TRIDENT REGIONAL MEDICAL CENTER
1. Target Overview & Investment Thesis
TRIDENT REGIONAL MEDICAL CENTER is a 388-bed suburban community hospital in DORCHESTER, SC with $637.5M in net patient revenue and a 16.1% operating margin. The hospital serves a payer mix of 25.3% Medicare, 5.2% Medicaid, and 69.6% commercial.
Thesis: Platform Growth. Our ML models identify $46.9M in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from 16.1% to 23.5% (+736bps).
| Net Revenue HCRIS | $637.5M |
| Current EBITDA COMPUTED | $102.8M |
| Operating Margin COMPUTED | 16.1% |
| Occupancy HCRIS | 82.7% |
| Revenue / Bed COMPUTED | $1.6M |
| Net-to-Gross HCRIS | 10.7% |
| Distress Probability ML | 39.0% |
2. Market Context & Competitive Position
SC has 85 Medicare-certified hospitals with a median operating margin of 1.3%. The target's margin of 16.1% places it above the state median. Among 16 size-comparable peers (194-776 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 (194-776), prioritizing same-state peers. 16 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| TRIDENT REGIONAL MEDICAL CENTE (Target) | SC | 388 | $637.5M | 16.1% |
| GHS GREENVILLE MEMORIAL HOSPIT | SC | 721 | $1.57B | 16.3% |
| 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% |
| ST. FRANCIS HOSPITAL INC | SC | 327 | $691.4M | 4.9% |
| GRAND STRAND REGIONAL MEDICAL | SC | 336 | $602.2M | 32.8% |
| ANMED HEALTH | SC | 367 | $596.7M | -2.3% |
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: $46.9M (736bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $13.4M | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $12.8M | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $12.6M | +198bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $7.8M | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $408K | +6bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $102.8M |
| + RCM Uplift | +$46.9M |
| Pro Forma EBITDA | $149.8M |
| Current Margin | 16.1% |
| Pro Forma Margin | 23.5% |
| WC Released (1x) | $24.5M |
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 | $158.2M | $1.15B | 7.25x | 48.6% |
| Base (11x exit) | 10.0x | 11.0x | $158.2M | $1.31B | 8.30x | 52.7% |
| Bull Case | 9.0x | 11.0x | $142.4M | $1.52B | 10.68x | 60.6% |
| Bull (12x exit) | 9.0x | 12.0x | $142.4M | $1.70B | 11.94x | 64.2% |
| Bear Case | 11.0x | 10.0x | $174.0M | $861.6M | 4.95x | 37.7% |
| Bear (11x exit) | 11.0x | 11.0x | $174.0M | $1.00B | 5.77x | 42.0% |
7. Key Risks & Mitigants
| Severity | Risk Factor | Mitigant |
|---|---|---|
| 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
- 16 hospitals with 194-776 beds
- Same-state prioritization (n=17)
- Comp margins: P25=-3.5% / P50=0.4% / P75=5.5%
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.