Ohio Public Finance Quarterly

KeyBanc Capital Markets (KBCM) and its healthcare practice, Cain Brothers, closed the syndication of $290 million of Senior Secured Credit Facilities in support of Altaris’ acquisition of the Life Sciences & Healthcare segment of Clarivate Plc (“Janus”). Proceeds were also used to support working capital and pay transaction-related expenses. KBCM was Joint Lead Arranger and Joint Bookrunner.

Clarivate’s Life Sciences & Healthcare segment is a leading technology-enabled data intelligence and services platform supporting pharma, biotech, and medtech customers across the product lifecycle, from R&D through commercialization. Janus’ products and services provide customers with unique insights at critical decision points, based on proprietary data and advanced curation capabilities. The business has a global footprint with ~2,400 employees, supported by 1,000+ scientific and regulatory specialists.

Founded in 2003 and based in New York, Altaris is a private equity firm focused on healthcare, investing across Pharmaceuticals & Pharma Services, Medical Devices & Diagnostics, and Healthcare Services. Altaris has raised five progressively larger funds and two dedicated co-investment vehicles. Known for its long-term investment approach, Altaris emphasizes value creation over time and employs a conservative use of leverage in its transactions.

On September 30, 2026, KeyBanc Capital Markets (KBCM) successfully advised Creedence Energy Services, LLC (Creedence or the Company), a portfolio company of Tower Arch Capital (Tower Arch), on its sale to Monomoy Capital Partners (Monomoy). KBCM was selected to serve as Creedence’s Sell-Side Advisor based on its strong institutional sponsor relationship, industry-leading Specialty Chemicals & Materials practice, proven M&A execution capabilities and relevant transaction experience.

Founded in 2014 and headquartered in Minot, North Dakota, Creedence is a leading independent provider of production and midstream chemical solutions to oil and gas operators across major U.S. producing basins. Creedence combines proprietary chemical formulations, advanced laboratory testing, blending capabilities, and responsive field service to develop tailored programs that optimize production, protect critical assets, and reduce equipment failures and downtime. Creedence’s solutions support existing production wells, midstream pipelines, and saltwater disposal facilities, and include specialized scale remediation and production stimulation treatments.

Headquartered in Salt Lake City, Utah, Tower Arch Capital is a growth-oriented middle-market private equity firm. Tower Arch seeks to partner with high-quality family- and entrepreneur-owned companies to deliver long-term value for their management teams and investors. Tower Arch brings operational, consulting, and financial expertise to companies to help them improve their operations, scale, and grow. Target investments include control positions in businesses with EBITDA between $8 million and $30 million.

Monomoy Capital Partners is a private investment firm with over $5.3 billion in assets under management across a family of investment funds. Monomoy focuses on investing in manufacturing, distribution, and services companies across industrial and consumer product sectors in North America. The firm is committed to providing middle-market businesses with strategic capital, management and operational expertise, and the ability to achieve sustainable success.

Cain Brothers, a division of KeyBanc Capital Markets, served as exclusive financial advisor to Dynamic Access, a portfolio company of RiverGlade Capital, on its sale to Blue Sea Capital.

Cain Brothers was engaged based on its experience in outsourced clinical services, expertise managing carveouts and business separations, and relationships within the relevant buyer universe. Working with RiverGlade and management, Cain Brothers designed and executed a competitive process to identify the optimal partner for Dynamic’s next phase of growth. The transaction continues Cain’s track record of representing sponsor-backed businesses and reinforces continued momentum within outsourced clinical services.

Headquartered in Dallas, Dynamic Access is the leading provider of outsourced vascular access services to hospitals and post-acute facilities across 25 states, performing more than 200,000 procedures annually. The company deploys specialized clinical teams to place and manage PICC lines, midlines, and peripheral IVs on-site, complementing its services with clinical education and supply management support that help facilities reduce complications and improve patient outcomes.

Founded in 2017, RiverGlade Capital is a Chicago-based investment firm focused on control buyouts of growth-oriented, lower middle market healthcare companies. The firm invests across provider services, outsourced services, and healthcare products and distribution. They partner with founder-owned, differentiated businesses to accelerate value and transform them into highly attractive strategic assets.

Blue Sea Capital is a private equity firm based in West Palm Beach, Florida, that invests in growth-oriented middle market healthcare companies valued up to $500 million. With over $2.4 billion in assets under management, Blue Sea Capital’s strategy is to partner with talented leaders and differentiated companies, typically as the first or second institutional investor, and deliver strategic and operational value-add that drives growth acceleration, industry outperformance and business transformation.

Cain Brothers, a division of KeyBanc Capital Markets, served as exclusive sell-side advisor to CommonSpirit Health on the sale of its affiliate, Trinity Health System, to the University of Pittsburgh Medical Center (UPMC). UPMC will integrate Trinity Health into their care network that currently serves Pennsylvania, New York and Maryland. 

Cain Brothers was engaged based on our expertise in hospital and health system M&A and strong understanding of the local market. Cain Brothers engaged parties interested in continuing Trinity Health’s mission and finalized a definitive agreement with UPMC. The transaction continues Cain Brothers' track record of successfully advising not-for-profit health systems and reinforces its leadership in the sector.

