Exit assumptions — anchored to real transactions

10× is our base — even the 6× floor returns 15.3×

The exit multiple is the biggest swing factor in the return, so we don't assume it — we anchor it to what acquirers actually pay for EMR/RCM software. The same category asset, athenahealth, re-rated from ~4.4× to ~11–12× as AI/automation demand arrived. Against that, our 10× base sits right where AI-native assets trade — and even the 6× floor returns ~15.3× the seed.

Our base case

10× → 25.4×

25.4× the $4M seed — where AI-native assets trade

Our downside floor

6× → 15.3×

even the floor returns ~15.3× the seed

Recent AI-era take-privates

6×–12×

avg ~10× EV/rev (athena re-trade ~12×)

Multiples re-rated ~3× as AI/automation demand arrived — that's the tailwind under our 10× base. Prior era (2018–20), RCM / EMR assets traded around ~4.4× EV/revenue. Recent take-privates clear far higher: athenahealth itself went from ~4.75× (Veritas/Evergreen, 2019) to ~11–12× (Hellman & Friedman + Bain, 2022) — the same asset re-rated ~3× in ~2.5 years as buyers paid up for AI and automation. So 10× is our base — right where the category's marquee asset already trades — and 6×, below the broad ~6.1× sector average, is our floor.

The comparable transactions

Recent take-privates and strategic acquisitions of revenue-cycle / health-IT platforms — the pool REV would exit into. High-quality, scaled assets clear well above the average.

Transaction	Year	Value	What it tells us
R1 RCM — take-private (TowerBrook + CD&R)	2024	~$8.9B	Scaled pure-play RCM commands multi-billion enterprise value.
athenahealth — Veritas/Evergreen	2019	~$5.7B	EMR+RCM platform, first take-private — ~4.75× EV/rev (prior era, on ~$1.2B revenue).
athenahealth — Bain + Hellman & Friedman	2022	~$17B	~11–12× EV/rev (on ~$1.4B) — the same asset re-traded ~3× higher in ~2.5 years; current-era, AI/automation-driven.
AdvancedMD — Francisco Partners	2024	~$1.1B	Cloud practice-management + RCM; active mid-market M&A.
RCM sector average — EV/revenue	2021–24	~6.1×	Our 6× floor sits here; the 10× base is the AI-native premium tier (where athena re-traded).

Strategics (Waystar, R1, Epic) are actively acquiring RCM/automation rather than building in-house — a deep, motivated buyer pool for an AI-native asset.

Why 10× is the right base

Multiples aren't uniform — acquirers pay up for the attributes REV is built around:

High gross margin (~78% PCP) — AI-native, not a labor-heavy billing shop.
Fast, capital-efficient growth — self-funded on a single $4M seed, no dilution.
Recurring + attach — SaaS + RCM on collections, with a captive distribution channel.
AI/automation — the exact capability strategics are buying rather than building.

That's the case for the 10× base. And the floor protects you: even at 6× the seed returns ~15.3×, and a 50%-of-plan miss at that floor still clears ~7.6× the round.

Sources

RCM M&A EV/revenue multiples (~6.1× 2021–24 vs ~4.4× 2018–20); R1 RCM ~$8.9B take-private (CD&R + TowerBrook, 2024); AdvancedMD ~$1.1B (Francisco Partners): Scope Research — Healthcare RCM valuation multiples & M&A 2025; VERTESS — RCM M&A trends.
athenahealth take-privates: ~$5.7B on ~$1.2B revenue (Veritas/Evergreen, 2019; ~4.75×) and ~$17B on ~$1.4B revenue (Bain + Hellman & Friedman, 2022; ~11–12×) — public transaction records. The same EMR/RCM asset re-rated ~3× as AI/automation demand expanded multiples.
Returns math: base ARR $50.9M, seed 20% of a $4M round; MOIC = ARR × multiple × 20% ÷ $4M. See margin & downside for the full sensitivity matrix.