SSH - ANN ARBOR
1. Target Overview & Investment Thesis
SSH - ANN ARBOR is a 36-bed suburban community hospital in WASHTENAW, MI with $22.1M in net patient revenue and a 1.2% operating margin. The hospital serves a payer mix of 36.4% Medicare, 0.3% Medicaid, and 63.3% commercial.
Thesis: Turnaround. Our ML models identify $1.6M in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from 1.2% to 8.5% (+736bps).
| Net Revenue HCRIS | $22.1M |
| Current EBITDA COMPUTED | $259K |
| Operating Margin COMPUTED | 1.2% |
| Occupancy HCRIS | 84.5% |
| Revenue / Bed COMPUTED | $615K |
| Net-to-Gross HCRIS | 17.5% |
| Distress Probability ML | 39.0% |
2. Market Context & Competitive Position
MI has 163 Medicare-certified hospitals with a median operating margin of -5.2%. The target's margin of 1.2% places it above the state median. Among 74 size-comparable peers (18-72 beds), the median margin is -3.3%. The target performs in line with or above peers.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (18-72), prioritizing same-state peers. 74 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| SSH - ANN ARBOR (Target) | MI | 36 | $22.1M | 1.2% |
| 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% |
| PROMEDICA HICKMAN HOSPITAL | MI | 58 | $124.7M | 5.5% |
| 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% |
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: $1.6M (736bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $465K | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $443K | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $438K | +198bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $269K | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $14K | +6bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $259K |
| + RCM Uplift | +$1.6M |
| Pro Forma EBITDA | $1.9M |
| Current Margin | 1.2% |
| Pro Forma Margin | 8.5% |
| WC Released (1x) | $849K |
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 | $399K | $18.0M | 45.15x | 114.2% |
| Base (11x exit) | 10.0x | 11.0x | $399K | $19.9M | 49.99x | 118.7% |
| Bull Case | 9.0x | 11.0x | $359K | $25.4M | 70.88x | 134.5% |
| Bull (12x exit) | 9.0x | 12.0x | $359K | $27.9M | 77.62x | 138.8% |
| Bear Case | 11.0x | 10.0x | $439K | $9.7M | 22.17x | 85.9% |
| Bear (11x exit) | 11.0x | 11.0x | $439K | $10.8M | 24.72x | 89.9% |
7. Key Risks & Mitigants
| Severity | Risk Factor | Mitigant |
|---|---|---|
| Low | Low net-to-gross ratio | Large contractual allowances suggest pricing discipline issues. Mitigant: payer renegotiation is an additional upside lever |
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 18-72 beds
- Same-state prioritization (n=75)
- Comp margins: P25=-12.3% / P50=-3.3% / P75=8.4%
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.