LINCOLN REGIONAL CENTER
1. Target Overview & Investment Thesis
LINCOLN REGIONAL CENTER is a 248-bed under-performing / distressed in nan, NE with $46.7M in net patient revenue and a -53.3% operating margin. The hospital serves a payer mix of 0.2% Medicare, 7.0% Medicaid, and 92.7% commercial.
Thesis: Undervalued. Our ML models identify $3.4M in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from -53.3% to -45.9% (+736bps).
| Net Revenue HCRIS | $46.7M |
| Current EBITDA COMPUTED | $-24.9M |
| Operating Margin COMPUTED | -53.3% |
| Occupancy HCRIS | 79.7% |
| Revenue / Bed COMPUTED | $188K |
| Net-to-Gross HCRIS | 100.0% |
| Distress Probability ML | 50.6% |
2. Market Context & Competitive Position
NE has 98 Medicare-certified hospitals with a median operating margin of -6.3%. The target's margin of -53.3% places it below the state median. Among 1689 size-comparable peers (124-496 beds), the median margin is -3.9%. The target's below-peer margin suggests operational improvement opportunity.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (124-496), prioritizing same-state peers. 1689 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| LINCOLN REGIONAL CENTER (Target) | NE | 248 | $46.7M | -53.3% |
| RONALD REAGAN UCLA | CA | 446 | $2.62B | -6.8% |
| LUCILE PACKARD CHILDRENS HOSPI | CA | 394 | $2.39B | -0.8% |
| MAYO CLINIC HOSPITAL | AZ | 315 | $2.25B | 1.4% |
| RAINBOW BABIES & CHILDRENS HOS | OH | 231 | $2.22B | -5.0% |
| EASTERN MAINE MEDICAL CENTER | ME | 352 | $2.05B | 48.1% |
| ARTHUR G JAMES CANCER HOSPITAL | OH | 356 | $1.95B | 21.0% |
| MOFFITT CANCER CENTER | FL | 218 | $1.91B | 16.0% |
| UCI MEDICAL CENTER | CA | 397 | $1.90B | -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: $3.4M (736bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $981K | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $934K | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $925K | +198bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $568K | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $30K | +6bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $-24.9M |
| + RCM Uplift | +$3.4M |
| Pro Forma EBITDA | $-21.5M |
| Current Margin | -53.3% |
| Pro Forma Margin | -45.9% |
| WC Released (1x) | $1.8M |
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 | $-38.3M | $-129.9M | 0.00x | -100.0% |
| Base (11x exit) | 10.0x | 11.0x | $-38.3M | $-155.3M | 0.00x | -100.0% |
| Bull Case | 9.0x | 11.0x | $-34.5M | $-156.4M | 0.00x | -100.0% |
| Bull (12x exit) | 9.0x | 12.0x | $-34.5M | $-180.8M | 0.00x | -100.0% |
| Bear Case | 11.0x | 10.0x | $-42.1M | $-134.6M | 0.00x | -100.0% |
| Bear (11x exit) | 11.0x | 11.0x | $-42.1M | $-161.8M | 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 |
| High | Elevated distress probability | Model estimates 50.6% 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
- 1689 hospitals with 124-496 beds
- Same-state prioritization (n=8)
- Comp margins: P25=-13.6% / P50=-3.9% / P75=5.8%
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.