Steward Health Care, that have just taken over the Gozo General Hospital, St Luke’s Hospital and Karin Grech have been in existence since 2010 and have reported yearly losses every year except 2015 when they reported a profit after settling an outstanding pension debt.

Steward recorded a loss $52 million in 2013 on $2.1 billion of revenue, according to an audited financial statement disclosed to the Massachusetts Center for Health Information and Analysis. That loss comes after Steward lost $33 million in 2012 and $59 million in 2011.

It had a $75 million operating loss in 2014. That reversed to an operating profit of more than $131 million in 2015, according to the company’s latest public filings. The company’s financial statement shows a $132 million gain from a “pension settlement” in 2015. Without the pension changes, Steward would have lost about $1 million on operations.

As Steward is owned by a private-equity firm, it is notoriously secretive about its financial details and has been repeatedly fined by state authorities for refusing to comply with statutory disclosure requirements.

Its financial sustainability is in doubt in the United States. This is a matter of particular concern because Steward Health Care is a for-profit business that  in its very short history did not hesitate to close down a hospital that was not making it enough money.