CARONDELET ST. MARYS HOSPITAL
1. Target Overview & Investment Thesis
CARONDELET ST. MARYS HOSPITAL is a 357-bed under-performing / distressed in PIMA, AZ with $167.2M in net patient revenue and a -12.3% operating margin. The hospital serves a payer mix of 20.1% Medicare, 5.0% Medicaid, and 74.9% commercial.
Thesis: Undervalued. Our ML models identify $12.3M in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from -12.3% to -5.0% (+736bps).
| Net Revenue HCRIS | $167.2M |
| Current EBITDA COMPUTED | $-20.6M |
| Operating Margin COMPUTED | -12.3% |
| Occupancy HCRIS | 32.0% |
| Revenue / Bed COMPUTED | $468K |
| Net-to-Gross HCRIS | 10.4% |
| Distress Probability ML | 51.9% |
2. Market Context & Competitive Position
AZ has 124 Medicare-certified hospitals with a median operating margin of -0.8%. The target's margin of -12.3% places it below the state median. Among 28 size-comparable peers (178-714 beds), the median margin is -0.3%. The target's below-peer margin suggests operational improvement opportunity.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (178-714), prioritizing same-state peers. 28 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| CARONDELET ST. MARYS HOSPITAL (Target) | AZ | 357 | $167.2M | -12.3% |
| MAYO CLINIC HOSPITAL | AZ | 315 | $2.25B | 1.4% |
| BANNER ESTRELLA MEDICAL CENTER | AZ | 317 | $1.84B | 79.2% |
| BANNER BAYWOOD MEDICAL CENTER | AZ | 323 | $1.39B | 79.1% |
| ST. JOSEPHS HOSPITAL & MEDICAL | AZ | 515 | $1.31B | -17.7% |
| PHOENIX CHILDRENS HOSPITAL | AZ | 352 | $1.26B | 6.0% |
| BANNER UNIVERSITY MEDICAL CENT | AZ | 656 | $1.09B | -5.9% |
| BANNER UNIVERSITY MED CENTER T | AZ | 533 | $1.03B | -4.6% |
| BANNER DESERT MEDICAL CENTER | AZ | 629 | $833.1M | 12.6% |
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: $12.3M (736bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $3.5M | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $3.3M | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $3.3M | +198bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $2.0M | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $107K | +6bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $-20.6M |
| + RCM Uplift | +$12.3M |
| Pro Forma EBITDA | $-8.3M |
| Current Margin | -12.3% |
| Pro Forma Margin | -5.0% |
| WC Released (1x) | $6.4M |
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 | $-31.7M | $-13.0M | 0.00x | -100.0% |
| Base (11x exit) | 10.0x | 11.0x | $-31.7M | $-24.6M | 0.00x | -100.0% |
| Bull Case | 9.0x | 11.0x | $-28.6M | $5.7M | 0.00x | -100.0% |
| Bull (12x exit) | 9.0x | 12.0x | $-28.6M | $-2.2M | 0.00x | -100.0% |
| Bear Case | 11.0x | 10.0x | $-34.9M | $-64.2M | 0.00x | -100.0% |
| Bear (11x exit) | 11.0x | 11.0x | $-34.9M | $-82.0M | 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 32.0%, fixed costs are spread over fewer patient days. Mitigant: volume growth is an additional upside lever not modeled in base case |
| High | Elevated distress probability | Model estimates 51.9% probability of financial distress. Mitigant: distressed entry pricing (7-9x) compensates for risk |
| Low | Low net-to-gross ratio | Large contractual allowances suggest pricing discipline issues. Mitigant: payer renegotiation is an additional upside lever |
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
- 28 hospitals with 178-714 beds
- Same-state prioritization (n=29)
- Comp margins: P25=-4.0% / P50=-0.3% / P75=6.3%
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.