SUTTER AMADOR HOSPITAL
1. Target Overview & Investment Thesis
SUTTER AMADOR HOSPITAL is a 52-bed suburban community hospital in AMADOR, CA with $108.9M in net patient revenue and a 7.5% operating margin. The hospital serves a payer mix of 46.0% Medicare, 4.2% Medicaid, and 49.8% commercial.
Thesis: Turnaround. Our ML models identify $8.0M in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from 7.5% to 14.9% (+736bps).
| Net Revenue HCRIS | $108.9M |
| Current EBITDA COMPUTED | $8.2M |
| Operating Margin COMPUTED | 7.5% |
| Occupancy HCRIS | 52.8% |
| Revenue / Bed COMPUTED | $2.1M |
| Net-to-Gross HCRIS | 29.2% |
| Distress Probability ML | 46.7% |
2. Market Context & Competitive Position
CA has 414 Medicare-certified hospitals with a median operating margin of -4.9%. The target's margin of 7.5% places it above the state median. Among 97 size-comparable peers (26-104 beds), the median margin is -4.7%. The target performs in line with or above peers.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (26-104), prioritizing same-state peers. 97 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| SUTTER AMADOR HOSPITAL (Target) | CA | 52 | $108.9M | 7.5% |
| RANCHO LOS AMIGOS NATL.REHAB.C | CA | 83 | $512.6M | 41.9% |
| USC NORRIS CANCER HOSPITAL | CA | 60 | $468.7M | 19.1% |
| KFH - FREMONT | CA | 100 | $296.2M | -6.6% |
| ADVENTIST HEALTH SONORA | CA | 84 | $274.3M | -7.4% |
| WOODLAND HEALTHCARE | CA | 74 | $211.5M | -3.2% |
| FRENCH HOSPITAL MEDICAL CENTER | CA | 98 | $208.6M | -2.1% |
| PALOMAR MEDICAL CENTER POWAY | CA | 95 | $203.9M | -3.6% |
| KFH - MORENO VALLEY | CA | 94 | $200.5M | -0.5% |
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: $8.0M (736bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $2.3M | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $2.2M | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $2.2M | +198bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $1.3M | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $70K | +6bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $8.2M |
| + RCM Uplift | +$8.0M |
| Pro Forma EBITDA | $16.2M |
| Current Margin | 7.5% |
| Pro Forma Margin | 14.9% |
| WC Released (1x) | $4.2M |
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 | $12.6M | $134.1M | 10.66x | 60.5% |
| Base (11x exit) | 10.0x | 11.0x | $12.6M | $151.6M | 12.05x | 64.5% |
| Bull Case | 9.0x | 11.0x | $11.3M | $182.1M | 16.08x | 74.3% |
| Bull (12x exit) | 9.0x | 12.0x | $11.3M | $202.0M | 17.84x | 77.9% |
| Bear Case | 11.0x | 10.0x | $13.8M | $89.9M | 6.50x | 45.4% |
| Bear (11x exit) | 11.0x | 11.0x | $13.8M | $103.4M | 7.47x | 49.5% |
7. Key Risks & Mitigants
| Severity | Risk Factor | Mitigant |
|---|---|---|
| Medium | Standard execution risk | RCM improvement requires management buy-in and 12-18 month implementation timeline |
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
- 97 hospitals with 26-104 beds
- Same-state prioritization (n=98)
- Comp margins: P25=-23.0% / P50=-4.7% / P75=2.3%
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.