Pre-LOI · Healthcare Services

Independent Sponsor LOI Negotiation in Healthcare Services

Securities and M&A counsel for independent sponsors negotiating healthcare services transactions, from LOI to close to the capital markets that open up afterward.

EV range $15M to $120M EV EBITDA $3M to $20M Audience Buy-side / Sponsor
The deal context

Every healthcare services acquisition has its own gravity. LOI Negotiation is the workstream where independent sponsor counsel earns the seat.

The typical healthcare services platform sits at $15M to $120M EV with EBITDA in the $3M to $20M range. The thesis runs on roll-up of physician practices and ancillary service lines. Most off-market healthcare deals come through advisors who have seen the structure before. Have one in your call list.

The moves

How LOI Negotiation actually gets structured.

  1. Cap the exclusivity at 60 days, with one 30-day extension you control.

  2. Name the earnout, the rollover percentage, and the management fee in the LOI itself, not later.

  3. Reserve QofE and rep-and-warranty insurance as buyer expenses, paid at close.

  4. Build a no-shop carve-out for inbound strategic bids above a threshold.

  5. In healthcare services, layer in PC/MSO structuring as part of the LOI Negotiation workstream.

The common mistake

Letting the seller's counsel draft the first LOI. The frame of reference sets every fight that follows.

Jason's take
"An LOI is not a non-binding nicety. It is the deal, in skeleton."
Jason Powell · LOI Negotiation
Capital after close

The deal is one thing. The capital that opens up after close is another.

Capital after close is where the IRR actually gets made. The right introductions at month nine through month thirty are where this practice works as hard as it does at the LOI.

MONTH 18
Senior refi
MONTH 24
Dividend recap
MONTH 36
Growth equity
YEAR 4–5
Strategic exit
TALK TO JASON

An LOI on the desk, a healthcare services target, and a LOI Negotiation question worth a real conversation.

Twenty minutes of practitioner-grade input from a securities attorney whose first move is to read the deal, not the engagement letter.