ST. CATHERINE OF SIENA MEDICAL CENTE
1. Target Overview & Investment Thesis
ST. CATHERINE OF SIENA MEDICAL CENTE is a 254-bed rural/critical access in SUFFOLK, NY with $233.7M in net patient revenue and a -20.0% operating margin. The hospital serves a payer mix of 52.5% Medicare, 2.0% Medicaid, and 45.4% commercial.
Thesis: Undervalued. Our ML models identify $17.2M in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from -20.0% to -12.7% (+736bps).
| Net Revenue HCRIS | $233.7M |
| Current EBITDA COMPUTED | $-46.8M |
| Operating Margin COMPUTED | -20.0% |
| Occupancy HCRIS | 49.7% |
| Revenue / Bed COMPUTED | $920K |
| Net-to-Gross HCRIS | 22.4% |
| Distress Probability ML | 48.8% |
2. Market Context & Competitive Position
NY has 196 Medicare-certified hospitals with a median operating margin of -17.5%. The target's margin of -20.0% places it below the state median. Among 97 size-comparable peers (127-508 beds), the median margin is -17.1%. The target's below-peer margin suggests operational improvement opportunity.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (127-508), prioritizing same-state peers. 97 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| ST. CATHERINE OF SIENA MEDICAL (Target) | NY | 254 | $233.7M | -20.0% |
| LENOX HILL HOSPITAL | NY | 415 | $1.32B | -35.1% |
| JACOBI MEDICAL CENTER | NY | 440 | $1.14B | -16.8% |
| HOSPITAL FOR SPECIAL SURGERY | NY | 200 | $1.12B | -29.3% |
| ROCHESTER GENERAL HOSPITAL | NY | 470 | $1.05B | -27.9% |
| NYC HEALTH+HOSPITAL/KINGS COUN | NY | 381 | $1.03B | -15.0% |
| NEWYORK-PRESBYTERIAN/QUEENS | NY | 476 | $890.1M | -50.0% |
| ST. FRANCIS HOSPITAL | NY | 364 | $889.3M | 2.0% |
| WHITE PLAINS HOSPITAL | NY | 292 | $884.7M | 8.7% |
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: $17.2M (736bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $4.9M | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $4.7M | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $4.6M | +198bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $2.8M | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $150K | +6bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $-46.8M |
| + RCM Uplift | +$17.2M |
| Pro Forma EBITDA | $-29.6M |
| Current Margin | -20.0% |
| Pro Forma Margin | -12.7% |
| WC Released (1x) | $9.0M |
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 | $-72.0M | $-136.7M | 0.00x | -100.0% |
| Base (11x exit) | 10.0x | 11.0x | $-72.0M | $-173.7M | 0.00x | -100.0% |
| Bull Case | 9.0x | 11.0x | $-64.8M | $-140.3M | 0.00x | -100.0% |
| Bull (12x exit) | 9.0x | 12.0x | $-64.8M | $-172.2M | 0.00x | -100.0% |
| Bear Case | 11.0x | 10.0x | $-79.2M | $-199.3M | 0.00x | -100.0% |
| Bear (11x exit) | 11.0x | 11.0x | $-79.2M | $-245.0M | 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
- 97 hospitals with 127-508 beds
- Same-state prioritization (n=98)
- Comp margins: P25=-27.9% / P50=-17.1% / P75=-9.1%
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.