KINDRED HOSPITAL FIRST HILL
1. Target Overview & Investment Thesis
KINDRED HOSPITAL FIRST HILL is a 80-bed community hospital in KING, WA with $41.7M in net patient revenue and a -4.0% operating margin. The hospital serves a payer mix of 17.6% Medicare, 0.0% Medicaid, and 82.4% commercial.
Thesis: Turnaround. Our ML models identify $3.1M in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from -4.0% to 3.3% (+736bps).
| Net Revenue HCRIS | $41.7M |
| Current EBITDA COMPUTED | $-1.7M |
| Operating Margin COMPUTED | -4.0% |
| Occupancy HCRIS | 67.3% |
| Revenue / Bed COMPUTED | $521K |
| Net-to-Gross HCRIS | 22.7% |
| Distress Probability ML | nan% |
2. Market Context & Competitive Position
WA has 104 Medicare-certified hospitals with a median operating margin of -10.3%. The target's margin of -4.0% places it above the state median. Among 29 size-comparable peers (40-160 beds), the median margin is -10.4%. The target performs in line with or above peers.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (40-160), prioritizing same-state peers. 29 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| KINDRED HOSPITAL FIRST HILL (Target) | WA | 80 | $41.7M | -4.0% |
| PHD#1 DBA SKAGIT VALLEY HOSPI | WA | 137 | $414.3M | -17.9% |
| ST. JOHN MEDICAL CENTER | WA | 122 | $335.0M | -4.4% |
| SWEDISH ISSAQUAH | WA | 157 | $282.7M | -6.1% |
| ST FRANCIS HOSPITAL | WA | 118 | $274.2M | -0.5% |
| PROVIDENCE CENTRALIA HOSPITAL | WA | 116 | $240.6M | -0.5% |
| OLYMPIC MEDICAL CENTER | WA | 78 | $237.9M | -12.2% |
| MULTICARE AUBURN MEDICAL CENTE | WA | 84 | $214.7M | -21.1% |
| PROV ST MARY MEDICAL CENTER | WA | 95 | $211.5M | -11.7% |
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: $3.1M (736bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $876K | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $834K | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $826K | +198bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $507K | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $27K | +6bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $-1.7M |
| + RCM Uplift | +$3.1M |
| Pro Forma EBITDA | $1.4M |
| Current Margin | -4.0% |
| Pro Forma Margin | 3.3% |
| WC Released (1x) | $1.6M |
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 | $-2.6M | $19.6M | 0.00x | -100.0% |
| Base (11x exit) | 10.0x | 11.0x | $-2.6M | $20.7M | 0.00x | -100.0% |
| Bull Case | 9.0x | 11.0x | $-2.3M | $30.0M | 0.00x | -100.0% |
| Bull (12x exit) | 9.0x | 12.0x | $-2.3M | $32.0M | 0.00x | -100.0% |
| Bear Case | 11.0x | 10.0x | $-2.8M | $5.1M | 0.00x | -100.0% |
| Bear (11x exit) | 11.0x | 11.0x | $-2.8M | $4.7M | 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
- 29 hospitals with 40-160 beds
- Same-state prioritization (n=30)
- Comp margins: P25=-18.3% / P50=-10.4% / P75=-2.2%
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.