PERSHING GENERAL HOSPITAL
1. Target Overview & Investment Thesis
PERSHING GENERAL HOSPITAL is a 13-bed rural/critical access in PERSHING, NV with $13.7M in net patient revenue and a -19.7% operating margin. The hospital serves a payer mix of 79.0% Medicare, 2.1% Medicaid, and 18.9% commercial.
Thesis: Turnaround. Our ML models identify $1.0M in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from -19.7% to -12.4% (+737bps).
| Net Revenue HCRIS | $13.7M |
| Current EBITDA COMPUTED | $-2.7M |
| Operating Margin COMPUTED | -19.7% |
| Occupancy HCRIS | 23.4% |
| Revenue / Bed COMPUTED | $1.1M |
| Net-to-Gross HCRIS | 71.5% |
| Distress Probability ML | 60.4% |
2. Market Context & Competitive Position
NV has 58 Medicare-certified hospitals with a median operating margin of 0.4%. The target's margin of -19.7% places it below the state median. Among 13 size-comparable peers (6-26 beds), the median margin is -13.8%. The target's below-peer margin suggests operational improvement opportunity.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (6-26), prioritizing same-state peers. 13 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| PERSHING GENERAL HOSPITAL (Target) | NV | 13 | $13.7M | -19.7% |
| CARSON VALLEY MEDICAL CENTER | NV | 23 | $84.3M | 6.8% |
| BANNER CHURCHILL COMMUNITY HOS | NV | 25 | $69.2M | 6.8% |
| HUMBOLDT GENERAL HOSPITAL | NV | 25 | $58.8M | -37.3% |
| WILLIAM BEE RIRIE HOSPITAL | NV | 25 | $35.1M | -17.9% |
| MESA VIEW REGIONAL HOSPITAL | NV | 25 | $34.9M | -4.2% |
| DESERT VIEW REGIONAL MEDICAL C | NV | 25 | $34.4M | 2.0% |
| BOULDER CITY HOSPITAL | NV | 25 | $30.7M | -13.8% |
| ST. ROSE DOMINICAN - DELIMA | NV | 10 | $21.8M | -45.3% |
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: $1.0M (737bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $288K | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $275K | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $273K | +199bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $167K | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $10K | +7bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $-2.7M |
| + RCM Uplift | +$1.0M |
| Pro Forma EBITDA | $-1.7M |
| Current Margin | -19.7% |
| Pro Forma Margin | -12.4% |
| WC Released (1x) | $527K |
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 | $-4.2M | $-7.7M | 0.00x | -100.0% |
| Base (11x exit) | 10.0x | 11.0x | $-4.2M | $-9.9M | 0.00x | -100.0% |
| Bull Case | 9.0x | 11.0x | $-3.8M | $-7.9M | 0.00x | -100.0% |
| Bull (12x exit) | 9.0x | 12.0x | $-3.8M | $-9.7M | 0.00x | -100.0% |
| Bear Case | 11.0x | 10.0x | $-4.6M | $-11.5M | 0.00x | -100.0% |
| Bear (11x exit) | 11.0x | 11.0x | $-4.6M | $-14.1M | 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 79.0% of days; rate updates may lag inflation. Mitigant: CDI/CMI lever directly increases Medicare reimbursement |
| Medium | Low occupancy | At 23.4%, 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 60.4% 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
- 13 hospitals with 6-26 beds
- Same-state prioritization (n=14)
- Comp margins: P25=-28.3% / P50=-13.8% / P75=4.4%
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.