COMANCHE COUNTY MEMORIAL HOSPITAL
1. Target Overview & Investment Thesis
COMANCHE COUNTY MEMORIAL HOSPITAL is a 201-bed safety-net/medicaid heavy in nan, OK with $304.2M in net patient revenue and a -7.9% operating margin. The hospital serves a payer mix of 34.3% Medicare, 28.4% Medicaid, and 37.3% commercial.
Thesis: Undervalued. Our ML models identify $22.4M in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from -7.9% to -0.5% (+736bps).
| Net Revenue HCRIS | $304.2M |
| Current EBITDA COMPUTED | $-23.9M |
| Operating Margin COMPUTED | -7.9% |
| Occupancy HCRIS | 62.7% |
| Revenue / Bed COMPUTED | $1.5M |
| Net-to-Gross HCRIS | 24.1% |
| Distress Probability ML | 50.7% |
2. Market Context & Competitive Position
OK has 147 Medicare-certified hospitals with a median operating margin of -8.8%. The target's margin of -7.9% places it above the state median. Among 17 size-comparable peers (100-402 beds), the median margin is -4.8%. The target's below-peer margin suggests operational improvement opportunity.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (100-402), prioritizing same-state peers. 17 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| COMANCHE COUNTY MEMORIAL HOSPI (Target) | OK | 201 | $304.2M | -7.9% |
| MERCY HOSPITAL OKC | OK | 344 | $674.3M | 10.5% |
| NORMAN REGIONAL HOSPITAL AUTHO | OK | 322 | $540.7M | -8.1% |
| INTEGRIS SOUTHWEST MEDICAL CEN | OK | 169 | $267.6M | -13.5% |
| HILLCREST HOSPITAL SOUTH | OK | 152 | $218.9M | 4.9% |
| SAINT FRANCIS HOSPITAL SOUTH | OK | 104 | $198.3M | 34.4% |
| SAINT FRANCIS HOSPITAL MUSKOGE | OK | 236 | $196.5M | 11.6% |
| MERCY HOSPITAL ARDMORE | OK | 140 | $158.8M | -1.1% |
| OSU MEDICAL CENTER | OK | 119 | $142.7M | -35.1% |
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: $22.4M (736bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $6.4M | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $6.1M | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $6.0M | +198bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $3.7M | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $195K | +6bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $-23.9M |
| + RCM Uplift | +$22.4M |
| Pro Forma EBITDA | $-1.5M |
| Current Margin | -7.9% |
| Pro Forma Margin | -0.5% |
| WC Released (1x) | $11.7M |
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 | $-36.7M | $66.3M | 0.00x | -100.0% |
| Base (11x exit) | 10.0x | 11.0x | $-36.7M | $61.0M | 0.00x | -100.0% |
| Bull Case | 9.0x | 11.0x | $-33.1M | $123.0M | 0.00x | -100.0% |
| Bull (12x exit) | 9.0x | 12.0x | $-33.1M | $124.4M | 0.00x | -100.0% |
| Bear Case | 11.0x | 10.0x | $-40.4M | $-33.7M | 0.00x | -100.0% |
| Bear (11x exit) | 11.0x | 11.0x | $-40.4M | $-50.2M | 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 |
| Medium | Elevated Medicaid exposure (28.4%) | Medicaid reimburses below cost in most states. Mitigant: denial reduction lever has highest impact on Medicaid claims |
| High | Elevated distress probability | Model estimates 50.7% probability of financial distress. Mitigant: distressed entry pricing (7-9x) compensates for risk |
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
- 17 hospitals with 100-402 beds
- Same-state prioritization (n=18)
- Comp margins: P25=-24.3% / P50=-4.8% / P75=10.5%
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.