MILFORD VALLEY MEMORIAL HOSPITAL
1. Target Overview & Investment Thesis
MILFORD VALLEY MEMORIAL HOSPITAL is a 23-bed safety-net/medicaid heavy in BEAVER, UT with $5.2M in net patient revenue and a -8.1% operating margin. The hospital serves a payer mix of 5.2% Medicare, 62.1% Medicaid, and 32.7% commercial.
Thesis: Turnaround. Our ML models identify $397K in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from -8.1% to -0.5% (+758bps).
| Net Revenue HCRIS | $5.2M |
| Current EBITDA COMPUTED | $-423K |
| Operating Margin COMPUTED | -8.1% |
| Occupancy HCRIS | 74.5% |
| Revenue / Bed COMPUTED | $228K |
| Net-to-Gross HCRIS | 119.3% |
| Distress Probability ML | 64.5% |
2. Market Context & Competitive Position
UT has 59 Medicare-certified hospitals with a median operating margin of 8.0%. The target's margin of -8.1% places it below the state median. Among 28 size-comparable peers (12-46 beds), the median margin is 4.8%. The target's below-peer margin suggests operational improvement opportunity.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (12-46), prioritizing same-state peers. 28 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| MILFORD VALLEY MEMORIAL HOSPIT (Target) | UT | 23 | $5.2M | -8.1% |
| GUNNISON VALLEY HOSPITAL | UT | 25 | $130.4M | -6.4% |
| LAYTON HOSPITAL | UT | 37 | $121.1M | 9.5% |
| PARK CITY HOSPITAL | UT | 37 | $120.8M | 13.7% |
| UINTAH BASIN MEDICAL CENTER | UT | 33 | $119.9M | 1.8% |
| MOUNTAIN WEST MEDICAL CENTER | UT | 36 | $96.1M | 38.5% |
| THE ORTHOPEDIC SPECIALTY HOSPI | UT | 40 | $88.7M | 12.4% |
| CASTLEVIEW HOSPITAL | UT | 39 | $84.5M | 21.5% |
| SPANISH FORK HOSPITAL | UT | 16 | $65.3M | 0.5% |
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: $397K (758bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $110K | +210bp | 18mo |
| Denial Rate Reduction | 12.0% | 6.5% | $109K | +208bp | 12mo |
| Cost to Collect | 4.5% | 2.5% | $105K | +200bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $64K | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $10K | +18bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $-423K |
| + RCM Uplift | +$397K |
| Pro Forma EBITDA | $-26K |
| Current Margin | -8.1% |
| Pro Forma Margin | -0.5% |
| WC Released (1x) | $201K |
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 | $-651K | $1.2M | 0.00x | -100.0% |
| Base (11x exit) | 10.0x | 11.0x | $-651K | $1.1M | 0.00x | -100.0% |
| Bull Case | 9.0x | 11.0x | $-586K | $2.2M | 0.00x | -100.0% |
| Bull (12x exit) | 9.0x | 12.0x | $-586K | $2.2M | 0.00x | -100.0% |
| Bear Case | 11.0x | 10.0x | $-716K | $-594K | 0.00x | -100.0% |
| Bear (11x exit) | 11.0x | 11.0x | $-716K | $-886K | 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 |
| Medium | Elevated Medicaid exposure (62.1%) | Medicaid reimburses below cost in most states. Mitigant: denial reduction lever has highest impact on Medicaid claims |
| High | Elevated distress probability | Model estimates 64.5% 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
- 28 hospitals with 12-46 beds
- Same-state prioritization (n=29)
- Comp margins: P25=-7.0% / P50=4.8% / P75=11.7%
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.