ST. MARYS HOSPITAL
1. Target Overview & Investment Thesis
ST. MARYS HOSPITAL is a 363-bed suburban community hospital in HENRICO, VA with $688.9M in net patient revenue and a 13.3% operating margin. The hospital serves a payer mix of 27.1% Medicare, 1.7% Medicaid, and 71.2% commercial.
Thesis: Platform Growth. Our ML models identify $50.7M in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from 13.3% to 20.7% (+736bps).
| Net Revenue HCRIS | $688.9M |
| Current EBITDA COMPUTED | $91.9M |
| Operating Margin COMPUTED | 13.3% |
| Occupancy HCRIS | 74.3% |
| Revenue / Bed COMPUTED | $1.9M |
| Net-to-Gross HCRIS | 25.9% |
| Distress Probability ML | 41.3% |
2. Market Context & Competitive Position
VA has 111 Medicare-certified hospitals with a median operating margin of 4.4%. The target's margin of 13.3% places it above the state median. Among 24 size-comparable peers (182-726 beds), the median margin is 4.9%. The target performs in line with or above peers.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (182-726), prioritizing same-state peers. 24 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| ST. MARYS HOSPITAL (Target) | VA | 363 | $688.9M | 13.3% |
| UNIVERSITY OF VIRGINIA MEDICAL | VA | 665 | $2.37B | 1.1% |
| CARILION MEDICAL CENTER | VA | 637 | $1.46B | -11.3% |
| SENTARA NORFOLK GENERAL HOSPIT | VA | 472 | $1.34B | 4.9% |
| CJW MEDICAL CENTER | VA | 612 | $1.00B | 32.8% |
| RIVERSIDE REGIONAL MEDICAL CEN | VA | 379 | $963.3M | -20.1% |
| WINCHESTER MEDICAL CENTER | VA | 455 | $694.7M | -5.8% |
| HENRICO DOCTORS HOSPITAL | VA | 686 | $660.5M | 18.9% |
| VIRGINIA HOSPITAL CENTER ARLIN | VA | 336 | $624.4M | 1.8% |
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: $50.7M (736bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $14.5M | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $13.8M | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $13.6M | +198bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $8.4M | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $441K | +6bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $91.9M |
| + RCM Uplift | +$50.7M |
| Pro Forma EBITDA | $142.6M |
| Current Margin | 13.3% |
| Pro Forma Margin | 20.7% |
| WC Released (1x) | $26.4M |
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 | $141.3M | $1.11B | 7.88x | 51.1% |
| Base (11x exit) | 10.0x | 11.0x | $141.3M | $1.27B | 8.99x | 55.1% |
| Bull Case | 9.0x | 11.0x | $127.2M | $1.48B | 11.66x | 63.4% |
| Bull (12x exit) | 9.0x | 12.0x | $127.2M | $1.66B | 13.02x | 67.1% |
| Bear Case | 11.0x | 10.0x | $155.5M | $813.6M | 5.23x | 39.2% |
| Bear (11x exit) | 11.0x | 11.0x | $155.5M | $945.4M | 6.08x | 43.5% |
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
- 24 hospitals with 182-726 beds
- Same-state prioritization (n=25)
- Comp margins: P25=-1.1% / P50=4.9% / P75=15.2%
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.