PRESENCE MERCY MEDICAL CENTER
1. Target Overview & Investment Thesis
PRESENCE MERCY MEDICAL CENTER is a 190-bed suburban community hospital in KANE, IL with $177.3M in net patient revenue and a 1.5% operating margin. The hospital serves a payer mix of 26.8% Medicare, 6.7% Medicaid, and 66.5% commercial.
Thesis: Undervalued. Our ML models identify $13.1M in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from 1.5% to 8.9% (+736bps).
| Net Revenue HCRIS | $177.3M |
| Current EBITDA COMPUTED | $2.7M |
| Operating Margin COMPUTED | 1.5% |
| Occupancy HCRIS | 34.4% |
| Revenue / Bed COMPUTED | $933K |
| Net-to-Gross HCRIS | 18.0% |
| Distress Probability ML | 51.7% |
2. Market Context & Competitive Position
IL has 208 Medicare-certified hospitals with a median operating margin of -5.3%. The target's margin of 1.5% places it above the state median. Among 96 size-comparable peers (95-380 beds), the median margin is -8.2%. The target performs in line with or above peers.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (95-380), prioritizing same-state peers. 96 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| PRESENCE MERCY MEDICAL CENTER (Target) | IL | 190 | $177.3M | 1.5% |
| CENTRAL DUPAGE HOSPITAL | IL | 347 | $1.30B | 16.4% |
| ANN & ROBERT H. LURIE CHILDREN | IL | 364 | $1.17B | -12.8% |
| SWEDISHAMERICAN HOSPITAL | IL | 324 | $752.0M | -2.8% |
| ADVOCATE NORTHSIDE HEALTH SYST | IL | 233 | $713.2M | 18.5% |
| NORTHERN ILLINOIS MEDICAL CENT | IL | 259 | $640.9M | -12.5% |
| BLESSING HOSPITAL | IL | 309 | $522.4M | -13.2% |
| NORTHWESTERN LAKE FOREST HOSPI | IL | 124 | $494.3M | -13.8% |
| SILVER CROSS HOSPITAL | IL | 296 | $479.7M | -1.1% |
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: $13.1M (736bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $3.7M | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $3.5M | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $3.5M | +198bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $2.2M | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $113K | +6bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $2.7M |
| + RCM Uplift | +$13.1M |
| Pro Forma EBITDA | $15.8M |
| Current Margin | 1.5% |
| Pro Forma Margin | 8.9% |
| WC Released (1x) | $6.8M |
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 | $4.2M | $148.5M | 35.42x | 104.1% |
| Base (11x exit) | 10.0x | 11.0x | $4.2M | $164.7M | 39.29x | 108.4% |
| Bull Case | 9.0x | 11.0x | $3.8M | $209.2M | 55.44x | 123.2% |
| Bull (12x exit) | 9.0x | 12.0x | $3.8M | $229.3M | 60.77x | 127.4% |
| Bear Case | 11.0x | 10.0x | $4.6M | $81.9M | 17.76x | 77.8% |
| Bear (11x exit) | 11.0x | 11.0x | $4.6M | $91.6M | 19.86x | 81.8% |
7. Key Risks & Mitigants
| Severity | Risk Factor | Mitigant |
|---|---|---|
| Medium | Low occupancy | At 34.4%, 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 51.7% probability of financial distress. Mitigant: distressed entry pricing (7-9x) compensates for risk |
| Low | Low net-to-gross ratio | Large contractual allowances suggest pricing discipline issues. Mitigant: payer renegotiation is an additional upside lever |
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
- 96 hospitals with 95-380 beds
- Same-state prioritization (n=97)
- Comp margins: P25=-20.8% / P50=-8.2% / P75=3.1%
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.