Q4 2013 saw a slight uptick in M&A activity in the US healthcare industry. The trend is expected to continue for the duration of the year, though not without some fits and starts. The challenges facing Healthcare CEOs and CFOs in the coming year will be many and diverse as the industry continues to work through the uncertainties still present in the marketplace. The stuttering start of the HelathCare.gov rollout and the continuing trickle of regulatory rulings coming from HHS are indications that the industry may not yet have the clarity that much of the marketplace expected to have by the New Year. In any event, shareholders seem to be growing impatient with the amount of sidelined capital as evidenced by how far the index trailed the broader market in Q4. Nimble executives will need to find ways to manage the transition of their current portfolio away from the old volume based fee for service model to the new value based healthcare paradigm. In addition, they need to be ready to make swift decisions on which operating units and businesses to keep, which to exit, and which to acquire. This bodes well for the lower middle market, and is evidenced by the deal count and trend line in value of invested capital seen in 2013. We expect to see deal value to rise as horizontal consolidations continue, and deal count to rise as vertical integration becomes one of the last cost control measures available to CEOs requiring rapid structural change.