A $22.7 Million Vote of Confidence: How One Fund Positioned for a 185% Winner

The Trade That Turned Heads

Crewe Advisors, a Utah-based investment firm, made a calculated bet on PACS Group (NYSE:PACS) in Q4, deploying approximately $22.72 million to acquire 1,035,747 shares. The move, disclosed via SEC filing on January 16, signals something beyond tactical trading—it’s a conviction play in a sector that’s quietly outperforming.

What makes this noteworthy isn’t just the fresh capital deployed, but the timing. PACS shares had already surged 184.9% over the preceding twelve months, substantially outpacing the S&P 500’s performance by 168 percentage points. Yet rather than trimming exposure after such gains, Crewe doubled down.

The Numbers Tell a Story

By quarter-end, Crewe’s total PACS position swelled to 2,147,815 shares, now valued at $82.45 million. The quarter-over-quarter increase of $67.19 million reflects both the fresh purchases and appreciation in the underlying security—a compounding effect that underscores the stock’s momentum.

More revealing is how this stake now ranks within the fund’s portfolio. PACS has climbed to the second-largest holding, commanding 7.3% of assets under management. For context, here’s how Crewe’s top positions stack up:

• IVV (S&P 500 ETF): $137.22 million (12.2%)
• PACS Group: $82.45 million (7.3%)
• SPY (S&P 500 ETF): $68.71 million (6.1%)
• IJH (Mid-cap ETF): $61.43 million (5.4%)
• IEFA (International ETF): $49.30 million (4.4%)

The decision to concentrate this much capital in a single healthcare stock—while maintaining broad market diversification through ETFs—reveals a deliberate strategy: core positions in defensive growth opportunities paired with index-level exposure.

What’s Driving the Conviction

Understanding the appeal requires looking under the hood at PACS’s operational performance. The company, a dominant player in post-acute and senior care services, reported third-quarter revenue of $1.34 billion, representing 31% year-over-year growth. Adjusted EBITDA reached $131.5 million, while operating cash flow exceeded $400 million through the first nine months.

Perhaps most compelling: occupancy rates at mature facilities hover near 95%, dramatically outpacing industry averages of approximately 80%. This gap suggests PACS operates with structural advantages—better unit economics, stronger demand capture, or both.

The Broader Context

As of January 15, PACS traded at $39.37 per share. The company commands a $6.02 billion market capitalization against trailing-twelve-month revenue of $5.14 billion and net income of $169.04 million.

PACS Group functions as a holding company within the post-acute healthcare ecosystem, operating a diversified network of senior care facilities, assisted living communities, and independent living options. The business model generates revenue primarily through service delivery and facility operations—a recurring, relatively recession-resistant income stream targeting an aging demographic.

What This Positioning Implies for Market Watchers

Crewe’s allocation decision carries implications beyond a single transaction. By anchoring PACS as a core position alongside broad index ETFs, the fund is essentially betting that:

1. Fundamentals will sustain valuation gains. The 185% appreciation wasn’t a bubble waiting to deflate; instead, earnings growth and operational leverage should continue justifying higher multiples.

2. Demographic tailwinds persist. Aging populations create secular demand for post-acute and senior care services, providing a multi-year growth runway independent of economic cycles.

3. Scale matters. PACS’s occupancy advantage and operational efficiency create competitive moats that justify premium positioning within a defensive portfolio.

Rather than chasing momentum into weakness, this trade pattern suggests institutional confidence in the fundamental narrative—a meaningful distinction for investors trying to separate trend from substance.