INTERMOUNTAIN
1. Target Overview & Investment Thesis
INTERMOUNTAIN is a 150-bed safety-net/medicaid heavy in ADA, ID with $31.5M in net patient revenue and a 26.3% operating margin. The hospital serves a payer mix of 12.2% Medicare, 45.4% Medicaid, and 42.5% commercial.
Thesis: Turnaround. Our ML models identify $2.3M in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from 26.3% to 33.7% (+736bps).
| Net Revenue HCRIS | $31.5M |
| Current EBITDA COMPUTED | $8.3M |
| Operating Margin COMPUTED | 26.3% |
| Occupancy HCRIS | 58.8% |
| Revenue / Bed COMPUTED | $210K |
| Net-to-Gross HCRIS | 25.0% |
| Distress Probability ML | 56.8% |
2. Market Context & Competitive Position
ID has 51 Medicare-certified hospitals with a median operating margin of -3.5%. The target's margin of 26.3% places it above the state median. Among 10 size-comparable peers (75-300 beds), the median margin is 5.2%. The target performs in line with or above peers.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (75-300), prioritizing same-state peers. 10 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| INTERMOUNTAIN (Target) | ID | 150 | $31.5M | 26.3% |
| ST LUKES MAGIC VALLEY REG MED | ID | 175 | $482.9M | -6.8% |
| PORTNEUF MEDICAL CENTER | ID | 142 | $390.3M | 13.4% |
| EASTERN IDAHO REGIONAL MEDICAL | ID | 233 | $370.5M | 42.0% |
| ST. ALPHONSUS MEDICAL CENTER - | ID | 96 | $263.3M | 15.2% |
| ST. LUKES NAMPA MEDICAL CENTER | ID | 87 | $255.6M | -10.1% |
| ST JOSEPH REGIONAL MEDICAL CEN | ID | 110 | $168.4M | -3.0% |
| WEST VALLEY MEDICAL CENTER | ID | 112 | $118.1M | 24.6% |
| IDAHO FALLS COMMUNITY HOSPITAL | ID | 88 | $98.9M | -23.1% |
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: $2.3M (736bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $662K | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $630K | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $624K | +198bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $383K | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $20K | +6bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $8.3M |
| + RCM Uplift | +$2.3M |
| Pro Forma EBITDA | $10.6M |
| Current Margin | 26.3% |
| Pro Forma Margin | 33.7% |
| WC Released (1x) | $1.2M |
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 | $12.7M | $77.8M | 6.11x | 43.6% |
| Base (11x exit) | 10.0x | 11.0x | $12.7M | $89.7M | 7.04x | 47.8% |
| Bull Case | 9.0x | 11.0x | $11.5M | $101.5M | 8.85x | 54.7% |
| Bull (12x exit) | 9.0x | 12.0x | $11.5M | $114.1M | 9.95x | 58.3% |
| Bear Case | 11.0x | 10.0x | $14.0M | $62.1M | 4.43x | 34.7% |
| Bear (11x exit) | 11.0x | 11.0x | $14.0M | $72.8M | 5.20x | 39.1% |
7. Key Risks & Mitigants
| Severity | Risk Factor | Mitigant |
|---|---|---|
| Medium | Elevated Medicaid exposure (45.4%) | Medicaid reimburses below cost in most states. Mitigant: denial reduction lever has highest impact on Medicaid claims |
| High | Elevated distress probability | Model estimates 56.8% probability of financial distress. Mitigant: distressed entry pricing (7-9x) compensates for risk |
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
- 10 hospitals with 75-300 beds
- Same-state prioritization (n=11)
- Comp margins: P25=-9.3% / P50=5.2% / P75=14.9%
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.