The Ledger

1.272 billion dollars: that is what a private equity buyer is paying to take medical device maker Avanos Medical private today, a 72 percent premium that shows what strategic buyers will pay for a company Wall Street had marked down. Avanos Medical shareholders vote today, July 22, 2026, on American Industrial Partners’ all-cash acquisition of the company for 25.00 dollars a share, a deal worth approximately 1.272 billion dollars that represents a 72.1 percent premium to Avanos’s closing price the day before the deal’s announcement and an 82.8 percent premium to its 30-day volume-weighted average price. Avanos, maker of pain-management, respiratory and specialty nutrition devices used in hospitals nationwide, cleared its last regulatory hurdle July 2 when it received all required antitrust approvals; the special meeting begins at 9 a.m. Eastern time in Atlanta, and the deal, once approved, is expected to close no later than July 27, 2026, taking the company off the New York Stock Exchange. Confidence: High on the deal terms and vote timing, since both come from Avanos’s own SEC filings; Medium on the vote’s outcome, since results were not yet public when this issue was prepared ahead of the meeting’s post-close tabulation. Sources: Avanos Medical’s Form DEFM14A merger proxy statement, U.S. Securities and Exchange Commission, Avanos Medical, Inc. and American Industrial Partners Receive Required Regulatory Approvals for Pending Merger, PR Newswire.

53 million dollars: that is the annualized rent a real estate investment trust expects to collect after replacing an operator that told it directly it wanted out of the nursing home business. Sabra Health Care REIT said July 21, 2026 it signed letters of intent to re-tenant all 26 skilled nursing facilities currently leased to Avamere, whose founder approached Sabra earlier this year to say he wanted to exit the skilled nursing business entirely; Sabra will move 22 of the properties to Cascadia Healthcare and the remaining four to an existing tenant, lifting combined annualized cash rent to about 53 million dollars, a 30 percent increase over the 41 million dollars Avamere paid in the year ended March 31, 2026, once the transition completes in the second half of 2026. The same update disclosed that Recovery Centers of America, a behavioral health operator, satisfied a 300 million dollar mortgage set to mature November 1 with a reduced 200 million dollar cash repayment that closed June 30, cutting Sabra’s pro forma leverage to 4.8 times from 5.0 times and its behavioral-health concentration to 9 percent of annualized cash net operating income from 13 percent; Sabra raised its full-year 2026 normalized funds-from-operations guidance to 1.53 to 1.55 dollars per share on the combined moves. Confidence: High on all figures, since they come directly from Sabra’s own SEC filing and investor release. Source: Sabra Issues Business Update and Increases Full-Year 2026 Guidance, Sabra Health Care REIT / SEC Form 8-K.

9 days: that is how long a nonprofit academic health system in Miami has left to strike a new contract with the country’s largest insurer before it goes out-of-network for hundreds of thousands of patients. UHealth, the University of Miami’s health system, and UnitedHealthcare have until July 31, 2026 to reach a new agreement or UHealth’s hospitals, clinics and physicians become out-of-network August 1 for UnitedHealthcare’s commercial, Affordable Care Act exchange and Medicaid plan members, though the insurer’s Medicare Advantage and Preferred Care Network plans fall under a separate contract and are unaffected. UHealth says UnitedHealthcare’s reimbursement has not kept pace with rising labor and supply costs and that the insurer denies medically necessary care it must then overturn on appeal 94 percent of the time; UnitedHealthcare says it has offered rate increases that would bring UHealth in line with what it pays peer South Florida hospitals while keeping premiums affordable for employers and members. At stake for patients: continuity of chemotherapy and other ongoing treatment, and in-network access to specialized units including the Sylvester Comprehensive Cancer Center and Bascom Palmer Eye Institute. Confidence: High on the deadline and each side’s stated position, since both come from the parties’ own public negotiation pages; Low on whose rate figures are accurate, since neither side has published the actual proposed contract terms. Sources: UHealth and UnitedHealthcare Negotiation, University of Miami Health System, Network Negotiations with Miami Health System (UHealth), UnitedHealthcare.

FRONTIER SCAN: a new antitrust lawsuit accuses MultiPlan and about two dozen insurers of running a shared pricing algorithm that held down what out-of-network doctors get paid, in a case that could reshape a market controlling up to 90 percent of that reimbursement. HealthLGX, a company holding claims assigned by emergency room and other physician practices, sued MultiPlan, now rebranded Claritev, along with UnitedHealth Group, Aetna, Cigna, Elevance Health, Humana, Centene, Molina Healthcare, Kaiser and roughly two dozen other insurers and plan administrators July 9, 2026 in the U.S. District Court for the Northern District of Illinois, alleging the defendants used MultiPlan’s “common pricing methodology” to suppress out-of-network reimbursement below competitive levels in a market the complaint says the group controls by 80 to 90 percent of dollar volume; the suit further alleges the suppression spread even to insurers that never used MultiPlan, because the tainted pricing data contaminated the FAIR Health benchmark other payers rely on. The complaint, which seeks treble damages, disgorgement and an injunction under the Sherman Act and state antitrust and consumer-protection laws, is one of several cases folded into a consolidated multidistrict litigation in the same district, where the next case-management conference is set for August 22. For every hospital, physician group and surgery center that bills out-of-network, the outcome could reset how those rates get set nationwide, a topic this newsletter has not yet covered directly despite tracking the underlying litigation for weeks. Confidence: High on the complaint’s filing date, defendants and core allegations, since they are confirmed by direct reporting on the filing; Medium on the market-share and damages figures, since these are the plaintiff’s allegations rather than a court’s findings. Source: New lawsuit accuses MultiPlan, insurers of out-of-network pricing “cartel,” Insurance Business America.

THE DEAL SHEET

Target	Acquirer/Investor	Vertical	Value	Source
Avanos Medical, Inc.	American Industrial Partners	Medtech, pain management, respiratory and specialty nutrition devices	$25.00/share cash, approximately $1.272 billion	Avanos Medical, Inc. and American Industrial Partners Receive Required Regulatory Approvals for Pending Merger, PR Newswire
26 skilled nursing facilities (Avamere portfolio)	Sabra Health Care REIT, re-tenanting to Cascadia Healthcare and an existing tenant	Post-acute real estate, skilled nursing	Approximately $53 million combined annualized cash rent	Sabra Issues Business Update and Increases Full-Year 2026 Guidance, Sabra Health Care REIT / SEC Form 8-K
Recovery Centers of America mortgage	Sabra Health Care REIT (reduced payoff)	Behavioral health real estate, mortgage satisfaction	$200 million cash repayment in full satisfaction of a $300 million mortgage	Sabra Issues Business Update and Increases Full-Year 2026 Guidance, Sabra Health Care REIT / SEC Form 8-K
Smile America Partners	Kaltroco Ltd. (from Beach Point Capital Management)	Dental service organizations, school-based mobile dental care	Undisclosed (company generates roughly $20 million EBITDA on about $100 million revenue)	Beach Point Capital Management Announces Successful Sale of Smile America Partners, Business Wire

Molina Healthcare releases second-quarter 2026 results after today’s market close, with its earnings call tomorrow, July 23, at 8 a.m. Eastern. Community Health Systems also reports after today’s close, with its call July 23. Universal Health Services reports July 27, Centene around July 28, Humana and Privia Health both around July 29 to August 6, and Cigna July 30.