PROVIDENCE ST JOSEPHS HOSPITAL
1. Target Overview & Investment Thesis
PROVIDENCE ST JOSEPHS HOSPITAL is a 23-bed rural/critical access in STEVENS, WA with $20.1M in net patient revenue and a -9.3% operating margin. The hospital serves a payer mix of 38.3% Medicare, 0.1% Medicaid, and 61.6% commercial.
Thesis: Turnaround. Our ML models identify $1.5M in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from -9.3% to -1.9% (+736bps).
| Net Revenue HCRIS | $20.1M |
| Current EBITDA COMPUTED | $-1.9M |
| Operating Margin COMPUTED | -9.3% |
| Occupancy HCRIS | 27.9% |
| Revenue / Bed COMPUTED | $875K |
| Net-to-Gross HCRIS | 49.9% |
| Distress Probability ML | 55.1% |
2. Market Context & Competitive Position
WA has 104 Medicare-certified hospitals with a median operating margin of -10.3%. The target's margin of -9.3% places it above the state median. Among 39 size-comparable peers (12-46 beds), the median margin is -9.8%. 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. 39 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| PROVIDENCE ST JOSEPHS HOSPITAL (Target) | WA | 23 | $20.1M | -9.3% |
| FRED HUTCHINSON CANCER CENTER | WA | 20 | $1.17B | -50.0% |
| JEFFERSON GENERAL HOSPITAL | WA | 25 | $148.0M | -3.0% |
| MASON GENERAL HOSPITAL | WA | 25 | $127.1M | -5.3% |
| KITTITAS VALLEY COMMUNITY HOSP | WA | 25 | $121.0M | 2.3% |
| TRI-STATE MEMORIAL HOSPITAL | WA | 25 | $107.0M | 0.8% |
| ISLAND HOSPITAL | WA | 43 | $106.1M | -15.0% |
| ASTRIA SUNNYSIDE HOSPITAL | WA | 25 | $102.5M | 1.7% |
| WHIDBEY GENERAL HOSPITAL | WA | 25 | $98.0M | -23.4% |
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: $1.5M (736bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $422K | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $402K | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $398K | +198bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $245K | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $13K | +6bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $-1.9M |
| + RCM Uplift | +$1.5M |
| Pro Forma EBITDA | $-384K |
| Current Margin | -9.3% |
| Pro Forma Margin | -1.9% |
| WC Released (1x) | $772K |
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 | $-2.9M | $2.5M | 0.00x | -100.0% |
| Base (11x exit) | 10.0x | 11.0x | $-2.9M | $1.8M | 0.00x | -100.0% |
| Bull Case | 9.0x | 11.0x | $-2.6M | $5.8M | 0.00x | -100.0% |
| Bull (12x exit) | 9.0x | 12.0x | $-2.6M | $5.5M | 0.00x | -100.0% |
| Bear Case | 11.0x | 10.0x | $-3.2M | $-4.0M | 0.00x | -100.0% |
| Bear (11x exit) | 11.0x | 11.0x | $-3.2M | $-5.4M | 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 | Low occupancy | At 27.9%, 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 55.1% 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
- 39 hospitals with 12-46 beds
- Same-state prioritization (n=40)
- Comp margins: P25=-15.7% / P50=-9.8% / P75=-4.3%
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.