Non-Emergency Medical Transportation Co, 15-Year Westchester County NY Operator

$5.1M

Revenue

$1.1M

SDE

3.8x

Multiple

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Full Editorial Writeup

This is a 15-year-old non-emergency medical transportation (NEMT) business operating out of Westchester County, New York, serving patients across Westchester, the Bronx, and all five NYC boroughs. The company moves wheelchair-bound, stretcher-bound, and special-needs patients to and from medical appointments, dialysis, and facility transfers. Revenue mixes across facility patients, Medicaid reimbursement, and private pay, which spreads payor concentration risk better than a pure Medicaid book.

The operation is asset-heavy and contract-anchored: the sale includes 32 wheelchair, stretcher, and TLC vans, contracts with hospitals and nursing homes, 5 TLC licenses, and NYS Department of Transportation authorization. That regulatory stack (TLC licensing plus DOT authorization) is a genuine barrier to entry in the NYC metro, where new entrants cannot simply buy vans and start hauling patients. The husband-and-wife owners run the business day to day with 34 employees, and are selling for "other interests" rather than retirement.

At $4.2M against $5.1M revenue and $1.1M cash flow, the deal prices at roughly 3.82x SDE. For a recession-resistant, contract-backed, license-protected healthcare logistics business in one of the densest aging-population markets in the country, that multiple is defensible if the cash flow and payor mix hold up in diligence.

Why we like it

Earnings quality is real: $1.1M cash flow on $5.1M revenue is a 21.6% margin, healthy for an asset-heavy transport business. The revenue comes from recurring, medically necessary trips (dialysis, treatment, facility transfers) rather than one-off discretionary rides, which makes the cash flow durable and predictable.
The moat is regulatory and relational: 5 TLC licenses, NYS DOT authorization, and standing contracts with hospitals and nursing homes are not things a new competitor can replicate overnight. In the NYC metro, licensing scarcity protects incumbents and gives this business pricing and volume stability.
Market tailwinds are structural and demographic: an aging Westchester and NYC population plus Medicaid-funded NEMT demand means volume grows regardless of the economic cycle. Dialysis and chronic-care transport in particular is non-discretionary and reimbursed, insulating the top line from downturns.
Operator advantage is clear: the owners are hands-on and the company already carries a mixed payor base (facilities, Medicaid, private pay) and a fleet of 32 vans owned in the deal. A buyer who adds dispatch technology, tightens routing, and pushes on private-pay margins can expand EBITDA without heavy new capex.

How to improve it

Audit and optimize routing and dispatch within the first 90 days: many NEMT operators run on manual scheduling that wastes driver hours and fuel. Deploying route-optimization software can lift trips-per-van-per-day and directly convert to margin without buying more vehicles.
Diversify and lock in facility contracts: review contract terms, renewal dates, and pricing across the hospital and nursing-home book. Convert verbal or handshake arrangements into multi-year agreements to de-risk revenue and improve the resale multiple.
Push the private-pay and higher-margin mix: Medicaid reimbursement rates are capped, but private-pay and facility-negotiated rates carry better economics. Building a light sales effort toward assisted-living communities and discharge planners can shift mix toward higher-margin trips.
Formalize fleet lifecycle and maintenance economics: with 32 vans, downtime and repair costs directly hit margin. Implement a preventive maintenance schedule and a staggered replacement plan so capex is predictable rather than lumpy.
Build a management layer to remove owner dependence: the husband-and-wife team runs daily operations, which is a valuation drag and a risk. Installing a general manager and dispatch supervisor in year one makes the business more scalable and more sellable later.
Expand geographic coverage using existing licenses: the TLC and DOT authorizations already cover NYC and Westchester. Adding vans and drivers to capture underserved corridors or new facility relationships grows revenue against fixed licensing and overhead.

Diligence notes

Verify the payor mix and reimbursement exposure: quantify the exact percentage of revenue from Medicaid versus facility contracts versus private pay. Medicaid rate changes and slow reimbursement cycles are the single biggest risk to NEMT cash flow and must be stress-tested.
Confirm the transferability of the 5 TLC licenses and NYS DOT authorization: licensing is the moat, but it can also be non-transferable or require re-approval on a change of ownership. Get written confirmation of the transfer process and timeline before closing.
Inspect the fleet condition and true capex needs: 32 vans of varying age can hide significant deferred maintenance. Obtain the age, mileage, and maintenance history of each vehicle to model realistic replacement capex against the reported $1.1M cash flow.
Scrutinize contract concentration and renewal risk: identify how much revenue comes from the top hospital and nursing-home accounts and when those contracts expire. Heavy concentration in one or two facilities would materially change the risk profile and the price you should pay.
Validate the cash flow add-backs and owner compensation: the $1.1M SDE includes owner earnings, and the husband-and-wife team is active in operations. Determine the cost to replace their labor with hired managers, since that expense reduces the true buyer cash flow.

Source

Originally listed on BizBuySell. View original listing →