SOUTHERN NH MEDICAL CENTER
1. Target Overview & Investment Thesis
SOUTHERN NH MEDICAL CENTER is a 138-bed suburban community hospital in HILLSBOROUGH, NH with $293.0M in net patient revenue and a -0.8% operating margin. The hospital serves a payer mix of 32.8% Medicare, 1.2% Medicaid, and 66.0% commercial.
Thesis: Undervalued. Our ML models identify $21.6M in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from -0.8% to 6.6% (+736bps).
| Net Revenue HCRIS | $293.0M |
| Current EBITDA COMPUTED | $-2.2M |
| Operating Margin COMPUTED | -0.8% |
| Occupancy HCRIS | 66.5% |
| Revenue / Bed COMPUTED | $2.1M |
| Net-to-Gross HCRIS | 34.1% |
| Distress Probability ML | 43.1% |
2. Market Context & Competitive Position
NH has 30 Medicare-certified hospitals with a median operating margin of -2.7%. The target's margin of -0.8% places it above the state median. Among 12 size-comparable peers (69-276 beds), the median margin is -3.7%. The target performs in line with or above peers.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (69-276), prioritizing same-state peers. 12 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| SOUTHERN NH MEDICAL CENTER (Target) | NH | 138 | $293.0M | -0.8% |
| ELLIOT HOSPITAL | NH | 215 | $660.8M | 14.5% |
| CONCORD HOSPITAL INC. | NH | 206 | $553.5M | -5.1% |
| WENTWORTH DOUGLASS HOSPITAL | NH | 118 | $500.9M | 10.7% |
| CATHOLIC MEDICAL CENTER | NH | 262 | $470.4M | -4.2% |
| PORTSMOUTH REGIONAL HOSPITAL | NH | 168 | $347.4M | 45.5% |
| EXETER HOSPITAL INC. | NH | 99 | $282.0M | -3.2% |
| ST. JOSEPH HOSPITAL | NH | 160 | $236.2M | -15.1% |
| CHESHIRE MEDICAL CENTER | NH | 86 | $236.2M | -22.4% |
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: $21.6M (736bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $6.2M | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $5.9M | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $5.8M | +198bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $3.6M | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $188K | +6bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $-2.2M |
| + RCM Uplift | +$21.6M |
| Pro Forma EBITDA | $19.4M |
| Current Margin | -0.8% |
| Pro Forma Margin | 6.6% |
| WC Released (1x) | $11.2M |
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 | $-3.4M | $201.1M | 0.00x | -100.0% |
| Base (11x exit) | 10.0x | 11.0x | $-3.4M | $220.1M | 0.00x | -100.0% |
| Bull Case | 9.0x | 11.0x | $-3.1M | $290.2M | 0.00x | -100.0% |
| Bull (12x exit) | 9.0x | 12.0x | $-3.1M | $315.7M | 0.00x | -100.0% |
| Bear Case | 11.0x | 10.0x | $-3.7M | $94.4M | 0.00x | -100.0% |
| Bear (11x exit) | 11.0x | 11.0x | $-3.7M | $102.6M | 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
- 12 hospitals with 69-276 beds
- Same-state prioritization (n=13)
- Comp margins: P25=-10.7% / P50=-3.7% / P75=8.0%
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.