PERRY COUNTY GENERAL HOSPITAL
1. Target Overview & Investment Thesis
PERRY COUNTY GENERAL HOSPITAL is a 22-bed community hospital in PERRY, MS with $4.1M in net patient revenue and a -25.4% operating margin. The hospital serves a payer mix of 97.2% Medicare, 0.0% Medicaid, and 2.8% commercial.
Thesis: Turnaround. Our ML models identify $314K in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from -25.4% to -17.7% (+768bps).
| Net Revenue HCRIS | $4.1M |
| Current EBITDA COMPUTED | $-1.0M |
| Operating Margin COMPUTED | -25.4% |
| Occupancy HCRIS | 8.4% |
| Revenue / Bed COMPUTED | $186K |
| Net-to-Gross HCRIS | 57.8% |
| Distress Probability ML | nan% |
2. Market Context & Competitive Position
MS has 110 Medicare-certified hospitals with a median operating margin of -12.5%. The target's margin of -25.4% places it below the state median. Among 59 size-comparable peers (11-44 beds), the median margin is -14.9%. The target's below-peer margin suggests operational improvement opportunity.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (11-44), prioritizing same-state peers. 59 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| PERRY COUNTY GENERAL HOSPITAL (Target) | MS | 22 | $4.1M | -25.4% |
| KINGS DAUGHTERS MEDICAL CENTER | MS | 22 | $91.5M | -8.4% |
| NORTH SUNFLOWER COUNTY HOSPITA | MS | 25 | $70.1M | -7.2% |
| MISSISSIPPI METHODIST REHAB CE | MS | 31 | $68.1M | -0.5% |
| NESHOBA COUNTY GENERAL HOSPITA | MS | 38 | $47.6M | -19.7% |
| MONROE REGIONAL HOSPITAL | MS | 25 | $45.6M | 0.9% |
| GEORGE COUNTY HOSPITAL | MS | 39 | $42.1M | -5.4% |
| OCHSNER MED CTR - HANCOCK | MS | 41 | $37.7M | -26.3% |
| S.E. LACKEY MEMORIAL HOSPITAL | MS | 25 | $34.1M | -2.1% |
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: $314K (768bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Denial Rate Reduction | 12.0% | 6.5% | $87K | +213bp | 12mo |
| Net Collection Rate | 93.5% | 97.0% | $86K | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $82K | +200bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $50K | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $10K | +23bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $-1.0M |
| + RCM Uplift | +$314K |
| Pro Forma EBITDA | $-725K |
| Current Margin | -25.4% |
| Pro Forma Margin | -17.7% |
| WC Released (1x) | $157K |
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 | $-1.6M | $-3.7M | 0.00x | -100.0% |
| Base (11x exit) | 10.0x | 11.0x | $-1.6M | $-4.6M | 0.00x | -100.0% |
| Bull Case | 9.0x | 11.0x | $-1.4M | $-4.1M | 0.00x | -100.0% |
| Bull (12x exit) | 9.0x | 12.0x | $-1.4M | $-4.9M | 0.00x | -100.0% |
| Bear Case | 11.0x | 10.0x | $-1.8M | $-4.8M | 0.00x | -100.0% |
| Bear (11x exit) | 11.0x | 11.0x | $-1.8M | $-5.8M | 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 | Heavy Medicare dependence | Medicare comprises 97.2% of days; rate updates may lag inflation. Mitigant: CDI/CMI lever directly increases Medicare reimbursement |
| Medium | Low occupancy | At 8.4%, fixed costs are spread over fewer patient days. Mitigant: volume growth is an additional upside lever not modeled in base case |
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
- 59 hospitals with 11-44 beds
- Same-state prioritization (n=60)
- Comp margins: P25=-22.6% / P50=-14.9% / P75=-6.4%
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.