CARSON CITY HOSPITAL
1. Target Overview & Investment Thesis
CARSON CITY HOSPITAL is a 48-bed under-performing / distressed in MONTCALM, MI with $43.8M in net patient revenue and a -16.6% operating margin. The hospital serves a payer mix of 32.8% Medicare, 1.4% Medicaid, and 65.8% commercial.
Thesis: Turnaround. Our ML models identify $3.2M in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from -16.6% to -9.2% (+736bps).
| Net Revenue HCRIS | $43.8M |
| Current EBITDA COMPUTED | $-7.2M |
| Operating Margin COMPUTED | -16.6% |
| Occupancy HCRIS | 10.5% |
| Revenue / Bed COMPUTED | $912K |
| Net-to-Gross HCRIS | 34.7% |
| Distress Probability ML | 57.6% |
2. Market Context & Competitive Position
MI has 163 Medicare-certified hospitals with a median operating margin of -5.2%. The target's margin of -16.6% places it below the state median. Among 74 size-comparable peers (24-96 beds), the median margin is -3.3%. The target's below-peer margin suggests operational improvement opportunity.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (24-96), prioritizing same-state peers. 74 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| CARSON CITY HOSPITAL (Target) | MI | 48 | $43.8M | -16.6% |
| TRINITY HEALTH LIVINGSTON | MI | 42 | $200.4M | 15.2% |
| CHELSEA HOSPITAL | MI | 79 | $187.8M | -1.1% |
| OAKLAWN HOSPITAL | MI | 78 | $156.6M | -12.4% |
| MYMICHIGAN MEDICAL CENTER ALMA | MI | 49 | $142.2M | -5.9% |
| SPECTRUM HEALTH UNITED MEMORIA | MI | 45 | $129.4M | 9.7% |
| MCLAREN LAPEER REGION | MI | 92 | $127.1M | -1.5% |
| DICKINSON COUNTY HEALTHCARE SY | MI | 49 | $126.3M | -4.7% |
| PROMEDICA HICKMAN HOSPITAL | MI | 58 | $124.7M | 5.5% |
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: $3.2M (736bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $919K | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $875K | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $867K | +198bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $533K | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $28K | +6bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $-7.2M |
| + RCM Uplift | +$3.2M |
| Pro Forma EBITDA | $-4.0M |
| Current Margin | -16.6% |
| Pro Forma Margin | -9.2% |
| WC Released (1x) | $1.7M |
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 | $-11.2M | $-15.6M | 0.00x | -100.0% |
| Base (11x exit) | 10.0x | 11.0x | $-11.2M | $-20.8M | 0.00x | -100.0% |
| Bull Case | 9.0x | 11.0x | $-10.0M | $-13.8M | 0.00x | -100.0% |
| Bull (12x exit) | 9.0x | 12.0x | $-10.0M | $-18.0M | 0.00x | -100.0% |
| Bear Case | 11.0x | 10.0x | $-12.3M | $-28.1M | 0.00x | -100.0% |
| Bear (11x exit) | 11.0x | 11.0x | $-12.3M | $-34.9M | 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 | Low occupancy | At 10.5%, 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 57.6% 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
- 74 hospitals with 24-96 beds
- Same-state prioritization (n=75)
- Comp margins: P25=-12.0% / P50=-3.3% / P75=7.7%
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.