Newsletter: Industry Insights

Cain Brothers, a division of KeyBanc Capital Markets, acted as buy-side advisor to Bookmark Medical, a portfolio company of Kinderhook Industries, on its acquisition of the Michigan assets of Village Medical, a subsidiary of VillageMD.

Cain Brothers has a longstanding relationship with Kinderhook and maintains on-going dialogue with Bookmark on M&A and capital raising opportunities. Cain Brothers was engaged based on our deep expertise in primary care, with this mandate further bolstering our credentials in the broader physician group and value-based care sectors.

Bookmark Medical is a provider-led healthcare organization dedicated to improving lives through high-quality care. Serving patients across Arizona, Massachusetts, Michigan, and Tennessee, Bookmark partners with providers to deliver coordinated, patient-centered care rooted in strong community relationships. Through primary care, specialty care, and affiliated provider partnerships, the organization is expanding access to healthcare while improving health outcomes for the communities it serves.

Kinderhook Industries is a private investment firm that has raised over $11 billion of committed capital and has made 500+ investments and follow-on acquisitions since its founding in 2003. Kinderhook matches differentiated, growth-oriented investment opportunities with its financial expertise and proprietary network of operating partners. Kinderhook focuses on middle market businesses with defensible niche market positioning in healthcare services, environmental & equipment services, and industrials & manufacturing.

VillageMD provides high-quality, accessible health care services for individuals and communities across the United States, with primary, multispecialty, and urgent care providers serving patients in traditional clinic settings, in patients’ homes, and through online appointments. Committed to serving all patients and working with all payers, VillageMD consistently innovates value-based care, bringing integrated applications, population insights and staffing expertise to its owned and affiliate practices, ensuring high-quality care, better patient outcomes, and a reduction in the total cost of care.

Cain Brothers, a division of KeyBanc Capital Markets, served as advisor to the combining of Evolution Physical Therapy and Fitness and True Sports Physical Therapy and simultaneous recapitalization by O2 Investment Partners. 

O2 acquired Evolution and True Sports through a newly formed holding company, creating a multi-state outpatient physical therapy and sports performance platform. The founders of both businesses rolled a meaningful portion of their ownership and will continue to lead the new company alongside O2. The transaction reflects Cain Brothers' continued momentum advising sponsors as well as founder-owned healthcare businesses.

Led by founder and CEO Michael Giunta, Evolution is an outpatient physical therapy and fitness provider operating across California, Colorado, and Connecticut. The company delivers a comprehensive service offering spanning sports-related physical therapy, orthopedic and rehabilitation services, performance training, and fitness.

Founded and led by Yoni Rosenblatt, True Sports is an outpatient physical therapy provider focused on sports-specific rehabilitation and performance. The company operates 23 clinics across Maryland, Pennsylvania, Delaware, and Virginia, with a concentration in Baltimore and the greater Maryland market.

Founded in 2010 and headquartered in Bloomfield Hills, Michigan, O2 is a lower middle-market private equity firm that acquires majority interests in family- and founder-owned businesses across niche services, technology, and select industrial sectors. O2 partners with management teams to build and grow their businesses and manages approximately $1.2 billion in assets across its funds.

Cain Brothers, a division of KeyBanc Capital Markets, served as financial advisor to Strive Medical, a portfolio company of NMS Capital, on its sale to Cardinal Health (NYSE: CAH).

Cain Brothers was engaged based on its experience in the home medical supply and DME sectors. The transaction continues Cain Brothers' track record of representing private equity-backed companies and momentum within the post-acute and distribution sectors.

Strive Medical, headquartered in Irving, Texas, is a provider of direct-to-patient urological, wound care, ostomy, incontinence and other medical supplies to patients in their homes and across the U.S. Since its founding, Strive has focused on giving patients the highest quality customer service and best products available.

Cardinal Health is a distributor of pharmaceuticals and specialty products, a global manufacturer and distributor of medical and laboratory products, a supplier of home-health and direct-to-patient products and services, an operator of nuclear pharmacies and manufacturing facilities and a provider of performance and data solutions. The company's customer-centric focus drives continuous improvement and leads to innovative solutions that improve people's lives every day.

