SHORE MEMORIAL HOSPITAL
1. Target Overview & Investment Thesis
SHORE MEMORIAL HOSPITAL is a 52-bed suburban community hospital in NORTHAMPTON, VA with $103.1M in net patient revenue and a 11.4% operating margin. The hospital serves a payer mix of 37.1% Medicare, 2.5% Medicaid, and 60.4% commercial.
Thesis: Turnaround. Our ML models identify $7.6M in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from 11.4% to 18.7% (+736bps).
| Net Revenue HCRIS | $103.1M |
| Current EBITDA COMPUTED | $11.7M |
| Operating Margin COMPUTED | 11.4% |
| Occupancy HCRIS | 40.0% |
| Revenue / Bed COMPUTED | $2.0M |
| Net-to-Gross HCRIS | 30.4% |
| Distress Probability ML | 49.2% |
2. Market Context & Competitive Position
VA has 111 Medicare-certified hospitals with a median operating margin of 4.4%. The target's margin of 11.4% places it above the state median. Among 45 size-comparable peers (26-104 beds), the median margin is 6.2%. The target performs in line with or above peers.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (26-104), prioritizing same-state peers. 45 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| SHORE MEMORIAL HOSPITAL (Target) | VA | 52 | $103.1M | 11.4% |
| CARILION NEW RIVER VALLEY MED | VA | 94 | $261.3M | -0.5% |
| RICHMOND COMMUNITY HOSPITAL | VA | 96 | $254.9M | 21.5% |
| JOHNSTON MEMORIAL HOSPITAL | VA | 100 | $188.3M | 6.1% |
| LONESOME PINE HOSPITAL | VA | 56 | $175.6M | 17.2% |
| LEWISGALE HOSPITAL - MONTGOMER | VA | 92 | $155.7M | 40.7% |
| CULPEPER MEMORIAL HOSPITAL | VA | 70 | $153.9M | 9.3% |
| COMMUNITY MEMORIAL HOSPITAL | VA | 66 | $135.2M | -31.0% |
| STAFFORD HOSPITAL | VA | 61 | $127.9M | 5.7% |
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: $7.6M (736bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $2.2M | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $2.1M | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $2.0M | +198bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $1.3M | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $66K | +6bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $11.7M |
| + RCM Uplift | +$7.6M |
| Pro Forma EBITDA | $19.3M |
| Current Margin | 11.4% |
| Pro Forma Margin | 18.7% |
| WC Released (1x) | $4.0M |
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 | $18.0M | $153.3M | 8.49x | 53.4% |
| Base (11x exit) | 10.0x | 11.0x | $18.0M | $174.4M | 9.67x | 57.4% |
| Bull Case | 9.0x | 11.0x | $16.2M | $205.3M | 12.65x | 66.1% |
| Bull (12x exit) | 9.0x | 12.0x | $16.2M | $228.8M | 14.09x | 69.7% |
| Bear Case | 11.0x | 10.0x | $19.8M | $109.4M | 5.51x | 40.7% |
| Bear (11x exit) | 11.0x | 11.0x | $19.8M | $126.8M | 6.39x | 44.9% |
7. Key Risks & Mitigants
| Severity | Risk Factor | Mitigant |
|---|---|---|
| Medium | Standard execution risk | RCM improvement requires management buy-in and 12-18 month implementation timeline |
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
- 45 hospitals with 26-104 beds
- Same-state prioritization (n=46)
- Comp margins: P25=-9.7% / P50=6.2% / P75=15.6%
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.