FISHERMENS HOSPITAL
1. Target Overview & Investment Thesis
FISHERMENS HOSPITAL is a 8-bed community hospital in MONROE, FL with $43.0M in net patient revenue and a 23.5% operating margin. The hospital serves a payer mix of 59.0% Medicare, 0.0% Medicaid, and 41.0% commercial.
Thesis: Turnaround. Our ML models identify $3.2M in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from 23.5% to 30.9% (+736bps).
| Net Revenue HCRIS | $43.0M |
| Current EBITDA COMPUTED | $10.1M |
| Operating Margin COMPUTED | 23.5% |
| Occupancy HCRIS | 4.6% |
| Revenue / Bed COMPUTED | $5.4M |
| Net-to-Gross HCRIS | 44.0% |
| 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 23.5% places it above the state median. Among 383 size-comparable peers (4-16 beds), the median margin is -9.5%. The target performs in line with or above peers.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (4-16), prioritizing same-state peers. 383 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| FISHERMENS HOSPITAL (Target) | FL | 8 | $43.0M | 23.5% |
| WENATCHEE VALLEY HOSPITAL | WA | 11 | $277.5M | -4.9% |
| NATIONAL JEWISH HEALTH | CO | 13 | $150.4M | -50.0% |
| FRANCISCAN HEALTH HAMMOND | IN | 10 | $117.7M | -4.3% |
| NEW YORK EYE AND EAR INFIRMARY | NY | 15 | $112.8M | -28.0% |
| OAK LEAF SURGICAL HOSPITAL LLC | WI | 13 | $109.8M | 34.1% |
| ST MARYS HOSPITAL SUPERIOR | WI | 16 | $98.2M | 18.6% |
| ARIZONA GENERAL HOSPITAL | AZ | 16 | $97.1M | 10.4% |
| JEWISH HOME FOR THE AGED | CA | 13 | $88.0M | -48.0% |
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: $3.2M (736bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $904K | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $861K | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $852K | +198bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $524K | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $28K | +6bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $10.1M |
| + RCM Uplift | +$3.2M |
| Pro Forma EBITDA | $13.3M |
| Current Margin | 23.5% |
| Pro Forma Margin | 30.9% |
| WC Released (1x) | $1.7M |
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 | $15.6M | $98.5M | 6.32x | 44.6% |
| Base (11x exit) | 10.0x | 11.0x | $15.6M | $113.4M | 7.28x | 48.7% |
| Bull Case | 9.0x | 11.0x | $14.0M | $128.9M | 9.19x | 55.9% |
| Bull (12x exit) | 9.0x | 12.0x | $14.0M | $144.8M | 10.32x | 59.5% |
| Bear Case | 11.0x | 10.0x | $17.1M | $77.6M | 4.53x | 35.3% |
| Bear (11x exit) | 11.0x | 11.0x | $17.1M | $90.9M | 5.30x | 39.6% |
7. Key Risks & Mitigants
| Severity | Risk Factor | Mitigant |
|---|---|---|
| Medium | Heavy Medicare dependence | Medicare comprises 59.0% of days; rate updates may lag inflation. Mitigant: CDI/CMI lever directly increases Medicare reimbursement |
| Medium | Low occupancy | At 4.6%, 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
- 383 hospitals with 4-16 beds
- Same-state prioritization (n=3)
- Comp margins: P25=-25.3% / P50=-9.5% / P75=3.1%
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.