ASCENSION ST VINCENT SETON SPECIALTY
1. Target Overview & Investment Thesis
ASCENSION ST VINCENT SETON SPECIALTY is a 72-bed community hospital in MARION, IN with $19.9M in net patient revenue and a 7.6% operating margin. The hospital serves a payer mix of 38.1% Medicare, 0.0% Medicaid, and 61.9% commercial.
Thesis: Turnaround. Our ML models identify $1.5M in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from 7.6% to 14.9% (+736bps).
| Net Revenue HCRIS | $19.9M |
| Current EBITDA COMPUTED | $1.5M |
| Operating Margin COMPUTED | 7.6% |
| Occupancy HCRIS | 27.1% |
| Revenue / Bed COMPUTED | $277K |
| Net-to-Gross HCRIS | 34.5% |
| Distress Probability ML | nan% |
2. Market Context & Competitive Position
IN has 171 Medicare-certified hospitals with a median operating margin of -1.1%. The target's margin of 7.6% places it above the state median. Among 75 size-comparable peers (36-144 beds), the median margin is 1.3%. The target performs in line with or above peers.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (36-144), prioritizing same-state peers. 75 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| ASCENSION ST VINCENT SETON SPE (Target) | IN | 72 | $19.9M | 7.6% |
| HENDRICKS REGIONAL HEALTH | IN | 130 | $423.4M | -3.6% |
| FRANCISCAN HEALTH MICHIGAN CIT | IN | 119 | $276.7M | 6.1% |
| ASCENSION ST. VINCENT CARMEL | IN | 124 | $268.5M | 38.3% |
| MEMORIAL HOSP & HEALTH CARE CT | IN | 96 | $259.1M | 28.7% |
| GOSHEN HOSPITAL | IN | 103 | $248.4M | -22.8% |
| RIVERVIEW HOSPITAL | IN | 121 | $233.1M | -19.0% |
| GOOD SAMARITAN HOSPITAL | IN | 99 | $233.1M | -12.9% |
| COMMUNITY HOSPITAL ANDERSON | IN | 128 | $214.6M | 1.3% |
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: $1.5M (736bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $418K | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $398K | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $394K | +198bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $242K | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $13K | +6bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $1.5M |
| + RCM Uplift | +$1.5M |
| Pro Forma EBITDA | $3.0M |
| Current Margin | 7.6% |
| Pro Forma Margin | 14.9% |
| WC Released (1x) | $764K |
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 | $2.3M | $24.6M | 10.61x | 60.4% |
| Base (11x exit) | 10.0x | 11.0x | $2.3M | $27.8M | 11.99x | 64.3% |
| Bull Case | 9.0x | 11.0x | $2.1M | $33.4M | 16.00x | 74.1% |
| Bull (12x exit) | 9.0x | 12.0x | $2.1M | $37.1M | 17.75x | 77.8% |
| Bear Case | 11.0x | 10.0x | $2.6M | $16.5M | 6.48x | 45.3% |
| Bear (11x exit) | 11.0x | 11.0x | $2.6M | $19.0M | 7.45x | 49.4% |
7. Key Risks & Mitigants
| Severity | Risk Factor | Mitigant |
|---|---|---|
| Medium | Low occupancy | At 27.1%, fixed costs are spread over fewer patient days. Mitigant: volume growth is an additional upside lever not modeled in base case |
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
- 75 hospitals with 36-144 beds
- Same-state prioritization (n=76)
- Comp margins: P25=-11.2% / P50=1.3% / P75=17.5%
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.