Missouri Home Hospice, LLC, a firm with portfolio companies throughout the post-acute care space, and MHS Equities, LLC have acquired Missouri-based Transitions Hospice, marking the third 2019 acquisition for Missouri Home Hospice.

In June, the company in a single transaction purchased three Nurses and Company assets, providing private services, home health care and hospice in the St. Louis, Mo.-metropolitan area. Through its Nurses & Company, Inc. holdings, Missouri Home Hospice in August completed the acquisition of Lake St. Louis, Mo.-based Home Assist in August of this year.

Missouri Home Hospice President Bobby Robertson is former CEO of Springfield, Mo.-based home health and hospice provider HealthCarefirst.

“The technology and services my team created at HealthCarefirst allowed me to enable more than 4,000 hospice and home health providers to care for our nation’s most vulnerable population, our seniors,” Robertson said. “Now I’m stepping into the shoes of my hospice and home health heroes to make a difference in my home State of Missouri.”

Hospice utilization is relatively high in Missouri, with 50.3% of Medicare-enrolled decedents electing hospice. Though it ranks the 20th state in the nation in terms of utilization, it’s percentage trails that of the No. 1 state, Utah, by 9.4%.

Despite record high valuations in the hospice hospice mergers & acquisitions market, activity continues to be robust, though the number of transactions took a dip in the third quarter compared to Q3 2018, according to a recent report by M&A advisory firm Mertz Taggart.

Players in the space are encouraged to pursue transactions by demographic tailwinds and the availability of capital.

The second quarter of 2019 saw 14 hospice transactions. Eight major hospice acquisitions took place during the first quarter of 2019, up from seven transactions during Q1 2018 as well as Q4 2018, which also saw seven transactions, according to a report from Mertz Taggart.

Among the most significant transactions in the second quarter occurred in May with the purchase of Texas-based Resolutions Hospice by Cornerstone Healthcare Inc., a subsidiary of The Pennant (NASDAQ: PNTG), for an undisclosed amount.

Addus HomeCare Corporation (NASDAQ: ADUS), which provides hospice in addition to other a home care services, recently completed the purchase of Hospice Partners of America, LLC, a multi-state provider of hospice services headquartered in Birmingham, Ala., for a cash purchase price of $130.0 million.A number of other high-profile companies, including Amedisys (NASDAQ: AMED) and LHC Group (NASDAQ: LHCG) have said they are actively seeking new acquisitions, focusing more of their efforts on building their hospice segments.