Non-Emergency Medical Transportation & Clinical Training Provider, Western US

$26.6M

Revenue

$6.0M

SDE

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Full Editorial Writeup

This is two entities sold together as a vertically integrated healthcare platform. The transport division runs non-emergency medical transportation (NEMT) with a full clinical spread: Basic Life Support, Critical Care Transport, gurney van, bariatric, and life assist. It contracts with hospitals, health systems, hospice providers, and government agencies for interfacility transfers, critical care runs, and event standby, completing roughly 45,000 trips in the trailing twelve months at about 124 trips per day.

The second entity is a clinical training business that operates as a national distributor of the American Heart Association's Resuscitation Quality Improvement (RQI) program and offers a broad menu of medical certifications. The clever part is the integration: the training arm functions as a workforce pipeline that feeds certified EMTs, nurses, and allied health professionals straight into the transport operation, lowering recruiting costs and keeping clinical quality consistent. Both serve individual practitioners and enterprise clients across the Western US.

At $26.6M revenue and $6.0M EBITDA, this is a real business with meaningful scale, not a lifestyle operation. The transport side ran an average 21.6% adjusted EBITDA margin from 2023 through the TTM ending July 2026, with training at 19.6%. Ownership is fragmented across eight individuals (five in transport, three in training, with some overlap), which is both a complication and an opportunity for a disciplined acquirer who can clean up the cap table and drive the integration harder.

Why we like it

Earnings quality is strong and diversified: $6.0M EBITDA on $26.6M revenue with two independent profit engines both running high teens to low twenties margins. NEMT revenue is anchored by hospital and health-system contracts and government payers, which are sticky and repeat by default rather than needing to be re-won each month.
The moat is real workforce integration, not marketing spin. Owning the AHA RQI training distribution and a certification school means the transport division sources its own EMTs, nurses, and allied staff, which is the single hardest constraint in this sector. That lowers recruiting cost, protects margin, and creates a structural advantage competitors relying on the open labor market do not have.
Market tailwinds are durable. NEMT demand rises with an aging population and hospital efforts to move patients efficiently between facilities, and it is heavily tied to essential medical needs that persist through downturns. Recently signed agreements are expected to add more than 1,000 trips per month with no incremental contract acquisition cost.
Clear operator upside sits in plain view. The listing flags a transport acceptance rate problem: declined trip requests are lost revenue that can be converted simply by adding capacity within existing service areas. That is high-margin volume already demanded, not speculative new-contract growth.

How to improve it

Attack the acceptance rate immediately. Quantify how many trip requests are being declined and why (fleet, staffing, dispatch), then add drivers and vehicles targeted at the highest-density declined lanes. Converting existing declined demand is the fastest path to incremental EBITDA with no customer acquisition cost.
Onboard the signed 1,000-plus trips per month cleanly. Build the staffing and scheduling plan before volume hits so the new contracts land at full margin rather than triggering overtime and subcontracted trips. Track first-90-day fulfillment rate on these accounts as a core KPI.
Scale the high-margin education programs. Push the new LVN, paramedic, expanded phlebotomy, and online CEU offerings, which are nationally deliverable and repeatable. Online CEU in particular carries near-zero marginal cost and can serve a national base well beyond the current Western US footprint.
Tighten the fleet and dispatch economics. Instrument cost per trip, deadhead miles, and vehicle utilization, then route-optimize and right-size the fleet. Small utilization gains flow directly to the bottom line on 45,000 annual trips.
Formalize and expand the payer and health-system contract base. Renegotiate rate escalators, add hospice and government interfacility volume, and pursue standby-event work that carries premium pricing. Longer-dated contracts also improve the exit multiple for a future buyer.
Simplify the ownership and reporting structure. With eight shareholders across two entities, consolidate into a single clean reporting stack with combined financials, shared back office, and unified KPIs. This reduces friction, cuts duplicated overhead, and makes the platform far more acquirable and financeable.
Build a formal referral loop between training graduates and transport hiring. Track what percentage of transport hires come from the training arm and set a target to raise it. Every internally sourced hire is a recruiting fee avoided and a faster, higher-quality onboard.

Diligence notes

Verify the revenue and margin split between the two entities and confirm the reported adjusted EBITDA. The $6.0M figure spans divisions with different margin profiles and covers a TTM ending July 2026, which is a forward window, so reconcile the actuals against audited or reviewed statements and understand what adjustments were made.
Scrutinize payer mix and contract terms on the transport side. Determine what share of revenue is Medicaid, commercial, hospital-direct, and government, and check reimbursement rates, renewal dates, exclusivity, and concentration. NEMT reimbursement rates and payer policy shifts are the biggest risk to margin durability.
Validate the AHA RQI distributor relationship and its exclusivity, term, and renewal conditions. The training division's positioning as a national AHA RQI distributor is described 'according to management,' so confirm the actual agreement, whether it is exclusive to any territory, and whether it survives a change of control.
Assess the eight-owner cap table and transition plan carefully. Understand which specific shareholders are staying, for how long, in what roles, and whether any key operator or key clinical/regulatory license holder is leaving. Also confirm which individuals hold the certifications, medical director relationships, and state operating authorizations required to run the transport business.
Confirm licensing, accreditation, and regulatory standing across all states of operation. NEMT and clinical training are both regulated, so verify vehicle certifications, EMT/CCT staffing compliance, insurance, and any open citations or audits. A gap here can halt operations or void contracts.
Examine the labor and fleet cost base underlying the margins. Confirm whether drivers are W-2 or contractors, the level of overtime and subcontracted trips, vehicle age and capex needs, and lease terms on the deployment hubs and classrooms. These drive whether the stated 21.6% transport margin holds as volume scales.

Source

Originally listed on BizBuySell. View original listing →