Founded in 2010, NMS Capital is a private equity firm managing over $2 billion in assets. NMS has partnered with founders and management teams in over 150 investments and follow-on acquisitions across Business Services and Healthcare Services. The firm’s strategy is to create long-term value by providing strategic and operational resources to accelerate organic and acquisition-driven growth to build industry-leading lower middle market companies in defensible and scalable end markets.

KeyBanc Capital Markets Inc. successfully closed ~$1.07 billion of syndicated senior secured credit facilities for US Fertility, a portfolio company of Amulet Capital Partners and L Catterton Partners. The financing included a $120 million Revolving Credit Facility, a ~$902 million Term Loan B, and a $46 million Delayed Draw Term Loan. Proceeds repriced the company’s existing credit facilities, lowering borrowing costs by 50 bps. KBCM served as Joint Lead Arranger, Joint Bookrunner, and Administrative Agent based on Cain Brothers’ expertise in the women’s health space, our long-standing relationship with the sponsors and best-in-class leveraged finance platform.

US Fertility is the largest fertility group in the U.S. offering a broad range of assistive reproductive technology services and ancillary life sciences offerings. Since 2021, the company has grown from ~85 physicians across 59 locations to the leading IVF platform in the nation, with over 200 physicians across 118 treatment locations and 32 embryology labs.

Founded in 2015, Amulet Capital Partners is a middle-market private equity firm focused exclusively on making investments in the broader healthcare industry. With $2.7 billion in AUM, they are currently investing out of their third fund. Amulet partners with strong businesses across high-conviction, high-growth subsectors within the broader life sciences outsourcing, healthcare provider, and payor and payor services ecosystems.

Founded in 1989, L Catterton is the largest consumer-focused private equity firm in the world, with over $38 billion AUM across nine fund strategies in 18 offices globally. They have extensive experience in consumer healthcare and multi-site service platforms. L Catterton has an operationally focused value creation approach, augmented by a deep operating team with highly differentiated capabilities.

KeyBanc Capital Markets and Cain Brothers, a division of KeyBanc Capital Markets, closed the syndication of a $1.038 billion Add-on Term Loan B and the offering of $500 million of Senior Secured Notes for athenahealth Group, a portfolio company of Hellman & Friedman and Bain Capital. Proceeds were used to refinance existing debt. KeyBanc acted as Joint Lead Arranger and Joint Bookrunner.

athenahealth provides cloud-based enterprise software solutions for medical groups and health systems. The company’s software-as-a-service is bundled with high-impact technology-enabled services primarily offered to physicians, as well as health insurers and life sciences. The core offerings include electronic healthcare record, revenue cycle management and other complementary solutions.

Hellman & Friedman is a preeminent global private equity firm with a distinctive investment approach focused on large-scale equity investments in high-quality growth businesses and targets equity investments ranging from $350 million to over $2 billion.

Bain Capital is one of the world’s largest private, multi-asset alternative investment firms and targets equity investments ranging from $150 million to $1 billion.

Cain Brothers, a division of KeyBanc Capital Markets, served as exclusive financial advisor to Smile America, a portfolio company of Beach Point Capital Management, in its sale to Kaltroco. 

Cain Brothers was engaged based on its experience in dental, specifically the pediatric dental sector, and long-standing relationship with the financial sponsor. Cain Brothers’ broad sector coverage enabled the Company to access a wide array of buyers and financing sources to facilitate the transaction.

Smile America is the leading provider of school-based dental care services, with a mission to provide access to oral healthcare to underserved populations. Smile America currently provides preventative care and minimally invasive dental procedures to 370,000+ patients in 8,000+ schools across 20 states.

Beach Point is a global alternative investment manager focused on opportunities across the credit spectrum. The firm’s integrated platform spans high-yield bonds, senior loans, CLO origination, securitized credit, direct lending, real estate credit, as well as hybrid and flexible capital solutions. Founded in 2009, Beach Point is employee-owned and manages over $20 billion in assets.

