools and definitions). Last modified: release 2321a4fc37a7, 2026-10-22. Figures are as filed in the named public sources. Astrelis is not a CPA firm and performs no audit, review or attestation of any facility.
