JAY HOSPITAL
1. Target Overview & Investment Thesis
JAY HOSPITAL is a 21-bed under-performing / distressed in SANTA ROSA, FL with $10.3M in net patient revenue and a -50.3% operating margin. The hospital serves a payer mix of 48.8% Medicare, 4.1% Medicaid, and 47.2% commercial.
Thesis: Turnaround. Our ML models identify $765K in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from -50.3% to -42.9% (+741bps).
| Net Revenue HCRIS | $10.3M |
| Current EBITDA COMPUTED | $-5.2M |
| Operating Margin COMPUTED | -50.3% |
| Occupancy HCRIS | 28.9% |
| Revenue / Bed COMPUTED | $492K |
| Net-to-Gross HCRIS | 17.8% |
| Distress Probability ML | 53.3% |
2. Market Context & Competitive Position
FL has 261 Medicare-certified hospitals with a median operating margin of 3.2%. The target's margin of -50.3% places it below the state median. Among 25 size-comparable peers (10-42 beds), the median margin is 3.1%. The target's below-peer margin suggests operational improvement opportunity.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (10-42), prioritizing same-state peers. 25 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| JAY HOSPITAL (Target) | FL | 21 | $10.3M | -50.3% |
| MARINERS HOSPITAL | FL | 16 | $74.3M | 17.0% |
| HENDRY REGIONAL MEDICAL CENTER | FL | 25 | $41.1M | -20.8% |
| ED FRASER MEMORIAL HOSPITAL | FL | 21 | $40.7M | 17.8% |
| MIAMI JEWISH HEALTH SYSTEMS I | FL | 32 | $36.6M | -50.0% |
| ADVENTHEALTH WAUCHULA | FL | 25 | $35.5M | 10.0% |
| NORTHWEST FLORIDA COMMUNITY HO | FL | 25 | $35.2M | -2.4% |
| PAM SPECIALTY HOSPITAL OF SARA | FL | 40 | $26.3M | 13.7% |
| ST JOHNS REHABILITATION HOSPIT | FL | 26 | $24.8M | -18.6% |
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: $765K (741bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $217K | +210bp | 18mo |
| Denial Rate Reduction | 12.0% | 6.5% | $207K | +200bp | 12mo |
| Cost to Collect | 4.5% | 2.5% | $206K | +200bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $126K | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $10K | +9bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $-5.2M |
| + RCM Uplift | +$765K |
| Pro Forma EBITDA | $-4.4M |
| Current Margin | -50.3% |
| Pro Forma Margin | -42.9% |
| WC Released (1x) | $396K |
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 | $-8.0M | $-26.6M | 0.00x | -100.0% |
| Base (11x exit) | 10.0x | 11.0x | $-8.0M | $-31.8M | 0.00x | -100.0% |
| Bull Case | 9.0x | 11.0x | $-7.2M | $-31.9M | 0.00x | -100.0% |
| Bull (12x exit) | 9.0x | 12.0x | $-7.2M | $-36.9M | 0.00x | -100.0% |
| Bear Case | 11.0x | 10.0x | $-8.8M | $-27.8M | 0.00x | -100.0% |
| Bear (11x exit) | 11.0x | 11.0x | $-8.8M | $-33.4M | 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 28.9%, 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 53.3% 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
- 25 hospitals with 10-42 beds
- Same-state prioritization (n=26)
- Comp margins: P25=-23.9% / P50=3.1% / P75=11.8%
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.