SOUTH SOUND BEHAVIORAL HOSPITAL
1. Target Overview & Investment Thesis
SOUTH SOUND BEHAVIORAL HOSPITAL is a 108-bed suburban community hospital in THURSTON, WA with $33.2M in net patient revenue and a 14.8% operating margin. The hospital serves a payer mix of 5.1% Medicare, 17.5% Medicaid, and 77.4% commercial.
Thesis: Turnaround. Our ML models identify $2.4M in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from 14.8% to 22.2% (+736bps).
| Net Revenue HCRIS | $33.2M |
| Current EBITDA COMPUTED | $4.9M |
| Operating Margin COMPUTED | 14.8% |
| Occupancy HCRIS | 81.6% |
| Revenue / Bed COMPUTED | $307K |
| Net-to-Gross HCRIS | 30.4% |
| Distress Probability ML | 44.6% |
2. Market Context & Competitive Position
WA has 104 Medicare-certified hospitals with a median operating margin of -10.3%. The target's margin of 14.8% places it above the state median. Among 30 size-comparable peers (54-216 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 (54-216), prioritizing same-state peers. 30 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| SOUTH SOUND BEHAVIORAL HOSPITA (Target) | WA | 108 | $33.2M | 14.8% |
| ST. JOSEPH MEDICAL CENTER | WA | 208 | $750.0M | 1.9% |
| CENTRAL WASHINGTON HOSPITAL | WA | 176 | $550.9M | -2.0% |
| YAKIMA VALLEY MEMORIAL HOSPITA | WA | 208 | $522.3M | -10.4% |
| LEGACY SALMON CREEK HOSPITAL | WA | 178 | $479.7M | -5.2% |
| SWEDISH MEDICAL CENTER CHERRY | WA | 181 | $463.4M | -15.0% |
| 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% |
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: $2.4M (736bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $696K | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $663K | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $657K | +198bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $404K | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $21K | +6bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $4.9M |
| + RCM Uplift | +$2.4M |
| Pro Forma EBITDA | $7.4M |
| Current Margin | 14.8% |
| Pro Forma Margin | 22.2% |
| WC Released (1x) | $1.3M |
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 | $7.6M | $56.9M | 7.51x | 49.7% |
| Base (11x exit) | 10.0x | 11.0x | $7.6M | $65.0M | 8.59x | 53.7% |
| Bull Case | 9.0x | 11.0x | $6.8M | $75.6M | 11.08x | 61.8% |
| Bull (12x exit) | 9.0x | 12.0x | $6.8M | $84.4M | 12.39x | 65.4% |
| Bear Case | 11.0x | 10.0x | $8.3M | $42.2M | 5.07x | 38.3% |
| Bear (11x exit) | 11.0x | 11.0x | $8.3M | $49.2M | 5.90x | 42.6% |
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
- 30 hospitals with 54-216 beds
- Same-state prioritization (n=31)
- Comp margins: P25=-20.3% / P50=-10.4% / P75=-2.9%
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.