CommonSpirit Health is one of the nation’s largest nonprofit Catholic health systems, handling over 25 million patient encounters annually across 156 hospital-based locations and 2,600 care sites. Serving 24 states, CommonSpirit Health employs 160,000 team members, including 45,000 nurses and 30,000 physicians. 

Trinity Health, based in Steubenville, Ohio, is a network of hospitals, physician practices and specialty services across the Ohio Valley, committed to improving community health with excellence and faith-driven service. 

UPMC is a leading nonprofit healthcare provider and insurer headquartered in Pittsburgh, Pennsylvania. With 100,000 employees and more than 5,000 physicians, UPMC operates more than 40 hospitals and 800 outpatient sites across Pennsylvania, New York, Maryland, and overseas. UPMC Insurance Services covers more four million members and invests nearly $2 billion annually in community benefits, the most of any health system in Pennsylvania.

KeyBanc Capital Markets and Cain Brothers, a division of KeyBanc Capital Markets, successfully priced a $92.5 million follow-on offering of common stock for InnovAge Holding Corp. (NASDAQ:  INNV). Proceeds were for the benefit of selling shareholders, including Welsh, Carson, Anderson & Stowe and Apax Partners. 

InnovAge is the market leader in managing the care for high-cost, frail, and predominantly dual-eligible seniors through the Program of All-inclusive Care for the Elderly (PACE). With a mission of enabling older adults to age independently in their own homes for as long as safely possible, InnovAge’s patient-centered care model is designed to improve the quality of care its participants receive, while reducing over-utilization of high-cost settings. InnovAge believes its PACE healthcare model is one in which all constituencies — participants, their families, providers and government payors — “win.” As of June 30, 2026, InnovAge has served approximately 8,230 participants across 20 centers in six states.

On September 17, 2026, KeyBanc Capital Markets (KBCM) successfully advised GLP Canada Ltd. (GLP or the Company) on its partnership with Atlantic Street Capital (Atlantic Street).

KBCM was selected to serve as GLP’s Exclusive Financial Advisor based on its multi-year relationship with GLP’s management and ownership, industry-leading specialty distribution investment banking practice, long history of transaction success within the HVAC industry, access to the best potential private equity partners and proven M&A execution capabilities.

Founded in 1958 and headquartered in Oakville, Ontario, GLP is a leading specialty HVAC distributor serving customers across North America. Through its complementary Distribution and Applied segments, GLP offers a comprehensive portfolio of HVAC equipment, accessories, parts, components and engineered systems across mission-critical, industrial, modular, commercial and residential applications. The Company’s technical expertise, long-standing vendor relationships, broad product offering and white-glove customer support position GLP as a trusted channel partner to customers throughout Canada and the U.S.

Founded in 2006 and headquartered in Greenwich, Connecticut, Atlantic Street Capital is a private equity firm focused on partnering with ambitious entrepreneurs and management teams of lower-middle-market businesses. Atlantic Street combines deep industry expertise, hands-on operational support and capital resources to help its portfolio companies accelerate organic and acquisition-driven growth. Atlantic Street operates with over $1.5 billion of assets under management.

Cain Brothers, a division of KeyBanc Capital Markets, served as exclusive financial advisor to Icario, a portfolio company of CVC Capital Partners, on its sale to Vitality Group.

Leveraging deep experience in payer tech and member engagement, Cain Brothers ran a competitive process targeting strategic buyers. The transaction resulted in a strategic combination pairing Icario's member engagement platform with Vitality's global behavior-change franchise, expanding Vitality's reach into health plan member engagement and gaps-in-care closure in the U.S. market.

Icario is an AI-powered, digital-first member engagement platform that leverages whole-person data, proprietary analytics, GenAI, behavioral science and omnichannel communication to deliver personalized member experiences at scale. The company helps health plans translate complex member-level data into engagement programs that motivate healthy behaviors, close gaps in care and improve outcomes. Icario serves some of the nation's largest health plans, reaching millions of Medicare, Medicaid and commercial members, while delivering measurable improvements in quality performance, care outcomes and member engagement.

Vitality, a subsidiary of Discovery (JSE: DSY), a South Africa-based financial services group, is a leading health engagement platform that helps improve health outcomes through technology, data, AI, incentives and behavioral science. Backed by Discovery's global expertise in insurance, wellness and behavior change, Vitality serves more than 52 million lives across Europe, the Americas, Asia, Africa and Oceania.

Founded in 1981, CVC Capital Partners is a Luxembourg-based private equity firm with over $245 billion of assets under management. The firm invests across a diverse range of sectors, including business services, consumer and retail, healthcare, technology, and infrastructure, partnering with management teams to scale businesses and create long-term value across its portfolio.

On September 2, 2026, KeyBanc Capital Markets and Key Government Finance successfully closed the $60 million Senior Secured Tax-Exempt Credit Facility for Spirit Lake Tribe. The proceeds will be used to support the construction and development of the new Spirit Lake Health Center in North Dakota.

