ST. SIMONS BY THE SEA
1. Target Overview & Investment Thesis
ST. SIMONS BY THE SEA is a 101-bed community hospital in nan, GA with $14.1M in net patient revenue and a 6.3% operating margin. The hospital serves a payer mix of 9.4% Medicare, 0.0% Medicaid, and 90.6% commercial.
Thesis: Turnaround. Our ML models identify $1.0M in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from 6.3% to 13.7% (+737bps).
| Net Revenue HCRIS | $14.1M |
| Current EBITDA COMPUTED | $896K |
| Operating Margin COMPUTED | 6.3% |
| Occupancy HCRIS | 51.4% |
| Revenue / Bed COMPUTED | $140K |
| Net-to-Gross HCRIS | 32.9% |
| Distress Probability ML | nan% |
2. Market Context & Competitive Position
GA has 165 Medicare-certified hospitals with a median operating margin of -2.8%. The target's margin of 6.3% places it above the state median. Among 58 size-comparable peers (50-202 beds), the median margin is -0.8%. The target performs in line with or above peers.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (50-202), prioritizing same-state peers. 58 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| ST. SIMONS BY THE SEA (Target) | GA | 101 | $14.1M | 6.3% |
| TIFT REGIONAL MEDICAL CENTER | GA | 181 | $372.8M | -10.9% |
| PIEDMONT NEWNAN HOSPITAL INC. | GA | 177 | $366.0M | 19.2% |
| NORTH FULTON REGIONAL HOSPITAL | GA | 178 | $320.1M | 6.6% |
| TANNER MEDICAL CENTER | GA | 196 | $307.5M | -42.3% |
| ST. JOSEPHS HOSPITAL INC. | GA | 188 | $300.6M | -15.6% |
| TANNER MEDICAL CENTER-VILLA RI | GA | 58 | $289.8M | 33.3% |
| PAULDING MEDICAL CENTER | GA | 112 | $288.5M | 9.0% |
| EMORY JOHNS CREEK HOSPITAL | GA | 154 | $269.1M | 3.5% |
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: $1.0M (737bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $296K | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $282K | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $280K | +198bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $172K | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $10K | +7bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $896K |
| + RCM Uplift | +$1.0M |
| Pro Forma EBITDA | $1.9M |
| Current Margin | 6.3% |
| Pro Forma Margin | 13.7% |
| WC Released (1x) | $541K |
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 | $1.4M | $16.3M | 11.83x | 63.9% |
| Base (11x exit) | 10.0x | 11.0x | $1.4M | $18.4M | 13.34x | 67.9% |
| Bull Case | 9.0x | 11.0x | $1.2M | $22.3M | 17.95x | 78.2% |
| Bull (12x exit) | 9.0x | 12.0x | $1.2M | $24.7M | 19.88x | 81.8% |
| Bear Case | 11.0x | 10.0x | $1.5M | $10.7M | 7.03x | 47.7% |
| Bear (11x exit) | 11.0x | 11.0x | $1.5M | $12.2M | 8.06x | 51.8% |
7. Key Risks & Mitigants
| Severity | Risk Factor | Mitigant |
|---|---|---|
| Medium | Standard execution risk | RCM improvement requires management buy-in and 12-18 month implementation timeline |
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
- 58 hospitals with 50-202 beds
- Same-state prioritization (n=59)
- Comp margins: P25=-11.3% / P50=-0.8% / 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.