CEDAR CREEK HOSPITAL
1. Target Overview & Investment Thesis
CEDAR CREEK HOSPITAL is a 54-bed community hospital in CLINTON, MI with $21.8M in net patient revenue and a 22.8% operating margin. The hospital serves a payer mix of 3.8% Medicare, 0.0% Medicaid, and 96.2% commercial.
Thesis: Turnaround. Our ML models identify $1.6M in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from 22.8% to 30.2% (+736bps).
| Net Revenue HCRIS | $21.8M |
| Current EBITDA COMPUTED | $5.0M |
| Operating Margin COMPUTED | 22.8% |
| Occupancy HCRIS | 88.5% |
| Revenue / Bed COMPUTED | $404K |
| Net-to-Gross HCRIS | 60.6% |
| Distress Probability ML | nan% |
2. Market Context & Competitive Position
MI has 163 Medicare-certified hospitals with a median operating margin of -5.2%. The target's margin of 22.8% places it above the state median. Among 51 size-comparable peers (27-108 beds), the median margin is -5.9%. The target performs in line with or above peers.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (27-108), prioritizing same-state peers. 51 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| CEDAR CREEK HOSPITAL (Target) | MI | 54 | $21.8M | 22.8% |
| KARMANOS CANCER HOSPITAL | MI | 106 | $284.8M | -27.8% |
| MCLAREN OAKLAND | MI | 107 | $214.4M | 1.6% |
| TRINITY HEALTH LIVINGSTON | MI | 42 | $200.4M | 15.2% |
| CHELSEA HOSPITAL | MI | 79 | $187.8M | -1.1% |
| BEAUMONT HOSPITAL - TAYLOR | MI | 99 | $184.3M | -0.2% |
| BEAUMONT HEALTH WAYNE | MI | 97 | $180.7M | -3.6% |
| OAKLAWN HOSPITAL | MI | 78 | $156.6M | -12.4% |
| MYMICHIGAN MEDICAL CENTER ALMA | MI | 49 | $142.2M | -5.9% |
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% | $458K | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $436K | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $432K | +198bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $265K | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $14K | +6bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $5.0M |
| + RCM Uplift | +$1.6M |
| Pro Forma EBITDA | $6.6M |
| Current Margin | 22.8% |
| Pro Forma Margin | 30.2% |
| WC Released (1x) | $836K |
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 | $7.6M | $48.8M | 6.39x | 44.9% |
| Base (11x exit) | 10.0x | 11.0x | $7.6M | $56.2M | 7.35x | 49.0% |
| Bull Case | 9.0x | 11.0x | $6.9M | $64.0M | 9.30x | 56.2% |
| Bull (12x exit) | 9.0x | 12.0x | $6.9M | $71.8M | 10.44x | 59.9% |
| Bear Case | 11.0x | 10.0x | $8.4M | $38.3M | 4.56x | 35.4% |
| Bear (11x exit) | 11.0x | 11.0x | $8.4M | $44.9M | 5.34x | 39.8% |
7. Key Risks & Mitigants
| Severity | Risk Factor | Mitigant |
|---|---|---|
| Medium | Standard execution risk | RCM improvement requires management buy-in and 12-18 month implementation timeline |
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
- 51 hospitals with 27-108 beds
- Same-state prioritization (n=52)
- Comp margins: P25=-13.8% / P50=-5.9% / P75=3.5%
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.