FRANKLIN MEMORIAL HOSPITAL
1. Target Overview & Investment Thesis
FRANKLIN MEMORIAL HOSPITAL is a 46-bed under-performing / distressed in FRANKLIN, ME with $103.4M in net patient revenue and a -17.3% operating margin. The hospital serves a payer mix of 22.9% Medicare, 11.0% Medicaid, and 66.1% commercial.
Thesis: Turnaround. Our ML models identify $7.6M in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from -17.3% to -10.0% (+736bps).
| Net Revenue HCRIS | $103.4M |
| Current EBITDA COMPUTED | $-17.9M |
| Operating Margin COMPUTED | -17.3% |
| Occupancy HCRIS | 50.3% |
| Revenue / Bed COMPUTED | $2.2M |
| Net-to-Gross HCRIS | 41.7% |
| Distress Probability ML | 49.1% |
2. Market Context & Competitive Position
ME has 38 Medicare-certified hospitals with a median operating margin of -8.3%. The target's margin of -17.3% places it below the state median. Among 28 size-comparable peers (23-92 beds), the median margin is -5.2%. The target's below-peer margin suggests operational improvement opportunity.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (23-92), prioritizing same-state peers. 28 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| FRANKLIN MEMORIAL HOSPITAL (Target) | ME | 46 | $103.4M | -17.3% |
| MERCY HOSPITAL | ME | 77 | $240.0M | -11.6% |
| YORK HOSPITAL | ME | 54 | $197.1M | -3.6% |
| PENOBSCOT BAY MEDICAL CENTER | ME | 81 | $171.6M | -21.7% |
| REDINGTON-FAIRVIEW GENERAL HOS | ME | 25 | $135.4M | -3.6% |
| THE AROOSTOOK MEDICAL CENTER | ME | 34 | $134.8M | -23.5% |
| LINCOLNHEALTH | ME | 25 | $116.8M | -0.9% |
| WALDO COUNTY GENERAL HOSPITAL | ME | 25 | $115.4M | -6.4% |
| STEPHENS MEMORIAL HOSPITAL - C | ME | 25 | $100.5M | 4.2% |
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: $7.6M (736bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $2.2M | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $2.1M | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $2.0M | +198bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $1.3M | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $66K | +6bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $-17.9M |
| + RCM Uplift | +$7.6M |
| Pro Forma EBITDA | $-10.3M |
| Current Margin | -17.3% |
| Pro Forma Margin | -10.0% |
| WC Released (1x) | $4.0M |
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 | $-27.5M | $-42.0M | 0.00x | -100.0% |
| Base (11x exit) | 10.0x | 11.0x | $-27.5M | $-55.2M | 0.00x | -100.0% |
| Bull Case | 9.0x | 11.0x | $-24.8M | $-39.0M | 0.00x | -100.0% |
| Bull (12x exit) | 9.0x | 12.0x | $-24.8M | $-49.9M | 0.00x | -100.0% |
| Bear Case | 11.0x | 10.0x | $-30.3M | $-71.1M | 0.00x | -100.0% |
| Bear (11x exit) | 11.0x | 11.0x | $-30.3M | $-88.1M | 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
- 28 hospitals with 23-92 beds
- Same-state prioritization (n=29)
- Comp margins: P25=-10.6% / P50=-5.2% / P75=0.6%
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.