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clinic os v3.0.0 — 2026.11

tl;dr in 30 seconds

  • From 1 clinic (2024.01) to 5 (2027.05, planned). Two medical corporation M&A deals (successions) since January 2025
  • 7,000+ patient visits a month, in person and online. At Hatanodai, our systems were fully up and running about three months after succession
  • PreMed's revenue comes from fees for headquarters services, software, medical equipment and facilities — not from a share of medical corporations' profits

PreMed began as a clinic consultancy. Today, as the headquarters of KAIZEN Group, one team drives the group's new openings and M&A (succession), standardizes how clinics are run, and builds our own operations software.
The group started with one clinic and plans to reach five by May 2027.

See the Japan Hospital Turnaround Execution Fund plan (tentative)

hospital turnaround — plan in 3 lines

Why
74.6% of hospitals ran an operating loss (FY2024, Council of Four Hospital Associations)
How
We go in, together with the bank, at hospitals a regional bank already lends to (PreMed puts in no capital). Beyond that, money and roles are split into three layers
Stage
A plan, at the stage of approaching financial institutions and funds. No fund has been formed
Briefing page (/en/fund/) →

clinics by 2027.05

1→ 5

From one clinic in January 2024 to five by May 2027 (planned)

m&a since 2025.01

2

Medical corporation M&A (succession)

patients / month

7,000+

Patient visits in a month across three in-person clinics and online care (2026.07)

changes to our software

6,500+

Changes merged into our operations software since 2026.03.20

01momentum

clinics, online care
and software changes.

How clinics, online consultations and system changes have grown. Here we show growth rates and the shape of each trend rather than raw counts.

clinics in our group

×3

group clinics, open (2024.01 → 2025.12)

online consultations

×4.7

online consultations (2026.01 → 08)

changes to our software / month

×53

monthly changes to our software (2026.03 → 09)

02why now

52.3% of clinic doctors
are 60 or older.

The average age of doctors working in Japan's clinics is 60.1. 52.3% are 60 or older, and 23.8% are 70 or older. Among the founders and representatives of the country's 105,521 clinics, 60.9% are 60 or older. Many clinics will face a generational handover in the years ahead. We are building the headquarters model and clinic os to be ready for them — now.

fig.0 clinic doctors by age, 2024Age distribution of doctors working in clinics
0%10%20%30%0.4%~296.5%30s16.5%40s24.3%50s28.5%60s23.8%70+

source: Ministry of Health, Labour and Welfare, Overview of the Statistics of Physicians, Dentists and Pharmacists 2024, Table 3

clinics in japan, 2025.10

105,521

General clinics nationwide

clinic owners aged 60+

60.9%

Share of clinic founders and corporate representatives (physicians) aged 60 or older (2024.12, by headcount)

clinic owners aged 70+

26.6%

The same, aged 70 or older

source: Ministry of Health, Labour and Welfare, Survey of Medical Institutions 2025 (overview) · Ministry of Health, Labour and Welfare, Statistics of Physicians, Dentists and Pharmacists 2024, Table 1

03track record

1 → 5 clinics
2024.01 — 2027.05

The number of clinics in the group, the timing of M&A, and the road ahead. Dotted lines are plans.

fig.1 clinics in kaizen group, and m&aClinics in the group (excluding online care) and M&A
012345202420252026202720281 2024.013 2025.124 2026.11 plan5 2027.05 planm&a 01m&a 02now

  1. Kids Clinic Marumaru (pediatrics) opens in Jiyugaoka. Our booking system, Galapagos, goes live

  2. A pediatric clinic opens in Chuo City, Tokyo (planned), bringing the group to five clinics

  3. next

    Galapagos for medical corporations and healthcare providers outside the group

  4. next

    hospital os for hospitals (in development)

  5. next

    The next succession — running each new clinic on the same clinic os

04thesis

Three strengths

  1. 01

    New openings and M&A (succession)

    The group can both open new clinics and take on existing ones. It opened its first clinic in Meguro in January 2024, completed its first M&A in January 2025, and in December 2025 took over a medical corporation running two clinics, in Shinagawa and Hatanodai. It plans to open pediatric clinics in Jiyugaoka in November 2026 and in Chuo City, Tokyo, in May 2027.

