ASCENSION SETON WILLIAMSON
1. Target Overview & Investment Thesis
ASCENSION SETON WILLIAMSON is a 181-bed suburban community hospital in WILLIAMSON, TX with $251.9M in net patient revenue and a 9.2% operating margin. The hospital serves a payer mix of 23.9% Medicare, 1.0% Medicaid, and 75.2% commercial.
Thesis: Turnaround. Our ML models identify $18.5M in annual EBITDA improvement potential from RCM optimization across 5 levers, lifting margin from 9.2% to 16.5% (+736bps).
| Net Revenue HCRIS | $251.9M |
| Current EBITDA COMPUTED | $23.1M |
| Operating Margin COMPUTED | 9.2% |
| Occupancy HCRIS | 77.8% |
| Revenue / Bed COMPUTED | $1.4M |
| Net-to-Gross HCRIS | 14.1% |
| Distress Probability ML | 39.1% |
2. Market Context & Competitive Position
TX has 583 Medicare-certified hospitals with a median operating margin of -0.7%. The target's margin of 9.2% places it above the state median. Among 157 size-comparable peers (90-362 beds), the median margin is 3.3%. The target performs in line with or above peers.
3. RCM Performance Analysis — Comparable Hospitals
Comps selected by bed count (90-362), prioritizing same-state peers. 157 hospitals in the comp set.
| Hospital | State | Beds | Revenue | Margin |
|---|---|---|---|---|
| ASCENSION SETON WILLIAMSON (Target) | TX | 181 | $251.9M | 9.2% |
| DELL CHILDRENS MEDICAL CENTER | TX | 262 | $901.9M | 25.5% |
| DRISCOLL CHILDRENS HOSPITAL | TX | 215 | $694.3M | 29.4% |
| ROUND ROCK HOSPITAL | TX | 165 | $681.4M | 8.7% |
| METHODIST SUGAR LAND HOSPITAL | TX | 337 | $679.6M | 12.6% |
| METHODIST WILLOWBROOK HOSPITAL | TX | 346 | $661.8M | 10.8% |
| GOOD SHEPHERD MEDICAL CENTER | TX | 314 | $557.4M | 0.7% |
| HOUSTON METHODIST THE WOODLAND | TX | 292 | $535.9M | 13.9% |
| METHODIST WEST HOUSTON HOSPITA | TX | 270 | $529.7M | 15.5% |
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: $18.5M (736bps margin improvement).
| Lever | Current | Target | EBITDA Impact | Margin | Ramp |
|---|---|---|---|---|---|
| Net Collection Rate | 93.5% | 97.0% | $5.3M | +210bp | 18mo |
| Cost to Collect | 4.5% | 2.5% | $5.0M | +200bp | 12mo |
| Denial Rate Reduction | 12.0% | 6.5% | $5.0M | +198bp | 12mo |
| A/R Days Reduction | 5200.0% | 3800.0% | $3.1M | +122bp | 9mo |
| Clean Claim Rate | 88.0% | 96.0% | $161K | +6bp | 6mo |
5. EBITDA Bridge
| Current EBITDA | $23.1M |
| + RCM Uplift | +$18.5M |
| Pro Forma EBITDA | $41.7M |
| Current Margin | 9.2% |
| Pro Forma Margin | 16.5% |
| WC Released (1x) | $9.7M |
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 | $35.6M | $337.9M | 9.50x | 56.9% |
| Base (11x exit) | 10.0x | 11.0x | $35.6M | $383.2M | 10.78x | 60.9% |
| Bull Case | 9.0x | 11.0x | $32.0M | $455.9M | 14.25x | 70.1% |
| Bull (12x exit) | 9.0x | 12.0x | $32.0M | $506.8M | 15.84x | 73.8% |
| Bear Case | 11.0x | 10.0x | $39.1M | $233.6M | 5.97x | 43.0% |
| Bear (11x exit) | 11.0x | 11.0x | $39.1M | $269.7M | 6.89x | 47.1% |
7. Key Risks & Mitigants
| Severity | Risk Factor | Mitigant |
|---|---|---|
| Low | Low net-to-gross ratio | Large contractual allowances suggest pricing discipline issues. Mitigant: payer renegotiation is an additional upside lever |
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
- 157 hospitals with 90-362 beds
- Same-state prioritization (n=158)
- Comp margins: P25=-9.9% / P50=3.3% / P75=13.7%
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.