ASCENSION BORGESS-LEE HOSPITAL
1. Target Overview & Investment Thesis
ASCENSION BORGESS-LEE HOSPITAL is a 25-bed under-performing / distressed in CASS, MI with $18.2M in net patient revenue and a -19.8% operating margin. The hospital serves a payer mix of 30.4% Medicare, 2.5% Medicaid, and 67.1% commercial.
Thesis: Turnaround. Our ML models identify $1.3M in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from -19.8% to -12.5% (+736bps).
| Net Revenue HCRIS | $18.2M |
| Current EBITDA COMPUTED | $-3.6M |
| Operating Margin COMPUTED | -19.8% |
| Occupancy HCRIS | 22.7% |
| Revenue / Bed COMPUTED | $728K |
| Net-to-Gross HCRIS | 42.7% |
| Distress Probability ML | 56.0% |
2. Market Context & Competitive Position
MI has 163 Medicare-certified hospitals with a median operating margin of -5.2%. The target's margin of -19.8% places it below the state median. Among 72 size-comparable peers (12-50 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 (12-50), prioritizing same-state peers. 72 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| ASCENSION BORGESS-LEE HOSPITAL (Target) | MI | 25 | $18.2M | -19.8% |
| TRINITY HEALTH LIVINGSTON | MI | 42 | $200.4M | 15.2% |
| MYMICHIGAN MEDICAL CENTER ALMA | MI | 49 | $142.2M | -5.9% |
| SPECTRUM HEALTH UNITED MEMORIA | MI | 45 | $129.4M | 9.7% |
| DICKINSON COUNTY HEALTHCARE SY | MI | 49 | $126.3M | -4.7% |
| MUNSON HEALTHCARE CADILLAC HOS | MI | 49 | $122.7M | 1.0% |
| MCLAREN CENTRAL MICHIGAN | MI | 49 | $118.9M | -35.3% |
| SPECTRUM HEALTH GERBER | MI | 25 | $116.2M | 16.0% |
| SPECTRUM HEALTH LUDINGTON | MI | 45 | $110.1M | 5.3% |
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: $1.3M (736bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $382K | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $364K | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $360K | +198bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $222K | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $12K | +6bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $-3.6M |
| + RCM Uplift | +$1.3M |
| Pro Forma EBITDA | $-2.3M |
| Current Margin | -19.8% |
| Pro Forma Margin | -12.5% |
| WC Released (1x) | $698K |
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 | $-5.6M | $-10.4M | 0.00x | -100.0% |
| Base (11x exit) | 10.0x | 11.0x | $-5.6M | $-13.3M | 0.00x | -100.0% |
| Bull Case | 9.0x | 11.0x | $-5.0M | $-10.6M | 0.00x | -100.0% |
| Bull (12x exit) | 9.0x | 12.0x | $-5.0M | $-13.1M | 0.00x | -100.0% |
| Bear Case | 11.0x | 10.0x | $-6.1M | $-15.3M | 0.00x | -100.0% |
| Bear (11x exit) | 11.0x | 11.0x | $-6.1M | $-18.8M | 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 |
| Medium | Low occupancy | At 22.7%, 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 56.0% 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
- 72 hospitals with 12-50 beds
- Same-state prioritization (n=73)
- Comp margins: P25=-10.9% / P50=-3.3% / P75=8.1%
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.