CENTRAL STATE HOSPITAL
1. Target Overview & Investment Thesis
CENTRAL STATE HOSPITAL is a 70-bed under-performing / distressed in JEFFERSON, KY with $4.7M in net patient revenue and a -100.0% operating margin. The hospital serves a payer mix of 7.2% Medicare, 0.3% Medicaid, and 92.4% commercial.
Thesis: Turnaround. Our ML models identify $361K in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from -100.0% to -428.2% (+762bps).
| Net Revenue HCRIS | $4.7M |
| Current EBITDA COMPUTED | $-20.6M |
| Operating Margin COMPUTED | -100.0% |
| Occupancy HCRIS | 74.7% |
| Revenue / Bed COMPUTED | $68K |
| Net-to-Gross HCRIS | 22.2% |
| Distress Probability ML | 41.4% |
2. Market Context & Competitive Position
KY has 114 Medicare-certified hospitals with a median operating margin of -0.6%. The target's margin of -100.0% places it below the state median. Among 50 size-comparable peers (35-140 beds), the median margin is 0.1%. The target's below-peer margin suggests operational improvement opportunity.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (35-140), prioritizing same-state peers. 50 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| CENTRAL STATE HOSPITAL (Target) | KY | 70 | $4.7M | -100.0% |
| BAPTIST HEALTH LAGRANGE | KY | 42 | $236.9M | 2.7% |
| ST. ELIZABETH FLORENCE | KY | 134 | $212.6M | 8.8% |
| SAINT JOSEPH EAST | KY | 138 | $209.5M | 2.6% |
| ST. CLAIRE MEDICAL CENTER | KY | 100 | $204.5M | -8.5% |
| HAZARD ARH | KY | 109 | $200.8M | -32.3% |
| T.J. SAMSON COMMUNITY HOSPITAL | KY | 112 | $189.4M | -10.5% |
| SAINT JOSEPH LONDON | KY | 118 | $173.7M | -8.1% |
| JENNIE STUART MEDICAL CENTER | KY | 122 | $165.3M | -6.1% |
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: $361K (762bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $99K | +210bp | 18mo |
| Denial Rate Reduction | 12.0% | 6.5% | $99K | +210bp | 12mo |
| Cost to Collect | 4.5% | 2.5% | $95K | +200bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $58K | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $10K | +20bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $-20.6M |
| + RCM Uplift | +$361K |
| Pro Forma EBITDA | $-20.3M |
| Current Margin | -100.0% |
| Pro Forma Margin | -428.2% |
| WC Released (1x) | $182K |
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 | $-31.8M | $-132.6M | 0.00x | -100.0% |
| Base (11x exit) | 10.0x | 11.0x | $-31.8M | $-156.2M | 0.00x | -100.0% |
| Bull Case | 9.0x | 11.0x | $-28.6M | $-165.3M | 0.00x | -100.0% |
| Bull (12x exit) | 9.0x | 12.0x | $-28.6M | $-188.7M | 0.00x | -100.0% |
| Bear Case | 11.0x | 10.0x | $-34.9M | $-124.1M | 0.00x | -100.0% |
| Bear (11x exit) | 11.0x | 11.0x | $-34.9M | $-147.8M | 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 |
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
- 50 hospitals with 35-140 beds
- Same-state prioritization (n=51)
- Comp margins: P25=-9.3% / P50=0.1% / P75=10.3%
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.