WYOMING STATE HOSPITAL
1. Target Overview & Investment Thesis
WYOMING STATE HOSPITAL is a 72-bed community hospital in UINTA, WY with $37.5M in net patient revenue and a 4.6% operating margin. The hospital serves a payer mix of 1.6% Medicare, 0.0% Medicaid, and 98.4% commercial.
Thesis: Turnaround. Our ML models identify $2.8M in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from 4.6% to 12.0% (+736bps).
| Net Revenue HCRIS | $37.5M |
| Current EBITDA COMPUTED | $1.7M |
| Operating Margin COMPUTED | 4.6% |
| Occupancy HCRIS | 65.6% |
| Revenue / Bed COMPUTED | $521K |
| Net-to-Gross HCRIS | 100.0% |
| Distress Probability ML | nan% |
2. Market Context & Competitive Position
WY has 29 Medicare-certified hospitals with a median operating margin of -7.5%. The target's margin of 4.6% places it above the state median. Among 8 size-comparable peers (36-144 beds), the median margin is -4.9%. 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. 8 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| WYOMING STATE HOSPITAL (Target) | WY | 72 | $37.5M | 4.6% |
| CAMPBELL COUNTY MEMORIAL HOSPI | WY | 66 | $179.4M | -22.8% |
| ST. JOHNS HOSPITAL | WY | 48 | $169.8M | -7.8% |
| MEM. HOSPITAL OF SHERIDAN CTY. | WY | 88 | $139.0M | -4.0% |
| IVINSON MEMORIAL HOSPITAL | WY | 76 | $128.5M | 9.0% |
| MEM. HOSPT. OF SWEETWATER COUN | WY | 58 | $107.7M | -8.9% |
| SAGE WEST HEALTH CARE | WY | 133 | $68.3M | -5.8% |
| WYOMNG BEHAVIORAL INSTITUTE | WY | 85 | $20.9M | 6.5% |
| ELKHORN VALLEY REHABILITATION | WY | 40 | $17.0M | 10.2% |
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: $2.8M (736bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $787K | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $750K | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $742K | +198bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $456K | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $24K | +6bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $1.7M |
| + RCM Uplift | +$2.8M |
| Pro Forma EBITDA | $4.5M |
| Current Margin | 4.6% |
| Pro Forma Margin | 12.0% |
| WC Released (1x) | $1.4M |
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 | $2.7M | $39.0M | 14.69x | 71.2% |
| Base (11x exit) | 10.0x | 11.0x | $2.7M | $43.7M | 16.48x | 75.1% |
| Bull Case | 9.0x | 11.0x | $2.4M | $53.7M | 22.48x | 86.4% |
| Bull (12x exit) | 9.0x | 12.0x | $2.4M | $59.3M | 24.82x | 90.1% |
| Bear Case | 11.0x | 10.0x | $2.9M | $24.3M | 8.33x | 52.8% |
| Bear (11x exit) | 11.0x | 11.0x | $2.9M | $27.7M | 9.49x | 56.8% |
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
- 8 hospitals with 36-144 beds
- Same-state prioritization (n=9)
- Comp margins: P25=-8.1% / P50=-4.9% / P75=7.1%
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.