HAWKINS COUNTY MEMORIAL HOSPITAL
1. Target Overview & Investment Thesis
HAWKINS COUNTY MEMORIAL HOSPITAL is a 6-bed suburban community hospital in HAWKINS, TN with $13.7M in net patient revenue and a -8.4% operating margin. The hospital serves a payer mix of 21.2% Medicare, 2.8% Medicaid, and 76.0% commercial.
Thesis: Turnaround. Our ML models identify $1.0M in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from -8.4% to -1.0% (+737bps).
| Net Revenue HCRIS | $13.7M |
| Current EBITDA COMPUTED | $-1.1M |
| Operating Margin COMPUTED | -8.4% |
| Occupancy HCRIS | 47.3% |
| Revenue / Bed COMPUTED | $2.3M |
| Net-to-Gross HCRIS | 18.3% |
| Distress Probability ML | 45.0% |
2. Market Context & Competitive Position
TN has 141 Medicare-certified hospitals with a median operating margin of -0.6%. The target's margin of -8.4% places it below the state median. Among 114 size-comparable peers (3-12 beds), the median margin is -8.7%. The target performs in line with or above peers.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (3-12), prioritizing same-state peers. 114 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| HAWKINS COUNTY MEMORIAL HOSPIT (Target) | TN | 6 | $13.7M | -8.4% |
| WENATCHEE VALLEY HOSPITAL | WA | 11 | $277.5M | -4.9% |
| FRANCISCAN HEALTH HAMMOND | IN | 10 | $117.7M | -4.3% |
| OCONTO HOSPITAL & MEDICAL CENT | WI | 10 | $80.4M | 1.1% |
| SUMMIT PACIFIC MEDICAL CENTER | WA | 10 | $73.6M | 9.1% |
| PHYSICIANS MEDICAL CENTER | IN | 10 | $60.0M | 24.9% |
| SAMUEL SIMMONDS MEMORIAL HOSPI | AK | 10 | $57.8M | -50.0% |
| INSTITUTE FOR ORTHOPAEDIC SURG | OH | 12 | $55.6M | 39.5% |
| JOYCE EISENBERG KEEFER MEDICAL | CA | 10 | $52.9M | 18.8% |
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: $1.0M (737bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $289K | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $275K | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $273K | +199bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $167K | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $10K | +7bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $-1.1M |
| + RCM Uplift | +$1.0M |
| Pro Forma EBITDA | $-136K |
| Current Margin | -8.4% |
| Pro Forma Margin | -1.0% |
| WC Released (1x) | $527K |
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 | $-1.8M | $2.6M | 0.00x | -100.0% |
| Base (11x exit) | 10.0x | 11.0x | $-1.8M | $2.2M | 0.00x | -100.0% |
| Bull Case | 9.0x | 11.0x | $-1.6M | $5.0M | 0.00x | -100.0% |
| Bull (12x exit) | 9.0x | 12.0x | $-1.6M | $5.0M | 0.00x | -100.0% |
| Bear Case | 11.0x | 10.0x | $-1.9M | $-1.9M | 0.00x | -100.0% |
| Bear (11x exit) | 11.0x | 11.0x | $-1.9M | $-2.8M | 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 |
| 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
- 114 hospitals with 3-12 beds
- Same-state prioritization (n=5)
- Comp margins: P25=-22.5% / P50=-8.7% / P75=2.4%
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 27, 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.