Kaltroco is a private investment company with headquarters in Jersey, Channel Islands and investment professionals in Nashville, Zurich, and Cape Town. Kaltroco partners with founders and management teams to pursue ambitious growth objectives. As a family-backed investment company with no outside investors and no restrictions on structure or hold period, Kaltroco has the flexibility to invest on the timeline that best fits its portfolio companies' needs and its partner management teams' objectives. Since its founding, Kaltroco has invested in over 30 companies globally, with a focus on the healthcare services, business services, and consumer industries.

Cain Brothers, a division of KeyBanc Capital Markets, served as exclusive financial advisor to Nutrisense, a portfolio company of 1315 Capital, on its sale to Dexcom (NASDAQ: DXCM).

Cain Brothers was engaged based on its experience in the medical device and health tech sectors. The acquisition represents a significant strategic move for hardware-focused Dexcom to accelerate their push into the large, Type 2 diabetic and metabolic health markets. By leveraging Nutrisense’s tech-enabled, direct-to-consumer distribution and coaching layer, Dexcom intends to increase sensor penetration, improve retention and monetize glucose data. The transaction continues Cain Brothers’ track record of representing private equity-backed companies and momentum in cross-sector M&A. 

Nutrisense is a digital metabolic health platform that combines continuous glucose monitoring (“CGM”), a mobile app and registered dietitian coaching to help users better understand how food, sleep and lifestyle affect their blood sugar. The company primarily serves health-motivated and pre-diabetic individuals through a subscription model, translating real-time glucose data into personalized nutrition and behavior guidance aimed at improving metabolic health and weight management.

Dexcom is a leading glucose sensing and continuous glucose monitoring company focused on helping people take control of their health through innovative biosensing technology. For more than 25 years, Dexcom’s technology has helped transform how people manage diabetes and track glucose, providing real-time insights that support more informed decisions and greater confidence in daily health management.

Founded in 2014, 1315 Capital is a healthcare-focused investment firm with over $1 billion of assets under management. The firm invests in commercial-stage companies across healthcare services, pharma/medtech products, pharma/medtech outsourcing, and health & wellness, partnering with management teams to scale businesses that positively impact patients, physicians and the broader healthcare system.

KeyBanc Capital Markets and Cain Brothers, a division of KeyBanc Capital Markets, acted as Active Joint Bookrunner for VSP Optical Group’s $1 billion public bond issuance.

After completing their inaugural bond offering in November 2025, VSP announced a second offering in May. Over a one-day marketing period and utilizing a pre-recorded presentation, the company garnered over $7.6 billion of orders and priced $500 million of seven-year and $500 million of 10-year Senior Unsecured Notes with no new issue concession. Proceeds were used to refinance existing indebtedness and fund general corporate purposes.

KeyBanc Capital Markets serves as Left Lead Arranger and Administrative Agent on VSP’s existing credit facilities and KBCM and Bank of America acted as joint leads on both the 2025 and 2026 bond offerings.

VSP is a doctor-governed, not-for-profit entity that creates value for members and opportunities for its network doctors. The company’s network has serviced over 91 million members and 1,200 retail locations. VSP’s three-pillar strategy focuses on growing its core competencies, which encompasses insurance, network, and supply chain capabilities, providing access to high-quality vision care and eyewear.  

Cain Brothers, a division of KeyBanc Capital Markets, acted as Exclusive Financial Advisor to Blue Cross and Blue Shield of Kansas City on its affiliation with Highmark, Inc.

Blue KC engaged Cain Brothers to identify a partner to help achieve efficiencies, add new capabilities and drive more affordable health care. Blue KC will maintain its local leadership, brand and commitment to accessible, affordable health care, while gaining access to Highmark’s scale, diversified businesses and leading technology capabilities. Cain Brothers is the leading advisor to Blue Cross and Blue Shield plans and this represents another significant affiliation within the sector.

Serving members since 1938, Blue Cross and Blue Shield of Kansas City is the largest not-for-profit health insurer in Missouri and the only not-for-profit commercial health insurer in Kansas City. Blue KC provides coverage to more than one million residents in the greater Kansas City area, with a mission to provide affordable access to healthcare and to improve the health of its members.

An independent licensee, Highmark, together with its affiliates, is the fifth-largest Blue Cross Blue Shield-affiliated organization in the country, with more than seven million members in Pennsylvania, Delaware, West Virginia and western and northeastern New York. Its diversified businesses serve group customer and individual needs across the U.S.

