STONEWALL JACKSON MEMORIAL HOSPITAL
1. Target Overview & Investment Thesis
STONEWALL JACKSON MEMORIAL HOSPITAL is a 49-bed under-performing / distressed in LEWIS, WV with $23.4M in net patient revenue and a -7.7% operating margin. The hospital serves a payer mix of 27.4% Medicare, 4.0% Medicaid, and 68.6% commercial.
Thesis: Turnaround. Our ML models identify $1.7M in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from -7.7% to -0.3% (+736bps).
| Net Revenue HCRIS | $23.4M |
| Current EBITDA COMPUTED | $-1.8M |
| Operating Margin COMPUTED | -7.7% |
| Occupancy HCRIS | 12.7% |
| Revenue / Bed COMPUTED | $477K |
| Net-to-Gross HCRIS | 29.2% |
| Distress Probability ML | 57.5% |
2. Market Context & Competitive Position
WV has 62 Medicare-certified hospitals with a median operating margin of -0.3%. The target's margin of -7.7% places it below the state median. Among 36 size-comparable peers (24-98 beds), the median margin is 2.6%. The target's below-peer margin suggests operational improvement opportunity.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (24-98), prioritizing same-state peers. 36 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| STONEWALL JACKSON MEMORIAL HOS (Target) | WV | 49 | $23.4M | -7.7% |
| REYNOLDS MEMORIAL HOSPITAL | WV | 94 | $123.6M | 3.8% |
| BECKLEY ARH | WV | 72 | $109.2M | -37.8% |
| ST. JOSEPHS HOSPITAL OF BUCKHA | WV | 25 | $101.4M | 15.7% |
| DAVIS MEMORIAL HOSPITAL | WV | 90 | $100.9M | -20.4% |
| JEFFERSON MEMORIAL HOSPITAL | WV | 25 | $85.5M | 9.7% |
| POTOMAC VALLEY HOSPITAL | WV | 25 | $69.5M | 16.2% |
| BOONE MEMORIAL HOSPITAL | WV | 25 | $61.8M | -12.0% |
| SUMMERSVILLE REGIONAL MED CENT | WV | 25 | $60.6M | 0.3% |
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: $1.7M (736bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $490K | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $467K | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $462K | +198bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $284K | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $15K | +6bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $-1.8M |
| + RCM Uplift | +$1.7M |
| Pro Forma EBITDA | $-72K |
| Current Margin | -7.7% |
| Pro Forma Margin | -0.3% |
| WC Released (1x) | $896K |
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 | $-2.8M | $5.4M | 0.00x | -100.0% |
| Base (11x exit) | 10.0x | 11.0x | $-2.8M | $5.0M | 0.00x | -100.0% |
| Bull Case | 9.0x | 11.0x | $-2.5M | $9.8M | 0.00x | -100.0% |
| Bull (12x exit) | 9.0x | 12.0x | $-2.5M | $10.0M | 0.00x | -100.0% |
| Bear Case | 11.0x | 10.0x | $-3.0M | $-2.3M | 0.00x | -100.0% |
| Bear (11x exit) | 11.0x | 11.0x | $-3.0M | $-3.5M | 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 12.7%, 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 57.5% 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
- 36 hospitals with 24-98 beds
- Same-state prioritization (n=37)
- Comp margins: P25=-13.7% / P50=2.6% / P75=10.9%
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.