ASCENSION SACRED HEART REHABILITATIO
1. Target Overview & Investment Thesis
ASCENSION SACRED HEART REHABILITATIO is a 21-bed suburban community hospital in MILWAUKEE, WI with $8.6M in net patient revenue and a 6.7% operating margin. The hospital serves a payer mix of 24.1% Medicare, 7.7% Medicaid, and 68.2% commercial.
Thesis: Turnaround. Our ML models identify $639K in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from 6.7% to 14.2% (+745bps).
| Net Revenue HCRIS | $8.6M |
| Current EBITDA COMPUTED | $579K |
| Operating Margin COMPUTED | 6.7% |
| Occupancy HCRIS | 49.8% |
| Revenue / Bed COMPUTED | $409K |
| Net-to-Gross HCRIS | 37.4% |
| Distress Probability ML | 50.6% |
2. Market Context & Competitive Position
WI has 150 Medicare-certified hospitals with a median operating margin of 0.4%. The target's margin of 6.7% places it above the state median. Among 81 size-comparable peers (10-42 beds), the median margin is 1.2%. The target performs in line with or above peers.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (10-42), prioritizing same-state peers. 81 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| ASCENSION SACRED HEART REHABIL (Target) | WI | 21 | $8.6M | 6.7% |
| MERCY WALWORTH HOSPITAL | WI | 25 | $616.4M | 4.4% |
| MEMORIAL MEDICAL CENTER INC. | WI | 25 | $138.4M | 8.1% |
| LAKEVIEW MEDICAL CENTER OF RIC | WI | 40 | $137.4M | -12.0% |
| MARSHFIELD MEDICAL CENTER-MINO | WI | 19 | $129.6M | -12.4% |
| MCHS-RED CEDAR | WI | 25 | $123.4M | 16.8% |
| MEMORIAL HOSPITAL OF BURLINGTO | WI | 33 | $118.8M | 15.3% |
| OAK LEAF SURGICAL HOSPITAL LLC | WI | 13 | $109.8M | 34.1% |
| SAUK PRAIRIE MEMORIAL HOSPITAL | WI | 36 | $109.1M | -0.1% |
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: $639K (745bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $180K | +210bp | 18mo |
| Denial Rate Reduction | 12.0% | 6.5% | $173K | +202bp | 12mo |
| Cost to Collect | 4.5% | 2.5% | $172K | +200bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $104K | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $10K | +11bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $579K |
| + RCM Uplift | +$639K |
| Pro Forma EBITDA | $1.2M |
| Current Margin | 6.7% |
| Pro Forma Margin | 14.2% |
| WC Released (1x) | $329K |
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 | $891K | $10.2M | 11.46x | 62.9% |
| Base (11x exit) | 10.0x | 11.0x | $891K | $11.5M | 12.93x | 66.9% |
| Bull Case | 9.0x | 11.0x | $802K | $13.9M | 17.36x | 77.0% |
| Bull (12x exit) | 9.0x | 12.0x | $802K | $15.4M | 19.24x | 80.6% |
| Bear Case | 11.0x | 10.0x | $980K | $6.7M | 6.86x | 47.0% |
| Bear (11x exit) | 11.0x | 11.0x | $980K | $7.7M | 7.87x | 51.1% |
7. Key Risks & Mitigants
| Severity | Risk Factor | Mitigant |
|---|---|---|
| High | Elevated distress probability | Model estimates 50.6% 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
- 81 hospitals with 10-42 beds
- Same-state prioritization (n=82)
- Comp margins: P25=-8.7% / P50=1.2% / P75=8.4%
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.