SMMHC
1. Target Overview & Investment Thesis
SMMHC is a 348-bed suburban community hospital in ST. FRANCOIS, MO with $68.6M in net patient revenue and a -42.9% operating margin. The hospital serves a payer mix of 0.8% Medicare, 3.2% Medicaid, and 96.0% commercial.
Thesis: Undervalued. Our ML models identify $5.0M in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from -42.9% to -35.6% (+736bps).
| Net Revenue HCRIS | $68.6M |
| Current EBITDA COMPUTED | $-29.4M |
| Operating Margin COMPUTED | -42.9% |
| Occupancy HCRIS | 92.0% |
| Revenue / Bed COMPUTED | $197K |
| Net-to-Gross HCRIS | 80.1% |
| Distress Probability ML | 44.9% |
2. Market Context & Competitive Position
MO has 138 Medicare-certified hospitals with a median operating margin of -6.2%. The target's margin of -42.9% places it below the state median. Among 31 size-comparable peers (174-696 beds), the median margin is -1.3%. The target's below-peer margin suggests operational improvement opportunity.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (174-696), prioritizing same-state peers. 31 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| SMMHC (Target) | MO | 348 | $68.6M | -42.9% |
| CHILDRENS MERCY HOSPITAL | MO | 328 | $1.44B | 30.5% |
| UNIV OF MISSOURI HEALTH CARE | MO | 521 | $1.36B | -2.0% |
| MERCY HOSPITAL SPRINGFIELD | MO | 617 | $1.05B | 6.1% |
| ST. LOUIS CHILDRENS HOSPITAL | MO | 445 | $886.1M | 6.4% |
| SAINT LUKES HOSPITAL OF KANSAS | MO | 466 | $883.5M | -12.4% |
| SSM HEALTH ST. MARYS HOSPITAL | MO | 501 | $792.8M | -0.0% |
| SSM SAINT LOUIS UNIVERSITY HOS | MO | 317 | $772.2M | -6.4% |
| MISSOURI BAPTIST MEDICAL CENTE | MO | 402 | $716.0M | 2.5% |
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: $5.0M (736bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $1.4M | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $1.4M | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $1.4M | +198bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $835K | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $44K | +6bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $-29.4M |
| + RCM Uplift | +$5.0M |
| Pro Forma EBITDA | $-24.4M |
| Current Margin | -42.9% |
| Pro Forma Margin | -35.6% |
| WC Released (1x) | $2.6M |
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 | $-45.3M | $-143.7M | 0.00x | -100.0% |
| Base (11x exit) | 10.0x | 11.0x | $-45.3M | $-172.8M | 0.00x | -100.0% |
| Bull Case | 9.0x | 11.0x | $-40.8M | $-170.8M | 0.00x | -100.0% |
| Bull (12x exit) | 9.0x | 12.0x | $-40.8M | $-198.4M | 0.00x | -100.0% |
| Bear Case | 11.0x | 10.0x | $-49.8M | $-154.2M | 0.00x | -100.0% |
| Bear (11x exit) | 11.0x | 11.0x | $-49.8M | $-185.8M | 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 |
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
- 31 hospitals with 174-696 beds
- Same-state prioritization (n=32)
- Comp margins: P25=-9.2% / P50=-1.3% / P75=5.7%
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.