  2. 02

    Standardized operations

    As headquarters, we handle business planning, patient acquisition (websites and advertising), recruiting, procurement, legal and claims review, and align operating procedures across clinics — including those that join through succession. At Hatanodai, booking, online intake and the claims system were fully running about three months after succession. At Ladies Clinic Naminami in Meguro, average monthly visits grew about 2.6x from February–April 2024, just after opening, to July–September 2026 (three-month averages).

  3. 03

    Our own operations software

    We build our own booking and intake systems, and have merged 6,500+ changes since 2026.03.20. Our booking system, Galapagos, is scheduled to go live in November 2026, and we welcome adoption and partnership inquiries from medical corporations and healthcare providers.

05flywheel

From one clinic to the next

Whether a clinic is newly opened or joins through succession, we bring in our headquarters know-how and our own software, grow patient visits, and carry that into the next clinic.

fig.2 how the headquarters compoundsThe headquarters cycle
HEADQUARTERSpremed inc.01NEW · M&Anew clinics · successionnew clinics · succession02PLAYBOOKstandardize opsplanning · marketing · claims review03SOFTWAREin-house softwaregalapagos · ai agents04GROWTHgrowth in visitsvisits ×2.6 at naminami
headquarterspremed inc.01new clinics · M&Anew clinics · m&a02standardize opsplaybook03in-house softwarein-house software04growth in visitsnaminami ×2.6The more clinics, the more places the playbook and software can work

06structure

Medical corporations and PreMed

Clinic operationsclinics
Clinics are run by medical corporations (KAIZEN Group). Under Japan's Medical Care Act, medical corporations may not distribute surplus as dividends.
PreMed's rolepremed inc.
A stock company separate from the medical corporations. As headquarters, it supports their operations through business planning, business development and software development.
Other businessesother
As facilities that add value to medical facilities, PreMed runs erb, a herbal ice-cream stand next to Ladies Clinic Naminami, and Studio KAJi, a women-only yoga and Pilates studio in Meguro.

07business model

How PreMed earns revenue

PreMed's revenue is not a share of medical corporations' profits. It is payment for the services, systems and goods PreMed provides. As the number of clinics grows, so does the reach of 01 and 02.

  1. 01

    Headquarters services

    Medical corporations contract PreMed for headquarters services — business planning, patient acquisition, recruiting, procurement, legal, claims review and more — and pay fees commensurate with the work. All clinical decisions are made by the medical corporations and their physicians.

  2. 02

    Operations software

    We provide our own software, including the Galapagos booking system, to the group's medical corporations, and are extending it to medical corporations and healthcare providers outside the group.

  3. 03

    Medical equipment trading

    Our subsidiary, Takayama Medical Exchange, connects healthcare providers looking for medical equipment with those looking to part with it.

  4. 04

    Facility operations

    As facilities that add value to medical facilities, we run erb, a herbal ice-cream stand, and Studio KAJi, a yoga and Pilates studio.

08hospital turnaround — plan

Japan Hospital Turnaround Execution Fund (tentative name, plan)

This is a plan to keep struggling hospitals in their communities. The first form: when a hospital that a regional bank is already lending to needs to be turned around, PreMed goes in on site together with the bank and supports the turnaround plan and its execution. Beyond that, we plan to share roles with real-estate investors and a fund to support hospital turnaround and succession. This is still a plan: no fund has been formed. Hospitals continue to be managed by their medical corporations and physicians.