This transaction represents Key’s first financing for Spirit Lake Tribe and long-standing track record of tribal financings secured by health services revenues. Key was selected to serve as Sole Lender and Structuring Agent due to its healthcare financing experience and established expertise supporting Native American construction projects.

The new, visionary Spirit Lake Health Center will be a 60,000-square-foot facility located on tribal land in Saint Michael, North Dakota. The center will bring together primary care, dental, behavioral health, pharmacy, radiology, dialysis, and related services under one roof, significantly expanding capacity to support over 35,000 annual patient visits and serve more than 13,000 individuals, the majority of whom are low-income and Native American.

About Spirit Lake Tribe
Spirit Lake Tribe is a federally recognized Tribe located in Fort Totten, North Dakota, with over 7,900 enrolled members. The Tribe operates a diverse portfolio of enterprises, including Sioux Manufacturing Corporation, Spirit Lake Housing Corporation, Cankdeska Cikana Community College, Four Winds Community School, Tate Topa Elementary & Middle School, and Spirit Lake Casino & Resort. The various enterprises support the Tribe’s long-term vision of economic self-determination, community development, and enhanced quality of life for tribal members.

About Spirit Lake Tribe Healthcare
The Tribe has operated the existing Spirit Lake Health Center for over 50 years, providing essential healthcare services to the community. The proposed project will support the replacement of the existing facility to meet the growing demand for access to critical healthcare in one of North Dakota’s most under-resourced communities.

Cain Brothers, a division of KeyBanc Capital Markets, acted as Buy-Side Advisor to Adena Health System on its acquisition of Fairfield Medical Center.

Cain Brothers was engaged based on our long-standing relationship and ongoing dialogue with management, and expertise in advising not-for-profit health systems. Cain provided tactical and strategic process-related recommendations and insight, while advising on valuation and pro forma credit implications. The acquisition expands Adena’s footprint into central Ohio and strengthens its commitment to delivering coordinated, high-quality care across medically underserved and rural communities.

Adena Health is an independent, locally governed not-for-profit health system founded in Chillicothe, Ohio in 1895. For more than 130 years, Adena has focused on delivering high-quality, locally accessible care to the communities it serves. Adena serves nearly 400,000 residents across a nine-county region of south-central and southern Ohio through 40+ care sites, including four hospitals with 341 licensed beds. With more than 3,300 employees, Adena is one of the region’s largest employers.

Fairfield is a not-for-profit, full-service acute care hospital in Lancaster, Ohio that has served its communities for more than 110 years. The hospital serves over 250,000 residents across five counties and employs more than 2,000 caregivers.

In August 2026, KeyBanc Capital Markets (KBCM) successfully closed on $650 million in Senior Notes due 2036 for MasTec, Inc. (MasTec). KBCM acted as Senior Co-Manager on the transaction.

MasTec is a leading infrastructure construction company that provides engineering, building, installation, and maintenance services for communications, energy, utility, and transportation infrastructure across North America. The company serves telecommunications, renewable energy, power delivery, and pipeline customers through its diversified infrastructure solutions.

On August 31, 2026, KeyBanc Capital Markets (KBCM) successfully advised on the sale of Myers Tire Supply (MTS), a division of Myers Industries (Myers), to Lion Equity Partners (Lion). KBCM was selected to serve as Myers’ Exclusive Sell-Side Advisor based on its industry-leading Specialty Distribution investment banking practice, proven M&A execution capabilities and long-standing relationship with Myers.

Headquartered in Akron, Ohio, Myers is a leading manufacturer of specialized plastic and metal products for the consumer, vehicle, food & beverage, general industrial and infrastructure end markets. Myers operates a portfolio of established brands and manufactures a diverse range of products, including material handling containers, storage solutions, fuel and water storage products, ground protection systems and other engineered products. Myers employs over 2,000 individuals, with over 30 locations globally.

Founded in 1933 and headquartered in Akron, Ohio, MTS is one of the nation’s leading distributors of specialized tire supplies, tools and equipment for the tire service market. MTS provides comprehensive retread and repair consumables, wheel weights, equipment, tire pressure monitoring systems, valves, shop supplies and tools. MTS’s footprint spans the continental U.S., serving thousands of customers across the passenger and commercial automotive markets through four distribution centers.

Headquartered in Denver, Colorado, Lion is a lower middle-market private equity investment firm with over $170 million of assets under management.

KeyBanc Capital Markets and Cain Brothers, a division of KeyBanc Capital Markets, successfully closed the syndication of $1.1 billion of Senior Notes for Universal Health Services, Inc. (NYSE: UHS).

KeyBanc Capital Markets served as Senior Co-Manager due to its industry expertise, long-standing relationship with the company, and leading debt capital markets capabilities.

Proceeds will be used to repay $700 million of existing 2026 Notes maturing on September 1 and amounts outstanding under its revolving credit facility related to the Talkspace acquisition.

UHS owns and operates acute care hospitals, behavioral health facilities, outpatient centers and other healthcare service locations. The company owns and/or operates approximately 375 inpatient facilities and 168 outpatient and other facilities located across 40 states, Washington, D.C., the United Kingdom and Puerto Rico.