ST THOMAS ASCENSION
1. Target Overview & Investment Thesis
ST THOMAS ASCENSION is a 90-bed community hospital in nan, TN with $11.0M in net patient revenue and a -38.5% operating margin. The hospital serves a payer mix of 9.5% Medicare, 0.0% Medicaid, and 90.5% commercial.
Thesis: Turnaround. Our ML models identify $812K in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from -38.5% to -31.1% (+740bps).
| Net Revenue HCRIS | $11.0M |
| Current EBITDA COMPUTED | $-4.2M |
| Operating Margin COMPUTED | -38.5% |
| Occupancy HCRIS | 38.0% |
| Revenue / Bed COMPUTED | $122K |
| Net-to-Gross HCRIS | 32.2% |
| Distress Probability ML | nan% |
2. Market Context & Competitive Position
TN has 141 Medicare-certified hospitals with a median operating margin of -0.6%. The target's margin of -38.5% places it below the state median. Among 57 size-comparable peers (45-180 beds), the median margin is 0.6%. The target's below-peer margin suggests operational improvement opportunity.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (45-180), prioritizing same-state peers. 57 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| ST THOMAS ASCENSION (Target) | TN | 90 | $11.0M | -38.5% |
| BLOUNT MEMORIAL HOSPITAL | TN | 145 | $326.0M | -8.5% |
| METRO NASHVILLE GENERAL HOSPIT | TN | 114 | $287.4M | 48.9% |
| TRISTAR HENDERSONVILLE MEDICAL | TN | 129 | $208.6M | 41.5% |
| TRISTAR STONECREST MEDICAL CEN | TN | 115 | $190.0M | 39.5% |
| BAPTIST MEM HOSPITAL TIPTON CO | TN | 48 | $179.0M | -5.8% |
| SKYRIDGE MEDICAL CENTER | TN | 176 | $163.5M | 17.3% |
| SUMNER REGIONAL MEDICAL CENTER | TN | 138 | $161.9M | -2.7% |
| VANDERBILT WILSON COUNTY HOSPI | TN | 113 | $158.7M | -7.1% |
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: $812K (740bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $230K | +210bp | 18mo |
| Denial Rate Reduction | 12.0% | 6.5% | $219K | +200bp | 12mo |
| Cost to Collect | 4.5% | 2.5% | $219K | +200bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $133K | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $10K | +9bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $-4.2M |
| + RCM Uplift | +$812K |
| Pro Forma EBITDA | $-3.4M |
| Current Margin | -38.5% |
| Pro Forma Margin | -31.1% |
| WC Released (1x) | $421K |
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 | $-6.5M | $-19.7M | 0.00x | -100.0% |
| Base (11x exit) | 10.0x | 11.0x | $-6.5M | $-23.8M | 0.00x | -100.0% |
| Bull Case | 9.0x | 11.0x | $-5.8M | $-23.2M | 0.00x | -100.0% |
| Bull (12x exit) | 9.0x | 12.0x | $-5.8M | $-27.1M | 0.00x | -100.0% |
| Bear Case | 11.0x | 10.0x | $-7.1M | $-21.7M | 0.00x | -100.0% |
| Bear (11x exit) | 11.0x | 11.0x | $-7.1M | $-26.2M | 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 |
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 45-180 beds
- Same-state prioritization (n=58)
- Comp margins: P25=-8.2% / P50=0.6% / P75=12.7%
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.