KIOWA COUNTY MEMORIAL HOSPTIAL
1. Target Overview & Investment Thesis
KIOWA COUNTY MEMORIAL HOSPTIAL is a 15-bed safety-net/medicaid heavy in KIOWA, KS with $7.5M in net patient revenue and a -42.9% operating margin. The hospital serves a payer mix of 22.8% Medicare, 34.6% Medicaid, and 42.6% commercial.
Thesis: Turnaround. Our ML models identify $559K in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from -42.9% to -35.4% (+748bps).
| Net Revenue HCRIS | $7.5M |
| Current EBITDA COMPUTED | $-3.2M |
| Operating Margin COMPUTED | -42.9% |
| Occupancy HCRIS | 39.3% |
| Revenue / Bed COMPUTED | $499K |
| Net-to-Gross HCRIS | 131.8% |
| Distress Probability ML | 66.0% |
2. Market Context & Competitive Position
KS has 152 Medicare-certified hospitals with a median operating margin of -17.7%. The target's margin of -42.9% places it below the state median. Among 99 size-comparable peers (8-30 beds), the median margin is -20.7%. The target's below-peer margin suggests operational improvement opportunity.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (8-30), prioritizing same-state peers. 99 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| KIOWA COUNTY MEMORIAL HOSPTIAL (Target) | KS | 15 | $7.5M | -42.9% |
| KANSAS CITY ORTHOPAEDIC INSTIT | KS | 17 | $86.3M | 21.1% |
| NEWMAN REGIONAL HEALTH | KS | 23 | $73.9M | -15.6% |
| KANSAS SURGERY & RECOVERY CENT | KS | 30 | $62.8M | 20.0% |
| UKHS GREAT BEND CAMPUS | KS | 29 | $53.8M | -22.8% |
| NEOSHO MEMORIAL REGIONAL MED C | KS | 21 | $53.8M | -13.0% |
| ATCHISON HOSPITAL ASSOCIATION | KS | 25 | $50.3M | -11.7% |
| CITIZENS MEDICAL CENTER | KS | 23 | $49.5M | -13.9% |
| WILLIAM NEWTON MEMORIAL HOSPIT | KS | 23 | $42.2M | -20.3% |
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: $559K (748bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $157K | +210bp | 18mo |
| Denial Rate Reduction | 12.0% | 6.5% | $152K | +204bp | 12mo |
| Cost to Collect | 4.5% | 2.5% | $150K | +200bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $91K | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $10K | +13bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $-3.2M |
| + RCM Uplift | +$559K |
| Pro Forma EBITDA | $-2.6M |
| Current Margin | -42.9% |
| Pro Forma Margin | -35.4% |
| WC Released (1x) | $287K |
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 | $-4.9M | $-15.6M | 0.00x | -100.0% |
| Base (11x exit) | 10.0x | 11.0x | $-4.9M | $-18.7M | 0.00x | -100.0% |
| Bull Case | 9.0x | 11.0x | $-4.4M | $-18.5M | 0.00x | -100.0% |
| Bull (12x exit) | 9.0x | 12.0x | $-4.4M | $-21.5M | 0.00x | -100.0% |
| Bear Case | 11.0x | 10.0x | $-5.4M | $-16.7M | 0.00x | -100.0% |
| Bear (11x exit) | 11.0x | 11.0x | $-5.4M | $-20.2M | 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 | Elevated Medicaid exposure (34.6%) | Medicaid reimburses below cost in most states. Mitigant: denial reduction lever has highest impact on Medicaid claims |
| High | Elevated distress probability | Model estimates 66.0% 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
- 99 hospitals with 8-30 beds
- Same-state prioritization (n=102)
- Comp margins: P25=-31.1% / P50=-20.7% / P75=-12.1%
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.