Most states would love to make 100 million in profits. The state has Johns Hopkins and University of Maryland which are great hospitals. Of course Anne Arundel Medical Center is pretty dang good too.
Operating profit does not occur in a vacuum. Some industries are stable and can thrive with razor thin margins, some are more volatile and require a wider margin to respond to their environment.
I don’t have enough information to know what their margins are but medicine operates in a very volatile environment. A hundred million dollars can disappear in a blink of the eye.