Henry Ford Health System lost money last year providing healthcare, but the Detroit-based system was able to post a positive net income thanks to its investment portfolio.

HFHS reported Monday an operating loss of $168 million, or a negative 2.5 percent operating margin, on net patient revenue of $4.2 billion. Cutting into its margins was a $135 million in COVID-19 related costs and a $200 million shortfall from insurance claims, including a $76 million premium deficiency reserve from healthcare costs and premiums from its integrated insurer Health Alliance Plan, the system said in a press release.

The health system reports that increasing labor shortages, supply chain disruptions, inflation and rising medical claims compounded its financial stress last year.

The Federal Emergency Management Agency also only paid out $13 million to HFHS in 2021 of the $111 million in reimbursable COVID costs it is eligible for, the health system said in the release.

Read more: Federal COVID-19 grants keep Henry Ford in the black

“Unfortunately, all of those factors caused significant increases in our expenses in 2021,” Robin Damschroder, Henry Ford’s executive vice president and CFO, said in a statement. “In the end, those expenses and other operational challenges outpaced the revenue we achieved. “

However, HFHS was able to post a positive total income of $41 million, or a margin of 0.6 percent, thanks to $200 million in returns from its investment portfolio.

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HFHS follows the trend of others in the industry, including insurer Blue Cross Blue Shield of Michigan, which last year also recorded a loss by its primary business that was offset by investments.

The Detroit nonprofit insurer reported a $374 million operating loss thanks to $860 million in costs from COVID-19 treatments and testing. However, the Blues were able to record $360 million in income on its $32.5 billion revenue for the year after the health insurance losses were offset by the performances of its non-health insurance subsidiaries and investment portfolio, which generated $907 million in positive returns.

The lower income reduced HFHS’ overall liquidity, knocking down the day the system can operate with no cash coming in the door to 182 days, down from 206 days in 2020. Though 2020 included $124 million in accelerated Medicare payments as a response to the outbreak of the pandemic.

This story first appeared in our sister publication, Crain’s Detroit Business.