TERRE HAUTE REGIONAL HOSPITAL
1. Target Overview & Investment Thesis
TERRE HAUTE REGIONAL HOSPITAL is a 141-bed suburban community hospital in VIGO, IN with $112.3M in net patient revenue and a 14.5% operating margin. The hospital serves a payer mix of 32.7% Medicare, 5.8% Medicaid, and 61.5% commercial.
Thesis: Turnaround. Our ML models identify $8.3M in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from 14.5% to 21.8% (+736bps).
| Net Revenue HCRIS | $112.3M |
| Current EBITDA COMPUTED | $16.2M |
| Operating Margin COMPUTED | 14.5% |
| Occupancy HCRIS | 32.0% |
| Revenue / Bed COMPUTED | $797K |
| Net-to-Gross HCRIS | 13.8% |
| Distress Probability ML | 51.9% |
2. Market Context & Competitive Position
IN has 171 Medicare-certified hospitals with a median operating margin of -1.1%. The target's margin of 14.5% places it above the state median. Among 51 size-comparable peers (70-282 beds), the median margin is 6.2%. The target performs in line with or above peers.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (70-282), prioritizing same-state peers. 51 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| TERRE HAUTE REGIONAL HOSPITAL (Target) | IN | 141 | $112.3M | 14.5% |
| UNION HOSPITAL INC. | IN | 258 | $581.9M | 3.8% |
| IU HEALTH BLOOMINGTON HOSPITAL | IN | 210 | $529.4M | 6.2% |
| REID HOSPITAL & HEALTH CARE SE | IN | 183 | $487.2M | 26.1% |
| IU HEALTH ARNETT HOSPITAL | IN | 194 | $426.2M | 16.1% |
| HENDRICKS REGIONAL HEALTH | IN | 130 | $423.4M | -3.6% |
| IU HEALTH NORTH HOSPITAL | IN | 153 | $413.3M | 24.2% |
| FRANCISCAN HEALTH LAFAYETTE | IN | 177 | $377.7M | 2.7% |
| PORTER REGIONAL HOSPITAL | IN | 199 | $370.6M | 22.1% |
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: $8.3M (736bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $2.4M | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $2.2M | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $2.2M | +198bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $1.4M | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $72K | +6bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $16.2M |
| + RCM Uplift | +$8.3M |
| Pro Forma EBITDA | $24.5M |
| Current Margin | 14.5% |
| Pro Forma Margin | 21.8% |
| WC Released (1x) | $4.3M |
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 | $25.0M | $189.8M | 7.60x | 50.0% |
| Base (11x exit) | 10.0x | 11.0x | $25.0M | $216.9M | 8.68x | 54.1% |
| Bull Case | 9.0x | 11.0x | $22.5M | $252.3M | 11.22x | 62.2% |
| Bull (12x exit) | 9.0x | 12.0x | $22.5M | $281.8M | 12.54x | 65.8% |
| Bear Case | 11.0x | 10.0x | $27.5M | $140.3M | 5.11x | 38.6% |
| Bear (11x exit) | 11.0x | 11.0x | $27.5M | $163.3M | 5.94x | 42.8% |
7. Key Risks & Mitigants
| Severity | Risk Factor | Mitigant |
|---|---|---|
| Medium | Low occupancy | At 32.0%, 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 51.9% 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
- 51 hospitals with 70-282 beds
- Same-state prioritization (n=52)
- Comp margins: P25=-8.2% / P50=6.2% / P75=18.7%
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.