South Shore University Hospital posts its best net margin since 2019, but patient care still runs $317 million short

The hospital has climbed out of the red in uneven steps. Its net margin was -3.3% in fiscal 2019, rose to 2.3% in 2020, slipped to break-even in 2021 and -0.6% in 2022, then held positive for three straight years at 2.8% in 2023, 2.4% in 2024 and 3.2% in 2025. The latest year produced $41.0 million of net income on $1.27 billion of total revenue. That still sits in the middle band nationally on Clinical Terminal's scale, which runs from -2.58% to 8.04%; hospitals above 8.04% rank in the top third.

The margin gain comes from revenue growing slightly faster than costs over six years of rapid expansion. Net patient revenue rose 70.5%, from $536.8 million in fiscal 2019 to $915.4 million in 2025. Operating expenses rose 67.1% over the same span, from $737.6 million to $1.23 billion. Salaries account for 50.1% of operating expenses, and contract labor for direct patient care was negligible at $133,000 in 2025.

The core business has not closed its gap. South Shore's patient-care margin, which the cost report computes as patient revenue minus the cost of patient care and which excludes all other income, was -34.7% in fiscal 2025. It has stayed between -34.3% and -41.2% every year since 2019, with no sustained trend. That figure is not the operating margin an audited statement would show, but it isolates how much of the hospital's bottom line depends on money that does not come from billing patients.

That other income reached $358.4 million in fiscal 2025, 28% of total revenue and roughly double the $177.4 million it contributed in 2019. The cost report does not itemize it, and for a hospital inside a 125-member system it can include funding that flows through Northwell rather than from the hospital's own operations. Whatever its source, the hospital's positive margin depends on it continuing.

Demand is not the problem. Beds were 96.5% occupied in fiscal 2025, or about 92% excluding nursery days, a level that leaves little room to grow volume without new capacity. The hospital billed $3.93 billion in gross charges and wrote off 76.7% of them in contractual allowances and discounts. Net Medicaid revenue fell from $101.3 million in fiscal 2023 to $89.7 million in 2025, a decline worth watching as New York's Medicaid financing shifts.

Several balance-sheet readings look alarming at the facility level but should not be read as South Shore's credit position. Days cash on hand was 8.7 and the current ratio was 0.97 in fiscal 2025; Northwell manages cash and borrowing at the system level, so those figures describe the hospital's working capital, not its access to liquidity. Total assets jumped from $771.3 million in fiscal 2023 to $1.16 billion in 2024, with liabilities rising from $806.9 million to $1.10 billion, a step change the cost reports do not explain.

The figures come from CMS hospital cost reports, which are facility-level filings rather than audited GAAP statements, and the fiscal 2025 report is listed as submitted, meaning it can still be amended. Northwell's consolidated results, days cash and debt service coverage are the measures that determine the system's credit standing.