LAKE BUTLER HOSPITAL
1. Target Overview & Investment Thesis
LAKE BUTLER HOSPITAL is a 25-bed community hospital in UNION, FL with $12.9M in net patient revenue and a 9.4% operating margin. The hospital serves a payer mix of 63.9% Medicare, 0.0% Medicaid, and 36.1% commercial.
Thesis: Turnaround. Our ML models identify $954K in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from 9.4% to 16.8% (+738bps).
| Net Revenue HCRIS | $12.9M |
| Current EBITDA COMPUTED | $1.2M |
| Operating Margin COMPUTED | 9.4% |
| Occupancy HCRIS | 27.3% |
| Revenue / Bed COMPUTED | $517K |
| Net-to-Gross HCRIS | 37.1% |
| Distress Probability ML | nan% |
2. Market Context & Competitive Position
FL has 261 Medicare-certified hospitals with a median operating margin of 3.2%. The target's margin of 9.4% places it above the state median. Among 41 size-comparable peers (12-50 beds), the median margin is -2.4%. The target performs in line with or above peers.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (12-50), prioritizing same-state peers. 41 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| LAKE BUTLER HOSPITAL (Target) | FL | 25 | $12.9M | 9.4% |
| MARINERS HOSPITAL | FL | 16 | $74.3M | 17.0% |
| MEDICAL CENTER OF DELTONA | FL | 43 | $45.4M | -30.2% |
| HENDRY REGIONAL MEDICAL CENTER | FL | 25 | $41.1M | -20.8% |
| ED FRASER MEMORIAL HOSPITAL | FL | 21 | $40.7M | 17.8% |
| DESOTO MEMORIAL HOSPITAL | FL | 49 | $38.5M | -18.7% |
| 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% |
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: $954K (738bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $271K | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $259K | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $257K | +199bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $157K | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $10K | +7bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $1.2M |
| + RCM Uplift | +$954K |
| Pro Forma EBITDA | $2.2M |
| Current Margin | 9.4% |
| Pro Forma Margin | 16.8% |
| WC Released (1x) | $496K |
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 | $1.9M | $17.6M | 9.37x | 56.5% |
| Base (11x exit) | 10.0x | 11.0x | $1.9M | $20.0M | 10.63x | 60.5% |
| Bull Case | 9.0x | 11.0x | $1.7M | $23.7M | 14.04x | 69.6% |
| Bull (12x exit) | 9.0x | 12.0x | $1.7M | $26.4M | 15.61x | 73.3% |
| Bear Case | 11.0x | 10.0x | $2.1M | $12.2M | 5.91x | 42.7% |
| Bear (11x exit) | 11.0x | 11.0x | $2.1M | $14.1M | 6.83x | 46.9% |
7. Key Risks & Mitigants
| Severity | Risk Factor | Mitigant |
|---|---|---|
| Medium | Heavy Medicare dependence | Medicare comprises 63.9% of days; rate updates may lag inflation. Mitigant: CDI/CMI lever directly increases Medicare reimbursement |
| Medium | Low occupancy | At 27.3%, fixed costs are spread over fewer patient days. Mitigant: volume growth is an additional upside lever not modeled in base case |
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
- 41 hospitals with 12-50 beds
- Same-state prioritization (n=42)
- Comp margins: P25=-25.1% / P50=-2.4% / P75=8.1%
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.