ADVENTHEALTH FISH MEMORIAL
1. Target Overview & Investment Thesis
ADVENTHEALTH FISH MEMORIAL is a 257-bed suburban community hospital in VOLUSIA, FL with $239.4M in net patient revenue and a 1.7% operating margin. The hospital serves a payer mix of 27.8% Medicare, 2.8% Medicaid, and 69.4% commercial.
Thesis: Undervalued. Our ML models identify $17.6M in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from 1.7% to 9.1% (+736bps).
| Net Revenue HCRIS | $239.4M |
| Current EBITDA COMPUTED | $4.1M |
| Operating Margin COMPUTED | 1.7% |
| Occupancy HCRIS | 52.3% |
| Revenue / Bed COMPUTED | $932K |
| Net-to-Gross HCRIS | 22.0% |
| Distress Probability ML | 47.3% |
2. Market Context & Competitive Position
FL has 261 Medicare-certified hospitals with a median operating margin of 3.2%. The target's margin of 1.7% places it below the state median. Among 108 size-comparable peers (128-514 beds), the median margin is 3.2%. The target's below-peer margin suggests operational improvement opportunity.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (128-514), prioritizing same-state peers. 108 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| ADVENTHEALTH FISH MEMORIAL (Target) | FL | 257 | $239.4M | 1.7% |
| MOFFITT CANCER CENTER | FL | 218 | $1.91B | 16.0% |
| MAYO CLINIC FLORIDA | FL | 304 | $1.09B | 21.6% |
| MOUNT SINAI MEDICAL CENTER OF | FL | 481 | $904.2M | 12.2% |
| TALLAHASSEE MEMORIAL HOSPITAL | FL | 483 | $871.6M | -4.8% |
| SHANDS JACKSONVILLE MEDICAL CE | FL | 481 | $861.4M | -7.1% |
| NICKLAUS CHILDRENS HOSPITAL | FL | 259 | $769.3M | 5.5% |
| HCA FLORIDA OCALA HOSPITAL | FL | 509 | $761.7M | 27.6% |
| MEMORIAL HOSPITAL WEST | FL | 486 | $741.4M | 5.2% |
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: $17.6M (736bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $5.0M | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $4.8M | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $4.7M | +198bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $2.9M | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $153K | +6bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $4.1M |
| + RCM Uplift | +$17.6M |
| Pro Forma EBITDA | $21.8M |
| Current Margin | 1.7% |
| Pro Forma Margin | 9.1% |
| WC Released (1x) | $9.2M |
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 | $6.4M | $203.6M | 31.89x | 99.9% |
| Base (11x exit) | 10.0x | 11.0x | $6.4M | $226.0M | 35.41x | 104.1% |
| Bull Case | 9.0x | 11.0x | $5.7M | $286.3M | 49.82x | 118.5% |
| Bull (12x exit) | 9.0x | 12.0x | $5.7M | $314.0M | 54.65x | 122.6% |
| Bear Case | 11.0x | 10.0x | $7.0M | $113.4M | 16.15x | 74.4% |
| Bear (11x exit) | 11.0x | 11.0x | $7.0M | $127.0M | 18.09x | 78.4% |
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
- 108 hospitals with 128-514 beds
- Same-state prioritization (n=109)
- Comp margins: P25=-5.3% / P50=3.2% / P75=17.3%
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.