GHS GREENVILLE MEMORIAL HOSPITAL
1. Target Overview & Investment Thesis
GHS GREENVILLE MEMORIAL HOSPITAL is a 721-bed large academic medical center in GREENVILLE, SC with $1.57B in net patient revenue and a 16.3% operating margin. The hospital serves a payer mix of 18.5% Medicare, 10.0% Medicaid, and 71.5% commercial.
Thesis: Platform Growth. Our ML models identify $115.9M in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from 16.3% to 23.7% (+736bps).
| Net Revenue HCRIS | $1.57B |
| Current EBITDA COMPUTED | $257.5M |
| Operating Margin COMPUTED | 16.3% |
| Occupancy HCRIS | 88.2% |
| Revenue / Bed COMPUTED | $2.2M |
| Net-to-Gross HCRIS | 28.7% |
| Distress Probability ML | 40.9% |
2. Market Context & Competitive Position
SC has 85 Medicare-certified hospitals with a median operating margin of 1.3%. The target's margin of 16.3% places it above the state median. Among 9 size-comparable peers (360-1442 beds), the median margin is 0.4%. The target performs in line with or above peers.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (360-1442), prioritizing same-state peers. 9 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| GHS GREENVILLE MEMORIAL HOSPIT (Target) | SC | 721 | $1.57B | 16.3% |
| MEDICAL UNIVERSITY OF SOUTH CA | SC | 817 | $2.61B | -2.0% |
| LEXINGTON MEDICAL CENTER | SC | 541 | $1.43B | 1.1% |
| SPARTANBURG REGIONAL MEDICAL C | SC | 665 | $1.18B | 7.2% |
| PRISMA HEALTH RICHLAND HOSPITA | SC | 600 | $913.3M | 0.4% |
| MCLEOD REGIONAL MEDICAL CENTER | SC | 524 | $792.5M | -4.9% |
| TRIDENT REGIONAL MEDICAL CENTE | SC | 388 | $637.5M | 16.1% |
| ANMED HEALTH | SC | 367 | $596.7M | -2.3% |
| PIEDMONT MEDICAL CENTER | SC | 374 | $387.0M | 8.3% |
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: $115.9M (736bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $33.1M | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $31.5M | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $31.2M | +198bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $19.2M | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $1.0M | +6bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $257.5M |
| + RCM Uplift | +$115.9M |
| Pro Forma EBITDA | $373.4M |
| Current Margin | 16.3% |
| Pro Forma Margin | 23.7% |
| WC Released (1x) | $60.4M |
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 | $396.1M | $2.86B | 7.21x | 48.5% |
| Base (11x exit) | 10.0x | 11.0x | $396.1M | $3.27B | 8.26x | 52.5% |
| Bull Case | 9.0x | 11.0x | $356.5M | $3.78B | 10.61x | 60.4% |
| Bull (12x exit) | 9.0x | 12.0x | $356.5M | $4.23B | 11.87x | 64.0% |
| Bear Case | 11.0x | 10.0x | $435.7M | $2.15B | 4.93x | 37.6% |
| Bear (11x exit) | 11.0x | 11.0x | $435.7M | $2.51B | 5.75x | 41.9% |
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
- 9 hospitals with 360-1442 beds
- Same-state prioritization (n=10)
- Comp margins: P25=-2.3% / P50=0.4% / P75=7.2%
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.