Diligence · Healthcare Services

Independent Sponsor Quality of Earnings in Healthcare Services

Independent sponsor counsel for healthcare services, focused on Quality of Earnings and the deal mechanics that protect sponsor economics and LP alignment.

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

An independent sponsor closing healthcare services transactions in the $15M to $120M EV range has a defined set of moves at the Quality of Earnings stage. Most of them are not in a generic M&A textbook.

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 Quality of Earnings actually gets structured.

  1. Engage QofE within five business days of LOI signing.

  2. Scope to include working capital normalization, deferred revenue, and customer concentration.

  3. Share preliminary findings with the seller before final report, to surface disputes early.

  4. Coordinate QofE findings into both the purchase agreement and the LP commitment package.

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

The common mistake

Treating QofE as a back-office exercise. It is the basis for the price, the working capital peg, and the LP pitch.

Jason's take
"The QofE is the deal book. Read it twice before you negotiate anything."
Jason Powell · Quality of Earnings
Capital after close

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

After close, the call list for refinancing, recapitalization, and growth equity gets short and known. Jason carries that list.

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 Quality of Earnings 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.