Driven largely by staffing expenses, costs are outstripping revenues at Dartmouth Health, New Hampshire’s largest private employer, according to filings with bondholders.

The Valley News reported that the Lebanon-based Dartmouth Health saw a $22.1 million loss, less than 1 percent, on a $2.9 billion operating budget in the fiscal year that ended June 30. It would have been a larger loss if not for $98.8 million DH received in federal stimulus funds.

That trend has only worsened in the first quarter of this year, which ended Sept. 30 with a $41.4 million loss, or nearly 6 percent, on a nearly $770 million operating budget. That loss includes $1.8 million in federal stimulus funds. The health system doesn’t expect any more, Audra Burns, a DH spokeswoman, said in a Monday email.

Burns said that to address the financial shortfalls, DH is focused on “improving our ability to discharge patients from our hospitals to an appropriate post-acute care facility.”

Staffing issues are at the top of the list of challenges. There is a national shortage of nurses, which has forced up wages both for permanent employees and for traveling nurses, according to chief financial officer Dan Jantzen.