WINDOM AREA HOSPITAL
1. Target Overview & Investment Thesis
WINDOM AREA HOSPITAL is a 18-bed suburban community hospital in COTTONWOOD, MN with $25.7M in net patient revenue and a 3.5% operating margin. The hospital serves a payer mix of 35.3% Medicare, 17.4% Medicaid, and 47.3% commercial.
Thesis: Turnaround. Our ML models identify $1.9M in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from 3.5% to 10.8% (+736bps).
| Net Revenue HCRIS | $25.7M |
| Current EBITDA COMPUTED | $891K |
| Operating Margin COMPUTED | 3.5% |
| Occupancy HCRIS | 17.8% |
| Revenue / Bed COMPUTED | $1.4M |
| Net-to-Gross HCRIS | 52.0% |
| Distress Probability ML | 60.9% |
2. Market Context & Competitive Position
MN has 141 Medicare-certified hospitals with a median operating margin of -3.6%. The target's margin of 3.5% places it above the state median. Among 90 size-comparable peers (9-36 beds), the median margin is -2.9%. The target performs in line with or above peers.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (9-36), prioritizing same-state peers. 90 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| WINDOM AREA HOSPITAL (Target) | MN | 18 | $25.7M | 3.5% |
| CUYUNA REGIONAL MEDICAL CENTER | MN | 25 | $180.8M | -4.0% |
| ST. MARYS REGIONAL HEALTH CENT | MN | 36 | $167.8M | 3.1% |
| MAYO CLINIC HEALTH SYSTEM - RE | MN | 27 | $149.3M | 1.8% |
| NEW ULM MEDICAL CENTER | MN | 24 | $128.6M | 4.2% |
| LAKEWOOD HEALTH SYSTEM | MN | 25 | $124.7M | 0.2% |
| GRAND ITASCA CLINIC AND HOSPIT | MN | 34 | $117.7M | 5.3% |
| AVERA MARSHALL REGIONAL MEDICA | MN | 25 | $115.2M | -17.0% |
| WELIA HEALTH | MN | 25 | $106.7M | 1.1% |
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: $1.9M (736bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $540K | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $514K | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $509K | +198bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $313K | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $16K | +6bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $891K |
| + RCM Uplift | +$1.9M |
| Pro Forma EBITDA | $2.8M |
| Current Margin | 3.5% |
| Pro Forma Margin | 10.8% |
| WC Released (1x) | $987K |
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 | $1.4M | $24.8M | 18.09x | 78.4% |
| Base (11x exit) | 10.0x | 11.0x | $1.4M | $27.7M | 20.23x | 82.5% |
| Bull Case | 9.0x | 11.0x | $1.2M | $34.4M | 27.90x | 94.6% |
| Bull (12x exit) | 9.0x | 12.0x | $1.2M | $37.9M | 30.73x | 98.4% |
| Bear Case | 11.0x | 10.0x | $1.5M | $14.9M | 9.88x | 58.1% |
| Bear (11x exit) | 11.0x | 11.0x | $1.5M | $16.9M | 11.19x | 62.1% |
7. Key Risks & Mitigants
| Severity | Risk Factor | Mitigant |
|---|---|---|
| Medium | Low occupancy | At 17.8%, 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 60.9% 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
- 90 hospitals with 9-36 beds
- Same-state prioritization (n=93)
- Comp margins: P25=-12.6% / P50=-2.9% / P75=2.9%
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.