CENTERSTONE OF FLORIDA INC.
1. Target Overview & Investment Thesis
CENTERSTONE OF FLORIDA INC. is a 41-bed community hospital in MANATEE, FL with $5.6M in net patient revenue and a -100.0% operating margin. The hospital serves a payer mix of 17.3% Medicare, 0.0% Medicaid, and 82.7% commercial.
Thesis: Turnaround. Our ML models identify $422K in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from -100.0% to -239.6% (+756bps).
| Net Revenue HCRIS | $5.6M |
| Current EBITDA COMPUTED | $-13.8M |
| Operating Margin COMPUTED | -100.0% |
| Occupancy HCRIS | 59.2% |
| Revenue / Bed COMPUTED | $136K |
| Net-to-Gross HCRIS | 45.7% |
| 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 -100.0% places it below the state median. Among 79 size-comparable peers (20-82 beds), the median margin is 2.2%. The target's below-peer margin suggests operational improvement opportunity.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (20-82), prioritizing same-state peers. 79 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| CENTERSTONE OF FLORIDA INC. (Target) | FL | 41 | $5.6M | -100.0% |
| ASCENSION SACRED HEART EMERALD | FL | 80 | $187.9M | 16.1% |
| GULF BREEZE HOSPITAL | FL | 65 | $121.8M | 12.8% |
| OVIEDO MEDICAL CENTER | FL | 64 | $110.9M | 7.4% |
| BARTOW REGIONAL MEDICAL CENTER | FL | 72 | $90.9M | 11.3% |
| BAPTIST MEDICAL CTR-NASSAU | FL | 54 | $85.1M | 2.1% |
| HCA FLORIDA PUTNAM HOSPITAL | FL | 82 | $82.7M | 11.5% |
| UCF LAKE NONA HOSPITAL | FL | 64 | $80.3M | 1.8% |
| BAYFRONT HEALTH PUNTA GORDA | FL | 82 | $78.7M | 3.9% |
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: $422K (756bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $117K | +210bp | 18mo |
| Denial Rate Reduction | 12.0% | 6.5% | $116K | +207bp | 12mo |
| Cost to Collect | 4.5% | 2.5% | $112K | +200bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $68K | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $10K | +17bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $-13.8M |
| + RCM Uplift | +$422K |
| Pro Forma EBITDA | $-13.4M |
| Current Margin | -100.0% |
| Pro Forma Margin | -239.6% |
| WC Released (1x) | $214K |
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 | $-21.2M | $-86.7M | 0.00x | -100.0% |
| Base (11x exit) | 10.0x | 11.0x | $-21.2M | $-102.3M | 0.00x | -100.0% |
| Bull Case | 9.0x | 11.0x | $-19.1M | $-107.8M | 0.00x | -100.0% |
| Bull (12x exit) | 9.0x | 12.0x | $-19.1M | $-123.2M | 0.00x | -100.0% |
| Bear Case | 11.0x | 10.0x | $-23.3M | $-81.9M | 0.00x | -100.0% |
| Bear (11x exit) | 11.0x | 11.0x | $-23.3M | $-97.7M | 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 |
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
- 79 hospitals with 20-82 beds
- Same-state prioritization (n=80)
- Comp margins: P25=-18.6% / P50=2.2% / P75=11.8%
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.