CARL ALBERT COMMUNITY MENTAL HEALTH
1. Target Overview & Investment Thesis
CARL ALBERT COMMUNITY MENTAL HEALTH is a 16-bed safety-net/medicaid heavy in PITTSBURGH, OK with $4.2M in net patient revenue and a -100.0% operating margin. The hospital serves a payer mix of 12.1% Medicare, 55.5% Medicaid, and 32.4% commercial.
Thesis: Turnaround. Our ML models identify $319K in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from -100.0% to -365.6% (+767bps).
| Net Revenue HCRIS | $4.2M |
| Current EBITDA COMPUTED | $-15.5M |
| Operating Margin COMPUTED | -100.0% |
| Occupancy HCRIS | 88.7% |
| Revenue / Bed COMPUTED | $260K |
| Net-to-Gross HCRIS | 17.8% |
| Distress Probability ML | 51.1% |
2. Market Context & Competitive Position
OK has 147 Medicare-certified hospitals with a median operating margin of -8.8%. The target's margin of -100.0% places it below the state median. Among 57 size-comparable peers (8-32 beds), the median margin is -17.8%. The target's below-peer margin suggests operational improvement opportunity.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (8-32), prioritizing same-state peers. 57 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| CARL ALBERT COMMUNITY MENTAL H (Target) | OK | 16 | $4.2M | -100.0% |
| OKLAHOMA SPINE HOSPITAL | OK | 23 | $79.0M | 8.4% |
| BRISTOW MEDICAL CENTER | OK | 25 | $48.5M | -12.6% |
| JEFFERSON COUNTY HOSPITAL | OK | 25 | $41.1M | 14.4% |
| PHYSICIANS HOSPITAL AT ANADARK | OK | 25 | $34.1M | -48.1% |
| LAKESIDE WOMENS HOSPITAL | OK | 23 | $33.0M | 16.5% |
| STROUD REGIONAL MEDICAL CENTER | OK | 25 | $31.4M | -50.0% |
| SURGICAL HOSPITAL OF OKLAHOMA | OK | 12 | $31.2M | -13.0% |
| HILLCREST HOSPITAL PRYOR | OK | 21 | $30.6M | -7.2% |
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: $319K (767bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Denial Rate Reduction | 12.0% | 6.5% | $88K | +212bp | 12mo |
| Net Collection Rate | 93.5% | 97.0% | $87K | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $83K | +200bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $51K | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $10K | +23bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $-15.5M |
| + RCM Uplift | +$319K |
| Pro Forma EBITDA | $-15.2M |
| Current Margin | -100.0% |
| Pro Forma Margin | -365.6% |
| WC Released (1x) | $159K |
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 | $-23.9M | $-99.1M | 0.00x | -100.0% |
| Base (11x exit) | 10.0x | 11.0x | $-23.9M | $-116.8M | 0.00x | -100.0% |
| Bull Case | 9.0x | 11.0x | $-21.5M | $-123.5M | 0.00x | -100.0% |
| Bull (12x exit) | 9.0x | 12.0x | $-21.5M | $-141.1M | 0.00x | -100.0% |
| Bear Case | 11.0x | 10.0x | $-26.3M | $-93.0M | 0.00x | -100.0% |
| Bear (11x exit) | 11.0x | 11.0x | $-26.3M | $-110.8M | 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 (55.5%) | Medicaid reimburses below cost in most states. Mitigant: denial reduction lever has highest impact on Medicaid claims |
| High | Elevated distress probability | Model estimates 51.1% probability of financial distress. Mitigant: distressed entry pricing (7-9x) compensates for risk |
| 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
- 57 hospitals with 8-32 beds
- Same-state prioritization (n=61)
- Comp margins: P25=-28.2% / P50=-17.8% / P75=-5.8%
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.