ROOKS COUNTY HEALTH CENTER
1. Target Overview & Investment Thesis
ROOKS COUNTY HEALTH CENTER is a 22-bed rural/critical access in ROOKS, KS with $19.8M in net patient revenue and a -3.5% operating margin. The hospital serves a payer mix of 74.6% Medicare, 0.2% Medicaid, and 25.1% commercial.
Thesis: Turnaround. Our ML models identify $1.5M in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from -3.5% to 3.8% (+736bps).
| Net Revenue HCRIS | $19.8M |
| Current EBITDA COMPUTED | $-703K |
| Operating Margin COMPUTED | -3.5% |
| Occupancy HCRIS | 27.0% |
| Revenue / Bed COMPUTED | $902K |
| Net-to-Gross HCRIS | 57.6% |
| Distress Probability ML | 57.7% |
2. Market Context & Competitive Position
KS has 152 Medicare-certified hospitals with a median operating margin of -17.7%. The target's margin of -3.5% places it above the state median. Among 109 size-comparable peers (11-44 beds), the median margin is -20.8%. The target performs in line with or above peers.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (11-44), prioritizing same-state peers. 109 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| ROOKS COUNTY HEALTH CENTER (Target) | KS | 22 | $19.8M | -3.5% |
| CHILDRENS MERCY HOSPITAL KANSA | KS | 42 | $108.5M | 14.7% |
| KANSAS CITY ORTHOPAEDIC INSTIT | KS | 17 | $86.3M | 21.1% |
| NEWMAN REGIONAL HEALTH | KS | 23 | $73.9M | -15.6% |
| KANSAS SPINE & SPECIALTY HOSPI | KS | 35 | $69.6M | 19.1% |
| KANSAS SURGERY & RECOVERY CENT | KS | 30 | $62.8M | 20.0% |
| VIA CHRISTI HOSP. WICHITA ST. | KS | 38 | $55.1M | 16.7% |
| UKHS GREAT BEND CAMPUS | KS | 29 | $53.8M | -22.8% |
| NEOSHO MEMORIAL REGIONAL MED C | KS | 21 | $53.8M | -13.0% |
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% | $417K | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $397K | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $393K | +198bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $241K | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $13K | +6bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $-703K |
| + RCM Uplift | +$1.5M |
| Pro Forma EBITDA | $758K |
| Current Margin | -3.5% |
| Pro Forma Margin | 3.8% |
| WC Released (1x) | $761K |
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 | $-1.1M | $10.0M | 0.00x | -100.0% |
| Base (11x exit) | 10.0x | 11.0x | $-1.1M | $10.6M | 0.00x | -100.0% |
| Bull Case | 9.0x | 11.0x | $-973K | $15.1M | 0.00x | -100.0% |
| Bull (12x exit) | 9.0x | 12.0x | $-973K | $16.2M | 0.00x | -100.0% |
| Bear Case | 11.0x | 10.0x | $-1.2M | $3.0M | 0.00x | -100.0% |
| Bear (11x exit) | 11.0x | 11.0x | $-1.2M | $2.9M | 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 | Heavy Medicare dependence | Medicare comprises 74.6% of days; rate updates may lag inflation. Mitigant: CDI/CMI lever directly increases Medicare reimbursement |
| Medium | Low occupancy | At 27.0%, 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 57.7% 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
- 109 hospitals with 11-44 beds
- Same-state prioritization (n=110)
- Comp margins: P25=-31.3% / P50=-20.8% / P75=-11.7%
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.