HOLLY HILLS HOSPITAL
1. Target Overview & Investment Thesis
HOLLY HILLS HOSPITAL is a 296-bed suburban community hospital in WAKE, NC with $57.9M in net patient revenue and a 22.4% operating margin. The hospital serves a payer mix of 9.3% Medicare, 0.4% Medicaid, and 90.4% commercial.
Thesis: Platform Growth. Our ML models identify $4.3M in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from 22.4% to 29.8% (+736bps).
| Net Revenue HCRIS | $57.9M |
| Current EBITDA COMPUTED | $13.0M |
| Operating Margin COMPUTED | 22.4% |
| Occupancy HCRIS | 75.2% |
| Revenue / Bed COMPUTED | $196K |
| Net-to-Gross HCRIS | 42.9% |
| Distress Probability ML | 44.2% |
2. Market Context & Competitive Position
NC has 129 Medicare-certified hospitals with a median operating margin of -2.0%. The target's margin of 22.4% places it above the state median. Among 33 size-comparable peers (148-592 beds), the median margin is 2.8%. The target performs in line with or above peers.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (148-592), prioritizing same-state peers. 33 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| HOLLY HILLS HOSPITAL (Target) | NC | 296 | $57.9M | 22.4% |
| REX HOSPITAL | NC | 489 | $1.51B | -0.8% |
| PRESBYTERIAN HOSPITAL | NC | 561 | $1.33B | 1.0% |
| FIRSTHEALTH MOORE REGIONAL HOS | NC | 412 | $813.8M | 8.8% |
| ATRIUM HEALTH CABARRUS | NC | 447 | $758.9M | 13.9% |
| DUKE RALEIGH HOSPITAL | NC | 186 | $683.0M | 3.7% |
| GASTON MEMORIAL HOSPITAL | NC | 424 | $641.8M | 7.0% |
| ATRIUM HEALTH PINEVILLE | NC | 365 | $575.1M | 25.8% |
| CATAWBA VALLEY MEDICAL CENTER | NC | 200 | $451.9M | 5.9% |
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: $4.3M (736bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $1.2M | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $1.2M | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $1.1M | +198bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $705K | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $37K | +6bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $13.0M |
| + RCM Uplift | +$4.3M |
| Pro Forma EBITDA | $17.2M |
| Current Margin | 22.4% |
| Pro Forma Margin | 29.8% |
| WC Released (1x) | $2.2M |
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 | $20.0M | $128.3M | 6.42x | 45.1% |
| Base (11x exit) | 10.0x | 11.0x | $20.0M | $147.6M | 7.39x | 49.2% |
| Bull Case | 9.0x | 11.0x | $18.0M | $168.1M | 9.35x | 56.4% |
| Bull (12x exit) | 9.0x | 12.0x | $18.0M | $188.7M | 10.50x | 60.0% |
| Bear Case | 11.0x | 10.0x | $22.0M | $100.5M | 4.57x | 35.5% |
| Bear (11x exit) | 11.0x | 11.0x | $22.0M | $117.6M | 5.36x | 39.9% |
7. Key Risks & Mitigants
| Severity | Risk Factor | Mitigant |
|---|---|---|
| Medium | Standard execution risk | RCM improvement requires management buy-in and 12-18 month implementation timeline |
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
- 33 hospitals with 148-592 beds
- Same-state prioritization (n=34)
- Comp margins: P25=-4.7% / P50=2.8% / P75=7.5%
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.