Disclaimer: Unless noted otherwise, views and analysis expressed here are the author's own and based on public sources. The article is intended for informational and entertainment purposes only. This is not financial advice. Please consult a professional for investment decisions.

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What did you guys think of last week’s writeup from our record-breaking Serial Acquirer Summit? There was so much content we had to break the writeup into two. Today, we are bringing you transcripts from the last two sessions, namely:

If you’re not familiar with the Simago or Evergreen stories, consider reading our primers first: 

<3 years, a €525M exit, 10x sponsor MOIC. We X-rayed Simago, the radiology rollup that galvanised the French rollup mania

MSP M&A WDYT? 7 lessons from Evergreen on scaling from 0 -> $1.5B revenue & $250M EBITDA

The Rollup of Tomorrow Vol.16: 50 deals per year & not slowing down. Ramsey Sahyoun on Evergreen’s M&A machine, capital allocation & AI-proof strategy

This week’s sponsors are the Swedish investment bank Redeye and Towards AI: a specialist consultancy firm that trains AI engineers and workforces, and deploys custom AI systems into serial acquirers.

Curious to see how Towards AI can accelaret your acquirer’s AI transformation? Get in touch today by replying to this email!  

Wait, what? What Swedish investment bank? That’s right! Every year in March Redeye organise the now-legendary Serial Acquirers conference in Stockholm. The dates for next year are 17+18 March. If you’ve never been, check out our writeup from this year’s event: Can Swedish serial acquirers STILL drive outsized shareholder returns? And other insights from the 2026 Redeye Conference

Book now for Early Bird pricing of SEK 22,500 (the equivalent in USD is divided by 10).

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Important caveat before we dive in: the transcripts have been significantly shortened and edited so the length of this article would be manageable. So it doesn’t replace attending the conference, but still gives you some excellent insights. 

Denis Piffaretti (DP): Rodolfo, today Hippocrates is the largest pharmacy chain in Italy. How did it all start? 

Rodolfo Guarino (RG): I co-founded Hippocrates 8 years ago, after a career in investment banking and private equity. Italian pharmacies are very different from the [UK / US] drugstore model: they sit at the centre of the national healthcare system. This is a highly regulated business. You cannot open new pharmacies; you can only buy an existing licence. You cannot move pharmacies around. You have a monopoly area at the municipal level, and another monopoly: you're the sole distributor of prescription drugs. Prices and margins for those are defined by law, and they represent approximately 50% of our profit.

I'd say there are easier roll-ups and harder roll-ups. My definition of easy is how visible the synergies are, and I tend to favour roll-ups with hard cost synergies. Here we had a business protected by regulation, but also with the potential for a lot of cost synergies. Your average independent pharmacy has a cost of goods sold of 65%. That's a huge chunk of cost, and you can attack it when you have €1.3B in sales, as we do now, versus our average acquisition target at €1.7M in sales. So we had downside protection and the ability to crystallise a first layer of cost synergies, and then build retail excellence, commercial excellence and so on.

DP: Charles-Henry, speaking of complex regulatory backdrops! In France, the restrictions around radiology practice ownership are quite tight. Yet 7 years in, you've built a very big and successful business, with €120M of EBITDA. How did you and your co-founder come up with the thesis?

Charles-Henry Beglin (CB): We started Simago in 2019 [RUE note: 1st acquisition closed in 2020] as a radiology centre roll-up, initially in France and now also in Italy and Romania. More recently we also started Builders Associés, a fund dedicated to roll-up investments and backing founders, which we finance with our own money.

France is the country of regulation, and that was our opportunity. We had no link with radiology. We did a top-down analysis of sectors to find the ones that were fragmented and a good basis for a roll-up. Then, within those, we looked for an equity story that would hold even if we stopped acquiring. We went for radiology. Inside that market, the professionals were the only buyers of other centres, like with pharmacies, and they were buying from each other at 0.5x EBITDA. So we said: if we acquire at 3-5x, we can still make the math work.

We also saw AI. In 2019, AI was already expected to be applied heavily in radiology, because ultimately radiology is telling whether a picture is pathological or not, which is very good for a computer. That was the long-term equity story. Everyone in France told us that if you're not a radiologist, you cannot acquire radiology centres. Still, we found a workaround which allowed us to acquire practices at very attractive prices initially.

DP: Let’s talk about your initial fundraise. Rodolfo, you raised €120M of equity in the first year, across two tranches, when you and Davide were only in your early 30s. How did you convince investors to back you for such a large amount?

RG: We prioritised the relationships that were closest to us. I come from a career in private equity, and I was lucky enough to do a number of deals in Italy alongside minority investors - entrepreneurs who would reinvest alongside our fund. So the first 5-6 meetings were with people who knew me from my private equity days, and they were fairly easy, versus what I'd anticipated. They'd say: "Look, Rodolfo, I've known you for four or five years. I like the thesis, the materials are very well done. I'll give you one million." By the 7th meeting, it started a snowball effect: we could say, "Look, we already have €5M in the bank." It became a me-too effect among the investors we were talking to - family offices, executives from private equity - and we built a significant starting point. 

All my colleagues at my private equity firm invested too, to get rid of me. Jokes aside, it was a roller coaster. In hindsight it didn't take long, but it was several months. A couple of times, investors tried to hold up all the others to renegotiate our MIP structure.

An essential part of our fundraising was a mantra we told ourselves: this is our project. No money is better than bad money. We said no to €30M, and we said no to €40M, because it came with strings attached on governance, board representation and so on. We were very clear: this is our project. If you want it, you can invest; these are the rules. So it was a mix of relationships to start, leveraging the snowball effect, and a lot of determination.

DP: Charles-Henry, you were also a private equity professional when you set up Simago with Clément [Martin], and you started more modestly in terms of initial equity. What convinced you to leave a successful private equity career, and to raise from Entrepreneur Invest?

