Addiction Treatment M&A

Addiction Treatment Center Letter of Intent: Terms to Resolve Before Exclusivity

An addiction treatment center letter of intent can look reassuring: a price, a target closing date and a buyer ready to move forward. The seller’s real decision is more specific. Are the economics clear enough, and the buyer sufficiently prepared, to justify limiting other discussions while the deal is developed? Before signing, resolve the assumptions that could change your proceeds, your obligations or the likelihood of closing. This guide focuses on that decision, rather than repeating a general acquisition due diligence checklist.

Tony Siebel Founder Managing Director Olympic M&A Concierge Medicine M&A Advisor

Tony Siebel — Founder & Managing Director, Olympic M&A

Former MDVIP Corporate Development Director · Top 50 M&A Advisors 2025 · $100M+ in completed healthcare transactions

What the LOI Should Accomplish

A useful LOI establishes the proposed deal’s commercial framework and the rules for getting to a definitive agreement. It should identify the parties, transaction perimeter, price mechanics, important conditions and negotiation process. It also exposes disagreements while both parties can still address them without the expense and disruption of a prolonged exclusive process.

Do not treat the label “nonbinding” as a complete legal answer. In ev3, Inc. v. Lesh, the Delaware Supreme Court distinguished binding LOI provisions from nonbinding deal terms. That decision illustrates why the actual wording matters; it is not a nationwide rule for every LOI. Your attorney should identify enforceable provisions, any negotiation obligations and the effect of the chosen governing law.

The business test is straightforward: can you describe what you are selling, what you might receive, what must happen before closing and how long you are committing to this buyer? If those answers depend on assumptions the buyer has not accepted, the LOI needs more work. The sister-site guide to selling an addiction treatment center covers the wider transaction process.

Step 1: Translate Headline Value into Seller Proceeds

Start by asking whether the quoted price is enterprise value, equity value or a different measure. Enterprise value typically describes the operating business before the agreed treatment of debt, cash and other adjustments. The seller receives the amount produced by the actual agreement’s calculation. Request a preliminary bridge from the headline offer to estimated cash at closing, with every deduction and deferred component shown.

For illustration only, consider a $10 million headline offer containing $2 million of rollover equity and a $1 million maximum earnout. That leaves $7 million before debt repayment, expenses, escrow, working-capital adjustments and taxes. It does not produce $10 million of cash at closing. This example describes payment mechanics, not an addiction-treatment valuation or a recommended structure.

Ask the buyer to model a base case and downside case using your actual balance sheet. Keep restricted or contingent amounts visible. If there is an escrow or holdback, specify its purpose, proposed release conditions and interaction with indemnification. Separate a price adjustment from a claim against the seller so the same issue cannot quietly enter the model twice. See working-capital closing adjustments for the detailed calculation questions.

Step 2: Identify Exactly What the Buyer Is Acquiring

A treatment business can contain several assets and activities that need different treatment. Resolve these four questions early:

  • Entities and locations. Does the offer cover the whole organization, selected facilities or specified assets? Identify excluded programs, inactive entities and related-party arrangements.
  • Real estate. Is owned property included, separately priced or retained by the seller under a new lease? Agree the commercial assumptions for rent and occupancy.
  • Receivables and cash. Will the buyer acquire accounts receivable? Who keeps cash and collects pre-closing claims? Specify how these decisions interact with the working-capital calculation.
  • Liabilities and obligations. Describe the proposed treatment of debt, leases, unpaid expenses, employee obligations, refunds and potential payer recoupments. Avoid relying on an undefined “debt-free” phrase.

Asset and equity structures can have different tax and consent implications. The IRS explains that a business asset sale involves allocating consideration among the assets transferred. Ask your tax advisor to assess the proposed structure before accepting the headline economics. Do not leave a material structure change to the end of negotiations.

Step 3: Set the Economic Rules Before Detailed Drafting

The LOI need not reproduce the purchase agreement, but major economic issues should have agreed principles. Put these subjects on the negotiation agenda:

  • Working capital. Establish the proposed target-setting method, included accounts, accounting principles and treatment of seasonality. Request an illustrative closing calculation using recent balances.
  • Receivable quality. Clarify reserves, denials, unbilled services and old balances. Decide how post-closing collections will be credited and which party can pursue disputed claims.
  • Earnout. Identify the metric, measurement period, maximum payment and key operating assumptions. Specify the intended approach to reporting, review rights and buyer-controlled changes affecting the calculation.
  • Rollover equity. Identify the issuer, proposed security class and valuation basis. Request information on debt, preference rights, dilution, governance, transfers and the distribution of exit proceeds.
  • Seller role. Outline any employment or consulting requirement, expected commitment, compensation and restrictions. Distinguish payment for the business from payment for future work.

Rollover deserves its own investment review. The SEC’s private-placement guidance highlights illiquidity, limited disclosure and loss risk for applicable private securities. Do not count a potential future exit as cash already earned. An LOI should provide enough clarity to evaluate the proposed investment, without assuming every rollover has the same securities or tax treatment. The separate guides to treatment-center earnouts and rollover equity address the detailed terms. For broader ownership context, see the sister-site guide to addiction treatment private equity.

2026 Addiction Treatment M&A Market Update

Put your decisions in context. Review the addiction treatment market update for a grounded look at buyer activity, operating conditions, and the questions owners should be asking.

