HALE HOOLA HAMAKUA
1. Target Overview & Investment Thesis
HALE HOOLA HAMAKUA is a 11-bed community hospital in HAWAII, HI with $20.2M in net patient revenue and a -20.3% operating margin. The hospital serves a payer mix of 44.2% Medicare, 0.0% Medicaid, and 55.8% commercial.
Thesis: Turnaround. Our ML models identify $1.5M in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from -20.3% to -12.9% (+736bps).
| Net Revenue HCRIS | $20.2M |
| Current EBITDA COMPUTED | $-4.1M |
| Operating Margin COMPUTED | -20.3% |
| Occupancy HCRIS | 60.2% |
| Revenue / Bed COMPUTED | $1.8M |
| Net-to-Gross HCRIS | 81.7% |
| Distress Probability ML | nan% |
2. Market Context & Competitive Position
HI has 26 Medicare-certified hospitals with a median operating margin of -14.7%. The target's margin of -20.3% places it below the state median. Among 715 size-comparable peers (6-22 beds), the median margin is -9.0%. The target's below-peer margin suggests operational improvement opportunity.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (6-22), prioritizing same-state peers. 715 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| HALE HOOLA HAMAKUA (Target) | HI | 11 | $20.2M | -20.3% |
| FRED HUTCHINSON CANCER CENTER | WA | 20 | $1.17B | -50.0% |
| WENATCHEE VALLEY HOSPITAL | WA | 11 | $277.5M | -4.9% |
| PORTERVILLE DEVELOPMENTAL CENT | CA | 17 | $193.6M | -6.0% |
| NATIONAL JEWISH HEALTH | CO | 13 | $150.4M | -50.0% |
| NORTON SOUND REGIONAL HOSPITAL | AK | 18 | $148.7M | -28.6% |
| TEXAS SPINE AND JOINT HOSPITAL | TX | 20 | $147.3M | 30.3% |
| GREAT FALLS CLINIC MEDICAL CEN | MT | 20 | $132.1M | 21.0% |
| MARSHFIELD MEDICAL CENTER-MINO | WI | 19 | $129.6M | -12.4% |
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: $1.5M (736bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $425K | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $405K | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $401K | +198bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $246K | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $13K | +6bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $-4.1M |
| + RCM Uplift | +$1.5M |
| Pro Forma EBITDA | $-2.6M |
| Current Margin | -20.3% |
| Pro Forma Margin | -12.9% |
| WC Released (1x) | $776K |
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 | $-6.3M | $-12.2M | 0.00x | -100.0% |
| Base (11x exit) | 10.0x | 11.0x | $-6.3M | $-15.5M | 0.00x | -100.0% |
| Bull Case | 9.0x | 11.0x | $-5.7M | $-12.6M | 0.00x | -100.0% |
| Bull (12x exit) | 9.0x | 12.0x | $-5.7M | $-15.4M | 0.00x | -100.0% |
| Bear Case | 11.0x | 10.0x | $-7.0M | $-17.6M | 0.00x | -100.0% |
| Bear (11x exit) | 11.0x | 11.0x | $-7.0M | $-21.6M | 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
- 715 hospitals with 6-22 beds
- Same-state prioritization (n=6)
- Comp margins: P25=-24.1% / P50=-9.0% / P75=1.7%
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.