MEMORIAL HOSPITAL
1. Target Overview & Investment Thesis
MEMORIAL HOSPITAL is a 31-bed suburban community hospital in SANDUSKY, OH with $79.9M in net patient revenue and a 4.6% operating margin. The hospital serves a payer mix of 34.0% Medicare, 3.7% Medicaid, and 62.4% commercial.
Thesis: Turnaround. Our ML models identify $5.9M in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from 4.6% to 11.9% (+736bps).
| Net Revenue HCRIS | $79.9M |
| Current EBITDA COMPUTED | $3.7M |
| Operating Margin COMPUTED | 4.6% |
| Occupancy HCRIS | 36.8% |
| Revenue / Bed COMPUTED | $2.6M |
| Net-to-Gross HCRIS | 27.6% |
| Distress Probability ML | 48.8% |
2. Market Context & Competitive Position
OH has 235 Medicare-certified hospitals with a median operating margin of -0.3%. The target's margin of 4.6% places it above the state median. Among 96 size-comparable peers (16-62 beds), the median margin is -1.7%. The target performs in line with or above peers.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (16-62), prioritizing same-state peers. 96 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| MEMORIAL HOSPITAL (Target) | OH | 31 | $79.9M | 4.6% |
| CRYSTAL CLINIC ORTHOPAEDIC CEN | OH | 59 | $173.3M | -14.9% |
| THE SURGICAL HOSPITAL AT SOUTH | OH | 24 | $166.6M | -3.1% |
| MEMORIAL HOSPITAL OF UNION COU | OH | 51 | $151.0M | 8.0% |
| GRADY MEMORIAL HOSPITAL | OH | 60 | $146.7M | 16.5% |
| GALION COMMUNITY HOSPITAL | OH | 25 | $128.2M | 16.6% |
| MARY RUTAN HOSPITAL | OH | 39 | $113.0M | -12.5% |
| AVITA ONTARIO HOSPITAL | OH | 49 | $109.2M | 16.0% |
| MERCY HEALTH-TIFFIN HOSPITAL | OH | 35 | $103.0M | 18.1% |
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: $5.9M (736bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $1.7M | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $1.6M | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $1.6M | +198bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $973K | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $51K | +6bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $3.7M |
| + RCM Uplift | +$5.9M |
| Pro Forma EBITDA | $9.5M |
| Current Margin | 4.6% |
| Pro Forma Margin | 11.9% |
| WC Released (1x) | $3.1M |
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 | $5.6M | $83.0M | 14.74x | 71.3% |
| Base (11x exit) | 10.0x | 11.0x | $5.6M | $93.1M | 16.53x | 75.3% |
| Bull Case | 9.0x | 11.0x | $5.1M | $114.4M | 22.56x | 86.5% |
| Bull (12x exit) | 9.0x | 12.0x | $5.1M | $126.3M | 24.91x | 90.2% |
| Bear Case | 11.0x | 10.0x | $6.2M | $51.7M | 8.35x | 52.9% |
| Bear (11x exit) | 11.0x | 11.0x | $6.2M | $58.9M | 9.51x | 56.9% |
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
- 96 hospitals with 16-62 beds
- Same-state prioritization (n=97)
- Comp margins: P25=-11.1% / P50=-1.7% / P75=12.3%
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.