SAN ANTONIO REGIONAL HOSPITAL
1. Target Overview & Investment Thesis
SAN ANTONIO REGIONAL HOSPITAL is a 363-bed suburban community hospital in SAN BERNARDINO, CA with $447.3M in net patient revenue and a 2.8% operating margin. The hospital serves a payer mix of 19.3% Medicare, 6.0% Medicaid, and 74.7% commercial.
Thesis: Undervalued. Our ML models identify $32.9M in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from 2.8% to 10.2% (+736bps).
| Net Revenue HCRIS | $447.3M |
| Current EBITDA COMPUTED | $12.6M |
| Operating Margin COMPUTED | 2.8% |
| Occupancy HCRIS | 58.8% |
| Revenue / Bed COMPUTED | $1.2M |
| Net-to-Gross HCRIS | 13.7% |
| Distress Probability ML | 45.2% |
2. Market Context & Competitive Position
CA has 414 Medicare-certified hospitals with a median operating margin of -4.9%. The target's margin of 2.8% places it above the state median. Among 155 size-comparable peers (182-726 beds), the median margin is -4.5%. The target performs in line with or above peers.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (182-726), prioritizing same-state peers. 155 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| SAN ANTONIO REGIONAL HOSPITAL (Target) | CA | 363 | $447.3M | 2.8% |
| STANFORD HEALTH CARE | CA | 657 | $6.76B | 3.7% |
| UC DAVIS MEDICAL CENTER | CA | 666 | $3.28B | -11.5% |
| UCSD MEDICAL CENTER | CA | 718 | $3.06B | -7.2% |
| RONALD REAGAN UCLA | CA | 446 | $2.62B | -6.8% |
| LUCILE PACKARD CHILDRENS HOSPI | CA | 394 | $2.39B | -0.8% |
| LOS ANGELES GENERAL MEDICAL CE | CA | 596 | $1.96B | 10.2% |
| UCI MEDICAL CENTER | CA | 397 | $1.90B | -2.5% |
| CITY OF HOPE NATIONAL MEDICAL | CA | 217 | $1.83B | -10.7% |
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: $32.9M (736bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $9.4M | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $8.9M | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $8.9M | +198bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $5.4M | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $286K | +6bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $12.6M |
| + RCM Uplift | +$32.9M |
| Pro Forma EBITDA | $45.6M |
| Current Margin | 2.8% |
| Pro Forma Margin | 10.2% |
| WC Released (1x) | $17.2M |
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 | $19.4M | $412.6M | 21.24x | 84.3% |
| Base (11x exit) | 10.0x | 11.0x | $19.4M | $460.1M | 23.69x | 88.3% |
| Bull Case | 9.0x | 11.0x | $17.5M | $575.1M | 32.90x | 101.1% |
| Bull (12x exit) | 9.0x | 12.0x | $17.5M | $632.5M | 36.18x | 105.0% |
| Bear Case | 11.0x | 10.0x | $21.4M | $241.6M | 11.31x | 62.4% |
| Bear (11x exit) | 11.0x | 11.0x | $21.4M | $272.7M | 12.76x | 66.4% |
7. Key Risks & Mitigants
| Severity | Risk Factor | Mitigant |
|---|---|---|
| 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
- 155 hospitals with 182-726 beds
- Same-state prioritization (n=156)
- Comp margins: P25=-15.9% / P50=-4.5% / P75=3.5%
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.