COALINGA REGIONAL MEDICAL CENTER
1. Target Overview & Investment Thesis
COALINGA REGIONAL MEDICAL CENTER is a 22-bed safety-net/medicaid heavy in FRESNO, CA with $1.8M in net patient revenue and a -100.0% operating margin. The hospital serves a payer mix of 17.8% Medicare, 43.7% Medicaid, and 38.5% commercial.
Thesis: Turnaround. Our ML models identify $150K in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from -100.0% to -313.7% (+822bps).
| Net Revenue HCRIS | $1.8M |
| Current EBITDA COMPUTED | $-5.9M |
| Operating Margin COMPUTED | -100.0% |
| Occupancy HCRIS | 16.5% |
| Revenue / Bed COMPUTED | $83K |
| Net-to-Gross HCRIS | 64.4% |
| Distress Probability ML | 69.5% |
2. Market Context & Competitive Position
CA has 414 Medicare-certified hospitals with a median operating margin of -4.9%. The target's margin of -100.0% places it below the state median. Among 60 size-comparable peers (11-44 beds), the median margin is -9.6%. The target's below-peer margin suggests operational improvement opportunity.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (11-44), prioritizing same-state peers. 60 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| COALINGA REGIONAL MEDICAL CENT (Target) | CA | 22 | $1.8M | -100.0% |
| TAHOE FOREST HOSPITAL | CA | 25 | $264.3M | 13.0% |
| PORTERVILLE DEVELOPMENTAL CENT | CA | 17 | $193.6M | -6.0% |
| ADVENTIST HEALTH CLEARLAKE | CA | 25 | $159.9M | -6.3% |
| RIDGECREST REGIONAL HOSPITAL | CA | 25 | $149.6M | -14.7% |
| HAZEL HAWKINS MEM. HOSPITAL | CA | 25 | $141.1M | -16.7% |
| GOLETA VALLEY COTTAGE HOSPITAL | CA | 24 | $111.9M | 14.8% |
| FAIRCHILD MEDICAL CENTER | CA | 25 | $109.4M | -0.3% |
| SUTTER COAST HOSPITAL | CA | 39 | $107.9M | 2.0% |
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: $150K (822bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Denial Rate Reduction | 12.0% | 6.5% | $43K | +238bp | 12mo |
| Net Collection Rate | 93.5% | 97.0% | $38K | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $37K | +200bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $22K | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $10K | +53bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $-5.9M |
| + RCM Uplift | +$150K |
| Pro Forma EBITDA | $-5.7M |
| Current Margin | -100.0% |
| Pro Forma Margin | -313.7% |
| WC Released (1x) | $70K |
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 | $-9.1M | $-37.3M | 0.00x | -100.0% |
| Base (11x exit) | 10.0x | 11.0x | $-9.1M | $-44.0M | 0.00x | -100.0% |
| Bull Case | 9.0x | 11.0x | $-8.1M | $-46.4M | 0.00x | -100.0% |
| Bull (12x exit) | 9.0x | 12.0x | $-8.1M | $-53.0M | 0.00x | -100.0% |
| Bear Case | 11.0x | 10.0x | $-10.0M | $-35.1M | 0.00x | -100.0% |
| Bear (11x exit) | 11.0x | 11.0x | $-10.0M | $-41.9M | 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 | Elevated Medicaid exposure (43.7%) | Medicaid reimburses below cost in most states. Mitigant: denial reduction lever has highest impact on Medicaid claims |
| Medium | Low occupancy | At 16.5%, 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 69.5% probability of financial distress. Mitigant: distressed entry pricing (7-9x) compensates for risk |
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
- 60 hospitals with 11-44 beds
- Same-state prioritization (n=61)
- Comp margins: P25=-19.2% / P50=-9.6% / P75=0.2%
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.