Cain Brothers, a division of KeyBanc Capital Markets, served as exclusive financial advisor to DME Express, a portfolio company of WayPoint Capital Partners, in its sale to Palladium Equity Partners.

Cain Brothers was engaged based on its extensive experience and expertise in the hospice and durable medical equipment sectors as well as broader post-acute services. The transaction continues Cain Brothers’ strong track record of representing private equity-backed companies and continued momentum in healthcare services M&A.

DME Express provides durable medical equipment to hospice providers across the U.S. With over 150 years of experience, the founders and management team understand the unique needs of hospices and nursing facilities and DME Express is a leading provider in each of its markets. The company is committed to consistent availability to patients and providers with high-quality medical equipment, proprietary technology and strong customer service.

WayPoint Capital Partners, founded in 2004, is a growth-oriented lower middle market private equity firm making control investments in exceptional founder and family-led companies across healthcare services and industrials. WayPoint brings strategic guidance, operational support, and long-term patient capital to help its businesses scale and thrive.

With over $3 billion in assets under management, Palladium seeks to acquire and grow companies in partnership with founders and experienced management teams by providing capital and strategic guidance. Since its founding in 1997, Palladium has invested in more than 240 companies. Palladium’s partners have experience in consumer, services, industrials, and healthcare sectors, with a focus on companies that will benefit from the growth in the U.S. Hispanic population.

Cain Brothers, a division of KeyBanc Capital Markets, served as advisor to SuperCare Health in its sale to Excellere Partners and KeyBanc Capital Markets served as Joint Lead Arranger, Joint Bookrunner, and Administrative Agent for debt financing associated with the transaction. 

Cain Brothers was engaged based on our long-standing relationship with the Company as well as knowledge of the durable medical and home medical equipment market and connectivity with buyers who would value SuperCare’s capitated and fee-for-service business model. Concurrently, KBCM syndicated Senior Secured Credit Facilities, proceeds of which were used to fund the acquisition, support capital expenditures and for general corporate purposes. 

Founded in 1974 and headquartered in City of Industry, California, SuperCare is a provider of comprehensive complex respiratory care management solutions for adults and children. Its product portfolio consists of ventilators, airway oscillation, CPAP, BiPAP, oxygen concentrators, respiratory medication and home medical equipment. The Company’s business segments are Complex Respiratory Care, Pediatric Respirator Care, and Value-Based Care. SuperCare operates 27 branches across five states and serves 150,000+ patients annually. 

Founded in 2006 and based in Denver, Colorado, Excellere is a private equity investment firm focused on investing in the Healthcare, Business Services, and Industrials industries. The Sponsor has ~$2.2 billion of assets under management and has raised four funds to date, with its latest fund (Excellere Capital Fund IV) raising $875 million of committed capital.

Cain Brothers, a division of KeyBanc Capital Markets, served as advisor to SuperCare Health in its sale to Excellere Partners and KeyBanc Capital Markets served as Joint Lead Arranger, Joint Bookrunner, and Administrative Agent for debt financing associated with the transaction. 

Cain Brothers was engaged based on our long-standing relationship with the Company as well as knowledge of the durable medical and home medical equipment market and connectivity with buyers who would value SuperCare’s capitated and fee-for-service business model. Concurrently, KBCM syndicated Senior Secured Credit Facilities, proceeds of which were used to fund the acquisition, support capital expenditures and for general corporate purposes. 

Founded in 1974 and headquartered in City of Industry, California, SuperCare is a provider of comprehensive complex respiratory care management solutions for adults and children. Its product portfolio consists of ventilators, airway oscillation, CPAP, BiPAP, oxygen concentrators, respiratory medication and home medical equipment. The Company’s business segments are Complex Respiratory Care, Pediatric Respirator Care, and Value-Based Care. SuperCare operates 27 branches across five states and serves 150,000+ patients annually. 

Founded in 2006 and based in Denver, Colorado, Excellere is a private equity investment firm focused on investing in the Healthcare, Business Services, and Industrials industries. The Sponsor has ~$2.2 billion of assets under management and has raised four funds to date, with its latest fund (Excellere Capital Fund IV) raising $875 million of committed capital.