CARLINVILLE AREA HOSPITAL
1. Target Overview & Investment Thesis
CARLINVILLE AREA HOSPITAL is a 25-bed rural/critical access in MACOUPIN, IL with $44.6M in net patient revenue and a 1.3% operating margin. The hospital serves a payer mix of 59.7% Medicare, 5.3% Medicaid, and 35.0% commercial.
Thesis: Turnaround. Our ML models identify $3.3M in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from 1.3% to 8.7% (+736bps).
| Net Revenue HCRIS | $44.6M |
| Current EBITDA COMPUTED | $577K |
| Operating Margin COMPUTED | 1.3% |
| Occupancy HCRIS | 30.3% |
| Revenue / Bed COMPUTED | $1.8M |
| Net-to-Gross HCRIS | 47.8% |
| Distress Probability ML | 55.2% |
2. Market Context & Competitive Position
IL has 208 Medicare-certified hospitals with a median operating margin of -5.3%. The target's margin of 1.3% places it above the state median. Among 74 size-comparable peers (12-50 beds), the median margin is -2.2%. The target performs in line with or above peers.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (12-50), prioritizing same-state peers. 74 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| CARLINVILLE AREA HOSPITAL (Target) | IL | 25 | $44.6M | 1.3% |
| GIBSON AREA HOSPITAL AND HEALT | IL | 25 | $125.0M | -6.7% |
| GRAHAM HOSPITAL ASSOCIATION | IL | 43 | $105.0M | -4.7% |
| PARIS COMMUNITY HOSPITAL | IL | 25 | $100.7M | -4.2% |
| OSF SAINT ANTHONYS HEALTH CENT | IL | 49 | $91.4M | -9.8% |
| ST. MARGARETS HEALTH - SPRING | IL | 44 | $88.1M | -12.7% |
| SAINT JOSEPH MEMORIAL HOSPITAL | IL | 25 | $86.0M | 33.9% |
| MCDONOUGH DISTRICT HOSPITAL | IL | 45 | $79.6M | -4.2% |
| WABASH GENERAL HOSPITAL | IL | 25 | $71.8M | 4.5% |
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: $3.3M (736bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $936K | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $891K | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $882K | +198bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $542K | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $29K | +6bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $577K |
| + RCM Uplift | +$3.3M |
| Pro Forma EBITDA | $3.9M |
| Current Margin | 1.3% |
| Pro Forma Margin | 8.7% |
| WC Released (1x) | $1.7M |
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 | $888K | $36.6M | 41.25x | 110.4% |
| Base (11x exit) | 10.0x | 11.0x | $888K | $40.6M | 45.69x | 114.8% |
| Bull Case | 9.0x | 11.0x | $799K | $51.7M | 64.68x | 130.2% |
| Bull (12x exit) | 9.0x | 12.0x | $799K | $56.6M | 70.86x | 134.5% |
| Bear Case | 11.0x | 10.0x | $976K | $19.9M | 20.40x | 82.8% |
| Bear (11x exit) | 11.0x | 11.0x | $976K | $22.2M | 22.77x | 86.8% |
7. Key Risks & Mitigants
| Severity | Risk Factor | Mitigant |
|---|---|---|
| Medium | Heavy Medicare dependence | Medicare comprises 59.7% of days; rate updates may lag inflation. Mitigant: CDI/CMI lever directly increases Medicare reimbursement |
| Medium | Low occupancy | At 30.3%, 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 55.2% 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
- 74 hospitals with 12-50 beds
- Same-state prioritization (n=75)
- Comp margins: P25=-7.5% / P50=-2.2% / P75=6.2%
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.