NOLAND HOSPITAL BIRMINGHAM II
1. Target Overview & Investment Thesis
NOLAND HOSPITAL BIRMINGHAM II is a 79-bed community hospital in JEFFERSON, AL with $11.5M in net patient revenue and a -0.3% operating margin. The hospital serves a payer mix of 35.1% Medicare, 0.0% Medicaid, and 64.9% commercial.
Thesis: Turnaround. Our ML models identify $851K in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from -0.3% to 7.1% (+740bps).
| Net Revenue HCRIS | $11.5M |
| Current EBITDA COMPUTED | $-36K |
| Operating Margin COMPUTED | -0.3% |
| Occupancy HCRIS | 28.1% |
| Revenue / Bed COMPUTED | $146K |
| Net-to-Gross HCRIS | 35.6% |
| Distress Probability ML | nan% |
2. Market Context & Competitive Position
AL has 115 Medicare-certified hospitals with a median operating margin of -8.5%. The target's margin of -0.3% places it above the state median. Among 43 size-comparable peers (40-158 beds), the median margin is -14.1%. The target performs in line with or above peers.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (40-158), prioritizing same-state peers. 43 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| NOLAND HOSPITAL BIRMINGHAM II (Target) | AL | 79 | $11.5M | -0.3% |
| SOUTH BALDWIN REGIONAL MEDICAL | AL | 112 | $168.2M | 46.4% |
| CULLMAN REGIONAL | AL | 137 | $167.1M | -4.9% |
| ATHENS LIMESTONE | AL | 66 | $88.9M | -20.9% |
| BRYCE HOSPITAL | AL | 98 | $76.4M | 29.5% |
| RUSSELL MEDICAL CENTER | AL | 45 | $75.3M | -14.8% |
| JACK HUGHSTON MEMORIAL HOSPITA | AL | 47 | $75.2M | 6.5% |
| COOSA VALLEY MEDICAL CENTER | AL | 122 | $73.0M | -11.7% |
| VAUGHAN REGIONAL MEDICAL CENTE | AL | 109 | $63.0M | -4.8% |
4. Predicted Improvement Opportunities
Improvement targets set at P75 of comparable peers with 60% gap closure assumption. Coefficients calibrated to published research bands. Total EBITDA uplift: $851K (740bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $242K | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $230K | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $230K | +200bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $140K | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $10K | +8bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $-36K |
| + RCM Uplift | +$851K |
| Pro Forma EBITDA | $815K |
| Current Margin | -0.3% |
| Pro Forma Margin | 7.1% |
| WC Released (1x) | $441K |
6. Returns Analysis — Scenario Matrix
5-year hold, 5.5x leverage, 3% organic growth, 10%/yr debt paydown. Base case uses 100% of predicted RCM uplift. Bull case: 130% uplift at lower entry. Bear case: 50% uplift at higher entry.
| Scenario | Entry | Exit | Equity In | Equity Out | MOIC | IRR |
|---|---|---|---|---|---|---|
| Base Case | 10.0x | 10.0x | $-55K | $8.3M | 0.00x | -100.0% |
| Base (11x exit) | 10.0x | 11.0x | $-55K | $9.1M | 0.00x | -100.0% |
| Bull Case | 9.0x | 11.0x | $-50K | $11.9M | 0.00x | -100.0% |
| Bull (12x exit) | 9.0x | 12.0x | $-50K | $12.9M | 0.00x | -100.0% |
| Bear Case | 11.0x | 10.0x | $-61K | $4.0M | 0.00x | -100.0% |
| Bear (11x exit) | 11.0x | 11.0x | $-61K | $4.4M | 0.00x | -100.0% |
7. Key Risks & Mitigants
| Severity | Risk Factor | Mitigant |
|---|---|---|
| High | Negative operating margin | RCM uplift bridge shows clear path to profitability; working capital release provides near-term cash cushion |
| Medium | Low occupancy | At 28.1%, fixed costs are spread over fewer patient days. Mitigant: volume growth is an additional upside lever not modeled in base case |
8. Data Sources & Methodology Appendix
Data Sources
- CMS HCRIS Cost Reports (Medicare-certified hospitals)
- CMS Medicare Utilization (DRG-level volumes)
- CMS Chronic Conditions (county-level disease prevalence)
- HCRIS multi-year trend data (financial time series)
Comparable Selection
- 43 hospitals with 40-158 beds
- Same-state prioritization (n=44)
- Comp margins: P25=-20.9% / P50=-14.1% / P75=6.0%
Bridge Methodology
- Targets: P75 of comparable peers (60% gap closure)
- Denial: avoidable share = 35% of delta × NPR
- AR: bad debt coefficient = $0.65 per day per $1K NPR
- NCR: 60% coefficient on collection rate improvement
- CDI: 0.75% of Medicare revenue per 0.01 CMI point
Returns Assumptions
- Leverage: 5.5x entry (84.6% debt / 15.4% equity)
- Organic growth: 3% annual EBITDA growth
- Debt paydown: 10% of principal per year
- Hold period: 5 years
Generated by SeekingChartis on April 26, 2026. All predictions use public data only. Confidence intervals calibrated via split conformal prediction (90% coverage target). This memo is for informational purposes and does not constitute investment advice.