There's a family in Sandy, Utah that used to own the Utah Jazz.
Before that, they owned car dealerships. Lots of them. And movie theaters. And insurance companies. And real estate developments. Larry H. Miller , the founder, the patriarch , built a $4 billion empire selling Toyotas and filling arena seats before he died in 2009. His widow Gail kept the ship steady. His sons took board seats. And a sharp former Jazz executive named Steve Starks got the CEO chair.
Then, in October 2020, Gail Miller announced she was selling the Jazz to Ryan Smith, the Qualtrics billionaire, for a reported $1.66 billion.
And that's when things got interesting for our industry.
Three months later , January 2021, while the rest of us were still arguing about COVID staffing waivers and trying to figure out which PPE suppliers were legit , the Larry H. Miller Group quietly announced it had acquired Advanced Health Care Corporation.
AHC. Founded in Idaho in 2001 by two brothers, Dave and Brett Nattress. Twenty-two skilled nursing and transitional rehab facilities. Home health agencies. Hospice services. About 3,500 employees spread across eight western states. Five-star CMS ratings. A reputation in the post-acute world as one of the best pure-play short-term rehab operators in the country.
Now, if you've been in this business longer than five minutes, you've seen the outsiders come and go. The hedge fund guys who thought buying nursing homes was like buying distressed debt. The tech bros who were going to "disrupt" long-term care with an app. The real estate investors who looked at the cap rates, got excited, then saw their first IJ survey and never returned a phone call again.
Here's what Steve Starks and his team have done since:
2021: Acquired AHC and immediately started integrating it into the Miller family's operational playbook. CEO Starks told the Deseret News: "We got to know the Advanced Health Care team and were really impressed by that business model and how they operated those skilled nursing facilities." Dave and Brett Nattress, the AHC founders, stayed involved. The Miller family didn't come in and blow up the culture. They kept the people who built it.
2022: Acquired an assisted living facility in Lehi, Utah. Renovated it. Launched a new brand: Aspen Ridge Senior Living. This wasn't a one-off real estate play , they were building a continuum.
2023-2025: Expanded AHC from 8 states to 11, adding Ohio, Pennsylvania, and Tennessee. Grew to 24 facilities. Maintained their 5-star ratings. Built out the staffing and billing verticals to support the clinical operations. Started talking publicly about being a "national, industry-leading healthcare continuum."
January 1, 2026: Showed up as the tenant on a $142 million, six-facility, 532-bed skilled nursing portfolio in the Mid-Atlantic , bankrolled by CareTrust REIT, one of the most aggressive healthcare landlords in the country. CareTrust's CIO James Callister described the Miller Group as having "a proven operating and credit profile." On the Q4 earnings call last week, CareTrust's team went out of their way to clarify: this is a new relationship, it's not Sabra, and they're excited about it.
That's not an exit. That's an entrance.
They're not trying to flip anything. This isn't a three-year hold looking for a 2x return. The Miller family builds businesses for generations. They owned the Jazz for 35 years. They've been selling cars for 40. When Steve Starks says they're in healthcare for the long haul, the family's track record actually supports that.
They built before they bought. Most outsiders acquire a bunch of facilities and then try to figure out operations. LHM bought one great operator , AHC , and spent two years learning the business before scaling. Then they added assisted living. Then staffing. Then real estate management. They built the platform piece by piece.
They have real capital. The Larry H. Miller Company is a multi-billion dollar privately held family business. They don't need to raise a fund or go to market for equity. When CareTrust offered them a 532-bed portfolio, the Miller Group didn't need to scramble for a guarantor. The balance sheet was already there.
They care about ratings. This isn't lip service. AHC operates 24 facilities with 5-star CMS ratings. In an industry where three stars is considered decent and four is aspirational, maintaining 5 stars across a multi-state portfolio while scaling is genuinely hard. Somebody in that building gives a damn about clinical outcomes.
Welcome to the industry, Miller family.