ASCENSION SACRED HEART GULF
1. Target Overview & Investment Thesis
ASCENSION SACRED HEART GULF is a 19-bed under-performing / distressed in GULF, FL with $19.5M in net patient revenue and a -100.0% operating margin. The hospital serves a payer mix of 32.7% Medicare, 2.1% Medicaid, and 65.3% commercial.
Thesis: Turnaround. Our ML models identify $1.4M in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from -100.0% to -114.8% (+736bps).
| Net Revenue HCRIS | $19.5M |
| Current EBITDA COMPUTED | $-23.8M |
| Operating Margin COMPUTED | -100.0% |
| Occupancy HCRIS | 21.1% |
| Revenue / Bed COMPUTED | $1.0M |
| Net-to-Gross HCRIS | 20.8% |
| Distress Probability ML | 53.5% |
2. Market Context & Competitive Position
FL has 261 Medicare-certified hospitals with a median operating margin of 3.2%. The target's margin of -100.0% places it below the state median. Among 18 size-comparable peers (10-38 beds), the median margin is -3.0%. The target's below-peer margin suggests operational improvement opportunity.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (10-38), prioritizing same-state peers. 18 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| ASCENSION SACRED HEART GULF (Target) | FL | 19 | $19.5M | -100.0% |
| 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% |
| ST JOHNS REHABILITATION HOSPIT | FL | 26 | $24.8M | -18.6% |
| SSH - DAYTONA BEACH | FL | 34 | $21.2M | 15.5% |
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: $1.4M (736bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $409K | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $390K | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $386K | +198bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $237K | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $12K | +6bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $-23.8M |
| + RCM Uplift | +$1.4M |
| Pro Forma EBITDA | $-22.4M |
| Current Margin | -100.0% |
| Pro Forma Margin | -114.8% |
| WC Released (1x) | $748K |
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 | $-36.7M | $-142.8M | 0.00x | -100.0% |
| Base (11x exit) | 10.0x | 11.0x | $-36.7M | $-169.0M | 0.00x | -100.0% |
| Bull Case | 9.0x | 11.0x | $-33.0M | $-176.2M | 0.00x | -100.0% |
| Bull (12x exit) | 9.0x | 12.0x | $-33.0M | $-201.9M | 0.00x | -100.0% |
| Bear Case | 11.0x | 10.0x | $-40.3M | $-138.1M | 0.00x | -100.0% |
| Bear (11x exit) | 11.0x | 11.0x | $-40.3M | $-165.0M | 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 |
| Medium | Low occupancy | At 21.1%, 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 53.5% 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
- 18 hospitals with 10-38 beds
- Same-state prioritization (n=19)
- Comp margins: P25=-21.7% / P50=-3.0% / P75=14.2%
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.