GREEN BAY, Wis., September 22, 2026: Cornerstone Business Services, Inc., an investment bank focused on lower middle market M&A, has been ranked No. 9 among sell-side firms on Axial’s Top 50 Lower Middle Market Healthcare Investors and M&A Advisors | 2026.
The list recognizes the 50 most active healthcare-focused members on Axial’s platform over the past 12 months, split between 25 buyside firms and 25 sell-side advisors. Rankings are based on Axial’s measured activity and outcomes on its platform.
How Axial Ranked the Healthcare Top 50
Axial’s methodology uses a weighted formula built on four inputs:
- The number of healthcare deals brought to market through Axial
- The level of buyer interest those deals generated from Axial’s buyside members
- The number of healthcare-specific investment mandates created on the platform
- Deals that advanced through signed NDAs, shared CIMs, indications of interest, letters of intent, and closings
“Healthcare owners are getting more inbound calls than they have in years, and almost all of it is one buyer at a time. One offer is not a market. Our job is to show an owner what the rest of the field will actually pay before they sign anything.”
— Scott Bushkie, Founder and Managing Partner
Cornerstone Insight in Axial’s 2026 Healthcare M&A Outlook
Axial surveyed dealmakers from the ranked firms on valuations, deal activity, and the year ahead. Scott Bushkie and Justin Thimmesch of Cornerstone both contributed.
Bushkie reported veterinary businesses trading at 10x to 14x EBITDA, among the highest ranges cited in the survey, and placed physician practices at 5x to 7x. Physician practices ranked second in deal activity at 51.7% of respondents, yet drew the largest share of lower-multiple responses at 30.8%.
Regulatory and policy uncertainty was the most cited challenge at 48.3%. Thimmesch pointed to uncertainty in federal and state-level funding. Bushkie raised changes to Medicare and Medicaid reimbursement. Valuation misalignment was named the biggest hurdle to closing a healthcare deal, cited by 41.4% of respondents.
Bushkie also noted that an aging owner population is bringing more sellers to market, and that compliance and regulatory complexity is pushing owners toward a partner or buyer who can carry the business further.
The overall outlook was positive. Of the dealmakers surveyed, 62.1% described their 12-month view as positive, and 48.3% expect healthcare deal flow to increase.
View Axial’s full 2026 Healthcare Top 50 and Outlook Survey.
What This Means for Healthcare Owners
Healthcare valuations vary widely inside a single category, and the survey results show it. Two businesses in the same specialty can sit several turns apart depending on payer mix, provider retention, and how clean the billing data looks in diligence.
Cornerstone’s Assurance 360™ process is built to identify qualified strategic and financial buyers, generate multiple offers, and give owners the ability to compare price, structure, closing certainty, and fit side by side. In 2025, sell-side engagements averaged 56 confidentiality agreements and eight indications of interest per opportunity.
Continued Recognition in Lower Middle Market M&A
The Healthcare Top 50 follows Cornerstone’s No. 3 ranking on Axial’s Q2 2026 Top 25 Lower Middle Market Investment Banks league table and its No. 13 ranking on Axial’s 2025 annual Top 25 list. The firm marked 25 years advising business owners through company sales in 2026.
About Axial
Axial is a private deal platform serving the lower middle market ($2.5M to $250M TEV) and publishes rankings based on activity and outcomes on its platform. Over 3,500 advisory firms and 3,000 corporate and financial buyers have joined Axial to connect with relevant capital partners, source actionable deals, and build new relationships.
About Cornerstone Business Services
Founded in 2001, Cornerstone Business Services is an investment bank serving the lower middle market and specializing in transactions for businesses with annual revenue of $5 million to $250 million. Headquartered in Green Bay, Wisconsin, the firm advises business owners throughout North America on sell-side transactions, acquisitions, and valuation services, including its Real Market Analysis (RMA).
Cornerstone’s Assurance 360™ process is designed to create multiple qualified offers and improve deal certainty. Over the past five years, the firm has maintained an average closing ratio of about 85%. Cornerstone also publishes original research on business owner readiness and exits, including the 2025 National Study on Selling Your Business. Cornerstone’s mission is to create a positive life-changing event for all the lives they touch.
Media Contact
Dan Hansher
Associate and Marketing Manager
Cornerstone Business Services
920-436-9890
press@cornerstone-business.com
Disclaimer: Past performance is not a guarantee of future results. Each transaction is unique and outcomes vary by company, timing, and market conditions.
