ASCENSION SETON EDGAR B DAVIS
1. Target Overview & Investment Thesis
ASCENSION SETON EDGAR B DAVIS is a 23-bed suburban community hospital in CALDWELL, TX with $35.1M in net patient revenue and a 5.1% operating margin. The hospital serves a payer mix of 21.0% Medicare, 0.3% Medicaid, and 78.7% commercial.
Thesis: Turnaround. Our ML models identify $2.6M in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from 5.1% to 12.5% (+736bps).
| Net Revenue HCRIS | $35.1M |
| Current EBITDA COMPUTED | $1.8M |
| Operating Margin COMPUTED | 5.1% |
| Occupancy HCRIS | 30.8% |
| Revenue / Bed COMPUTED | $1.5M |
| Net-to-Gross HCRIS | 29.4% |
| Distress Probability ML | 50.5% |
2. Market Context & Competitive Position
TX has 583 Medicare-certified hospitals with a median operating margin of -0.7%. The target's margin of 5.1% places it above the state median. Among 235 size-comparable peers (12-46 beds), the median margin is -8.9%. The target performs in line with or above peers.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (12-46), prioritizing same-state peers. 235 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| ASCENSION SETON EDGAR B DAVIS (Target) | TX | 23 | $35.1M | 5.1% |
| WISE HEALTH SYSTEM - PARKWAY | TX | 36 | $361.0M | -15.5% |
| CORYELL MEMORIAL HOSPITAL | TX | 25 | $305.9M | -1.5% |
| TEXAS ORTHOPEDIC HOSPITA | TX | 42 | $237.8M | 46.3% |
| METHODIST HOSPITAL FOR SURGERY | TX | 32 | $178.4M | 22.8% |
| TEXAS SPINE AND JOINT HOSPITAL | TX | 20 | $147.3M | 30.3% |
| NORTH CENTRAL SURGICAL HOSPITA | TX | 24 | $143.6M | 32.0% |
| SCOTT AND WHITE HOSPITAL TAYLO | TX | 25 | $139.7M | -47.5% |
| BAYLOR SURGICAL HOSPITAL AT FO | TX | 30 | $136.0M | 14.8% |
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: $2.6M (736bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $738K | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $703K | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $696K | +198bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $428K | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $22K | +6bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $1.8M |
| + RCM Uplift | +$2.6M |
| Pro Forma EBITDA | $4.4M |
| Current Margin | 5.1% |
| Pro Forma Margin | 12.5% |
| WC Released (1x) | $1.3M |
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 | $2.8M | $37.8M | 13.58x | 68.5% |
| Base (11x exit) | 10.0x | 11.0x | $2.8M | $42.5M | 15.26x | 72.5% |
| Bull Case | 9.0x | 11.0x | $2.5M | $51.9M | 20.72x | 83.4% |
| Bull (12x exit) | 9.0x | 12.0x | $2.5M | $57.4M | 22.90x | 87.1% |
| Bear Case | 11.0x | 10.0x | $3.1M | $24.0M | 7.83x | 50.9% |
| Bear (11x exit) | 11.0x | 11.0x | $3.1M | $27.4M | 8.93x | 54.9% |
7. Key Risks & Mitigants
| Severity | Risk Factor | Mitigant |
|---|---|---|
| Medium | Low occupancy | At 30.8%, fixed costs are spread over fewer patient days. Mitigant: volume growth is an additional upside lever not modeled in base case |
| High | Elevated distress probability | Model estimates 50.5% probability of financial distress. Mitigant: distressed entry pricing (7-9x) compensates for risk |
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
- 235 hospitals with 12-46 beds
- Same-state prioritization (n=236)
- Comp margins: P25=-37.9% / P50=-8.9% / P75=9.0%
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.