CB: Private equity jobs are great, well-paying jobs. But at some point you want to build yourself and be in control. As for why we started more modestly than Rodolfo, we had fewer connections with potential investors. We went directly to small-cap funds. Most of them said no. Entrepreneur Invest said yes and backed us with €7M initially. So we were at the other extreme.

DP: You both took on a private equity investor with a majority, or at least significant, stake relatively early - 3 years in for Simago, 2 years for Hippocrates. Was that always part of the plan?

RG: Exit timing was opportunistic, in the midst of COVID. Many businesses and sectors weren't doing well, while we were performing, and there was a lot of dry powder around. We said: this is the time, because we're proving how anti-cyclical and resilient our business is, and how much white space there is.

Choosing Antin was the best thing that could have happened to us. I strongly believe that one of the sources of competitive advantage in a roll-up is access to capital. Antin promised to invest €300M a year in M&A. Partnering with an infrastructure fund proved even more helpful for accessing debt capital markets. Shortly after we sold in 2021, interest rates shot up. This was the worst possible moment to raise capital, which you need if you're investing €300M every year. But then, Antin’s capital markets team secured an infrastructure package on incredible terms that no one else in the market got. 

CB: When we started, we were acquiring centres at 3-5x EBITDA. Shortly after, we raised unitranche financing with a 5x leverage covenant, so effectively we could go on indefinitely at those levels. But about two years in, we saw a lot of competition coming into the market, which was unfortunate because the regulation had been the same for 20 years before that. Prices for targets rose above our leverage, and we needed larger investment firms. Entrepreneur Invest was great for setting things up, but not for following on. So we started the process, and we were very happy to partner with Ardian.

DP: You both have co-founders - Clément and Davide respectively. How do you split responsibilities, and how has that changed as the business grew?

CB: At the beginning we were very M&A-focused. Clément came from a consulting background and I came from private equity, so he shadowed me a bit to learn how to do deals. Within 12 months we were each doing our own deals. 

RG: For the first 1.5 years, Davide and I did everything together. Since we're not from the pharmacy business, we had to close the knowledge gap - and we did that quickly. At the same time, as our scale increased, eventually Davide took control of operations, while I focused on M&A. Even today, I personally follow 85-90% of all acquisitions.

DP: Charles-Henry, AI was topical in radiology even before ChatGPT. In 2016, Geoffrey Hinton, the “Godfather of AI”, famously proclaimed that we should stop training radiologists because machines would be better within five years. Ten years later, you've built a €120M EBITDA business with a lot of radiologists. Was Geoff Hinton wrong, or was he too early?

CB: Geoff Hinton was very early for sure, and partly wrong. We’ve seen evidence that, on most exams, AI outperforms human radiologists. AI is an amazing opportunity when it comes to patient safety and time to access care. At the same time, I cannot fathom a scenario, certainly not in Europe, where a government allows for a medical imaging report to be issued without a radiologist's signature. The surgeon will base the decision on whether to operate on the radiologist’s report. Look at lab services, which have been automated for the last 10 or 15 years. The biologist isn't doing anything medically anymore, and yet they still sign the report. I believe that radiologists will exist for quite some time. Moreover, niche exams won't be targeted by AI algorithms at all, because the business case isn’t lucrative enough. 

DP: What do your 100-day integration plans look like today? What's non-negotiable in Week 1?

CB: Non-negotiable in Week 1 - and I believe this applies outside radiology - is controlling the money. Getting access to the bank accounts and all the cheques and credit cards in people's hands, because you're putting rules in place on who can spend money. Very quickly after that, maybe in Week 2, all finance-related elements come back to HQ, and any new hire is approved by HQ. That's the back end. Then it's about inserting the centre into your capex programme and deploying your AI algorithms: renewing the servers, and training your radiologists and secretaries to use the AI programmes. That's already a good start.

RG: For Hippocrates, integration is at the core of our success. We acquire a pharmacy every 3 days. We don’t have 100-day plans, we have “minus-100-day plans”: integration starts as soon as we sign an LOI. By the time we close, we've met all the people, the business is running on our systems, and we have access to the bank accounts. That's the only way to survive at our pace!

Alex Prokofjev (AP): Ramsey, why don't you start by introducing yourself and briefly recapping the history of Evergreen. Also, the abbreviation MSP is being thrown around a lot. What IS a Managed Service Provider, and why is this a good business to be in?

Ramsey Sahyoun (RS): My partner Jeff Totten and I met working at Alpine Investors, which is a PE firm in the US. We were inspired by Berkshire Hathaway. We went to their AGM in Omaha, and that was the point at which Jeff and I decided to build a holding company for the rest of our careers. This idea became Evergreen Services Group. We are very fortunate to have Alpine's backing.  

As for MSPs… These are trusted technology partners for small businesses. A typical customer is a 30-person business that does not have a full-time IT person on staff. An MSP can do everything that a person would do for less than the cost of a full-time employee. Our average customer pays us around $4,000 / month to manage all their IT.

What we really like about the industry is the breadth of the value proposition. There are 6 different services we provide to small businesses: everything from help desk support and network monitoring, to cybersecurity, to reselling and managing cloud infrastructure. Now AI services - workflow automation - are becoming part of the business too. It's a great industry: 70% recurring revenue, 100%-plus net revenue retention, and if you do it well, you can grow organically in the double digits. We continue to be excited about it.

AP: I can spot an intriguing pattern. Some of the aggregators that presented today were founded by people who were young and had no clue about the underlying industries… and yet they succeeded. I'm not trying to promote irresponsible roll-up strategies, but in 2017 there weren't many MSP aggregators around. Were there any omens that convinced you and Jeff this was going to work out?