TRUMBULL MEMORIAL HOSPITAL
1. Target Overview & Investment Thesis
TRUMBULL MEMORIAL HOSPITAL is a 197-bed suburban community hospital in TRUMBULL, OH with $143.9M in net patient revenue and a 1.4% operating margin. The hospital serves a payer mix of 22.8% Medicare, 6.2% Medicaid, and 70.9% commercial.
Thesis: Undervalued. Our ML models identify $10.6M in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from 1.4% to 8.7% (+736bps).
| Net Revenue HCRIS | $143.9M |
| Current EBITDA COMPUTED | $2.0M |
| Operating Margin COMPUTED | 1.4% |
| Occupancy HCRIS | 45.0% |
| Revenue / Bed COMPUTED | $731K |
| Net-to-Gross HCRIS | 17.6% |
| Distress Probability ML | 49.2% |
2. Market Context & Competitive Position
OH has 235 Medicare-certified hospitals with a median operating margin of -0.3%. The target's margin of 1.4% places it above the state median. Among 78 size-comparable peers (98-394 beds), the median margin is 0.6%. The target performs in line with or above peers.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (98-394), prioritizing same-state peers. 78 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| TRUMBULL MEMORIAL HOSPITAL (Target) | OH | 197 | $143.9M | 1.4% |
| RAINBOW BABIES & CHILDRENS HOS | OH | 231 | $2.22B | -5.0% |
| ARTHUR G JAMES CANCER HOSPITAL | OH | 356 | $1.95B | 21.0% |
| GOOD SAMARITAN HOSPITAL | OH | 361 | $870.9M | 3.5% |
| KETTERING HEALTH MAIN CAMPUS | OH | 383 | $722.7M | -0.7% |
| KETTERING HEALTH DAYTON | OH | 317 | $667.6M | 3.3% |
| AULTMAN HOSPITAL | OH | 365 | $586.2M | -5.6% |
| DAYTON CHILDRENS HOSPITAL | OH | 181 | $569.1M | 7.9% |
| GENESIS HEALTHCARE SYSTEM | OH | 282 | $527.6M | 0.6% |
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: $10.6M (736bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $3.0M | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $2.9M | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $2.8M | +198bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $1.8M | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $92K | +6bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $2.0M |
| + RCM Uplift | +$10.6M |
| Pro Forma EBITDA | $12.6M |
| Current Margin | 1.4% |
| Pro Forma Margin | 8.7% |
| WC Released (1x) | $5.5M |
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 | $3.1M | $119.1M | 38.82x | 107.9% |
| Base (11x exit) | 10.0x | 11.0x | $3.1M | $132.0M | 43.02x | 112.2% |
| Bull Case | 9.0x | 11.0x | $2.8M | $168.0M | 60.82x | 127.4% |
| Bull (12x exit) | 9.0x | 12.0x | $2.8M | $184.0M | 66.65x | 131.6% |
| Bear Case | 11.0x | 10.0x | $3.4M | $65.1M | 19.30x | 80.8% |
| Bear (11x exit) | 11.0x | 11.0x | $3.4M | $72.7M | 21.55x | 84.8% |
7. Key Risks & Mitigants
| Severity | Risk Factor | Mitigant |
|---|---|---|
| Low | Low net-to-gross ratio | Large contractual allowances suggest pricing discipline issues. Mitigant: payer renegotiation is an additional upside lever |
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
- 78 hospitals with 98-394 beds
- Same-state prioritization (n=79)
- Comp margins: P25=-8.8% / P50=0.6% / P75=7.1%
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.