ASCENSION SETON SHOAL CREEK
1. Target Overview & Investment Thesis
ASCENSION SETON SHOAL CREEK is a 54-bed community hospital in TRAVIS, TX with $10.0M in net patient revenue and a -100.0% operating margin. The hospital serves a payer mix of 8.5% Medicare, 0.0% Medicaid, and 91.5% commercial.
Thesis: Turnaround. Our ML models identify $745K in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from -100.0% to -115.3% (+742bps).
| Net Revenue HCRIS | $10.0M |
| Current EBITDA COMPUTED | $-12.3M |
| Operating Margin COMPUTED | -100.0% |
| Occupancy HCRIS | 59.8% |
| Revenue / Bed COMPUTED | $186K |
| Net-to-Gross HCRIS | 26.0% |
| Distress Probability ML | nan% |
2. Market Context & Competitive Position
TX has 583 Medicare-certified hospitals with a median operating margin of -0.7%. The target's margin of -100.0% places it below the state median. Among 229 size-comparable peers (27-108 beds), the median margin is 0.2%. The target's below-peer margin suggests operational improvement opportunity.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (27-108), prioritizing same-state peers. 229 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| ASCENSION SETON SHOAL CREEK (Target) | TX | 54 | $10.0M | -100.0% |
| DECATUR COMMUNITY HOSPITAL | TX | 81 | $361.0M | -15.5% |
| WISE HEALTH SYSTEM - PARKWAY | TX | 36 | $361.0M | -15.5% |
| CHILDRENS MEDICAL CENTER OF PL | TX | 72 | $336.7M | 20.9% |
| BAYLOR HEART AND VASCULAR HOSP | TX | 53 | $255.0M | 30.0% |
| TEXAS ORTHOPEDIC HOSPITA | TX | 42 | $237.8M | 46.3% |
| PRESBYTERIAN HOSP FLOWER MOUND | TX | 99 | $215.0M | 28.3% |
| LAKE GRANBURY MEDICAL CENTER | TX | 53 | $181.6M | 38.5% |
| METHODIST HOSPITAL FOR SURGERY | TX | 32 | $178.4M | 22.8% |
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: $745K (742bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $211K | +210bp | 18mo |
| Denial Rate Reduction | 12.0% | 6.5% | $201K | +201bp | 12mo |
| Cost to Collect | 4.5% | 2.5% | $201K | +200bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $122K | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $10K | +10bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $-12.3M |
| + RCM Uplift | +$745K |
| Pro Forma EBITDA | $-11.6M |
| Current Margin | -100.0% |
| Pro Forma Margin | -115.3% |
| WC Released (1x) | $385K |
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 | $-18.9M | $-73.8M | 0.00x | -100.0% |
| Base (11x exit) | 10.0x | 11.0x | $-18.9M | $-87.3M | 0.00x | -100.0% |
| Bull Case | 9.0x | 11.0x | $-17.1M | $-91.0M | 0.00x | -100.0% |
| Bull (12x exit) | 9.0x | 12.0x | $-17.1M | $-104.3M | 0.00x | -100.0% |
| Bear Case | 11.0x | 10.0x | $-20.8M | $-71.4M | 0.00x | -100.0% |
| Bear (11x exit) | 11.0x | 11.0x | $-20.8M | $-85.3M | 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
- 229 hospitals with 27-108 beds
- Same-state prioritization (n=230)
- Comp margins: P25=-14.1% / P50=0.2% / P75=11.9%
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.