ROLLING HILLS HOSPITAL
1. Target Overview & Investment Thesis
ROLLING HILLS HOSPITAL is a 60-bed community hospital in PONTOC, OK with $22.2M in net patient revenue and a 16.8% operating margin. The hospital serves a payer mix of 57.7% Medicare, 0.0% Medicaid, and 42.3% commercial.
Thesis: Turnaround. Our ML models identify $1.6M in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from 16.8% to 24.1% (+736bps).
| Net Revenue HCRIS | $22.2M |
| Current EBITDA COMPUTED | $3.7M |
| Operating Margin COMPUTED | 16.8% |
| Occupancy HCRIS | 95.5% |
| Revenue / Bed COMPUTED | $370K |
| Net-to-Gross HCRIS | 36.2% |
| Distress Probability ML | nan% |
2. Market Context & Competitive Position
OK has 147 Medicare-certified hospitals with a median operating margin of -8.8%. The target's margin of 16.8% places it above the state median. Among 66 size-comparable peers (30-120 beds), the median margin is -4.4%. The target performs in line with or above peers.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (30-120), prioritizing same-state peers. 66 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| ROLLING HILLS HOSPITAL (Target) | OK | 60 | $22.2M | 16.8% |
| OKLAHOMA HEART HOSPITAL | OK | 97 | $342.0M | -2.8% |
| STILLWATER MEDICAL CENTER | OK | 52 | $270.2M | -9.9% |
| SAINT FRANCIS HOSPITAL SOUTH | OK | 104 | $198.3M | 34.4% |
| ST ANTHONY SHAWNEE HOSPITAL | OK | 57 | $169.2M | -6.1% |
| MCBRIDE CLINIC ORTHOPEDIC HOSP | OK | 68 | $166.9M | -5.0% |
| OKLAHOMA HEART HOSPITAL SOUTH | OK | 43 | $148.5M | -0.6% |
| OKLAHOMA SURGICAL HOSPITAL | OK | 74 | $146.2M | 17.7% |
| COMMUNITY HOSPITAL | OK | 45 | $143.9M | 21.7% |
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: $1.6M (736bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $466K | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $444K | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $439K | +198bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $270K | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $14K | +6bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $3.7M |
| + RCM Uplift | +$1.6M |
| Pro Forma EBITDA | $5.3M |
| Current Margin | 16.8% |
| Pro Forma Margin | 24.1% |
| WC Released (1x) | $851K |
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 | $5.7M | $40.8M | 7.14x | 48.2% |
| Base (11x exit) | 10.0x | 11.0x | $5.7M | $46.8M | 8.18x | 52.3% |
| Bull Case | 9.0x | 11.0x | $5.1M | $54.0M | 10.50x | 60.0% |
| Bull (12x exit) | 9.0x | 12.0x | $5.1M | $60.5M | 11.75x | 63.7% |
| Bear Case | 11.0x | 10.0x | $6.3M | $30.8M | 4.90x | 37.4% |
| Bear (11x exit) | 11.0x | 11.0x | $6.3M | $35.9M | 5.72x | 41.7% |
7. Key Risks & Mitigants
| Severity | Risk Factor | Mitigant |
|---|---|---|
| Medium | Heavy Medicare dependence | Medicare comprises 57.7% of days; rate updates may lag inflation. Mitigant: CDI/CMI lever directly increases Medicare reimbursement |
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
- 66 hospitals with 30-120 beds
- Same-state prioritization (n=67)
- Comp margins: P25=-20.9% / P50=-4.4% / P75=6.1%
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.