GBH - GENEVA
1. Target Overview & Investment Thesis
GBH - GENEVA is a 20-bed suburban community hospital in ASHTABULA, OH with $5.6M in net patient revenue and a 24.6% operating margin. The hospital serves a payer mix of 33.9% Medicare, 0.2% Medicaid, and 65.9% commercial.
Thesis: Turnaround. Our ML models identify $426K in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from 24.6% to 32.1% (+756bps).
| Net Revenue HCRIS | $5.6M |
| Current EBITDA COMPUTED | $1.4M |
| Operating Margin COMPUTED | 24.6% |
| Occupancy HCRIS | 78.5% |
| Revenue / Bed COMPUTED | $282K |
| Net-to-Gross HCRIS | 30.7% |
| Distress Probability ML | 42.0% |
2. Market Context & Competitive Position
OH has 235 Medicare-certified hospitals with a median operating margin of -0.3%. The target's margin of 24.6% places it above the state median. Among 69 size-comparable peers (10-40 beds), the median margin is -3.4%. The target performs in line with or above peers.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (10-40), prioritizing same-state peers. 69 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| GBH - GENEVA (Target) | OH | 20 | $5.6M | 24.6% |
| THE SURGICAL HOSPITAL AT SOUTH | OH | 24 | $166.6M | -3.1% |
| GALION COMMUNITY HOSPITAL | OH | 25 | $128.2M | 16.6% |
| MARY RUTAN HOSPITAL | OH | 39 | $113.0M | -12.5% |
| MERCY HEALTH-TIFFIN HOSPITAL | OH | 35 | $103.0M | 18.1% |
| JOINT TOWNSHIP DISTRICT MEMORI | OH | 33 | $95.6M | 9.3% |
| FULTON COUNTY HEALTH CENTER | OH | 25 | $95.2M | -7.4% |
| UH SAMARITAN MEDICAL CENTER | OH | 39 | $88.9M | -3.5% |
| MEMORIAL HOSPITAL | OH | 31 | $79.9M | 4.6% |
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: $426K (756bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $118K | +210bp | 18mo |
| Denial Rate Reduction | 12.0% | 6.5% | $117K | +207bp | 12mo |
| Cost to Collect | 4.5% | 2.5% | $113K | +200bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $69K | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $10K | +17bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $1.4M |
| + RCM Uplift | +$426K |
| Pro Forma EBITDA | $1.8M |
| Current Margin | 24.6% |
| Pro Forma Margin | 32.1% |
| WC Released (1x) | $216K |
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 | $2.1M | $13.4M | 6.29x | 44.4% |
| Base (11x exit) | 10.0x | 11.0x | $2.1M | $15.4M | 7.24x | 48.6% |
| Bull Case | 9.0x | 11.0x | $1.9M | $17.5M | 9.14x | 55.7% |
| Bull (12x exit) | 9.0x | 12.0x | $1.9M | $19.7M | 10.27x | 59.3% |
| Bear Case | 11.0x | 10.0x | $2.3M | $10.6M | 4.51x | 35.2% |
| Bear (11x exit) | 11.0x | 11.0x | $2.3M | $12.4M | 5.29x | 39.5% |
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
- 69 hospitals with 10-40 beds
- Same-state prioritization (n=70)
- Comp margins: P25=-12.5% / P50=-3.4% / P75=12.0%
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.