Volume 12, Issue 11, June 3, 2025
By: David E. Coit, Jr., DBA, CVA, CVGA, CM&AA, CBEC, CAIM
You often hear about the sale of a healthcare company where the buyer paid the seller a price based on a "market multiple" of something, with that purchase price (or offer) typically based on a multiple of revenue, earnings before interest, taxes, depreciation, and amortization (EBITDA), or adjusted EBITDA.
In this column, I will break down what market multiples represent.
Before we dive further into market multiples, it's important to acknowledge that when coming up with offers, buyers take a deep dive analysis of the past performance of a company of interest, then they estimate what synergies they bring to the table regarding the expected future performance of the company post-acquisition. Buyers typically use a discounted cash flow analysis to estimate the future value of the company. This process allows buyers to estimate the future after-tax cash flows that they’ll derive from the purchase, based on how much they pay for the company.
Once the buyer has an estimate of how much its willing to offer to buy a company, they convert that dollar amount into a market multiple of some performance measure of the company’s performance. For example, the buyer might convert the amount it wishes to offer into a multiple of the company’s annual revenue or adjusted EBITDA. However, seasoned buyers also look at what similar companies sold for in the past, based on the same market multiples. If there have been a number of recent merger and acquisition (M&A) transactions for similar companies where the purchase price was 5.0x to 5.5x adjusted EBITDA and 1.0x to 1.1x annual revenue, the buyer might amend its offer to fit within other recent M&A transactions.
Some buyers also look to see what larger public companies in the same sector are valued at. For example, a large publicly traded home care business might show an enterprise value of $2.13 billion, trailing 12-month revenue of $1.21 billion, and EBITDA of $128.0 million. That company would have a market multiple of 1.88x revenue or 17.82x EBITDA. Those market multiples would represent the top of the market in terms of valuations.
Most seasoned buyers have "rules of thumb" guidelines they follow for each sector, such as never making an offer in excess of 1.50x revenue or 7.0x EBITDA for a home care business unless there’s something very special about the target company. Other buyers might have a rule that they get fully paid back from the cash flow of the acquired company in five years or less.
There’s something to remember when looking at multiples of cash flow or EBITDA: The inverse of the multiple is an approximation of the buyer’s return on investment. So, a 5.0x multiple is equal to a 20.0% return on investment (i.e., 1 ÷ 5 = .20 or 20.0%). Similarly, a 7.0x multiple purchase price would provide the buyer with an approximate return on investment (ROI) of 14.28%. Most buyers are seeking +20.0% ROI on M&A transactions. As such, if a buyer makes an offer of 7.0x cash flow or EBITDA, it is expecting future cash flow or EBITDA to grow to fulfill the desire for a +20.0% ROI.
Earlier I mentioned that buyers usually undertake a discounted cash flow analysis using after-tax cash flow or EBITDA to estimate the value of a target company. You might find it strange that they use after-tax dollars in their analysis even though many companies do not pay taxes. The reality is that income taxes must be paid by someone. If it’s not paid by the company, it’s paid by the owners of the company. Buyers want to determine their cash ROI after taxes.
Buyers can take advantage of structured purchases to offer a higher multiple and still retain their desired ROI. A seller note is a typical method of structuring a purchase where the future cash flows of the acquired company are used to pay a portion of the purchase pricing. A buyer may offer a 6.0x multiple of EBITDA purchase price but pay a 4.0x multiple of EBITDA at closing followed by a five-year seller note equal to a 2.0x multiple of EBITDA.
Similarly, the buyer may offer the seller an earnout based on the future performance of the acquired company. A buyer may offer a 6.0x with 4.0x at closing followed by a percentage of future EBITDA not to exceed 2.0x of the closing EBITDA.
The concept of market multiples is a way of communicating value between buyers and sellers. A seller doesn’t sell based on multiples but rather based on real dollars. The same holds true for buyers. Buyers undertake great effort to estimate the value of target companies, specifically to them.
David E. Coit, Jr., DBA, CVA, CVGA, CM&AA, CBEC, CAIM
I am a seasoned commercial and corporate finance professional with over 30 years of experience. As part of the VERTESS team, I provide clients with valuation, financial analysis, and consulting support. I have completed over 400 business valuations. Most of the valuation work I do at VERTESS is for healthcare companies such as behavioral healthcare, home healthcare, hospice care, substance use disorder treatment providers, physical therapy, physician practices, durable medical equipment companies, outpatient surgical centers, dental offices, and home sleep testing providers.
I hold certifications as a Certified Valuation Analyst (CVA), issued by the National Association of Certified Valuators and Analysts, Certified Value Growth Advisor (CVGA), issued by Corporate Value Metrics, Certified Merger & Acquisition Advisor (CM&AA), issued by the Alliance of Merger & Acquisition Advisors, and Certified Business Exit Consultant (CBEC), issued by Pinnacle Equity Solutions, and Certified Acquisition Integration Manager (CAIM), issued by Intista. Moreover, the topic of my doctoral dissertation was business valuation.
I earned a Doctorate in Business Administration from Walden University with a specialization in Corporate Finance (4.0 GPA), an MBA from Keller Graduate School of Management, and a BS in Economics from Northern Illinois University. I am a member of the Golden Key International Honor Society and Delta Mu Delta Honor Society.
Before joining VERTESS, I spent approximately 20 years in commercial finance, having worked in senior-level management positions at two Fortune 500 companies. During my commercial finance career, I analyzed the financial condition of thousands of companies and successfully sold over $2 billion in corporate debt to institutional buyers.
I am a former adjunct professor with 15 years of experience teaching corporate finance, securities analysis, business economics, and business planning to MBA candidates at two nationally recognized universities.
Email David Coit or Call: (480) 285-9708.