MCDONOUGH DISTRICT HOSPITAL
1. Target Overview & Investment Thesis
MCDONOUGH DISTRICT HOSPITAL is a 45-bed suburban community hospital in MC DONOUGH, IL with $79.6M in net patient revenue and a -4.2% operating margin. The hospital serves a payer mix of 39.2% Medicare, 5.7% Medicaid, and 55.2% commercial.
Thesis: Turnaround. Our ML models identify $5.9M in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from -4.2% to 3.1% (+736bps).
| Net Revenue HCRIS | $79.6M |
| Current EBITDA COMPUTED | $-3.4M |
| Operating Margin COMPUTED | -4.2% |
| Occupancy HCRIS | 21.3% |
| Revenue / Bed COMPUTED | $1.8M |
| Net-to-Gross HCRIS | 40.5% |
| Distress Probability ML | 55.8% |
2. Market Context & Competitive Position
IL has 208 Medicare-certified hospitals with a median operating margin of -5.3%. The target's margin of -4.2% places it above the state median. Among 72 size-comparable peers (22-90 beds), the median margin is -2.1%. The target's below-peer margin suggests operational improvement opportunity.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (22-90), prioritizing same-state peers. 72 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| MCDONOUGH DISTRICT HOSPITAL (Target) | IL | 45 | $79.6M | -4.2% |
| MIDWESTERN REGIONAL MEDICAL CE | IL | 73 | $1.38B | 80.5% |
| MORRIS HOSPITAL | IL | 89 | $210.8M | 1.7% |
| HERRIN HOSPITAL | IL | 85 | $198.4M | 20.2% |
| KATHERINE SHAW BETHEA HOSPITAL | IL | 66 | $136.9M | -12.8% |
| PROCTOR HOSPITAL | IL | 72 | $133.9M | 34.9% |
| GIBSON AREA HOSPITAL AND HEALT | IL | 25 | $125.0M | -6.7% |
| ST. MARY MEDICAL CENTER | IL | 83 | $116.4M | 15.0% |
| GRAHAM HOSPITAL ASSOCIATION | IL | 43 | $105.0M | -4.7% |
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: $5.9M (736bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $1.7M | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $1.6M | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $1.6M | +198bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $968K | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $51K | +6bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $-3.4M |
| + RCM Uplift | +$5.9M |
| Pro Forma EBITDA | $2.5M |
| Current Margin | -4.2% |
| Pro Forma Margin | 3.1% |
| WC Released (1x) | $3.1M |
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 | $-5.2M | $36.4M | 0.00x | -100.0% |
| Base (11x exit) | 10.0x | 11.0x | $-5.2M | $38.4M | 0.00x | -100.0% |
| Bull Case | 9.0x | 11.0x | $-4.7M | $56.0M | 0.00x | -100.0% |
| Bull (12x exit) | 9.0x | 12.0x | $-4.7M | $59.7M | 0.00x | -100.0% |
| Bear Case | 11.0x | 10.0x | $-5.7M | $8.8M | 0.00x | -100.0% |
| Bear (11x exit) | 11.0x | 11.0x | $-5.7M | $7.8M | 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 |
| Medium | Low occupancy | At 21.3%, fixed costs are spread over fewer patient days. Mitigant: volume growth is an additional upside lever not modeled in base case |
| High | Elevated distress probability | Model estimates 55.8% 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
- 72 hospitals with 22-90 beds
- Same-state prioritization (n=73)
- Comp margins: P25=-9.7% / P50=-2.1% / P75=11.3%
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.