Briefing page →

fig.3 why hospitalsWhere hospital finances stand (from published surveys)
fact.0174.6%Hospitals in operating loss050100%FY2024hospitals with an operating loss, fy2024source: Council of Four Hospital Associationsfact.0213.6%Private hospitals, net worth < 0050100%FY2024private hospitals with negative net worth, fy2024source: Teikoku Databankfact.0395%+Failures ending in liquidation (2025)050100%2–3 civil rehabilitations a yearfailures ending in liquidationsource: Teikoku Databankpublic data onlyHospitals need a plan and someone to carry it out — before the courts
fact.0174.6%Hospitals in operating loss050100%FY2024hospitals with an operating loss, fy2024source: Council of Four Hospital Associationsfact.0213.6%Private hospitals, net worth < 0050100%FY2024private hospitals with negative net worth, fy2024source: Teikoku Databankfact.0395%+Failures ending in liquidation (2025)050100%2–3 civil rehabilitations a yearfailures ending in liquidationsource: Teikoku DatabankHospitals need a plan and someone to carry it out — before the courts

74.6% of hospitals ran an operating loss in FY2024, and 13.6% of private hospitals had negative net worth. Yet more than 95% of healthcare providers that failed in 2025 ended in liquidation; only three went through civil rehabilitation. We believe hospitals need someone to build and carry out a turnaround plan before they reach the courts.

source: Council of Four Hospital Associations, hospital management survey (2025.11, Japanese) · Teikoku Databank, hospital management trends (2025.12, Japanese) · Teikoku Databank, healthcare provider failures (2026.01, Japanese)

fig.4 entering with the bankStarting from hospitals a regional bank already lends to (plan)
regional bank — already lending to the hospitalRegional bank (already lending)Early signsearly signs01losses, cash flow,physicians leaving, successorLender consults usbank refers02early on,for a client hospitalOn-site diagnosison-site diagnosis03numbers, operationsand the medical sideImprovement planimprovement plan04built with the bank;rescheduling, public loansExecution on siteexecution on site05admin director, planning,finance and systemsMonthly reportmonthly report06progress on the plan,in numbers, to the bankexitRecoveryrecoveryorSuccession to physicians (three layers)succession to physiciansPreMed puts in no capital. Management decisions stay with the medical corporation and physicians. For planning costs, we are considering the national improvement-planning programno capital from premed · physicians decide · public planning program under consideration
regional bank — already lendingRegional bank (already lending)Early signsearly signs01losses, cash flow,physicians leaving, successorLender consults usbank refers02early on,for a client hospitalOn-site diagnosison-site diagnosis03numbers, operationsand the medical sideImprovement planimprovement plan04built with the bank;rescheduling, public loansExecution on siteexecution on site05admin director, planning,finance and systemsMonthly reportmonthly report06progress on the plan,in numbers, to the bankexitRecoveryrecoverySuccession to physicians (three layers)succession to physiciansPreMed puts in no capital.Decisions: the corp. and physicians

The first form is to go in together with a regional bank when a hospital it already lends to needs to be turned around. When early signs appear — continuing losses, cash-flow strain, physicians leaving, no successor — the bank consults us, and PreMed goes on site to check the numbers, operations and the medical side. We then build an improvement plan together with the bank, combined with rescheduling and public medical lending (such as the Welfare and Medical Service Agency). In execution we take on roles on site — administrative director, planning, finance and systems — and report progress to the bank every month in numbers. The exit is either recovery or succession to physicians.

For the bank, it adds one more option: supporting a client hospital together from an early stage, and keeping healthcare in the community. PreMed does not put in capital, and management decisions remain with the medical corporation and its physicians. Some public medical loans require an improvement plan backed by a financial institution; building and executing that plan is our role. For the cost of planning, we are considering the national program that supports improvement planning.

fig.5 three layersThree layers, and how money and roles flow. Dashed = plan
Medical Care Act — no dividends, no equity if newmedical care act: no dividends; no equity in new corporationsBanks · public lendersbanks · public medical lenderslendersReal-estate investorsreal-estate investors (plan)propertyFundfund (plan)fundPreMedpremed inc.×The fund does not invest in a medical corporationLoansloansBuysbuys the buildingEquityequityEquityequityMedical corp. (hospital)medical corporation — the hospitallayer 1Buildings · equipmentbuildings · large equipmentlayer 2Support companiessupport companies — joint holdco (plan)layer 3Managed by the corp. and physiciansHospital director: a physician (by law)Sell and lease backsale & leasebackHQ support, software, etc.Joint holdco: fund + PreMedSupport and software (fees commensurate with the work)Leases the building
who providesthree layersFundfund (plan)PreMedpremed inc.Support companiesjoint holdco (plan)layer 3HQ support, software, etc.Joint holdco: fund + PreMedReal-estate investorsreal-estate investors (plan)buysBuildings · equipmentsale & leasebacklayer 2Medical Care Act — no dividends, no equity if new×The fund does not invest in a medical corporationmedical care act: no dividends; no equity in new corporationsBanks · public lendersbanks · public lendersloansMedical corp. (hospital)medical corporationlayer 1Managed by the corp. and physiciansLayer 3 supports layer 1; layer 2 leases to itservices and leases may cross the line; equity does not