Step 4: Give Exclusivity a Defined Purpose and End

Exclusivity usually limits some or all discussions with alternative buyers for an agreed period. Read the precise restriction: solicitation, information sharing, negotiations and responses to unsolicited interest may be treated differently. Confirm who is bound and which transactions are covered. A restriction affecting the operating company could also reach a separate property sale or financing unless its scope is carefully addressed.

Tie the requested period to a credible work plan. Ask when the buyer will complete financial review, deliver the first purchase-agreement draft, resolve financing and submit required applications. Establish named decision-makers and a schedule for reporting unresolved issues. A buyer’s need for time is understandable; the seller should know what that time is intended to accomplish.

Negotiate the expiration date, any extension mechanism and the circumstances in which restrictions can end. Address what happens if the buyer changes the price, misses agreed milestones or stops progressing the transaction. Extensions should be considered against new evidence of progress and remaining work. There is no single appropriate exclusivity period for every treatment-center sale, and expiration does not automatically extinguish every surviving obligation.

Step 5: Test Whether the Deal Can Actually Close

Identify closing dependencies while selecting the buyer. In addiction treatment, these questions can change the attractiveness of an otherwise strong offer:

  • Regulatory path. What ownership-change notices, applications or approvals does the structure require? Assign responsibility for state licensing and any program-specific requirements, including OTP oversight where relevant.
  • Payer continuity. Which contracts, enrollments or authorizations need action? Determine the proposed billing entity and how the parties would handle a gap between closing and payable claims.
  • Financing and approvals. Identify acquisition funding, lender conditions, investment-committee approvals and any other unresolved internal authorization. Ask which conditions can still prevent the buyer from proceeding.
  • Third-party agreements. Identify material lease, landlord, management, vendor or other contract consents. Decide who approaches each party and what happens if a required consent is unavailable.

For an OTP transaction, SAMHSA’s program-change instructions distinguish ownership, sponsor and location changes. A generic promise to transfer the licenses is inadequate. For any treatment model, define the major anticipated closing conditions and an outside date, then have counsel resolve the detailed allocation of delay risk in the definitive documents.

Control Access and Communication During Exclusivity

Agree who may contact employees, referral sources, payers and landlords, and how those contacts will be coordinated. A buyer may reasonably need access to key people, but an unplanned outreach can disrupt operations or reveal a sale before the owner is ready. Preserve the seller’s responsibility for running the business while setting a workable schedule for permitted meetings and information requests.

Patient information requires separate treatment. An LOI or NDA does not by itself establish permission to disclose identifiable substance use disorder records. The HHS Part 2 guidance should inform counsel’s review of applicable records and disclosure pathways. Agree access controls, permitted recipients and return or retention obligations, while using appropriately prepared aggregate information when it answers the commercial question.

Who Should Review the LOI Before You Sign?

The addiction treatment M&A advisor should challenge commercial assumptions and compare the proposal with available alternatives. Transaction counsel should assess binding language, exclusivity, liability and drafting gaps; healthcare counsel should verify the regulatory path. Tax and accounting advisors should test structure, proceeds and adjustments. Coordinate their reviews before signing. A material objection discovered afterward may require reopening terms when the seller has already restricted other options.

Make a Specific Go-or-No-Go Decision

Before signing, ask the team to identify unresolved items, estimate their possible effect on proceeds and explain which are acceptable to carry forward. Record the economic assumptions, next milestones and authority to approve changes. If the offer depends on an unverified condition that could materially alter the result, resolve it or make its treatment explicit before granting exclusivity.

FAQ: Addiction Treatment Center Letters of Intent

Is an addiction treatment center LOI legally binding?

It depends on the document and applicable law. An LOI may combine nonbinding commercial terms with binding confidentiality, exclusivity, expense or other provisions. Counsel should identify those obligations and any duty to negotiate before the seller signs.

How long should exclusivity last?

The period should reflect the transaction’s actual work plan and closing dependencies. Negotiate a defined end date, milestones and extension terms. The right duration depends on readiness, financing, regulatory requirements and the information already reviewed; no fixed period suits every sale.

What price details belong in the LOI?

Clarify the value being quoted, cash at closing, rollover, earnout, escrow and proposed debt, expense and working-capital adjustments. Ask for an illustrative proceeds calculation. A headline number is insufficient when different components have different conditions, timing and risk.

Can the buyer change the price after signing an LOI?

A proposal may be revised as facts and negotiations develop, subject to the document’s terms and governing law. Define the offer’s assumptions and discuss how a material revision affects exclusivity. Do not assume either that the price is guaranteed or that every change is unrestricted.

Should licensing and payer issues wait until the purchase agreement?

Major dependencies should be identified before exclusivity. The LOI can establish the intended structure and principal conditions while counsel develops detailed requirements. An unresolved approval or billing assumption can affect timing, cash needs and the economics of the proposed transaction.
Tony Siebel Founder Managing Director Olympic M&A Concierge Medicine M&A Advisor

About Tony Siebel

Founder & Managing Director, Olympic M&A — Former MDVIP Corporate Development Director

Tony Siebel is the Founder and Managing Director of Olympic M&A. His background includes corporate development and physician-practice acquisitions at MDVIP, as well as serving as Vice President and Associate Partner at Stoneridge Partners, including work in its Behavioral Health Division.

Olympic M&A advises founders and healthcare business owners on transactions with private equity groups and strategic acquirers. Learn more about the firm’s behavioral health advisory services and discuss the scope of support appropriate for your business.

Contact Olympic M&A | info@olympicma.com | 502.360.8320

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