ASCENSION ST. VINCENTS SOUTHSIDE HO
1. Target Overview & Investment Thesis
ASCENSION ST. VINCENTS SOUTHSIDE HO is a 230-bed suburban community hospital in DUVAL, FL with $237.6M in net patient revenue and a -1.4% operating margin. The hospital serves a payer mix of 17.2% Medicare, 5.6% Medicaid, and 77.2% commercial.
Thesis: Undervalued. Our ML models identify $17.5M in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from -1.4% to 6.0% (+736bps).
| Net Revenue HCRIS | $237.6M |
| Current EBITDA COMPUTED | $-3.3M |
| Operating Margin COMPUTED | -1.4% |
| Occupancy HCRIS | 49.4% |
| Revenue / Bed COMPUTED | $1.0M |
| Net-to-Gross HCRIS | 15.4% |
| 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 -1.4% places it below the state median. Among 114 size-comparable peers (115-460 beds), the median margin is 4.4%. The target's below-peer margin suggests operational improvement opportunity.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (115-460), prioritizing same-state peers. 114 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| ASCENSION ST. VINCENTS SOUTHSI (Target) | FL | 230 | $237.6M | -1.4% |
| MOFFITT CANCER CENTER | FL | 218 | $1.91B | 16.0% |
| MAYO CLINIC FLORIDA | FL | 304 | $1.09B | 21.6% |
| NICKLAUS CHILDRENS HOSPITAL | FL | 259 | $769.3M | 5.5% |
| SOUTH MIAMI HOSPITAL | FL | 375 | $688.4M | 11.6% |
| BOCA RATON REGIONAL HOSPITAL | FL | 361 | $609.5M | -9.6% |
| JOHNS HOPKINS ALL CHILDRENS HO | FL | 259 | $584.5M | -10.3% |
| HOLY CROSS HOSPITAL | FL | 286 | $566.3M | -0.7% |
| HCA FLORIDA KENDALL HOSPITAL | FL | 424 | $541.2M | 35.2% |
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: $17.5M (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% | $152K | +6bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $-3.3M |
| + RCM Uplift | +$17.5M |
| Pro Forma EBITDA | $14.2M |
| Current Margin | -1.4% |
| Pro Forma Margin | 6.0% |
| WC Released (1x) | $9.1M |
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 | $-5.1M | $152.9M | 0.00x | -100.0% |
| Base (11x exit) | 10.0x | 11.0x | $-5.1M | $166.5M | 0.00x | -100.0% |
| Bull Case | 9.0x | 11.0x | $-4.6M | $222.6M | 0.00x | -100.0% |
| Bull (12x exit) | 9.0x | 12.0x | $-4.6M | $241.5M | 0.00x | -100.0% |
| Bear Case | 11.0x | 10.0x | $-5.6M | $67.1M | 0.00x | -100.0% |
| Bear (11x exit) | 11.0x | 11.0x | $-5.6M | $72.0M | 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 |
| 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
- 114 hospitals with 115-460 beds
- Same-state prioritization (n=115)
- Comp margins: P25=-4.6% / P50=4.4% / P75=16.9%
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.