Under Japan's Medical Care Act, medical corporations may not distribute surplus as dividends, and those established since April 2007 have no equity stakes. In this plan, therefore, the fund does not invest in the medical corporation — the hospital itself. The plan splits money and roles into three layers. (1) The medical corporation borrows from banks and public medical lenders, and is managed by the medical corporation and its physicians. (2) Buildings and large equipment are sold to real-estate investors and leased back. (3) For the surrounding stock companies (headquarters support, software and the like), the fund and PreMed form a joint holding company. The fund comes in at layers 2 and 3.

fig.6 what it means for each partnerWhat it means for lenders and investors (plan)
Main bank · regional banksmain bank · regional bankslenderImprovement support for clients, on siteprogress checked in monthly numbersturnaround hands, monthly numbersPublic medical lenderspublic medical lenderspublicAn improvement plan backed by a lenderthe plan their loans requirethe improvement plan their loans requireReal-estate investorsreal estate investorsassetsOwn buildings and equipment, lease to the hospitalcontinued care underpins the rentbuildings and equipment, leased backFundfundholdcoSupport companies, via a joint holdcogrows the same way with each successiona joint holdco that grows with each successionNone of these is equity in the medical corporationnone of these is equity in the medical corporation · plan
Main bank · regional banksmain bank · regional bankslenderImprovement support for clients, on siteprogress checked in monthly numbersturnaround hands, monthly numbersPublic medical lenderspublic medical lenderspublicAn improvement plan backed by a lenderthe plan their loans requirethe improvement plan their loans requireReal-estate investorsreal estate investorsassetsOwn buildings and equipment, lease to the hospitalcontinued care underpins the rentbuildings and equipment, leased backFundfundholdcoSupport companies, via a joint holdcogrows the same way with each successiona joint holdco that grows with each successionNone of these is equity in the medical corporationnone of these is equity in the medical corporation

For the main bank, it means a partner that supports a client hospital's improvement — from building the plan to carrying it out on site. Some public medical loans require an improvement plan backed by a financial institution, and we support building it. Real-estate investors own hospital buildings and large equipment and lease them to the hospital; the fund holds the surrounding stock companies through a joint holding company with PreMed. None of these is equity in the medical corporation.

fig.7 successionSuccession uses the same three layers. Dashed = plan
beforeafterMedical corp. (hospital)medical corporationlayer 1Members and directors changePhysicians take over managementwithin the medical corporationMedical corp. (physician-led)physicians manageSupport companiessupport companieslayer 3Joint holdco takes on the shares (plan)Fund + PreMedshare transfer (plan)Joint holdco (plan)fund + premedBuildings · equipmentbuildings · equipmentlayer 2Real-estate investors take it on (plan)The medical corp. leases it backsale & leasebackReal-estate investors (plan)leases back to layer 1Medical Care Act — no dividends, no equity if newmedical care act: no dividends; no equity in new corporations×The fund does not take over the medical corp.Managed by the corp. and physicians. Dashed = plansame three layers as fig.4 · dashed = plan
beforeafterMedical corp. (hospital)medical corporationlayer 1Medical corp. (physician-led)physicians manageMembers and directors changePhysicians take over managementwithin the medical corporationSupport companiessupport companieslayer 3Joint holdco (plan)fund + premedJoint holdco takes on the shares (plan)Fund + PreMedshare transfer (plan)Buildings · equipmentbuildings · equipmentlayer 2Real-estate investors (plan)leases back to layer 1Real-estate investors take it on (plan)The medical corp. leases it backsale & leasebackMedical Care Act — no dividends, no equity if new×The fund does not take over the medical corp.medical care act: no dividends; no equity in new corporationsManaged by the corp. and physicians. Dashed = plansame three layers as fig.4 · dashed = plan

