Roll-Up Economics
🛡️ Public data only — no PHI permitted on this instance.
Roll-Up / Platform Economics
Multiple arb · add-on cadence · synergy capture · debt capacity · exit waterfall — 1,470 corpus deals
Entry EBITDA
$12.0M
Exit EBITDA
$48.0M
Add-Ons
23
Deployed
$321M
Synergies (Run-Rate)
$33.6M
Multiple Arb
$534M
Base MOIC
1.62x
Base IRR
10.2%
Corpus Deals
1,470
Platform EBITDA Walk — Entry → Exit
Multiple Arbitrage Waterfall
| Stage | EBITDA ($M) | Implied Multiple | Implied EV ($M) | Incremental Value ($M) |
|---|---|---|---|---|
| Entry (Platform Acquisition) | $12.00 | 9.50x | $114.00 | $+0.00 |
| Post Bolt-On Growth | $26.40 | 10.92x | $288.42 | $+174.42 |
| Organic + Synergy Capture | $36.00 | 12.35x | $444.60 | $+156.18 |
| Platform Re-Rating | $48.00 | 13.50x | $648.00 | $+203.40 |
Add-On Cohorts — Deployment Pacing
| Year | Targets Closed | Avg Entry Mult | Avg EV ($M) | Total Deployed ($M) | Synergy Capture | Integ Time (mo) |
|---|---|---|---|---|---|---|
| 2024 | 2 | 6.65x | $13.68 | $27.36 | 49.0% | 12 |
| 2025 | 6 | 6.84x | $13.68 | $82.08 | 54.0% | 14 |
| 2026 | 6 | 6.84x | $13.68 | $82.08 | 59.0% | 14 |
| 2027 | 6 | 6.65x | $13.68 | $82.08 | 64.0% | 12 |
| 2028 | 3 | 7.60x | $15.96 | $47.88 | 71.0% | 16 |
Synergy Capture — Run-Rate & Cost to Achieve
| Category | Annual Run-Rate ($M) | Capture (mo) | One-Time Cost ($M) | Exec Risk | Confidence |
|---|---|---|---|---|---|
| RCM / Billing Consolidation | $3.93 | 12 | $1.09 | low | high |
| Payer Contract Renegotiation | $6.98 | 18 | $0.65 | medium | medium |
| Supply Chain / GPO Arbitrage | $2.62 | 9 | $0.44 | low | high |
| Back-Office Consolidation (HR, Finance) | $1.75 | 15 | $0.87 | low | high |
| Technology Platform Unification | $3.05 | 24 | $2.62 | high | medium |
| Malpractice / Insurance Pooling | $1.31 | 8 | $0.22 | low | high |
| Clinical Ops Standardization | $5.45 | 20 | $1.75 | medium | medium |
| Revenue Cycle Optimization | $4.58 | 14 | $1.09 | medium | high |
| Cross-Sell / New Service Lines | $3.93 | 30 | $0.87 | high | low |
Integration Cost by Workstream
| Workstream | $/Add-On ($k) | Total Cost ($M) | Duration (mo) | Peak FTE |
|---|---|---|---|---|
| Financial / Tax Diligence | $185 | $4.25 | 6 | 18 |
| Legal / Contract Review | $225 | $5.17 | 8 | 18 |
| IT Systems Migration | $340 | $7.82 | 9 | 18 |
| EHR/PM Unification | $485 | $11.15 | 14 | 18 |
| Billing System Consolidation | $220 | $5.06 | 8 | 18 |
| HR / Payroll Integration | $95 | $2.19 | 5 | 18 |
| Rebrand / Marketing | $145 | $3.33 | 7 | 18 |
| Compliance Program Alignment | $118 | $2.71 | 4 | 18 |
| Facilities / Lease Review | $78 | $1.79 | 3 | 18 |
Debt Capacity Trajectory
| Stage | EBITDA ($M) | Leverage | Max Debt ($M) | Equity Check ($M) | Dry Powder ($M) |
|---|---|---|---|---|---|
| Entry | $12.00 | 5.50x | $66.00 | $29.70 | $+8.40 |
| Post Year-1 Add-Ons | $19.20 | 5.75x | $110.40 | $49.68 | $+18.24 |
| Post Year-2 Add-Ons | $26.40 | 6.00x | $158.40 | $71.28 | $+31.68 |
| Post Year-3 Add-Ons | $33.60 | 5.75x | $193.20 | $86.94 | $+31.92 |
| Exit Year | $48.00 | 5.50x | $264.00 | $118.80 | $+33.60 |
Year-by-Year EBITDA Walk Detail
| Period | Standalone ($M) | Acquired ($M) | Synergies ($M) | Total EBITDA ($M) | Organic Growth |
|---|---|---|---|---|---|
| 2024 (Entry) | $12.00 | $0.00 | $0.00 | $12.00 | +0.0% |
| 2025 | $12.48 | $4.68 | $1.08 | $18.24 | +52.0% |
| 2026 | $18.97 | $9.36 | $2.16 | $30.49 | +67.2% |
| 2027 | $31.71 | $14.04 | $3.24 | $48.99 | +60.7% |
| 2028 | $50.95 | $18.72 | $4.32 | $73.99 | +51.0% |
| 2029 | $76.95 | $23.40 | $5.40 | $48.00 | -35.1% |
Exit Scenario Matrix — Downside, Base, Upside, IPO
| Scenario | Exit EBITDA ($M) | Multiple | Exit EV ($M) | Less Debt ($M) | Equity Proceeds ($M) | MOIC | IRR |
|---|---|---|---|---|---|---|---|
| Downside (7x) | $40.80 | 7.00x | $285.60 | $212.16 | $73.44 | 0.52x | -12.4% |
| Base (10x) | $48.00 | 10.00x | $480.00 | $249.60 | $230.40 | 1.62x | +10.2% |
| Upside Strategic (13x) | $51.84 | 13.00x | $673.92 | $269.57 | $404.35 | 2.85x | +23.3% |
| IPO / Public Comp (15x) | $53.76 | 15.00x | $806.40 | $279.55 | $526.85 | 3.71x | +30.0% |
Roll-Up Thesis: 4x EBITDA growth from $12.0M → $48.0M via
23 add-ons deploying $321M in aggregate. Multiple arbitrage ($9.5x → $13.5x) creates $534M of value;
synergies add $33.6M run-rate. Base-case MOIC 1.62x / IRR 10.2% —
materially dependent on exit multiple. Integration cost $43.47M is ~13.5% of deployed capital;
risks concentrated in EHR unification and cross-sell revenue synergies (high execution risk). Downside exit of 7x produces material equity erosion.