CHARLOTTE HUNGERFORD HOSPITAL
1. Target Overview & Investment Thesis
CHARLOTTE HUNGERFORD HOSPITAL is a 91-bed suburban community hospital in LITCHFIELD, CT with $163.6M in net patient revenue and a -8.9% operating margin. The hospital serves a payer mix of 33.8% Medicare, 14.3% Medicaid, and 51.9% commercial.
Thesis: Turnaround. Our ML models identify $12.0M in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from -8.9% to -1.6% (+736bps).
| Net Revenue HCRIS | $163.6M |
| Current EBITDA COMPUTED | $-14.6M |
| Operating Margin COMPUTED | -8.9% |
| Occupancy HCRIS | 73.2% |
| Revenue / Bed COMPUTED | $1.8M |
| Net-to-Gross HCRIS | 30.0% |
| Distress Probability ML | 44.7% |
2. Market Context & Competitive Position
CT has 39 Medicare-certified hospitals with a median operating margin of -6.8%. The target's margin of -8.9% places it below the state median. Among 15 size-comparable peers (46-182 beds), the median margin is -7.9%. The target's below-peer margin suggests operational improvement opportunity.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (46-182), prioritizing same-state peers. 15 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| CHARLOTTE HUNGERFORD HOSPITAL (Target) | CT | 91 | $163.6M | -8.9% |
| JOHN DEMPSEY HOSPITAL | CT | 141 | $590.3M | -24.8% |
| THE WILLIAM W. BACKUS HOSPITAL | CT | 172 | $411.7M | -4.3% |
| MIDSTATE MEDICAL CENTER | CT | 143 | $346.8M | -2.3% |
| ST. MARYS HOSPITAL | CT | 163 | $311.2M | -2.5% |
| THE GRIFFIN HOSPITAL | CT | 101 | $217.2M | -13.8% |
| MANCHESTER MEMORIAL HOSPITAL | CT | 139 | $208.4M | -6.8% |
| BRISTOL HOSPITAL INC | CT | 123 | $146.0M | -6.6% |
| WINDHAM COMMUNITY MEMORIAL HOS | CT | 46 | $123.7M | 5.6% |
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: $12.0M (736bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $3.4M | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $3.3M | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $3.2M | +198bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $2.0M | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $105K | +6bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $-14.6M |
| + RCM Uplift | +$12.0M |
| Pro Forma EBITDA | $-2.6M |
| Current Margin | -8.9% |
| Pro Forma Margin | -1.6% |
| WC Released (1x) | $6.3M |
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 | $-22.5M | $23.9M | 0.00x | -100.0% |
| Base (11x exit) | 10.0x | 11.0x | $-22.5M | $18.9M | 0.00x | -100.0% |
| Bull Case | 9.0x | 11.0x | $-20.3M | $51.3M | 0.00x | -100.0% |
| Bull (12x exit) | 9.0x | 12.0x | $-20.3M | $50.0M | 0.00x | -100.0% |
| Bear Case | 11.0x | 10.0x | $-24.8M | $-29.1M | 0.00x | -100.0% |
| Bear (11x exit) | 11.0x | 11.0x | $-24.8M | $-40.0M | 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 |
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
- 15 hospitals with 46-182 beds
- Same-state prioritization (n=16)
- Comp margins: P25=-22.1% / P50=-7.9% / P75=-4.7%
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.