Succession is built on the same three layers. On the medical corporation's side, members and directors change and physicians take over its management; the surrounding stock companies and the buildings are taken on by the joint holding company and real-estate investors respectively (plan). The fund never takes over the medical corporation itself.

fig.8 monthly numbersChecking progress in monthly numbers. Dashed = plan
The floorthe floordaily reports, bookings, billing, recordsDaily dashboarddaily dashboardnumbers ready the same dayMonthly reportmonthly reportchange from last month, and whyReporting to lenders · fundreporting to lenders · fundplan progress, every monthWhat we trackPatients / dayRevenue / patientInsurance / self-payBooking fill rateNo-show rateReturn after first visitRunning today at our group's clinics. Hospitals and reporting are plannedrunning today at our clinics · hospitals and reporting = plan
The floorthe floordaily reports, bookings, billing, recordsDaily dashboarddaily dashboardnumbers ready the same dayMonthly reportmonthly reportchange from last month, and whyReporting to lenders · fundreporting to lenders · fundplan progress, every monthWhat we trackPatients / dayRevenue / patientInsurance / self-payBooking fill rateNo-show rateReturn after first visitRunning today at our group's clinics.Hospitals and reporting are planned

At our group's clinics, our own software turns daily reports, bookings, billing and medical records into a daily management dashboard and a monthly report. Patients per day, revenue per patient, the insurance/self-pay mix, booking fill rate and more are lined up every month, along with the change from the previous month and why. We plan to bring the same system into hospitals so that lenders and the fund can check the turnaround plan's progress in monthly numbers.

track record — clinics

successions since 2025.01
2
succession → systems running
~3 mo
visits at naminami, since opening
×2.6
changes to our software
6,500+

All of these are results at our group's clinics. Two successions of medical corporations since January 2025. At Hatanodai, booking, online intake and the claims system were fully running about three months after succession. At Naminami in Meguro, monthly visits (three-month averages) grew about 2.6x from just after opening. Our software has taken in 6,500+ changes since March 20, 2026. A hospital track record is what the pilot will build.

fig.9 roadmapPhased plan. Dashed = plan
phase 0OutreachoutreachnowExplain the plan tolenders and fundsexplaining the planphase 1 · planTrack recordtrack record≤ 3 monthsTake on medical due diligence;firm up how we assess hospitalsmedical due diligencephase 2 · planPilotpilot3–12 monthsWith a lender, at one hospital:from improvement plan to executionone hospital, plan to executionphase 3 · planHoldco · fundjoint holdco · fund1 year +A joint holdco for support companies,and forming the fundformation, with partnersTimeframes are indicative. Phase 1 onward is a plan and may changedashed = plan · subject to change
phase 0nowOutreachExplain the plan tolenders and fundsoutreach — explaining the planphase 1≤ 3 monthsTrack recordTake on medical due diligence;firm up how we assess hospitalstrack record — medical due diligencephase 23–12 monthsPilotWith a lender, at one hospital:from improvement plan to executionpilot — one hospital, plan to executionphase 31 year +Holdco · fundA joint holdco for support companies,and forming the fundjoint holdco · fund — formation, with partnersTimeframes are indicative. Phase 1 onward is a plan and may change

We start by approaching financial institutions and funds, build a track record, run a pilot at one hospital, and then move to forming a joint holding company and the fund. Timeframes are indicative.

who we'd like to talk to

We would like to start by explaining the plan and exchanging views with regional banks that lend to hospitals, investors interested in hospital real estate and medical equipment, and funds focused on healthcare.

Contact us (investors and financial institutions)

This section outlines a plan and does not constitute a solicitation to invest. Its contents may change.

contact

For investors and financial institutions

We share detailed information about our business in individual meetings.

Please write to [email protected], in English or Japanese.

This page is intended as a company introduction and does not constitute a solicitation to acquire securities. Plans reflect our expectations at the time of writing and may change.