RAINIER SPRINGS
1. Target Overview & Investment Thesis
RAINIER SPRINGS is a 72-bed suburban community hospital in CLARK, WA with $21.7M in net patient revenue and a -9.0% operating margin. The hospital serves a payer mix of 9.4% Medicare, 1.3% Medicaid, and 89.3% commercial.
Thesis: Turnaround. Our ML models identify $1.6M in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from -9.0% to -1.7% (+736bps).
| Net Revenue HCRIS | $21.7M |
| Current EBITDA COMPUTED | $-2.0M |
| Operating Margin COMPUTED | -9.0% |
| Occupancy HCRIS | 69.5% |
| Revenue / Bed COMPUTED | $301K |
| Net-to-Gross HCRIS | 38.9% |
| Distress Probability ML | 44.4% |
2. Market Context & Competitive Position
WA has 104 Medicare-certified hospitals with a median operating margin of -10.3%. The target's margin of -9.0% places it above the state median. Among 28 size-comparable peers (36-144 beds), the median margin is -11.0%. The target performs in line with or above peers.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (36-144), prioritizing same-state peers. 28 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| RAINIER SPRINGS (Target) | WA | 72 | $21.7M | -9.0% |
| PHD#1 DBA SKAGIT VALLEY HOSPI | WA | 137 | $414.3M | -17.9% |
| ST. JOHN MEDICAL CENTER | WA | 122 | $335.0M | -4.4% |
| 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% |
| ST ANTHONY HOSPITAL | WA | 112 | $200.1M | -4.3% |
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: $1.6M (736bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $455K | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $433K | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $429K | +198bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $264K | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $14K | +6bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $-2.0M |
| + RCM Uplift | +$1.6M |
| Pro Forma EBITDA | $-364K |
| Current Margin | -9.0% |
| Pro Forma Margin | -1.7% |
| WC Released (1x) | $831K |
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 | $-3.0M | $3.0M | 0.00x | -100.0% |
| Base (11x exit) | 10.0x | 11.0x | $-3.0M | $2.3M | 0.00x | -100.0% |
| Bull Case | 9.0x | 11.0x | $-2.7M | $6.6M | 0.00x | -100.0% |
| Bull (12x exit) | 9.0x | 12.0x | $-2.7M | $6.4M | 0.00x | -100.0% |
| Bear Case | 11.0x | 10.0x | $-3.3M | $-4.0M | 0.00x | -100.0% |
| Bear (11x exit) | 11.0x | 11.0x | $-3.3M | $-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 |
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 36-144 beds
- Same-state prioritization (n=29)
- Comp margins: P25=-19.0% / P50=-11.0% / P75=-2.0%
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.